Early inflammatory processes in the skin.

Skin is considered as the border defining the limits of the body from the external world and functions as a barrier between the two. In this capacity, it has evolved to be an integral part of the innate and adaptive immune system. Although many reviews have described skin inflammation and processes that lead to its clinical manifestations, we are not aware of any reviews that have focused on immunologic activity occurring in the absence of any visual inflammatory cues. In this review, we discuss the importance of subclinical inflammation in human skin and its relevance to innate immune surveillance under physiologic conditions. Reactive oxygen species generated by metabolic processes, ultraviolet radiation or oxidizers may damage cells, initiating proinflammatory cascades. In addition to serving as structural skin components, keratinocytes have significant immunologic activity: they secrete proinflammatory cytokines and mediators, including interleukin (IL)-1α, IL-6, IL-10, tumor necrosis factor-α and granulocyte-macrophage colony-stimulating factor. Infant skin is particularly susceptible to irritation, inflammation and infection, since skin barrier function is not fully developed after birth and continues to mature throughout the first few years of life. Non-invasive methods such as fluorescence spectroscopy, spectral imaging and diffuse reflectance spectroscopy, as well as minimally invasive tape stripping, can be used to assess subclinical inflammatory markers in vivo, including erythema, epidermal cell proliferation rate and cytokine concentrations. Appropriately formulated skin care products may help maintain skin barrier integrity and enhance its capacity. In the future, assessment of subclinical inflammation may help clinicians prevent acute or chronic inflammatory conditions of the skin.

Intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis. Clinical report and review of literature.

The sclerosing peritonitis (SP) is a rare illness secondary to the peritoneal dialysis or due to intraperitoneal chemotherapy or the positioning of a peritoneal-jugular shunt in cirrhotic patient with refractory ascites or due to unknown other factors (idiopathic form) like in our patient. The clinical pattern is various and insidious, but when an intestinal occlusive symptomatology is presents an urgent operation is mandatory. The surgical operation is often not easy and asks for a lot of attention especially in the dialyzed subject or in patients with cirrhosis, due to the possibility of postoperative bleeding and other serious complications that can result in fatal outcome. In this report we describe surgical treatment, pathologic pattern and clinical findings of this rare disease.

Preparation and characterization of poly(methyl methacrylate) - iron (III) oxide microparticles using a modified solvent evaporation method.

At present, there is widespread interest in developing new, biocompatible microparticles made from polymers such as poly(methyl methacrylate) (PMMA) that could have applications ranging from diagnostic imaging to drug delivery. In these experiments, there were two primary objectives: (1) to stabilize a suspension of iron (III) oxide (alpha-Fe(2)O(3); mean diameter = 100 nm) nanoparticles in a solution of PMMA by using an emulsifier and different mixtures of two miscible solvents; and (2) to fabricate PMMA-alpha-Fe(2)O(3) microparticles by using an oil-in-water (o/w) solvent evaporation method. By accomplishing the first objective, it was hypothesized that the encapsulation efficiency of alpha-Fe(2)O(3) within PMMA microparticles would improve and induce the clustering of alpha-Fe(2)O(3) along the circumferential edges of the microparticles. Of the seven emulsifiers tested, Tween 80 was selected primarily for its hydrophilicity and its ability to produce a stable alpha-Fe(2)O(3) dispersion. As a result, 22 batches of microspheres (11 with Tween 80 and 11 without) were made and the solvent (dichloromethane) to co-solvent (ethyl acetate) ratios were varied. Particles made with solvent mixtures of >50% ethyl acetate (<50% dichloromethane) were more likely to be hollow and had larger mean volumetric particle diameters (>5 microns) than particles made with mixtures containing >50% dichloromethane. Particles made with Tween 80 were larger, more porous, and had alpha-Fe(2)O(3) aligned along the circumferential edges of the particles. The use of solvent mixtures did not improve the encapsulation efficiency of alpha-Fe(2)O(3) but the use of ethyl acetate helped to induce the clustering of alpha-Fe(2)O(3) along the peripheries of the microparticles.

Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations?

The high prevalence of habitual snoring (35% of the general population) and the increasing demand for an effective treatment have led, in the last decade, to the generalisation of laser-assisted uvulopalatoplasty (LAUP). However, acceptable studies on its effectiveness are lacking. The present randomised, placebo-controlled study included 25 nonapnoeic and mild obstructive sleep apnoea snorers to evaluate LAUP effectiveness for snoring. Group I received a one-stage LAUP treatment and group II a placebo (simulated snore surgery followed by an oral placebo). Before each treatment and 3 months after, the variables and procedures assessed were: body weight; sleepiness (Epworth sleepiness scale); quality of life (SF-36); subjective snoring intensity (0-10 analogue scale); objective snoring intensity (average decibel intensity); snoring index (number of snores per hour); and apnoea/hypopnea index. No differences were observed in body weight, sleepiness, quality of life, subjective and objective intensity, and frequency of snoring, and apnoea/hypopnea index between the groups before and 3 months after treatment. In conclusion, this study provides evidence of the lack of effectiveness of one-stage laser-assisted uvulopalatoplasty for snoring in nonapnoeic and mild obstructive sleep apnoea patients, with the result that it does not meet the expectations generated by the procedure.

Splenic trauma following colonoscopy.

A case of splenic trauma after colonoscopy is reported. After description of their experience, the Authors report a review of the literature and some considerations about clinical diagnosis and surgical or medical therapy for this pathology.

[Langerhans cell histiocytosis of the temporal bone]. / Histiocitosis de células de Langerhans de hueso temporal.

Eosinophilic granuloma (EG) is a localized, benign form of Langerhans' cell histiocytosis. It is the least severe of the histiocytosis syndromes and characterized by lytic lesions of one or more bones. Temporal bone lesions usually occur in association with multifocal disease, but isolated lesions may occur in either the mastoid bone alone or in the entire temporal bone affecting other sites in the body. Two cases of EG of the temporal bone are reported and the literature is reviewed.

[Secondary brain herniation. A case report]. / Meningoencefalocele secundario. A propósito de un caso.

A 47-year-old woman with left temporal bone herniation had a history of treatment of chronic cholesteatomatous otitis media. After clinical and radiological diagnosis, the defect was repaired using a middle fossa craniotomy approach and a Vicryl-collagen(R) plate. There were no postoperative surgical complications and the repair was successful. The sequellae of herniation of the temporal lobe and dura are potentially lethal and difficult to correct surgically.

Involvement of thiol metabolism in resistance to glucantime in Leishmania tropica.

Clinical resistance to pentavalent antimonials, in the form of pentostam (sodium stibogluconate) or glucantime (N-methylglucamine antimoniate), has long been recognized as a problem in Leishmaniasis. However, the mechanisms of resistance are unclear. We selected in vitro a Leishmania tropica line resistant to 1.2 mg/mL of Sb(V) of glucantime (GLU-R10). The cell line has a stable phenotype for at least 6 months and a resistance index of 1400-fold. The resistant line has no cross-resistance to pentostam or to SbCl3 and SbCl5. The resistance to glucantime was reverted by buthionine sulfoximine (BSO) and chlorambucil (CLB); however, thiol analyses by HPLC of wild-type and GLU-R10 cell lines, in the presence or absence of the drug, showed no differences between these two cell lines. The resistant line had a DNA amplification shown as a circular extrachromosomal element (G-circle) of approximately 22 kb. However, the specific probes for gamma-glutamyl cysteine synthetase, ornithine decarboxylase and trypanothione reductase did not recognize the G-circle amplified in the GLU-R10. The G-circle did not arise from the H region and was not related with P-glycoprotein Pgp-MDR- or Pgp-MRP-like genes. Northern blot analysis of the G-circle showed that a single transcript of approximately 6 kb was overexpressed in the resistant line. Molecular characterization of the G-circle would lead to the determination of the gene(s) involved in resistance to glucantime in Leishmania.

[Cerebral abscess of otogenic origin located simultaneously in the temporal and cerebellar regions]. / Absceso cerebral de origen otógeno. Localización simultánea temporal y cerebelosa.

A 28-year-old male was seen for chronic left ear disease. A brain abscess appeared in the left temporal lobe and later spread to the cerebellum. Diagnosis was clinical and radiological. Intravenous antibiotic treatment resulted in resolution of the temporal abscess on CT. However, a new abscess that appeared in the left cerebellar hemisphere required neurosurgical debridement. The patient's microbiological cultures and history suggested an otological origin. Brain abscess is a serious complication of ear disease that requires early diagnosis and treatment.

Vitamin D metabolite-mediated hypercalcemia in Wegener's granulomatosis.

Hypercalcemia may occur during the course of various granuloma-forming diseases. Herein we describe a patient who had symptomatic hypercalcemia as a prominent sign of Wegener's granulomatosis. We observed a direct correlation between the serum levels of 1,25-dihydroxyvitamin D [1,25(OH)2D] and both the serum and the urinary calcium levels. Administration of prednisone and cyclophosphamide led to a substantial decrease in the levels of calcium and serum 1,25(OH)2D, but the serum levels of 25-hydroxyvitamin D remained unchanged. Two months after admission of the patient, the levels of calcium and 1,25(OH)2D increased; after we increased the dose of cyclophosphamide, these levels decreased (the dose of corticosteroids was not changed). We suggest that the excessive synthesis of 1,25(OH)2D was inhibited by a direct or indirect action not only of prednisone but also of cyclophosphamide on the 1 alpha-hydroxylation of 25-hydroxyvitamin D in the activated macrophage of Wegener granulomas. Furthermore, in view of this case and two other recently reported cases, we believe that Wegener's granulomatosis must be definitively added to the list of granulomatous diseases that are responsible for 1,25(OH)2D-mediated hypercalcemia.

[Phyolaryngocele: a case report and review of literature]. / Piolaringocele. Presentación de un caso y revisión de la literatura.

A case of pyolaryngocele presented as a lateral cervical mass that produced acute dyspnea requiring tracheotomy. The diagnosis was by direct laryngoscopy, which revealed outflow of purulent material with pressure on the tumor, and was confirmed by CT. Broad-spectrum antibiotic treatment was given and the pyolaryngocele was excised by lateral extramucosal tyrotomy. The literature on laryngocele and pyolaryngocele was reviewed.

[Obstructive apnea syndrome during sleep secondary to a pharyngeal lymphoma. Improvement with continuous pressure treatment of the upper airway]. / Síndrome de apneas obstructivas durante el sueno (SAOS) secundario a un linfoma faríngeo. Mejoría con tratamiento con presión continua de la vía aérea superior (CPAP).

Obstructive sleep apnea syndrome (OSAS) is characterized by multiple episodes of upper airway (UA) obstruction during sleep. Patients experience daytime hypersomnia, sluggishness and inability to concentrate; snoring at night is common. We report the case of a man with Hodgkin's lymphoma without full remission and with pharyngeal recidivism leading to OSAS. He experienced marked diurnal hypersomnia accompanied by behavior disorders. Examination revealed flow-volume OSAS, suggesting UA instability. Cervical computed tomography showed a prevertebral lymphomatous mass in the pharynx causing significant UA compression. UA size increased considerably after use of continuous positive airway pressure (CPAP), which normalized sleep and produced significant relief of symptoms. Later, after chemotherapy, OSAS resolved and the patient was able to abandon CPAP treatment.

[Surgical multiple level reconstruction of the upper airways for treatment of obstructive sleep apnea. Two clinical cases]. / Reconstrucción quirúrgica multinivel de la vía aérea superior en el tratamiento del síndrome de apneas obstructivas durante el sueño. Dos casos clínicos.

Techniques for surgical correction of the soft palate are used commonly to treat obstructive sleep apnea syndrome (OSAS), but a satisfactory cure cannot be ensured because such techniques usually involve localized correction of the upper airways (UA) whereas UA collapse during sleep involves the entire length. The development of correction techniques for the entire extension of the UA may help to solve this problem. We report the first two cases of multilevel UA surgical reconstruction in OSAS performed in Spain. The excellent results obtained favor routine use of this type of surgery once it has been validated in clinical practice.

Glutathione and trypanothione in several strains of Trypanosoma cruzi: effect of drugs.

Glutathione (GSH), trypanothione (T(SH)2) and glutathionyl spermidine (GSH-SP) concentrations were determined in the Tulahuén and LQ strains and the DM 28c clone of Trypanosoma cruzi. The concentrations of GSH, T(SH)2 and GSH-SP, expressed as nmol of GSH per g of parasite fresh weight, were 60.1, 397.8 and 103.9, respectively, for the Tulahuén strain. For the DM 28c clone, the values were 113.9, 677.9 and 164.1, respectively, and for the LQ strain they were 199.1, 1100.5 and 55.3, respectively. When the parasites were treated with 10 microM nifurtimox or 50 microM benznidazole for 2 h, the concentrations of all three reduced thiols decreased strongly. The total amount of T(SH)2 decreased by more than 50%. Treatment of the parasites with 5 mM buthionine sulfoximine, an inhibitor of GSH synthesis, for 6 h diminished the concentrations of the reduced thiols by between 27% and 53% with respect to the controls. Cyclohexylamine, an inhibitor of spermidine synthesis, decreased the concentrations of T(SH)2 and GSH-SP but not that of GSH. It is possible to conclude from this study that trypanothione is the most important thiol involved in the detoxication of nifurtimox and benznidazole in T. cruzi and that electrophilic reduced metabolites of both drugs are most probably conjugated with GSH, T(SH)2 and GSH-SP, thus decreasing their concentrations. GSH biosynthesis is an important drug target.

[Yag-laser for the treatment of laryngeal and oral hemangiomas]. / Yag-Láser en el tratamiento de hemangiomas de laringe y ca vidad oral.

Laryngeal and bucal hemangiomas are uncommon, although they carry with them, because of its sitting, a vital risk. The AA. report 2 hemangioma cases, one localized on the edge of the tongue, the other one on the aryepiglottic fold. Both were treated with photocoagulation by neodymiun-yttrium-aluminium (Nd-YaG) laser, with favorable follow-up and few complications.

Effects and mode of action of 1,4-naphthoquinones isolated from Calceolaria sessilis on tumoral cells and Trypanosoma parasites.

The naphthoquinones 2-hydroxy-3-(1,1-dimethylallyl)-1,4-naphthoquinone (CS-1), (-)-2,3,3-trimethyl-2-3-dihydronaphtho[2,3-b]furan-4,9-quinone (CS-3), and 2-acetoxy-3-(1,1-dimethylallyl)-1,4-naphthoquinone (CS-5) isolated from Calceolaria sessilis were tested against Trypanosoma cruzi epimastigotes, the TA3 tumor cell line and the methotrexate-resistant subline TA3-MTX-R. Naphthoquinone CS-3 was the most active; the 50% culture growth inhibition (I50) on T. cruzi (Tulahuén and LQ strain and DM28c clone) was at concentrations ranging from 2.1 to 5.2 mumolar. Also CS-3 inhibited TA3 and TA3-MTX-R culture growth with an I50 of 2.1 and 3.8 mumolar, respectively. Naphthoquinone CS-3 inhibited the respiration of the tumor cells by interfering with the electron transport at some point between NADH and ubiquinone. The respiration of T. cruzi was not inhibited by naphthoquinone CS-3. Naphthoquinone CS-3 produced a temporary increase of oxygen consumption in T. cruzi and tumor cells, suggesting the generation and participation of free radicals.

Purification and preliminary sequencing of Tc-45, an immunodominant Trypanosoma cruzi antigen: absence of homology with cruzipain, cruzain, and a 46-kilodalton protein.

In spite of being separated by more than 20 million years of evolution, the murine and human immune systems share extensive similarities. Thus, experimental results obtained with the murine model may have predictive value for human Chagas' disease. Challenge of the H-2 congenic mouse stains A.SW (H-2s) and A.CA (H-2f) with Trypanosoma cruzi yields different results. The A.CA animals die approximately 12 days postinfection, while A.SW mice survive indefinitely. A 45-kD protein (Tc45), an antigen differentially recognized by the A.SW strain, is present in cultured epimastigotes and blood trypomastigotes. We describe here its purification from epimastigotes. The presence of Tc45 was monitored and a single band was detected. Since the molecular weights of Tc45, cruzipain, cruzain, and a 46-kD parasite polypeptide are similar, it was important to determine if these molecules are related. A complete lack of homology was observed when the sequence of cruzain, cruzipain, and the 46-kD polypeptide were compared with the preliminary sequence of Tc45.

[Carotid paraganglioma: a case report]. / Paraganglioma carotídeo. Caso clínico.

Carotid paraganglioma are tumors arising from chemoreceptor paraganglioma cells. These cells have proved to have an embryologic origin from the neural crests. Due to their low incidence these tumors are not an habitually found in daily practices. We present a case of carotid body paraganglioma diagnosed by clinical exploration, CT scan, magnetic resonance imaging and magnetic resonance angiography which was successfully treated by surgery. The diagnostic and therapeutic difficulties present in these tumors are discussed.