[Intracranial tuberculoma simulating a malignant tumor: case report and literature review]. / Tuberculoma intracraneal simulando neoplasia maligna. Caso clinico y revision dela literatura.

INTRODUCTION: Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. Tuberculoma is a granulomatous inflammatory process mimicking in rare occasions a malignant neoplasm radiologically. The authors report a case of a giant right frontal tuberculoma mimicking a malignant tumor and review the literature. CASE REPORT: A sixty four-year-old women with several weeks of headache and behavior alterations admitted at the hospital with light right hemiparesis. The MRI showed a left frontal tumor suggestive of a malignant tumor. CT showed bone infiltration. At surgery, a nodular, avascular lesion was found and pathological examination confirmed granulomatous inflammation suspecting tuberculoma. Mycobacterium tuberculosis complex-specific PCR assay confirmed diagnosis. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the early diagnosis, surgical resection and the complementary antituberculosis treatment. CONCLUSIONS: We present the unusual presentation of a giant brain tuberculoma which MRI led us to believe was a malignant tumor. Computed Tomography revealed bone infiltration. Positive diagnosis could be established on the basis of the pathology results of a brain biopsy or detection of DNA of Mycobacterium tuberculosis in the PCR study.

Effect of use of different landmark methods on determining stifle angle and on calculated tibial tuberosity advancement.

OBJECTIVES: Firstly, to investigate the effect that using different landmarks has on the measured stifle angle. Secondly, to determine whether any differences in measured stifle angle would lead to variations in the required extent of tibial tuberosity advancement (TTA). METHODS: Three greyhound stifles were positioned in a total of 66 different angles. Radiographic exposures of each stifle angle were made. For each radiograph i) the stifle angle was measured using each of three sets of landmarks and ii) the extent of TTA required to obtain a patella tendon angle of 90° was measured. Each radiograph was plotted graphically according to the stifle angle and the extent of TTA required. Linear regression analysis was used to calculate the TTA required for a stifle angle of 135° measured using each of the three landmark sets. RESULTS: On average, the stifle angle determined by the Long Axes method differed by 18° from the stifle angle determined with the Kinematic method. The stifle angle determined using the Eminence method differed from that determined using the Kinematic method by three degrees. The use of the Long Axes of the tibia and femur as landmarks to determine a stifle angle resulted in 5 mm and 4 mm over-advancement of the tibial tuberosity compared to the use of Kinematic or Eminence landmark methods respectively. CLINICAL SIGNIFICANCE: The method used to measure the stifle joint angle can influence the value of the required TTA advancement. This is an additional variable that should be considered during TTA planning and when comparing in vivo and in vitro studies.

[Visceral leishmaniasis and bronchial asthma: influence of steroid therapy in the development of the macrophage activation syndrome and relative adrenal insufficiency]. / Leishmaniasis visceral y asma bronquial: influencia del tratamiento esteroideo en el desarrollo del síndrome de activación macrofágica e insuficiencia suprarrenal relativa.

The risk of suffering opportunistics infections in the immunoincompetent patient is a fact perfectly established. An uncommon situation constitutes the bronchopaties, pathologies with a high prevalence among the general population that they require habitually, among other, steroid treatment. The immunosupression confers to the clinical evolution of the infections, as a consequence of the inadequate response to the physical stress, due to the inhibition of the hypothalamus-hypophysis axis being able to in particularly serious cases, to develop the denominated macrophage activation syndrome, a serious and uncommon syndrome that darkens the clinical prognosis in these patients. In presence of a feverish syndrome of uncertain origin in a patient in immunosuppressor treatment, although it is to low dose, it is necessary to carry out a exhaustive differential diagnosis, should consider, among them, the infection for Leishmania, a parasitosis whose incidence is increasing notably in the last years in the immunosuppressed population. We present the clinical case of a 63 year-old patient, immunoincompetent as a consequence of secondary chronic steroid therapy to asthmatic bronchopaty that experiences an uncommon form of visceral leishmaniasis in our area, consistent in multiorganic failure in the context of the development of a macrophage activation syndrome.

Evaluation of the effect of signalment and owner-reported impairment level on accelerometer-measured changes in activity in osteoarthritic dogs receiving a non-steroidal anti-inflammatory.

In veterinary medicine, evaluation of osteoarthritis (OA) treatment efficacy remains challenging. Measurement of activity, utilizing accelerometers, provides a surrogate measure of pain through measuring effects on activity, and the objective data collected can be used to assess the efficacy of treatments. However, little is known about how dog characteristics impact the accelerometry-measured response to treatment. The objectives of this study were to evaluate the effect of signalment and initial impairment level on accelerometer-measured changes in activity in osteoarthritic dogs after receiving a non-steroidal anti-inflammatory (NSAID). Fifty-seven client-owned dogs with OA-associated pain and mobility impairment were administered meloxicam for 2 weeks, following a 2-week baseline, and spontaneous activity was measured using an Actical accelerometer unit. Signalment factors and disease variables were recorded (age, sex, weight, impairment level, forelimb or hindlimb pain). Initial degree of impairment had a significant effect on changes in weekly (P=0.009), weekday (P=0.044) activity following NSAID treatment. Greater initial impairment was associated with larger positive changes in activity. Degree of impairment should be taken into consideration during the development of a clinical trial. Appropriate selection of candidates based on initial degree of impairment may permit a greater treatment effect, therefore increasing the power of the study.

[Symptomatic secondary hyponatraemia due to combined treatment anticonvulsant and antidepressant: risk of sudden death in epilepsy?]. / Hiponatremia sintomática secundaria a tratamiento conjunto anticomicial y antidepresivo: ¿riesgo de muerte súbita en epilepsia?

The notable incidence of epilepsy in the general population, with the presence, more and more frequent of refractory therapeutic, it forces the anticonvulsant polytherapy. If we depart from the fact, that many of the epilepsies have a secondary cause, with affective disorders associate, we can understand the most habitual association of anticonvulsant and antidepressant. We present the clinical case of a 37-year-old-woman with refractory therapeutic epilepsy associated to exogenous depressive syndrome, in combined treatment with Carbamazepine, Lamotrigine and Venlafaxine, that suffers a episode of syncope secondary to symptomatic hyponatraemia, generated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The relevance of this case resides in the fact that the hyponatraemia generated by this pharmacological combination, up to now, it has not been described in the literature. This electrolytic anomaly can derive in secondary neurological and cardiovascular effects, in so outstanding occasions, as to produce the phenomenon denominated sudden death in the epileptic patient (SUDEP). We recommended a strict ionic control in those patients that require anti-epileptic and anti-depressant treatment combined, in order to avoiding paroxistic vascular episodes and to minimize the risk of SUDEP.

[Macro creatine kinase: illness marker. Practical guide for the management]. / Macro-creatincinasa: marcador de enfermedad. Guía práctica para su manejo.

BACKGROUND AND OBJECTIVE: The Macro creatine kinase (Macro-CK) is a complex constituted by polymerization of isoenzymes of creatine kinase (CK-BB or CK-MM together with IgG in the type I and oligomers of CK mitochondrial in the type II). Their presence in plasma generates false elevations of the CK-MB isoenzyme, upon interfering with the techniques of imunoinhibition used in the emergency room laboratories, what it constitute a serious problem in the diagnosis of squares of myocardial ischemia. The ignorance of this clinical situation has pushed us to present this study in order to begin to consider their utility like marker of illness, giving shortly, some recommendations for the correct management of this discovery in the emergency. SUBJECTS AND METHOD: They have been studied the total of patients valued in the emergency for 16 months that they gathered this requirements (25), valuing the pathology that appeared under this analytic determination. The identification of the isoenzymes of CK was carried out by means of agarose gel electrophoresis. RESULTS: The 13 cases with Macro-CK type I (9 women and 4 males) had a half age of 64 years (4-89). The levels means of CK were 274 mU/mL with a CK-MB of 440 U/L (166%). The 7 cases with Macro-CK type II (1 woman and 6 males) had a half age of 69 years (32-80). The levels means of CK were 314 mU/mL with a CK-MB of 569 U/L (191%). The 53.8% of the patients with Macro-CK type I presented any cardiovascular pathology, the 38.5% diabetes mellitus and the 30.8% pathology muscle-articulate with possible component autoimmune. The 100% of the patients with Macro-CK type II suffered processes malignant tumors, highlighting the presence of tumors of digestive origin and prostatic, with metastasis, being the more frequent in liver and bone (71.4%), and a high mortality of the 71.4% (5 deaths). The Macro-CK type II (form oligomer of mitochondrial) is liberated like consequence of a lesion of the mitochondrias of the affected fabrics tissues, associating to serious illnesses like cirrhosis and tumors. CONCLUSIONS: In all the studied cases the payees of Macro-CK presented underlying pathology, being in the case of Macro-CK type I of heart prevalence, and in the case of type II of nature tumoral. A management Macro-CK algorithm is also presented for the emergency.

Captopril inhibits pp60(c-src) tyrosine phosphorylation in cultured human mesangial cells.

The present experiments were devoted to analyzing the mechanisms involved in the captopril-dependent inhibition of human mesangial cell proliferation. Studies were performed in cultured human mesangial cells incubated with captopril, an angiotensin II-converting enzyme inhibitor with antioxidant properties, lisinopril, a non-antioxidant angiotensin II-converting enzyme inhibitor, and tocopherol, a pure antioxidant. Both angiotensin II-converting enzyme inhibitors significantly inhibited fetal calf serum-induced [3H]thymidine uptake by human mesangial cells, in a dose- and time-dependent manner, an effect which was not observed with tocopherol. The antiproliferative effect of captopril and its ability to block tyrosine phosphorylation of human mesangial cells proteins were significantly greater than those of lisinopril. Moreover, captopril significantly prevented the fetal calf serum-induced tyrosine phosphorylation of pp60(c-src). The present results suggest that the antiproliferative ability of captopril does not completely depend on its angiotensin II-converting enzyme inhibitor properties, pointing to a possible interaction of the drug with the intracellular mechanisms responsible for the transmission of the proliferative signals.

Mechanical comparison of median sternotomy closure in dogs using polydioxanone and wire sutures.

OBJECTIVES: To compare the mechanical properties of two different materials for canine median sternotomy closure. STUDY DESIGN: In vitro biomechanical study. SAMPLE POPULATION: Twelve canine cadaveric entire sternum and portion of associated ribs and musculature. METHODS: Median sternotomy leaving the manubrium intact was closed using polydioxanone and stainless steel wire in a figure of eight pattern. Constructs were loaded in a servohydraulic material testing system and displacement was compared at loads of 125, 150, 200, 250, 300, 350 and 400 N, and at failure. RESULTS: Displacement at loads up to 400 N and failure did not show any statistical difference between the polydioxanone and the stainless steel wire. However, the loading forces to create failure of the construct were superior for the stainless steel. Polydioxanone and stainless steel wire had the same response to distractive forces for loads applied up to 400 N. CLINICAL SIGNIFICANCE: This study cannot recommend the use of polydioxanone over wires but suggests that polydioxanone can potentially be an alternative for primary median sternotomy closure in selected patients.

Endometrial adenocarcinoma and mucometra in a 6-year-old Alaska Malamute dog.

A 6-year-old female Alaska Malamute dog was presented for evaluation of abdominal enlargement referred by a local veterinarian. On the history, the owner complained of chronic abdominal enlargement initiated more than 4 months ago, reduced appetite, occasional vomiting and general dullness. He also complained of greenish mucous intermittent vaginal discharge starting 10 days ago. The bitch was chronically treated with medroxiprogesterone acetate. A laparatomy was performed and fluid in the abdomen was found and aspirated during the surgery. Also a very fluid-filled distended uterus and a mass in the distal part of the left uterine horn were found. The mass was encapsulated by the omentum, but areas of necrosis and calcification were identified. Histopathological diagnosis was endometrial adenocarcinoma.

Reactive oxygen species induce proliferation of bovine aortic endothelial cells.

The effects of reactive oxygen species (ROS) on different cellular types are variable. In some conditions they can be harmful metabolites, but they can also act as intracellular messengers that are able to activate different transcription factors. Based on previous reports in which ROS were shown to stimulate the proliferation of mesenchymal cells, this study was carried out to assess this effect on bovine aortic endothelial cells (BAECs). When cells were incubated with glucose oxidase (GO), an enzyme that generates H2O2 continuously, a significant increase in BAEC proliferation was detected. BAEC proliferation was measured by the incorporation of [3H]-thymidine in the DNA of BAECs, and also by an increase in the number of cells. The effect observed with GO was maximal at 8-24 h. Catalase abolishes proliferation. We also tested the ability of GO to phosphorylate tyrosine residues in endothelial cell proteins. A significant increase in tyrosine phosphorylation was found, which might constitute the molecular basis for proliferative effect of GO. In conclusion, these results demonstrate the ability of H2O2 to stimulate BAEC proliferation at least under certain experimental conditions. We suggest a general activation of the cascade of tyrosine phosphorylation as one of the possible cellular mechanisms responsible for GO-induced BAEC proliferation.

Hiponatremia sintomática secundaria a tratamiento conjunto anticomicial y antidepresivo: ¿riesgo de muerte súbita en epilepsia? / Symptomatic secondary hyponatremia due to combined treatment anticonvulsant and antidepressant: risk of sudden death in epilepsy?

La notable incidencia de epilepsia en nuestro medio, con la presencia, cada vez más frecuente, de refractariedad terapéutica, obliga a la politerapia anticomicial. Si partimos del hecho, de que muchas de las epilepsias tienen una base secundaria, con trastornos comportamentales asociados, podemos comprender la cada vez más habitual asociación entre fármacos anticomiciales y antidepresivos. Presentamos el caso clínico de una mujer de 37 años, afecta de epilepsia farmacorresistente asociada a síndrome depresivo exógeno, en tratamiento conjunto con Carbamacepina, Lamotrigina y Venlafaxina que sufre cuadro sincopal secundario a hiponatremia sintomática, cuya patogénesis radica en un mecanismo de secreción inadecuada de hormona antidiurética (SIADH). La relevancia de este caso radica en el hecho de que la hiponatremia generada por esta combinación farmacológica, hasta ahora, no ha sido descrita en la literatura. Esta anomalía electrolítica puede derivar en efectos secundarios neurológicos y cardiovasculares, en ocasiones tan relevantes, como para producir el fenómeno conocido como muerte súbita en el paciente epiléptico (SUDEP). Recomendamos, por ello, un estricto control iónico en aquellos pacientes en tratamiento conjunto anticomicial y antidepresivo, a fin de evitar episodios paroxísticos vasculares y minimizar el riesgo de SUDEP

The notable incidence of epilepsy in the general population, with the presence, more and more frequent of refractory therapeutic, it forces the anticonvulsant polytherapy. If we depart from the fact, that many of the epilepsies have a secondary cause, with affective disorders associate, we can understand the most habitual association of anticonvulsant and antidepressant. We present the clinical case of a 37-year-old-woman with refractory therapeutic epilepsy associated to exogenous depressive syndrome, in combined treatment with Carbamazepine, Lamotrigine and Venlafaxine, that suffers a episode of syncope secondary to symptomatic hyponatraemia, generated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The relevance of this case resides in the fact that the hyponatraemia generated by this pharmacological combination, up to now, it has not been described in the literature. This electrolytic anomaly can derive in secondary neurological and cardiovascular effects, in so outstanding occasions, as to produce the phenomenon denominated sudden death in the epileptic patient (SUDEP). We recommended a strict ionic control in those patients that require anti-epileptic and anti-depressant treatment combined, in order to avoiding paroxistic vascular episodes and to minimize the risk of SUDEP

Macro-creatincinasa: marcador de enfermedad. Guía práctica para su manejo / Macro creatine kinase: illness marker. Practical guide for the management

Fundamento y objetivo: La Macrocreatincinasa (Macro-CK) es un complejo constituido por polimerización de isoenzimas de creatincinasa (CK-BB o CK-MM unidas a IgG en la tipo I y oligómeros de CK mitocondrial en la tipo II). Su presencia en plasma genera falsas elevaciones de la isoenzima CK-MB, al interferir con las técnicas de inmunoinhibición empleadas en los laboratorios de urgencias, lo que constituye un grave problema en el diagnóstico de cuadros de cardiopatía isquémica. El desconocimiento de esta situación clínica nos ha empujado a presentar este estudio para empezar a considerar su utilidad como marcador de enfermedad, dando brevemente, unas recomendaciones para el correcto manejo de este hallazgo en el Servicio de Urgencias. Pacientes y Método: Se han estudiado el total de pacientes valorados en el Servicio de Urgencias durante 16 meses que reunían dichos requisitos (25), valorando la patología que subyacía bajo esta determinación analítica. La identificación de las isoenzimas de CK fueron realizadas mediante electroforesis en gel de agarosa. Resultados: Los 13 casos con Macro-CK tipo I (9 mujeres y 4 varones) tenían una edad media de 64 años (4-89). Los niveles medios de CK fueron 274 mU/mL con una CK-MB de 440 U/L (166%). Los 7 casos con Macro-CK tipo II (1 mujer y 6 varones) tenían una edad media de 69 años (32-80). Los niveles medios de CK fueron 314 mU/mL con una CK-MB de 569 U/L (191%). El 53,8% de los pacientes con Macro-CK tipo I presentaban alguna patología cardiovascular, el 38,5% diabetes mellitus y el 30,8% patología músculo-articular con posible componente autoinmune. El 100% de los pacientes con Macro-CK tipo II padecían procesos neoplásicos, destacando la presencia de tumores de origen digestivo y prostático, con afectación metastásica, siendo las más frecuentes en hígado y hueso (71,4%), y una alta mortalidad del 71,4% (5 exitus). La Macro-CK tipo II (forma oligomérica mitocondrial) es liberada como consecuencia de una lesión de las mitocondrias de los tejidos afectados, asociándose a enfermedades graves como cirrosis y tumores. Conclusiones: En todos los casos estudiados los portadores de Macro-CK presentaron patología subyacente, siendo en el caso de Macro-CK tipo I de predominio cardíaco, y en el caso de tipo II de naturaleza neoplásica. También, presentamos un algoritmo de manejo de la Macro-CK para el servicio de urgencias

Background and objective: The Macro creatine kinase (Macro-CK) is a complex constituted by polymerization of isoenzymes of creatine kinase (CK-BB or CK-MM together with IgG in the type I and oligomers of CK mitochondrial in the type II). Their presence in plasma generates false elevations of the CK-MB isoenzyme, upon interfering with the techniques of imunoinhibition used in the emergency room laboratories, what it constitute a serious problem in the diagnosis of squares of myocardial ischemia. The ignorance of this clinical situation has pushed us to present this study in order to begin to consider their utility like marker of illness, giving shortly, some recommendations for the correct management of this discovery in the emergency. Subjects and method: They have been studied the total of patients valued in the emergency for 16 months that they gathered this requirements (25), valuing the pathology that appeared under this analytic determination. The identification of the isoenzymes of CK was carried out by means of agarose gel electrophoresis. Results: The 13 cases with Macro-CK type I (9 women and 4 males) had a half age of 64 years (4-89). The levels means of CK were 274 mU/mL with a CK-MB of 440 U/L (166%). The 7 cases with Macro-CK type II (1 woman and 6 males) had a half age of 69 years (32-80). The levels means of CK were 314 mU/mL with a CK-MB of 569 U/L (191%). The 53.8% of the patients with Macro-CK type I presented any cardiovascular pathology, the 38.5% diabetes mellitus and the 30.8% pathology muscle-articulate with possible component autoimmune. The 100% of the patients with Macro-CK type II suffered processes malignant tumors, highlighting the presence of tumors of digestive origin and prostatic, with metastasis, being the more frequent in liver and bone (71.4%), and a high mortality of the 71.4% (5 deaths). The Macro-CK type II (form oligomer of mitochondrial) is liberated like consequence of a lesion of the mitochondrias of the affected fabrics tissues, associating to serious illnesses like cirrhosis and tumors. Conclusions: In all the studied cases the payees of Macro-CK presented underlying pathology, being in the case of Macro-CK type I of heart prevalence, and in the case of type II of nature tumoral. A management Macro-CK algorithm is also presented for the emergency

Tuberculoma intracraneal simulando neoplasia maligna. Caso clinico y revision de la literatura / Intracranial tuberculoma simulating a malignant tumor: Case report and literature review

Introducción. Las manifestaciones extrapulmonares de la tuberculosis (TBC) que afectan al Sistema Nervioso Central (SNC) por diseminación hematógena no son una entidad infrecuente. El tuberculoma es un proceso inflamatorio granulomatoso que radiológicamente, en raras ocasiones, simula un tumor maligno. A continuación se expone el caso y la revisión de la literatura sobre un tuberculoma gigante frontal derecho que simula un tumor maligno.Caso clínico. Mujer de 64 años de edad que ingresa en nuestro hospital tras varias semanas de cefalea acompañada de trastornos del comportamiento y discreta hemiparesia derecha. Las imágenes de RMN cerebral mostraban una lesión frontal izquierda sugestiva de tumor maligno. Las imágenes de TAC mostraban afectación ósea. En la cirugía se observó una lesión nodular y avascular con posterior confirmación anatomopatológica de inflamación granulomatosa altamente sugestiva de tuberculoma. La PCR frente a Mycobacterium tuberculosis complex confirmó el diagnóstico. Los tuberculomas intracraneales son una forma poco frecuente de tuberculosis del SNC. El pronóstico está relacionado con el diagnóstico precoz, el grado de resección quirúrgica y el tratamiento complementario con fármacos antituberculosos.Conclusiones. Exponemos una presentación poco frecuente de un tuberculoma cerebral gigante que mediante RMN nos hizo pensar en un tumor maligno. La TAC mostró la infiltración ósea. El diagnóstico definitivo puede establecerse en base a los resultados anatomopatológicos de la biopsia cerebral o mediante la detección del ADN de Mycobacterium tuberculosis por PCR (AU)

Introduction. Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. Tuberculoma is a granulomatous inflammatory process mimicking in rare occasions a malignant neoplasm radiologically. The authors report a case of a giant right frontal tuberculoma mimicking a malignant tumor and review the literature. Case report. A sixtyfour-year-old women with several weeks of headache and behavior alterations admitted at the hospital with light right hemiparesis. The MRI showed a left frontal tumor suggestive of a malignant tumor. CT showed bone infiltration. At surgery, a nodular, avascular lesion was found and pathological examination confirmed granulomatous inflammation suspecting tuberculoma. Mycobacterium tuberculosis complex-specific PCR assay confirmed diagnosis. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the early diagnosis, surgical resection and the complementary antituberculosis treatment. Conclusions. We present the unusual presentation of a giant brain tuberculoma which MRI led us to believe was a malignant tumor. Computed Tomography revealed bone infiltration. Positive diagnosis could be established on the basis of the pathology results of a brain biopsy or detection of DNA of Mycobacterium tuberculosis in the PCR study (AU)

Proteína relacionada con la hormona paratiroidea: efectos autocrinos y paracrinos en los vasos sanguíneos y en el glomérulo renal / Protein related to parathyroid hormone: autocrine and effects of blood vessels and renal glomeruli

La hormona paratiroidea (PTH) y la proteína relacionada con la PTH (PTHrP) producen efectos biológicos similares a través del receptor PTH/PTHrP. Poco se sabe del papel fisiológico de la PTHrP, que inicialmente se identificó como el agente responsable de la hipercalcemia asociada a enfermedades malignas. Aunque esta proteína se produce ampliamente en diferentes tejidos, su concentración se encuentra debajo de los límites de detección, hecho que sugiere que en circunstancias fisiológicas actúa en forma autocrina o paracrina. Se han descrito algunas diferencias en los efectos de ambas proteínas posiblemente relacionados con la existencia de diferentes receptores. En este sentido, recientemente se ha descrito un receptor específico para la PTH, el receptor PTH-2. Estudios recientes han demostrado la expresión del receptor PTH/PTHrP y de la PTHrP en el glomérulo renal. Además, existen datos que muestran un efecto directo de PTH y PTHrP sobre el flujo plasmático renal y la filtración glomerular. La PTHrP posee las características de una proteína multifuncional, incluyendo efectos proliferativos sobre las células mesangiales, y se especula que tenga un papel importante en la fisiología y fisiopatología renales (AU)