RESUMEN
We present the first reported case of Aspergillus vertebral osteomyelitis and epidural abscess in Singapore in a 50-year-old man with post-tuberculous bronchiectasis. The patient presented with acute urinary retention and flaccid paraplegia. Despite surgical debridement and treatment with voriconazole, the patient developed multiorgan failure and died two weeks after presentation. Early diagnosis and prompt initiation of treatment are emphasised in the hope of improving the outcome of this aggressive condition.
Asunto(s)
Aspergilosis/diagnóstico , Aspergillus fumigatus , Absceso Epidural/diagnóstico , Osteomielitis/diagnóstico , Neumonectomía , Complicaciones Posoperatorias/diagnóstico , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/cirugía , Compresión de la Médula Espinal/diagnóstico , Espondilitis/diagnóstico , Vértebras Torácicas , Administración Oral , Antifúngicos/administración & dosificación , Aspergilosis/patología , Aspergilosis/cirugía , Diagnóstico Diferencial , Absceso Epidural/patología , Absceso Epidural/cirugía , Resultado Fatal , Humanos , Infusiones Intravenosas , Laminectomía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteomielitis/patología , Osteomielitis/cirugía , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/cirugía , Aspergilosis Pulmonar/patología , Pirimidinas/administración & dosificación , Compresión de la Médula Espinal/patología , Compresión de la Médula Espinal/cirugía , Espondilitis/patología , Espondilitis/cirugía , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Triazoles/administración & dosificación , VoriconazolRESUMEN
1. Cardiac fibroblasts play an important regulatory role in cardiac remodelling by undergoing proliferation, differentiation and upregulating various gene products, including some cytokines and extracellular matrix (ECM) proteins. A highly potent mediator of cardiac remodelling is angiotensin (Ang) II. 2. In the present study, the suppression subtractive hybridization method was used to identify differentially expressed cDNAs in adult rat cardiac fibroblasts induced by AngII. 3. Following mRNA isolation of non-stimulated and AngII-stimulated cells, cDNAs of both populations were prepared and subtracted by suppression polymerase chain reaction. Sequencing of the partially enriched cDNAs identified 36 genes differentially expressed, including ECM proteins (pro-alpha(1) collagen type III, fibronectin), structural protein (spectrin), enzyme (GTP-specific succinyl-CoA synthetase), transcriptional regulators (glucocorticoid-induced leucine zipper, inhibitor of DNA binding 3) and proteins involved in cell division control (cdc2) or cell signalling (insulin-like growth factor binding protein-3, mutant p53-binding protein, grp75, CGI-121, protein phosphatase type 2A, tspan-2 and Sam68). 4. The diversity of genes identified in the present study further emphasises the central role of AngII in the regulation of cardiac remodelling.