Assessment of antigenic supplementation of bovine purified protein derivative for diagnosis of subclinical infection with Mycobacterium bovis in cattle.

Bovine tuberculosis (bTB) is usually diagnosed in vivo and ex vivo on the basis of delayed hypersensitivity reactions with a complex pool of antigens named bovine tuberculin (PPDB). The IFN-γ release assay (IGRA) for bTB is a blood-based assay that improves detection of infected cattle at early stages that escape skin testing. Improvements to IFN-γ testing with specific proteins have been performed to increase sensitivity. DosR regulon-related antigens are well known mycobacterial proteins expressed during the non-replicative phases of infection, this has been useful to improve the diagnosis of subclinical forms of TB in suspected individuals. Transcripts of DosR genes mb2054c, mb2057c, and mb2660c have been identified by our group in lymph nodes of IFN-γ test negative cattle. This led us to hypothesize that DosR-related proteins may potentiate the IFN-γ response to PPDB in animals with a false negative IFN-γ test, making evident subclinical infection. Three hundred animals were evaluated by means of IGRA and post-mortem microbiological analysis of tissue samples to validate M. bovis infection. We found that 176 out of 300 animals showed an overall increased OD in complemented IGRA with two purified protein cocktails in comparison to PPDB alone, and were scrutinized for a subclinical infection; thirty percent when PPDB was supplemented with a cocktail of four DosR antigens, and 70% when PPDB was supplemented with a cocktail of six antigens (four DosR and two RD1 antigens). Forty five animals showed a substantial IFN-γ overproduction but remained negative, and 40 animals changed the result to a positive test. Only 18 out of 176 IFN-γ high producing animals were also positive to M. bovis isolation. Fifty seven animals with no visible lesions at slaughter and with a negative IGRA test result contained M. bovis DNA in tissue samples. In conclusion, Mb1762c, Mb2054c, Mb2057c, and Mb2660c have the potential to increase sensitivity of the IFN-γ in vitro test for bTB diagnosis when supplemented to PPDB.

Hydrosurgery as a safe and efficient debridement method in a clinical wound unit.

OBJECTIVE: Hydrosurgical debridement allows removal of non-viable tissue, preserving healthy tissues. This study was designed to analyse whether hydrosurgery, used in a clinical wounds unit, is an effective and safe method that may reduce debridement time. METHODS: Patients' wounds had the following characteristics: wounds with devitalised tissue needing rapid debridement, wounds with cavities, or non-healing wounds. Hydrosurgical debridement uses a pressurised stream of saline (0.9% sodium chloride) and a vacuum around this stream to remove the devitalised tissue of the wound, preserving healthy surrounding tissues. RESULTS: This prospective study comprised of 53 wounds from 39 patients. The wound aetiology included 39.7% arterial insufficiency, 22.6% pressure ulcers (PUs), 15.1% diabetic foot ulcers (DFUs), 9.4% venous leg ulcers (VLUs), and 13.2% from other aetiologies. The percentage of wounds according the size was the following: 32.1% (<10cm2), 43.4% (10-49cm2), 15.1% (50-99cm2), and 9.4% (≥100cm2). Superficial wounds were 43.4% of the total and 56.6% of wounds had cavities. Pain associated with the hydrosurgery was mild to moderate. There were no hydrosurgery-related adverse events. For effective debridement, the required sessions were as follows: one procedure (73.6%), two procedures (18.9%) and three procedures (7.5%). There was a statistical significant direct correlation (r=0.307) between the number of required sessions and wound size. All patients improved in a week (>80% of granulation tissue). CONCLUSION: We demonstrate that hydrosurgery is an effective and rapid debridement method that can be used safely in the outpatient setting.

[Refractory neurosarcoidosis and infliximab: a growing experience]. / Neurosarcoïdose réfractaire et infliximab : une expérience grandissante.

Neurosarcoidosis is a rare disease that can involve all the nervous system with variable clinical onset and prognosis. The initial therapeutic approach is mainly based on corticosteroids and immunosuppressive agents. Treatment of refractory forms of neurosarcoidosis is not well established and emerging immunomodulating drugs like infliximab have been recently tested. The clinical report of a new case of neurosarcoidosis responding to infliximab is followed by a review of the new therapeutic agents available for the treatment of refractory neurosarcoidosis.

A sex difference and no effect of ApoE type on the amount of cytoskeletal alterations in the nucleus basalis of Meynert in Alzheimer's disease.

In the nucleus basalis of Meynert (NBM) we studied the presence of early cytoskeletal alterations as shown by the antibody Alz-50 in ApoE-typed patients. Using an image analysis system, the area covered by Alz-50 staining and the percentage of neurons stained by Alz-50 were determined. There were no significant differences in the area covered by Alz-50 or in the proportion of Alz-50-stained neurons in the nucleus basalis of Meynert of Alzheimer's disease (AD) patients with one or two ApoE epsilon4 alleles as compared with those without any ApoE e4 allele. However, there was a significant sex difference in Alz-50 staining: female Alzheimer's disease patients showed more severe early cytoskeletal alterations than males. We also found a significant relationship between the number of Alz-50-stained neurons and the severity of dementia.

[Double tachycardia (hisian and auricular) in a bradycardia-tachycardia syndrome (author's transl)]. / Doble taquicardia (hisiana y auricular) en un síndrome bradicardia-taquicardia.

The present case corresponds to a patient with a mitro-aortic valvulopathy of rheumatic origin with syncopal episodes and nauseas, who, in the ECG showed alternatively an extreme sinusal bradycardia and supraventricular tachyarrhythmias. It was interpreted as a typical case of bradycardia-tachycardia syndrome in which the crises of tachyarrhythmias consisted of episodes of double tachycardia with incomplete supra-hisian atrial-ventricular dissociation, documented by obtaining right atrial electrograms and hisian-electrograms during the episodes. Treatment was initiated with verapamil (10 mg intravenously every 8 hours) after an endocavitary pacemaker of demand had been placed. After 3 months the result was very satisfactory with good tolerance to the medical treatment and complete disappearance of the symptomatology.

[The quality of life of the patient with unstable angina treated by spinal cord electrical stimulation]. / Calidad de vida del paciente con angina inestable tratado con estimulación eléctrica medular.

Quality of life was evaluated in patients with unstable angina before and after surgical therapy with spinal cord electrical stimulation (SCES). Overall 12 patients were evaluated, with quantification of the mean weekly number of anginal attacks, the degree of effort provoking them and the Nottingham Health Profile (NHP). The criteria of inclusion in the study were: angina grade IV, resistant to drug therapy and without indication of surgery. The mean follow-up period was 9.8 +/- 8.2 months. A significant reduction in the weekly number of anginal attacks (preoperative 30.9 +/- 14.5; postoperative 9.6 +/- 8.2; p less than 0.01); improvement in functional class (p less than 0.001), and significant improvement (p greater than 0.05) in the pain, energy, sleep, social isolation and emotional reactions areas of NHP were observed. It was concluded that SCES is a useful procedure in patients with unstable angina untreatable by other medical or surgical methods, as it reduces the number of anginal attacks and increases quality of life of the patients without additional risk.

[Usefulness of 2-D ultrasound in diagnosis of pericardial partial defects]. / Utilidad de la eco 2-D en el diagnóstico de defectos parciales de pericardio.

A case of 2 year old female, asymptomatic, was referred to this hospital in order that an abnormal radiological cardiac shape could be studied. Physical examination and ECG were normal. The 2-D ultrasound showed systolic deformation on the antero-lateral wall in the left ventricle, with an increased ecogenity and protrusion of the left earlobe to the left lung. A CT scan showed a defect of the pericardium at the same level. After the revision of the pericardium, we concluded that the use of an invasive test to diagnose this disease is not necessary, the 2-D ultrasound being enough to show the defect.

[Spinal electrical stimulation. Current indications and results in a series of 46 patients]. / Estimulación eléctrica medular. Indicaciones actuales y resultados en una serie de 46 pacientes.

We report the clinical results observed in a series of 46 patients with chronic pain who underwent spinal cord electrical stimulation. Candidates were selected according to previous clinical criteria and they were followed-up during a period of 5 to 27 months. Fifteen patients had a residual backache after surgery of the lumbar spine, 19 patients complained angina pectoris, 5 patients peripheral vasculopathies, and 7 subjects had different types of neurogenic pain. A total of 5 patients failed to complete the trial period of 7 to 10 days. Among the 34 patients who continued to use the medullar stimulation, good results were obtained in 75% of cases of backache , 100% of patients with angina and vasculopathies, and 50% of patients with neurogenic pain. There were no relevant complications. We conclude that the results of spinal cord stimulation can be improved by using more strict indications, by performing a previous test period before definitive implantation, and by achieving a large technical experience.

High cervical spinal cord stimulation for unstable angina pectoris.

Twelve patients with grade IV unstable angina were treated with high cervical spinal cord stimulation (SCS). All patients had been previously treated with maximal tolerated doses of beta-blockers and calcium antagonists and had no possibility of revascularization surgery or intraluminal angioplasty. Multipolar electrodes were implanted using a percutaneous technique, and the parameters of stimulation were pulse width 0.1 ms, frequency 120 Hz, intensity that caused no unpleasant paresthesias, with two periods of 4 h 'on' daily. After a mean follow-up of 9.8 +/- 8.2 months the clinical results show a significant reduction in the number of angina attacks (p less than 0.01) and in their grade (p less than 0.001). In the treadmill ergometric test, a significant increase in the time until angina and double product (p less than 0.01) was observed. We conclude that the SCS is a very low-risk technique that significantly increases the quality of life of patients with unstable angina.

Estenosis carotídea en pacientescon antecedentes de radioterapia cervical:orientación diagnóstica y actitud terapéutica / Carotid stenosis in patients with a history of cervical radiotherapy: diagnostic guidelines and therapeutic attitude

Objetivos. Se ha descrito una mayor prevalencia de patología carotídea en los pacientes sometidos a radioterapia cervical. Nuestro objetivo es analizar la prevalencia, la localización de la lesión y la morbimortalidad de este grupo de pacientes dentro de nuestra serie de cirugía carotídea. Pacientes y métodos. De un total de 480 casos que se intervinieron de cirugía carotídea entre 1995 y 2002, nueve pacientes (1,87 por ciento) presentaban el antecedente de radioterapia cervical. Resultados. La edad media del grupo de pacientes que se irradiaron fue de 62,4 ñ 4,1 años. La causa más frecuente de radioterapia cervical fue el carcinoma de laringe (55 por ciento). Siete pacientes (78 por ciento) presentaban una estenosis sintomática del territorio carotídeo. El 45 por ciento (cuatro) de las lesiones fueron de carótida primitiva, y el resto, de carótida interna. Se realizaron siete endarterectomías, una interposición de segmento de Dacron en la carótida primitiva y una angioplastia más un stent de la carótida primitiva. En cuanto a los resultados inmediatos, ningún paciente presentó ninguna focalidad neurológica central, y se observó una focalidad neurológica periférica transitoria en dos pacientes (25 por ciento). Los resultados tardíos con un seguimiento medio de 2,7 años, revelaron que el 100 por ciento de los pacientes permanecieron asintomáticos, y se observó una oclusión de la carótida interna a los tres años. Conclusiones. La edad media en el grupo de pacientes que se irradiaron es inferior respecto al grupo global de cirugía carotídea ( p < 0,05), y se da una mayor afectación de la carótida primitiva en este grupo. No aumenta la morbimortalidad global, y la morbilidad neurológica periférica es ligeramente superior pero reversible (AU)

Hematoma epidural espontáneo de localización espinal / Spontaneous spinal epidural hematoma

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