Obstrucción biliar por fascioliasis hepática / Biliary obstruction due to hepatic fascioliasis

Hepatic fascioliasis is produced by a platyhelminth, trematode: the hepatic Fasciola. In recent years, its incidence has increased in all countries, including Latin America. The diagnosis is based on clinical and epidemiological background information, hemogramm with eosinophil count; Ig G ELISA; and copro-parasitological and duodenal aspirate in search of parasite eggs. Images are useful, endoscopic ultrasound, Computed Tomography (CT), abdominal Magnetic Resonance Imaging (MRI), especially in case of complications. The endoscopic retrograde cholangiopancreatography (ERCP) is useful both for diagnosis and treatment (extraction of adult Fasciola), as it was in hte present clinical case. This parasite can also be found incidentally in the course of a surgery planned for other reasons. In the present clinical case we present a 41-year-old patient, farmer, with apparent ingestion of water and contaminated aquatic vegetables. Initially he presented only fever and hypereosinophilia; with fascioliasis diagnosis. The pathology recurred after 18 month with biliary obstruction. The clinical and epidemiological background information was a fundamental tool for diagnosis, together with abdominal CT. Initially it evolved with bad response to several antiparasitic treatments and then it progressed positively. After that, the pathology recurred with complications. ERCP was performed to extract adult Fasciola. Currently in symptomatic remission after endoscopic intervention and drug treatment.

La fascioliasis hepática es producida por un platelminto, tremátodo: la Fasciola hepática. En los últimos años ha incrementado su incidencia en todos los países, incluyendo América Latina. El diagnóstico se basa en los antecedentes clínicos, epidemiológicos, hemograma con recuento de eosinófilos; IgG Elisa; copro-parasitológicos y aspirado duodenal en búsqueda de huevo de parásitos. Las imágenes son de utilidad, endosonografía, tomografía computada (TC), resonancia magnética (RM) abdominal, especialmente en caso de complicaciones. La colangio-pancreatografía retrógrada endoscópica (CPRE) es útil tanto como para el diagnóstico como para el tratamiento (extracción de fasciolas adultas), como se realizó en el presente caso clínico. Este parásito también se puede encontrar incidentalmente en el transcurso de una cirugía por otros motivos. Presentamos el caso de un paciente de 41 años, originario de una zona rural, agricultor, con ingesta aparente de agua y vegetales acuáticos contaminados. Cursó inicialmente sólo con fiebre e hipereosinofilia; con diagnóstico de fascioliasis. Al cabo de 18 meses su patología recurrió con cuadro clínico de obstrucción biliar. El antecedente clínico y epidemiológico fue una herramienta fundamental para el diagnóstico, además, de la TC abdominal. Evolucionó inicialmente con mala respuesta a varios tratamientos antiparasitarios, y luego mejoró. Posteriormente, su patología recurrió con complicaciones. Se realizó CPRE con extracción de Fasciolas adultas. Actualmente, se encuentra en remisión sintomática mantenida, después de la intervención endoscópica y el tratamiento medicamentoso.

5-HT1A autoreceptor modulation of locomotor activity induced by nitric oxide in the rat dorsal raphe nucleus

The dorsal raphe nucleus (DRN) is the origin of ascending serotonergic projections and is considered to be an important component of the brain circuit that mediates anxiety- and depression-related behaviors. A large fraction of DRN serotonin-positive neurons contain nitric oxide (NO). Disruption of NO-mediated neurotransmission in the DRN by NO synthase inhibitors produces anxiolytic- and antidepressant-like effects in rats and also induces nonspecific interference with locomotor activity. We investigated the involvement of the 5-HT1A autoreceptor in the locomotor effects induced by NO in the DRN of male Wistar rats (280-310 g, N = 9-10 per group). The NO donor 3-morpholinosylnomine hydrochloride (SIN-1, 150, and 300 nmol) and the NO scavenger S-3-carboxy-4-hydroxyphenylglycine (carboxy-PTIO, 0.1-3.0 nmol) were injected into the DRN of rats immediately before they were exposed to the open field for 10 min. To evaluate the involvement of the 5-HT1A receptor and the N-methyl-D-aspartate (NMDA) glutamate receptor in the locomotor effects of NO, animals were pretreated with the 5-HT1A receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT, 8 nmol), the 5-HT1A receptor antagonist N-(2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl)-N-2-pyridinyl-cyclohexanecarboxamide maleate (WAY-100635, 0.37 nmol), and the NMDA receptor antagonist DL-2-amino-7-phosphonoheptanoic acid (AP7, 1 nmol), followed by microinjection of SIN-1 into the DRN. SIN-1 increased the distance traveled (mean ± SEM) in the open-field test (4431 ± 306.1 cm; F7,63 = 2.44, P = 0.028) and this effect was blocked by previous 8-OH-DPAT (2885 ± 490.4 cm) or AP7 (3335 ± 283.5 cm) administration (P < 0.05, Duncan test). These results indicate that 5-HT1A receptor activation and/or facilitation of glutamate neurotransmission can modulate the locomotor effects induced by NO in the DRN.

5-HT1A autoreceptor modulation of locomotor activity induced by nitric oxide in the rat dorsal raphe nucleus.

The dorsal raphe nucleus (DRN) is the origin of ascending serotonergic projections and is considered to be an important component of the brain circuit that mediates anxiety- and depression-related behaviors. A large fraction of DRN serotonin-positive neurons contain nitric oxide (NO). Disruption of NO-mediated neurotransmission in the DRN by NO synthase inhibitors produces anxiolytic- and antidepressant-like effects in rats and also induces nonspecific interference with locomotor activity. We investigated the involvement of the 5-HT(1A) autoreceptor in the locomotor effects induced by NO in the DRN of male Wistar rats (280-310 g, N = 9-10 per group). The NO donor 3-morpholinosylnomine hydrochloride (SIN-1, 150, and 300 nmol) and the NO scavenger S-3-carboxy-4-hydroxyphenylglycine (carboxy-PTIO, 0.1-3.0 nmol) were injected into the DRN of rats immediately before they were exposed to the open field for 10 min. To evaluate the involvement of the 5-HT(1A) receptor and the N-methyl-D-aspartate (NMDA) glutamate receptor in the locomotor effects of NO, animals were pretreated with the 5-HT(1A) receptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT, 8 nmol), the 5-HT(1A) receptor antagonist N-(2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl)-N-2-pyridinyl-cyclohexanecarboxamide maleate (WAY-100635, 0.37 nmol), and the NMDA receptor antagonist DL-2-amino-7-phosphonoheptanoic acid (AP7, 1 nmol), followed by microinjection of SIN-1 into the DRN. SIN-1 increased the distance traveled (mean ± SEM) in the open-field test (4431 ± 306.1 cm; F(7,63) = 2.44, P = 0.028) and this effect was blocked by previous 8-OH-DPAT (2885 ± 490.4 cm) or AP7 (3335 ± 283.5 cm) administration (P < 0.05, Duncan test). These results indicate that 5-HT(1A) receptor activation and/or facilitation of glutamate neurotransmission can modulate the locomotor effects induced by NO in the DRN.

Simultaneous pancreas-kidney transplantation in a human immunodeficiency virus-positive recipient: a case report.

BACKGROUND: After the development of highly active antiretroviral therapy (HAART) for patients with human immunodeficiency virus (HIV), there has been increased interest in organ transplantation for this selected population. There is a lack of reports about pancreas transplant in HIV+ recipients. CASE REPORT: We report the case of a 43-year-old HIV+ man who presented with type 1 diabetes for 25 years and end-stage-renal disease. He underwent dialysis therapy for the prior 3 years. His CD4 count was 830 cells/mL and a negative viral load was achieved after 3 months of antiretroviral therapy. His nutritional status was favorable; no opportunistic infections had occurred. A simultaneous pancreas-kidney transplantation (SPKT) was performed from a 19-year-old deceased trauma victim. Pancreas implantation was enteric-portal drainage. No induction immunosuppression was used, but rather tacrolimus, sodium mycophenolate, and steroids. In the postoperative period, there was a delayed kidney graft function requiring hemodialysis for 14 days. On postoperative day 11, a kidney biopsy specimen showed mild rejection, which was successfully treated with steroids. The patient was discharged after 22 days; he was normoglycemic and insulin-independent with a serum creatinine value of 1.9 mg/dL. Currently, his outcome has been uneventful, without a readmission or opportunistic infections. After 5 months postoperation, the viral load is negative and the CD4 count is 460 cells/mL. The current serum creatinine level is 1.1 mg/dL; no insulin has been required. COMMENT: HIV has been considered to be an absolute contraindication to organ transplantation, because of the infection risk due to severe immunosuppression, to interactions between antiretroviral and immunosuppressive drugs, and to reluctance to offer an organ to a terminal patient. However, transplants in HIV+ patients have shown good results, when a patient has an acceptable CD4 level, a low viral load, and minimal antiretroviral therapy.

Long-term safety of fluticasone furoate nasal spray in adults and adolescents with perennial allergic rhinitis.

BACKGROUND: Fluticasone furoate is a novel-enhanced affinity glucocorticoid and its long-term safety must be assessed. This study was designed to assess the safety and tolerability of 12-month intranasal administration of fluticasone furoate in adult and adolescent patients with perennial allergic rhinitis (PAR). METHODS: In this randomized, double-blind, placebo-controlled, parallel-group study, 806 patients with PAR were randomized to once daily (od) fluticasone furoate nasal spray 110 microg (n = 605) or vehicle placebo nasal spray (n = 201) for 12 months, following a 7- to 14-day screening period. Safety was assessed by monitoring adverse events (AEs), 24-h urinary cortisol excretion, nasal and ophthalmic examinations, electrocardiograms and clinical laboratory tests. Plasma concentrations of fluticasone furoate were determined from blood samples. RESULTS: Fluticasone furoate was well tolerated. The incidence of most AEs was similar to that observed with placebo, with the exception of epistaxis, which was more frequently reported on active treatment. There were no clinically meaningful differences between fluticasone furoate and placebo in terms of safety assessments, including mean changes in ophthalmic parameters and 24-h urine cortisol excretion. Plasma concentrations of fluticasone furoate were not quantifiable in the majority of patients following intranasal administration. CONCLUSIONS: Long-term (12-month) administration of fluticasone furoate 110 microg od revealed an AE profile typical of the intranasal corticosteroid class in both adult and adolescent patients with PAR, with no evidence of clinically relevant systemic corticosteroid exposure.

Estudio clinico, histopatológico y ultraestructural del músculo de la lengua en pacientes con carcinoma epidermoide / A clinical, histopathological and ultrastructural study of tongue muscle in patients with squamous cell carcinoma

En el presente trabajo se realizó un estudio mediante microscopÝa de luz y electrónica de transmisión con el fin de estudiar las alteraciones musculares producidas en el músculo de la lengua en pacientes con carcinoma epidermoide. Las anomalÝas estructuras observadas incluyeron, alteraciones tanto en el sistema contrßctil como sarcotubular, por otro lado se observó atrofia y necrosis segmentaria, alteración de mitocondrias y proliferación de organelos, asÝ como vaculolas, lisosomas y grßnulos de lipofucsina. El infiltrado mononuclear estuvo representado principalmente por neutrófilos, macrófagos y mastocitos. Este estudio representa el primer reporte sobre las alteraciones ultraestructurales a nivel del músculo de la lengua producida por esta patologÝa maligna

Dioclein, a new nitric oxide- and endothelium-dependent vasodilator flavonoid.

In the present work, the vasorelaxant effect of dioclein, a new flavonoid isolated from Dioclea grandiflora (Leguminoseae), was investigated in the rat aorta. Dioclein induced a concentration-dependent relaxation in vessels pre-contracted with phenylephrine (IC(50)=1.3+/-0.3 microM), a response which was abolished after endothelium removal. Neither indomethacin (10 microM), an inhibitor of cyclo-oxygenase, nor atropine (1 microM), an antagonist of muscarinic receptors, modified the effect of dioclein. Dioclein (30 microM) induced a significant increase in guanosine 3':5'-cyclic monophosphate (cyclic GMP) levels in aortic rings with endothelium. The nitric oxide (NO) synthase inhibitor, N(G)-nitro-L-arginine-methyl-ester (L-NAME, 300 microM), strongly inhibited or abolished the relaxing effect and rise in cyclic GMP levels induced by dioclein. Furthermore, dioclein (30 microM) had no effect on the endothelium-independent relaxation produced by the NO donor, 3-morpholino-sydnonimine (SIN-1), while superoxide dismutase (100 U ml(-1)) significantly potentiated it. These results indicate that, in the rat aorta, dioclein induces a NO- and endothelium-dependent vasorelaxant effect, which is associated with cyclic GMP elevation. This vasorelaxation likely results from enhanced synthesis of NO rather than enhanced biological activity of NO.

Microvascular pathology in the skeletal muscle paraneoplastic phenomenon.

An electron microscopic investigation was made in order to study capillary alterations in the muscle paraneoplastic phenomenon associated with different malignant tumours. Several abnormalities were found including basement membrane widening and lamination, endothelial hypertrophy, a varied degree of lumen occlusion, and proliferative changes in pericytes. A degenerative process leading to capillary necrosis was also observed. A mononuclear cell infiltrate formed by macrophages, lymphocytes and mast cells was seen. The capillary changes observed suggest the existence of an autoimmune vascular factor in the etiopathogenesis of muscle damage in this phenomenon.

Skeletal muscle ultrastructural alterations in a case of Guillain-Barre syndrome.

The structural study of a muscle biopsy from a case of Guillain-Barré syndrome showed the typical findings of neurogenic atrophy and several abnormalities not commonly observed in denervated muscle as fibre necrosis, capillary alterations and infiltration of macrophages and occasional mast cells. The histopathological picture was similar to that found in the muscular compromise of some autoimmune diseases. The possibility for an immune mechanism in the muscle damage of Guillain-Barré syndrome is discussed.

Skeletal muscle ultrastructural alterations in a case of Guillain-Barre syndrome

El estudio estructural de una biopsia muscular de un paciente afectado por el síndrome de Guillain-Barré mostró los hallazgos típicos de la atrofia neurogenética, concomitantemente con anormalidades observadas infrecuentemente en el músculo desnervado como necrosis de las fibras, alteraciones capilares e infiltrado constituído por macrófagos y mastocitos ocasionales. El aspecto histopatológico fue similar al encontrado en el compromiso muscular de algunas enfermedades autoinmunes. Se discute la posible existencia de un mecanismo autinmune en el daño muscular del síndrome de Guillain-Barré

Peritonitis bacteriana espontánea en adultos no cirróticos / Spontaneous bacterial peritonitis in non cirrhotic adults

Se presentan dos casos de peritonitis bacteriana espontánea describriendo las características de este cuadro clínico propio de pacientes con defectos inmunitarios, especialmente cirróticos o con ascitis. La punción abdominal es el principal elemento diagnóstico. El cultivo de esta generalmente demuestra el desarrolo de un sólo germen, habitualmente E. Coli. La exploración quirúrgica está indicada en los casos no asociados a ascititis o cuando en éstos no se puede destacar la presencia de un foco intraabdominal. En ella lo más importante es el aseo exhaustivo de la cavidad peritoneal y una minuciosa exploración que descarte razonablemente una lesión orgánica

Ultrastructure of skeletal muscle in rheumatoid myositis.

Muscle biopsies from 8 cases of rheumatoid myositis (5 females and 3 males) were studied by electron microscopy. All muscle fibers studied showed either necrosis or atrophy, the latter varying from slight to severe. Mononuclear cell infiltration was present in all cases, with 4 types of cells observed (lymphocytes, plasma cells, macrophages and mast cells). The capillary endothelium showed proliferation of organelles, occlusion of lumina, and thickening of the basement membrane. The pathogenesis of muscle damage in rheumatoid myositis is discussed.

Ultrastructure of lipofuscin granules in normal human skeletal muscles.

Se realizo un estudio ultraestructural de los granulos de lipofucsina en musculos esqueleticos de humanos, cuyas edades estaban comprendidas entre los 20 y los 45 anos. Los granulos formaron 3 poblaciones de acuerdo a sus diametros, estando todos ellos delimitados por una membrana sencilla. Su interior estaba formado en todos los granulos observados por dos componentes, siendo uno electron-denso y el otro electron-opaco. El componente electron-denso se presento en algunos casos particulado, mientras que en otros homogeneo.El componente electron-opaco estaba constituido por gotas de lipidos, las cuales se encontraban en algunos granulos limitadas por una membrana sencilla, en tanto que en otros formaban na interfase con el componente electron-denso. Los granulos de lipofucsina se localizaron proximos a nucleos, mitocondrias, glucogenosomas, gotas de lipidos y particulas B de glucogeno. Se sugiere que algunas de esas estructuras e inclusiones pudieran ser responsables de la formacion de los granulos de lipofucsina