Deroofing: A safe, effective and well-tolerated procedure in patients with hidradenitis suppurativa.

INTRODUCTION: Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain dissatisfied with systemic treatment, and more than one-third are dissatisfied with surgical procedures. OBJECTIVES: A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications. METHODS: HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post-surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated. RESULTS: The mean closure time of the post-deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post-op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9-10 points). CONCLUSION: Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post-op pain and should be part of holistic HS management.

Defining hidradenitis suppurativa phenotypes based on the elementary lesion pattern: results of a prospective study.

BACKGROUND: It has been proposed that two main phenotypes of hidradenitis suppurativa (HS) exist. This proposal is based upon different elementary structures detected in the skin, namely follicular subtypes and inflammatory subtypes. Having an accurate definition of these two variants could help us to better identify patients who may require an early intervention with currently approved targeted immunomodulatory therapies. OBJECTIVE: To define and distinguish between the epidemiological, clinical and analytic characteristics of these two HS phenotypes. METHODS: An observational, descriptive, non-randomized and prospective study was conducted. Patients diagnosed with HS between May 2012 and April 2017 by a specialized unit were included. Ultrasound evaluation was performed in all cases. RESULTS: About 197 patients were included, 100 women and 97 men, aged between 25 and 47 years. The mean age of onset was significantly different between phenotypes, ranging between 26.69 ± 9.05 in the inflammatory subtype and 17.62 ± 6.42 in the follicular subtype. Follicular subtype patients exhibited a significantly higher number of nodules combined with the presence of multiple commedons (5.65 ± 3.38 versus 0.89 ± 2.72). This contrasted with the higher count of abscesses and fistulas detected in the inflammatory subtype (respectively, 4 ± 2.74 and 3.11 ± 2.56 versus 0.56 ± 1.02 and 0.26 ± 0.56). IgA levels were significantly higher in the inflammatory subtype (497.71 ± 262.26 versus 232.38 ± 84.06). Mean IHS4 score evaluation was higher in the inflammatory subtype (21.04 ± 11.9) compared with the follicular phenotype (7.54 ± 4.66). The inflammatory subtype was found to be an independent risk factor for disease aggressiveness in the multivariate analysis (OR 0.034 [95% CI 0.015-0.072]). LIMITATIONS: Small sample size. CONCLUSION: Preliminary data suggest the existence of an inflammatory HS phenotype that is associated with higher aggressiveness and major risk of progression during natural history of the disease.

Left ventricular diastolic function and cardiometabolic factors in obese normotensive children.

BACKGROUND AND AIM: Left ventricular (LV) hypertrophy and diastolic function have been found to be associated with obesity and hypertension in adults. However, there are scarce data about the association of obesity itself to cardiac alteration in children. The aim of this study was to detect early changes in LV structure and function in obese children and whether they are associated with the biomarkers of metabolic risk and endothelial activation. METHODS AND RESULTS: A total of 130 children aged 7-16 years (88 obese and 42 normal-weight children) were studied. All children had normal resting blood pressure. Two-dimensional ultrasound with M-mode imaging was performed to assess the LV mass index (LVMi), calculated as LV mass/height(2.7), and the peak diastolic of pulmonary venous flow velocity (PVFD). Tissue Doppler imaging was used to analyze ventricular performance through the ratio of the transmitral peak early filling velocity to the early average diastolic peak myocardial velocity (E/E'). The indicators of metabolic control, inflammation, and endothelial cell activation were evaluated. Compared to the controls, the obese subjects had significantly higher LVMi and E/E' and lower PVFD values, the two latest being found especially in severely obese subjects. In the multivariate analysis, the parameters of diastolic function (E/E' and PVFD) were independently associated with obesity, apolipoprotein A1, soluble vascular cell endothelial molecule-1 (sVCAM-1), and retinol-binding protein 4 (RBP4). CONCLUSION: An echocardiographic evaluation of diastolic function is a useful tool to detect early cardiac changes in obese children. Emergent cardiovascular risk markers such as apolipoprotein A1, RBP4, and sVCAM-1 are associated with the parameters of diastolic function.

Insuficiencia respiratoria global como primera manifestación de una neoplasia testicular. A propósito de un caso / Global respiratory failure as the presentation form of testicular neoplasia. A case report

Los tumores testiculares son las neoplasias más frecuentes en el grupo de edad entre 15 y 35 años, teniendo una alta tasa de curación, no obstante, siguen apareciendo debuts tardíos con manifestaciones metastásicas atípicas que pueden provocar un diagnóstico inicial erróneo. Presentamos el caso cínico de un paciente de 26 años con neoplasia testicular cuya primera sintomatología fue un cuadro de dificultad respiratoria, sensación distérmica y nerviosismo, cuyo estado de salud empeoró progresivamente siendo necesario su ingreso en la unidad de cuidados intensivos (AU)

Testicular tumors are the most common malignancies in the 15–35 years age group. They have a high recovery rate but late onsets may appear with atypical metastatic signs, which may lead to an erroneous initial diagnosis. We report a clinical case of a 26 years old patient with testicular neoplasm whose first symptoms were the presence of respiratory distress, feeling feverish and nervousness. His health condition progressively worsened and required admission to the intensive care unit (AU)

Diseño de un programa de investigación sobre utilización de terapia celular y BMP en artrodesis lumbar / Design of a research program on the use of cell therapy and BMP in lumbar arthrodesis

Presentamos los resultados en raquis utilizando proteínas morfogénicas de hueso (BMP-7) y células troncales pluripotenciales capacitadas a la línea osteogénica. En el ensayo clínico aleatorizado y controlado, los resultados mostraron que la BMP-7 consiguió una formación de hueso similar al autoinjerto. Igualmente, en otra cohorte prospectiva y controlada, se apreció una formación de hueso cuando se utilizó BMP-7 con aloinjerto mayor que con aloinjerto solo. En ningún paciente se observaron efectos secundarios. Los estudios experimentales mostraron resultados prometedores con la terapia celular. Se discuten las bases actuales de la terapia celular (AU)

We report the spinal results of the use of bone morphogenetic protein (BMP-7) and pluripotent stem cells differentiated to the osteogenic lineage. The results of this randomized, controlled clinical trial show that BMP-7 achieved similar bone formation to the use of autograft. Equally, in another controlled prospective cohort, greater bone formation was found when BMP-7 was used with allograft compared with allograft alone. No adverse effects were found. Experimental studies of cell therapy show promising results. The current foundations of cell therapy are discussed (AU)

Hematoma epidural cervical espontáneo: a propósito de un caso y revisión de la bibliografía / Spontaneous cervical epidural hematoma: a case report and review of the literature

Presentamos el caso de una paciente de 78 años de edad con un hematoma epidural espinal espontáneo que debutó con dolor interescapular brusco junto con hemiparesia izquierda y mejoría significativa a los 15 minutos. Inicialmente diagnosticada de angor, la persistencia de dolor en raquis cervicodorsal aconseja la realización de una resonancia magnética (RM). Esta muestra una lesión en el conducto raquídeo, de localización epidural, desde C3 hasta D2, de señal heterogénea, con áreas hiperintensas en secuencias T1 y áreas hipointensas en eco de gradiente y sin signos de mielopatía compresiva. Diagnosticada de hematoma epidural, debido a la evolución favorable de la clínica se optó por un tratamiento conservador. En la segunda RM se observó reabsorción completa del hematoma epidural (AU)

Rotación del residente de Farmacia Hospitalaria en un centro de Atención Primaria / Rotation by the Hospital Pharmacy resident within a Primary Care Centre

El farmacéutico de Atención Primaria, es hoy en día un profesional integrado en los equipos asistenciales de Atención Primaria. Su objetivo fundamental es mejorar la calidad asistencial prestada por el Sistema Sanitario, lo que exige coordinación entre los Centros de Atención Primaria y especializada. Con el objetivo de conocer las funciones y actividades de estos profesionales y su relación con el ámbito hospitalario, se proyectó una rotación del farmacéutico residente de farmacia hospitalaria de 3 tercer año en un centro de Atención Primaria.La duración de la experiencia fue de 6 semanas, valorándose positivamente por todas las partes implicadas, por lo que se ha incluido dentro del programa de formación de residentes de nuestro Hospital. (AU)

[Hyperinsulinism, heart rate variability and circadian variation of arterial pressure in obese hypertensive patients]. / Hyperinsulinisme, variabilité de la fréquence cardiaque et variation circadienne de la pression artérielle chez les sujets obèses hypertendus.

AIMS: During insulin resistance, sympathetic nerve activity is increased. However insulin resistance is a common feature of obesity and essential hypertension, it is unclear if chronic hyperinsulinemia per se contributes to sympathetic overactivation. The purpose of our study was to explore++ the relationships between chronic hyperinsulinemia and heart rate variability (HRV), a non-intensive tool to assess autonomic function, in obese and hypertensive subjects. METHODS: 24 hours Holter ECG for HRV time and frequency domain analysis was performed in 77 patients, mean age 53 +/- 10 years, 52 men and 25 women, free of diabetes, without beta-blockers, divided in four groups according to three parameters, body mass index (BMI > 27 kg/m2 in man and > 25 kg/m2 in woman defined obesity), arterial pressure and insulinemia (fasting insulinemia > 25 mUI/L defined hyperinsulinemia): 27 patients obese, hypertensive, with hyperinsulinemia; 28 patients obese, hypertensive, without hyperinsulinemia; 12 patients non obese, hypertensive, without hyperinsulinemia; 10 patients obese, normotensive, without hyperinsulinemia. RESULTS: In comparison with the three other groups, patients with hyperinsulinemia showed a significant decrease (p < 0.05) of SDNN and the power of total spectrum (0.01-1 Hz) band, which are indexes of global HRV, and a significant decrease (p < 0.005) of SD and the normalized power of the low frequency (0.04-0.15 Hz) band, both indexes reflecting sympathetic modulation of HRV. In contrast, no significant difference was observed between the four groups for indexes of HRV reflecting parasympathetic tone. These relations were independent of mean RR. Fasting insulinemia was significantly (p < 0.0001) related with HRV in time domain (SDNN; r = -0.43; SD: r = -0.49) and spectral domain (total spectrum: r = -0.49; low frequency: r = -0.52). CONCLUSION: Chronic hyperinsulinemia appears to be an important determinant of HRV, particularly for the indexes reflecting sympathetic influence, independent of obesity and hypertension.

Study of fluidity of low density lipoproteins from liver cirrhotic patients.

BACKGROUND AND AIM: Liver disease is accompanied by major quantitative and qualitative modifications in plasma lipoprotein metabolism. Alterations in plasma lipoprotein composition and a lower susceptibility to in vitro peroxidation of low density lipoprotein (LDL) and erythrocyte membranes have been observed in liver cirrhosis. The main objective of the present work was to investigate LDL chemical composition and fluidity in liver cirrhosis using the fluorescence polarization (Pf) of the 1,6-diphenyl-1,3,5-hexatriene (DPH) probe. METHODS AND RESULTS: The chemical composition of LDL was studied in 12 cirrhotic patients and 22 controls by conventional methods and its fatty acid composition by gas chromatography. LDL fluidity was determined by measuring the DPH Pf values. A decrease in molecular order was demonstrated by the significant (p < 0.05) decrease in Pf values in the cirrhotics. Modifications in LDL fluidity are correlated with its composition. A significant increase in triglyceride content (p < 0.05), and significant increases in triglyceride/protein and triglyceride/phospholipid ratios were observed in the cirrhotics. CONCLUSIONS: Our results demonstrate that the higher LDL fluidity of cirrhotic patients may be due to an increased triglyceride content.

Metabolic and anti-atherogenic effects of long-term benfluorex in dyslipidemic insulin-resistant sand rats (Psammomys obesus).

Benfluorex is a clinical lipid-lowering agent with antihyperglycemic properties. The effect of long-term oral treatment (10 mg/kg/day for 7.5 months) on carbohydrate and lipid metabolism and aortic morphology was investigated in 24 insulin-resistant sand rats receiving a standard laboratory diet supplemented with cholesterol (2%). Untreated controls (n=34) developed impaired glucose tolerance, hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia and elevated plasma LDL- and VLDL-cholesterol, positively correlated with the proportion of the thoracic aorta displaying oil red O-positive atherosclerosis; ultrastructural examination showed intimal lipid deposits, foam cells, polymorph infiltrates and fibrosis. Benfluorex-treated animals showed significant decreases in glucose intolerance, hyperinsulinemia, hypertriglyceridemia, hypercholesterolemia, and plasma LDL- and VLDL-cholesterol, with no evidence of aortic atheroma. The metabolic benefits of benfluorex may protect against the long-term development of atherosclerosis in the insulin-resistant dyslipidemic syndrome.

Preoperative embolization of solid cervicomedullary junction hemangioblastomas: report of two cases.

Solid cervicomedullary haemangioblastomas represent a small but technically challenging subset of posterior fossa haemangioblastomas because of their site, high vascularity and tendency to bleed. We present our experience with preoperative embolisation of two solid cervicomedullary haemangioblastomas. In both cases the main feeding artery was the posterior inferior cerebellar artery. Arterial pedicles were catheterised with a microcatheter. The embolic material was small particles (150-250 microm) of polyvinyl alcohol. The result was almost complete preoperative obliteration of the vessels of the tumours. The procedure was well tolerated and facilitated easier bloodless, successful resection in both cases, 24 h after embolisation.

S15261, a novel agent for the treatment of insulin resistance. Studies on Psammomys obesus.

S15261 is a novel compound that has been proposed for the treatment of insulin resistance syndrome. We have studied the effects of this drug in insulin resistant sand rats (Psammomys obesus). When sand rats are transferred from their natural desert environment and placed on a laboratory chow diet, they become overweight, develop hypertriglyceridaemia, hypercholesterolaemia, become insulin resistant, and ultimately diabetic. In the present study glucose intolerant animals, with very mild if any hyperglycaemia were used. Chronic treatment for a month with S15261 normalised plasma levels of triglycerides and cholesterol. The effects on cholesterol were the result of a decrease in LDL- and VLDL-cholesterol without any modification of HDL-cholesterol. In this study only female sand rats showed elevated plasma glucose levels, which were normalised by S15261. The compound also decreased plasma insulin levels both in male and female sand rats. An oral glucose tolerance test showed a major improvement in glucose tolerance in both male and female animals treated with S15261. These data confirm in another animal model the therapeutic benefits of S15261 in insulin resistant states.

Increased susceptibility to lipid oxidation of low-density lipoproteins and erythrocyte membranes from diabetic patients.

The aim of the present study was to determine if low-density lipoproteins (LDLs) and red blood cell (RBC) membranes from diabetic patients present an increased susceptibility to lipoperoxidation, which might be related to the increased incidence of atherosclerosis in diabetes. LDLs and RBC membranes were isolated from 11 insulin-dependent (IDDM) and 18 non-insulin-dependent diabetic (NIDDM) patients and exposed to a peroxidative stress by incubation with phenylhydrazine. The susceptibility to peroxidation was determined by measuring the production of thiobarbituric acid-reactive substances (TBARS) after the incubation. The following parameters were also evaluated: plasma glucose, triglycerides (TG), phospholipids (PL), total and high-density lipoprotein (HDL) cholesterol, apolipoprotein (apo) A-I, apo B, hemoglobin A1c (HbA1c), LDL PL and cholesterol, LDL fatty acid composition, and RBC membrane PL and cholesterol. Although they were apparently normolipidemic, diabetic patients showed an increased susceptibility to peroxidation in LDLs and erythrocyte membranes as compared with control subjects. The amount of arachidonic acid in LDLs and the PL concentration of RBC membranes from diabetic patients were significantly higher than in normal subjects. The increased lipoperoxidability of both RBC membranes and LDLs might play a central role in the pathogenesis of the vascular complications of diabetes mellitus.

Reduced Na(+)-K(+)-ATPase activity and plasma lysophosphatidylcholine concentrations in diabetic patients.

A fraction from normal human plasma inhibiting Na(+)-K(+)-ATPase has been recently identified as lysophosphatidylcholine (LPC). The aim of this study was to investigate the existence of a relationship between the activity of the cellular membrane Na(+)-K(+)-ATPase and plasma LPC in human diabetes. We studied 10 patients with insulin-dependent-diabetes mellitus (IDDM), 14 patients with non-insulin-dependent diabetes mellitus (NIDDM), and 10 sex- and age-matched control subjects. Plasma LPC concentrations were increased in both IDDM and NIDDM patients compared with control subjects. Na(+)-K(+)-ATPase activity was reduced in both groups of patients in erythrocyte and platelet membranes. There was a significant correlation between the concentrations of plasma LPC and Na(+)-K(+)-ATPase activity in both erythrocyte and platelet membranes (P < 0.01). To investigate the effect of LPC on the enzyme, Na(+)-K(+)-ATPase activity was determined in erythrocyte membranes obtained from six healthy subjects after in vitro incubation with increasing concentrations of LPC (1-10 microM). Enzymatic activity was significantly reduced by in vitro LPC at a concentration of 2.5 microM, with a further decrease at 5 microM. These data suggest that the decrease in Na(+)-K(+)-ATPase activity in diabetes might be due to increased LPC concentrations.

Susceptibility to in vitro lipid peroxidation of low density lipoproteins and erythrocyte membranes from liver cirrhotic patients.

The aim of the present study was to investigate the susceptibility of low density lipoprotein (LDL) and red blood cell membranes (RCM) from liver cirrhotic patients and control subjects, to the peroxidative stress, induced in vitro by phenylhydrazine. The susceptibility to peroxidation was determined by measuring the formation of the thiobarbituric acid reactive substances (TBARS) after incubation with phenylhydrazine. Moreover the levels of cholesterol (C) and phospholipid (PL) were evaluated in plasma and isolated LDL and RCM. A significant decrease in plasma C, LDL-C and RCM-C content (p < 0.001, p < 0.01 and p < 0.05 respectively) and RCM-PL content (p < 0.01) were found in cirrhotic patients compared to controls. The lower susceptibility to in vitro peroxidation was shown by the TBARS levels significantly lower in LDL and RCM from cirrhotic patients with respect to controls (p < 0.0001 for both of them). Moreover significant positive correlations were found between TBARS-LDL and LDL-C or LDL-PL (r = +0.72, p < 0.0001; r = +0.58, p < 0.001) and between TBARS-RCM and RCM-C (r = +0.35, p < 0.05) or RCM-PL (r = 0.37, p < 0.05) from combined patients and controls. Our data seem to ascribe the lower in vitro peroxidability to the lower levels of plasma lipids.

Effect of desialylation on low density lipoproteins: comparative study before and after oxidative stress.

Aim of our study was to investigate the effect of the desialylation induced by neuraminidase treatment on low density lipoprotein susceptibility to peroxidative stress induced by incubation with copper ions. Our results show that peroxidative stress induces the formation of aggregates that was not observed in desialylated low density lipoproteins. An increase in thiobarbituric reactive substances and a decrease in polyunsaturated fatty acids content have been shown in oxidized LDL. These modifications were less pronounced in oxidized low density lipoproteins previously treated by neuraminidase. The present data suggest a lower susceptibility to peroxidative stress in previously desialylated low density lipoproteins.

Physico-chemical properties of copper-oxidized high density lipoprotein: a fluorescence study.

The modifications of the physico-chemical properties of the high density lipoprotein (HDL) before and after in vitro induced oxidation by copper ions have been studied using the fluorescence polarization (Pf) of the phosphatidylcholine derivative of 1,6-diphenyl-1,3,5-hexatriene (DPH-PC) and of the cationic derivative (TMA-DPH). We have observed that HDL oxidation is associated with a decrease of the molecular order at the lipoprotein surface as demonstrated by the increase in Pf with respect to untreated HDL. Moreover in oxidized HDL the polarity-sensitive probe laurdan has shown a decrease of the polarity in its microenvironment. It has been suggested that a decrease in HDL fluidity would inhibit cholesterol reverse transport from peripheral tissues in form of HDL core cholesteryl esters. Peroxidation of HDL, if occurring in vivo, could contribute to the progress of atherogenesis by decreasing cholesterol efflux from peripheral tissues.

Lower susceptibility of low density lipoprotein to in vitro oxidation in diabetic patients.

The susceptibility to peroxidative stress of low density lipoprotein (LDL), induced by incubation with CuSO4, has been studied in eleven diabetic patients and eleven control subjects. Our results suggest that oxidized LDL (OX-LDL) of diabetic patients have a significant higher reactivity to 2,4,6-trinitrobenzene sulfonic acid (TNBS) than controls, that indicates a lower susceptibility of LDL to oxidative stress. Furthermore using the fluorescence polarization (Pf) of 1,6-diphenyl-1,3,5-hexatriene (DPH) and its phosphatidylcholine derivative (DPH-PC) we have shown that peroxidation induces a decrease of fluidity in OX-LDL of controls and diabetic patients, both at the lipoprotein surface, where is localized DPH-PC and at the interface between lipoprotein surface and core which is probed by DPH.