Probiotics and autoimmunity: an evolutionary perspective.

Probiotics are microorganisms that have demonstrated beneficial effects on human health. Probiotics are usually isolated from the commensal microflora that inhabits the skin and mucosas. We propose that probiotics represent the species of microorganisms that have established a symbiotic relationship with humans for the longest time. Cultural practices of ancient human societies used to favor that symbiosis and the transmission of probiotics from generation to generation. New practices, introduced as a result of industrialization, such as childbirth by surgical delivery, ingestion of pasteurized and synthetic compounds-supplemented food, cleaner homes, indiscriminate use of antibiotics and so on, have led in recent years to the replacement of probiotics by other microorganisms that are not as well adapted to the microenvironments of the human body. These newly settled microorganisms lack many of the beneficial effects of probiotics. Our hypothesis is that the sudden change (from an evolutive perspective) in human intestinal microflora may importantly contribute to the rise in the incidence of autoimmune diseases, observed in the last half a century.

[Pseudotumorous hepatic tuberculosis: laparoscopic appearance]. / Tuberculosis hepática seudotumoral. Aspecto laparoscópico.

Local hepatic tuberculosis without active pulmonary or miliary tuberculosis is an uncommon diagnosis. Even less common is the finding of a nodular form of local hepatic tuberculosis. There is a growing incidence of the disease related to human immunodeficiency virus. The authors report a case of pseudotumoral hepatic tuberculosis in a patient without AIDS, manifesting as prolonged fever, diagnosed previously as metastatic liver. Imaging studies of the liver and laparoscopic findings suggested metastatic disease. The correct diagnosis was made by histology of biopsies obtained in laparoscopy, which is an easy and cheap method, with less morbidity and mortality than surgical intervention. The case report illustrates the difficulty in reaching the correct diagnosis, most often confused with carcinoma of the liver, primary or metastatic. A greater awareness of this rare clinical entity may prevent needless surgical intervention since the majority of patients respond well to antituberculous chemotherapy.

[Purtscher's retinopathy and acute alcoholic pancreatitis]. / Retinopatía de Purtscher y pancreatitis aguda alcohólica.

We report the case of a 27-year-old man with alcoholic acute pancreatitis, who developed an acute loss of visual acuity; a bilateral Purtscher's retinopathy, a rare complication of acute pancreatitis, was confirmed by ophthalmoscopy.

[Association of porphyria cutanea tarda and hepatitis C virus]. / Asociación entre porfiria cutánea tarda y virus de la hepatitis C.

UNLABELLED: Porphyria cutanea tarda (PCT) is caused by reduced activity of hepatic uroporphyrinogen decarboxylase. However extrinsic factors such as alcohol abuse and drug intake are required for the clinical manifestation of the disease. Hepatitis C virus antibodies have been detected in a high percentage of patients with PCT. Hepatitis C virus is probably the main pathogenetic factor of liver damage in patients with PCT. AIM: To study the association between hepatitis C virus and PCT in our patients with PCT. MATERIAL AND METHODS: We have investigated six patients diagnosed of PCT in order to detect the presence of hepatitis C virus and other possible causes of the disease. RESULTS: We have found that 66% of our patients had hepatitis C virus antibodies, 50% ethanol abuse, of which 2/3 presented hepatitis C virus antibodies, and one case of HIV.

[Sarcoidosis simulating carcinoma of the head of pancreas]. / Sarcoidosis simulando carcinoma de cabeza de páncreas.

Sarcoidosis is a granulomatous disease of unknown origin with a variable clinical presentation. Although involvement of every organ has been described, the pulmonary system is most frequently involved. Isolated extrapulmonary disease is rare. Hepatic manifestations include granulomatous hepatitis and hilar lymphadenopathy. We describe a case of sarcoidosis initially presenting as extrahepatic jaundice.

Use of a prospectively measured incidence rate of nosocomial diarrhea in an infant/toddler ward as a meaningful quality assessment tool.

OBJECTIVE: To determine the incidence of nosocomial diarrhea as a quality assessment tool, to compare such a rate with a standard rate based on results reported in the literature, and to estimate the hospital cost of narrowing the gap between both. METHODS: This was a prospective hospital-based surveillance study of patients in a 16-cradle ward of a 316-bed public-owned children's hospital in Buenos Aires, Argentina. One hundred six pediatric patients were enrolled during the 3-month surveillance period. Data were collected by a non-attending physician under the usual conditions of care. The clinical staff members were blinded to the objectives of the investigation. RESULTS: The detected incidence rate was 22.6 episodes of nosocomial diarrhea per 100 admissions. This was 6.4-fold higher than the standard rate. Each day of nosocomial diarrhea lengthened the duration of hospitalization and thereby increased the total hospital bill of each patient. The potential savings from narrowing the gap between both rates was as much as $302,400 per year. CONCLUSIONS: Nosocomial diarrhea stands out as a relevant target both for quality improvement opportunity assessment and for cost-containment-oriented efforts.

[Wegener's granulomatosis with gastrointestinal involvement]. / Granulomatosis de Wegener con afectación gastrointestinal.

Wegener's granulomatosis is a necrotizing granulomatous vasculitis often characterized by involvement of the upper respiratory tract, lungs and kidney, although any organic system can be affected. We present the case of a female patient with Wegener's granulomatosis diagnosed by biopsy of the kidney, and severe gastrointestinal bleeding with fatal course. Endoscopic findings of the colon and the histopathology of the biopsy are discussed.

[Caroli's syndrome: a variable entity]. / Síndrome de Caroli: una entidad variable.

We present the case of a 56 year old woman with Caroli's disease associated to congenital liver fibrosis, renal nephrocalcinosis and cutaneous vasculitis of the legs. Clinical signs of portal hypertension were treated by a shunt technique. After an asymptomatic period, the patient suffers now from crisis of angiocholitis.