[Management of corneal hydrops using air and micro-punctures]. / Manejo del hydrops corneal mediante aire y micropunciones.

CASE REPORT: A 22-year- old woman with an acute hydrops and Descemet membrane detachment was managed by intracameral air injection combined with multiple corneal stromal venting incisions for the drainage of intrastromal fluid. No intraoperative complications were encountered, and the intrastromal fluid was resolved over 2 weeks. DISCUSSION: Acute corneal hydrops is a significant complication of keratoconus. If not treated, resolution usually occurs over a period of 2-4 months. The persistent oedema can cause complications, such as corneal neovascularisation, infection and corneal perforation.

N-aryl piperazine metabotropic glutamate receptor 5 positive allosteric modulators possess efficacy in preclinical models of NMDA hypofunction and cognitive enhancement.

Impaired transmission through glutamatergic circuits has been postulated to play a role in the underlying pathophysiology of schizophrenia. Furthermore, inhibition of the N-methyl-d-aspartate (NMDA) subtype of ionotropic glutamate receptors (NMDAR) induces a syndrome that recapitulates many of the symptoms observed in patients with schizophrenia. Selective activation of metabotropic glutamate receptor subtype 5 (mGlu5) may provide a novel therapeutic approach for treatment of symptoms associated with schizophrenia through facilitation of transmission through central glutamatergic circuits. Here, we describe the characterization of two novel N-aryl piperazine mGlu5 positive allosteric modulators (PAMs): 2-(4-(2-(benzyloxy)acetyl)piperazin-1-yl)benzonitrile (VU0364289) and 1-(4-(2,4-difluorophenyl)piperazin-1-yl)-2-((4-fluorobenzyl)oxy)ethanone (DPFE). VU0364289 and DPFE induced robust leftward shifts in the glutamate concentration-response curves for Ca(2+) mobilization and extracellular signal-regulated kinases 1 and 2 phosphorylation. Both PAMs displayed micromolar affinity for the common mGlu5 allosteric binding site and high selectivity for mGlu5. VU0364289 and DPFE possessed suitable pharmacokinetic properties for dosing in vivo and produced robust dose-related effects in reversing amphetamine-induced hyperlocomotion, a preclinical model predictive of antipsychotic-like activity. In addition, DPFE enhanced acquisition of contextual fear conditioning in rats and reversed behavioral deficits in a mouse model of NMDAR hypofunction. In contrast, DPFE had no effect on reversing apomorphine-induced disruptions of prepulse inhibition of the acoustic startle reflex. These mGlu5 PAMs also increased monoamine levels in the prefrontal cortex, enhanced performance in a hippocampal-mediated memory task, and elicited changes in electroencephalogram dynamics commensurate with procognitive effects. Collectively, these data support and extend the role for the development of novel mGlu5 PAMs for the treatment of psychosis and cognitive deficits observed in individuals with schizophrenia.

Anaphylaxis due to hypersensitivity to Anisakis simplex.

Anaphylactic reactions are among the most frequent causes for requests for emergency medical care. It is possible that no clear precipitating factor can be found delaying the onset of adequate treatment and increasing the risk of new episodes of anaphylaxis in the future. Hypersensitivity to Anisakis simplex, an intestinal parasite found in fish, is an unusual cause of anaphylaxis but it should always be borne in mind in countries where a great deal of fish is consumed, especially if it is eaten raw or undercooked. 3 cases of anaphylaxis due to hypersensitivity to A. simplex are described.

[Ureteral endometriosis]. / Endometriosis ureteral.

OBJECTIVE: To report a case of ureteral endometriosis, an uncommon disease in the urological practice that is diagnosed late and may cause irreversible damage to the upper urinary tract. METHODS/RESULTS: A case of unilateral ureteral endometriosis is presented. After attempting hormonal therapy and endourological management, the patient eventually underwent aggressive surgical treatment. CONCLUSIONS: The diagnosis of ureteral endometriosis should be considered in women presenting with noncalculous renal obstruction, particularly premenopausal women of low parity or those who have had previous pelvic surgery. Only a high index of suspicion and the radiological supports may help to reduce the number of alarming nephrectomies associated to this condition.

[Morbidity of childhood bronchial asthma in the emergency room]. / Estudio de la morbilidad del asma bronquial infantil en un servicio de urgencias.

BACKGROUND: An allergic etiology could be found in more than the 80% of the patients with bronchial asthma. Specific immunotherapy is the only known etiologic treatment, reducing clinical symptoms and requirement of medication. However only a few patients are controlled by an allergist. The aim of the present study was to verify the influence of control and treatment carried out by patients in childhood asthma recruitment that came to the emergency room of our hospital (Hospital Clínico San Carlos) between December 95 and June 96. MATERIAL AND METHOD: Children to 15 years old were included in the study. We analysed: age, sex, clinical record, previous treatment (pharmacological and etiological), basal symptoms, necessity to be admitted to hospital, medical previous control. RESULTS: 163 patients came to emergency room because of asthma exacerbation. They were divided in two groups: less than 3 years (average 17.45 months) and more than 3 years (average 8 years) (Sd: 3.4). Sex: 65% male sex and 35% female sex. 44.17% came during the greater pollinization period in our field, with a statistical significance compared with other periods (p: 0.0023). 81 patients (49.7%) had been previously diagnosed of bronchial asthma. 15% of the patients were controlled by an allergist, with a stable situation in 92% of them. 68.4% of patients who were controlled by a paediatrician and 40% who were controlled in a officially approved centre (p: 0.015) were stable. 55 patients had continuous treatment and 21.8% of them were been treated with immunotherapy. 17.7% of patients without immunotherapy were admitted to hospital. None of the patients on immunotherapy were hospitalised. CONCLUSIONS: It is essential to do an early diagnosis and a combined follow-up by an allergist and a paediatrician to succeed in a good control of the disease from its beginning. In our experience, the children who were controlled by an allergist had a more stable situation and were also more easily controlled. The specific treatment should be initiated in the early stage of the disease being the only factor that modify the immune response and prevents against the development of asthma in children with rhinitis.

[Histiocytoid hemangioma of the epididymis. A very unusual entity]. / Hemangioma histiocitoide de epidídimo. Una entidad de gran rareza.

The presence of vascular origin tumor in the epididymis and testicle, are today considered of low frequency. We report a case of histiocytoid (epithelioid) hemangioma of the epididymis. Its differential diagnosis with the adenomatoid tumor, is discussed.

Hemangioma histiocitoide de epididimo. Una entidad de gran rareza / Histiocytoid hemangioma of the epididymis. A very strange entity

La presencia de tumoraciones de origen vascular en el epidídimo y testículo, se consideran hoy en día de baja frecuencia. Presentamos un caso de hemangioma histiocitoide (epitelioide) de epidídimo. Se discute su diagnóstico diferencial con el tumor adenomatoide (AU)

Occupational asthma caused by champignon flies.

BACKGROUND: Occupational bronchial asthma in mushroom (champignon) workers is unusual, although reports on it appeared in 1938 and 1951; we have not found any others since those dates. Here we report the case of a 52-year-old man who works as a champignon cultivator. He suffered rhinoconjunctivitis and asthma attacks whenever he entered the champignon culture caves. We studied flies as a possible antigen source. We collected these insects from the growing sites in order to identify them, and then prepare an extract; the samples turned out to be of two families of insects of the order Diptera, 98% from the Phoridae family (Brachycera suborder) and 2% from the Sciaridae (Nematocera suborder). METHODS: Skin prick tests, conjunctival provocation tests, serum specific IgE, specific IgE-binding fractions in immunoblotting, and monitoring of PEFR (at work and off work) were performed. RESULTS: IgE-mediated hypersensitivity to these flies was demonstrated by skin prick test, conjunctival provocation test, serum specific IgE, and IgE-binding fractions in immunoblotting. Monitoring of PEFR both at work and off work showed a clear relationship between symptoms, or fall in PEFR, and the workplace. CONCLUSIONS: We report the case of a patient suffering from asthma and rhinoconjunctivitis caused by hypersensitivity to fly proteins.

[Mucinous adenocarcinoma. Unusual prostatic tumor]. / Adenocarcinoma mucinoso. Una tumoración prostática poco frecuente.

We report a case of mucinous adenocarcinoma of the prostate. A 80 years-old patient was diagnosed with a transrectal multiple biopsy. We comment on the special histological patterns of the tumor as well as the established criterion for an appropriate diagnosis.

Ketomethylene and methyleneamino pseudopeptide analogues of insect allatostatins inhibit juvenile hormone and vitellogenin production in the cockroach Blattella germanica.

Metabolic studies on insect allatostatins have suggested that the dipeptide Leu-Tyr may be a target for endopeptidases. In order to increase resistance to degradation, methyleneamino psi [CH2NH] and ketomethylene psi [COCH2] peptide bond surrogates have been introduced at the position Leu3-Tyr4 of the allatostatin Asp-Arg-Leu-Tyr-Ser-Phe-Gly-Leu-amide (BLAST-2), and Leu3-Phe4 of [Phe4]BLAST-2, respectively. Assays of inhibition of juvenile hormone (JH) synthesis in vitro by corpora allata from the cockroach Blattella germanica showed that both analogues were similarly active to the respective model peptides. The methyleneamino analogue was further tested in vivo as an inhibitor of JH synthesis, and in vivo and in vitro as an inhibitor of vitellogenin production by the fat body of B. germanica. The analogue was less active than BLAST-2 when tested in vitro, but more active than it when tested in vivo.

A double-blind, placebo-controlled study of immunotherapy with grass-pollen extract Alutard SQ during a 3-year period with initial rush immunotherapy.

Thirty patients with asthma and/or monosensitized allergic rhinitis caused by grass pollen whose ages ranged from 15 to 35 years were selected. Two groups were established at random: an active group and a placebo group, and a double-blind study was done on treatment with immunotherapy for a period of 3 continuous years, with initiation doses administered according to the rush immunotherapy technique. Grass-pollen allergen extract Alutard SQ and histamine as a placebo were used. The objective parameters of efficacy evaluated were end-point cutaneous tests, conjunctival provocation, bronchial provocation, and symptom/medication scores, as well as specific immunoglobulin determinations. The statistical evaluation of the results was significant for the differences existing between the initial and final time of the active group, and there were significant differences between the two groups for all of the parameters considered. We found no relationship between clinical improvement and the range of specific immunoglobulin E values. Regarding the safety of the treatment, systemic adverse effects were manifested only in the initial phase (rush immunotherapy), and were easily controlled by treatment. We conclude that the efficacy and safety of immunotherapy with grass pollen make it possible to consider this treatment fundamental in these patients.

[Multicenter drug surveillance of sublingual immunotherapy in allergic patients]. / Estudio multicéntrico de farmacovigilancia de inmunoterapia sublingual en pacientes alérgicos.

A study of pharmacovigilance has been performed in 522 patients suffering from allergic rhinitis and/or asthma. Sensitization was due to pollens and mites in ther majority of cases. The treatment consisted in biologically standardized glycerinated allergenic extracts for specific sublingual immunotherapy (SLIT) and, major allergens were also quantified, depending on the allergenic composition. The aims of the study were to assay the effect of the SLIT in a short-and-medium-term course and to know the adverse reactions most frequently appearing, as well as the unexpected side effects that are only possible to know through the study of a numerous sample of patients. We also evaluated the factors that can modify the tolerance of the treatment, such as the onset of patient's disease and its severity. All the patients had a clinical history of, at least, two years of evolution and positive skin-prick test to the allergen/s cause of their atopic disorder. Exclusion criteria were immunotherapy in the last two years, pregnancy and those situations in which the immunotherapy is contraindicated according to the EAACI requirements. In order to carry out the daily record of the SLIT as well as the possible appearance of symptoms, two diaries were given to each patient. Tolerance was evaluated by the physician at the end of the build-up phase (3 months) and when the maintenance phase finished (5 months later). Total administered doses were 44.021, the final number of patients who registered any adverse reaction in relation with SLIT was 41 (7.9%), with a number of 67 adverse reactions that means a 0.15% over the total administered doses.(ABSTRACT TRUNCATED AT 250 WORDS)

[Classification of mental diseases. From Bertillon to CID-10: a century of international collaboration]. / Clasificacíon de las enfermedades mentales: de Bertillón a la CID-10, un siglo de colaboración internacional.

The first International Classification of Diseases (ICD) was approved during the Congress of the Statistical International Institute, in Chicago, in Paris, in 1893. It was based on a list of diseases prepared by Jacques Bertillon. Minor changes were introduced in this classification during decennial revisions made at international meetings and it remained in use until 1948, when the World Health Organization's Provisional Committee was charged with the task of producing ICD-6. ICD-6 represented a major shift from the previous internal conceptualization, particularly in what concerns the Chapter V., dealing with mental disorders. From 1955 on WHO produced with approximately a 10-year interval ICV-7, 8, and 9. Few modifications in relation to ICD-6 were introduced by these revisions, except for the introduction of a glossary of terms in the chapter on mental disorders. This glossary had a major impact towards the development of a common language in psychiatry. Based on epidemiological findings, and based also on an intensive and extensive international network of clinicians and investigators, ICD-10 was published in 1992. It represented a substantial improvement regarding the conceptualization of the classification of mental disorders, in relation to previous revisions of the ICD. Future tasks relating to ICD-10 include training of health personnel for its proper utilization, in addition to finalizing further ICD-10 versions, e.g. for research purposes and for primary health care use.

[Use of serological markers of hepatitis B and C viruses in a health center]. / Utilización de marcadores serológicos del virus de la hepatitis B y C en un centro de salud.

OBJECTIVE: To find the use of serological markers for the Hepatitis B (HBV) and Hepatitis C (HCV) viruses by doctors at an urban Health Centre, assessing the number of requests and their diagnostic effectiveness. DESIGN: Prospective and retrospective study of observation. SETTING: Primary Care. Urban Health Centre. PATIENTS: All those for whom requests for HBV and HCV serological markers were made between 1.1.92 and 30.3.93. MEASUREMENTS AND MAIN RESULTS: A total of 131 requests for HBV markers and 82 for HVC ones were made during the study period (1% of the total analyses performed). 30.5% of the HBV markers and 12.2% of the HCV ones were positive. 36% of the requests for HBV markers were for preventive as against 64% for diagnostic reasons. The diagnostic effectiveness (percentage of positives among the requests made for diagnostic reasons) was 35.7% for HBV and 13% for HCV serology. The manner of contagion could not be determined from the information collected in the clinical notes for 56% of the patients with positive serology. The performance of a Hepatic Biopsy was recorded for 10% of the patients with positive HBV or HCV serology, with diagnoses of 4 cases of active chronic Hepatitis and one of late cutaneous Porphyria. CONCLUSIONS: The availability of an accessible and correct request form for HBV and HCV markers could assist greater diagnostic accuracy and referral to specialists if required.