Pustulosis exantemática generalizada aguda simulando necrólisis epidérmica tóxica: forma combinada / Acute Generalized Exanthematous Pustulosis Simulating Toxic Epidermal Necrolysis: Overlapping Processes

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A multi-scale model of the interplay between cell signalling and hormone transport in specifying the root meristem of Arabidopsis thaliana.

The growth of the root of Arabidopsis thaliana is sustained by the meristem, a region of cell proliferation and differentiation which is located in the root apex and generates cells which move shootwards, expanding rapidly to cause root growth. The balance between cell division and differentiation is maintained via a signalling network, primarily coordinated by the hormones auxin, cytokinin and gibberellin. Since these hormones interact at different levels of spatial organisation, we develop a multi-scale computational model which enables us to study the interplay between these signalling networks and cell-cell communication during the specification of the root meristem. We investigate the responses of our model to hormonal perturbations, validating the results of our simulations against experimental data. Our simulations suggest that one or more additional components are needed to explain the observed expression patterns of a regulator of cytokinin signalling, ARR1, in roots not producing gibberellin. By searching for novel network components, we identify two mutant lines that affect significantly both root length and meristem size, one of which also differentially expresses a central component of the interaction network (SHY2). More generally, our study demonstrates how a multi-scale investigation can provide valuable insight into the spatio-temporal dynamics of signalling networks in biological tissues.

Exantema en un lactante / Skin Rash on an Infant

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Carcinoma epidermoide secundario a papilomatosis oral florida / Squamous cell carcinoma following papillomatosis oral florida

La papilomatosis oral florida puede evolucionar hacia un carcinoma verrucoso de mucosa oral, que aparece en personas mayores y relacionado con la infección por el virus del papiloma humano. Se caracteriza por lesiones de curso crónico, vegetantes o verrucosas, rosadas y que a veces están cubiertas de una pseudomembrana amarillenta. Caso clínico: Presentamos el caso clínico de una paciente mujer de 65 años que presentaba desde hacía más de 3 años lesiones ulcerativas y verrucosas que afectaban a todo el paladar duro, asociado a la pérdida reciente de dos molares. En otras zonas de la cavidad oral las lesiones eran verrucosas rosadas y cubiertas de una membrana pseudoamarillenta. La realización de una TAC confirmó la destrucción del suelo del seno maxilar con penetración de un proceso expansivo que en el estudio histológico se confirmó como carcinoma epidermoide infiltrante, secundario a papilomatosis oral florida. Conclusión: Las infecciones mucosas por VPH son enfermedades con un claro potencial de malignización, por lo que deben ser vigiladas muy estrechamente, estando indicado un tratamiento que vaya encaminado a la resolución completa del cuadro en tanto en cuanto la evolución del proceso y el estado clínico del paciente lo permita. El tratamiento precoz es de gran utilidad

The oral florid papillomatosis can evolve into a verrucous carcinoma of oral mucosa, that appears in older people and related with the infection due to human papilloma virus. Its characteristics are chronic lesions, vegetating or verrucous, of a pink color and which are sometimes covered with a yellowish pseudo-membrane. Clinical case: A 65-year-old female patient that presented verrucous and ulcerative lesions for more than 3 years that affected all the hard palate, associated with the recent loss of two molars is reported. In other areas of the oral cavity the lesions were pink, verrucous, and covered with a yellowish- like membrane. The practice of a CT confirmed the destruction of the floor of the maxillary sinus with penetration of an expansive process that in the histologic study was confirmed as infiltrating epidermoid carcinoma, secondary to oral florid papillomatosis. Conclusion: The mucous infections by HPV are illnesses with a clear potential of malignancy, reason why a close eye should be kept on them, a treatment being indicated that directs toward the complete resolution of the clinical pattern as long as the evolution of the process and the clinical condition of the patient permit it

Emergency coronary revascularization in a liver transplant recipient.

A liver transplant recipient in cardiogenic shock from an acute myocardial infarction and failed coronary angioplasty underwent successful emergency coronary artery bypass graft surgery. Our case is only the fourth documented report of a coronary artery bypass graft in a liver transplant patient and the first conducted on an emergency basis in a patient in cardiogenic shock. Preservation of both cardiac and liver function has been evident in all cases. Based on these findings, liver transplantation should not be a deterrent or contraindication to coronary artery bypass or cardiac surgery.

Effect of cocarboxylase in dogs subjected to experimental septic shock.

We examined the effects of cocarboxylase treatment on both the hemodynamic variables and metabolic function during endotoxic shock in dogs. Cocarboxylase inhibited deterioration in metabolic function as reflected by improved pH and base excess as well as maintenance of normal oxygen consumption. Significant improvements in mean arterial pressure and cardiac index were also seen. Cocarboxylase is a major coenzyme of mitochondrial pyruvate dehydrogenase and may exert its beneficial effects via this complex.

Beneficial effects of cocarboxylase in the treatment of experimental myocardial infarction in dogs.

Cocarboxylase, or thiamine pyrophosphate, is an essential coenzyme in the catabolism of pyruvate. The authors evaluated the effects of a stable cocarboxylase solution in the treatment of an experimentally created acute myocardial infarction in 14 healthy mongrel dogs. The left anterior descending artery was ligated for 60 minutes and data were collected at the following points: A) prior to ligation, B) 15 minutes after ligation, C) 30 minutes after ligation, and D) 60 minutes after ligation. In one group (Group II), cocarboxylase (150 mgm/kg) was given systematically via a central line 15 minutes and 45 minutes after ligation, while in Group I an equal amount of D5W was given. Hemodynamic data include heart rate, systolic and mean arterial pressure, pulmonary wedge pressure, right arterial pressure, and cardiac output. Myocardial O2 consumption was determined by the method of Rooke and Feigl. Electrocardiographic data were also monitored throughout the experiment. In both groups, preligation (point A) hemodynamic data were similar. In Group II, there were beneficial hemodynamic changes versus Group I (expressed as percentage recovery of hemodynamic performance from preligation) at points C and D, with significant (P less than 0.05) decreases in heart rate, increased stroke volume, decreased systemic vascular resistance, and decreased myocardial O2 consumption. EKG criteria also showed improvement in Group II versus Group I. In conclusion, this experiment suggests that cocarboxylase may be beneficial to ischemic canine myocardium by virtue of its favorable systemic hemodynamic effects.

Diagnosis and management of traumatic ventricular septal defect.

Four cases of ventricular septal defect secondary to stab wounds of the heart are presented. One of three patients arriving at the Emergency Department in shock and who were resuscitated required an emergency thoracotomy. These patients had immediate repair of their external cardiac wounds in the Operating Room. Cases 1 and 3 developed heart failure and loud systolic murmur postoperatively. Case 4 was treated with chest tube for a left hemothorax and developed heart failure after discharge. In Cases 1, 2, and 3, 2-D echocardiography detected and located a VSD. In Case 3 Doppler measurement showed elevated RV pressure (45 mm Hg) and decreased peak tricuspid to mitral flow ratio (0.36, normal = 0.6). All patients underwent cardiac catheterization. In Case 4 there was associated mitral regurgitation. Cases 1 and 3 had pulmonary to systemic flow ratios greater than 3:1. Cases 1, 3, and 4 underwent operative repair. In Case 1 the VSD was closed with a dacron patch, and in Cases 3 and 4 it was sutured with Teflon pledgets. In Case 4 a puncture wound of the mitral valve annulus was simultaneously repaired. All patients are alive but in Case 1 postoperative 2-D echocardiography demonstrated partial dehiscence of the patch which has not required reoperation and in Case 3 post-repair 2-D echocardiography and Doppler flow studies have shown an intact VSD repair. This series of post-traumatic VSD demonstrates its varying clinical presentation and the diagnostic and followup benefits offered by 2-D echocardiography, especially when combined with Doppler flow measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Pericardial substitutes: delayed reexploration and findings.

Four patients' experience with two varieties of pericardial substitutes has been evaluated. Two patients received glutaraldehyde-preserved, formalin-fixed bovine bioprosthetic pericardial substitutes. These were associated with dense prosthesis-to-epicardium adhesions and the formation of a thick gelatinous peel. Two other patients received glutaraldehyde-preserved, ethanol-fixed bovine bioprosthetic pericardial substitutes. One patient had minimal prosthesis-to-epicardium adhesions, and the remaining patient demonstrated moderate prosthesis-to-epicardium adhesions with giant-cell and lymphocyte fibrosis. In all patients prosthesis-to-sternum adhesions were minimal. These observations suggest that careful washing is essential in all bioprosthetic implants to eliminate residual preservatives and fixatives. In addition, preservation in ethanol is associated with less prosthesis-epicardium reaction than is formalin preservation. Both products are successful in easing reentry, and no episode of infection has been associated with either prosthesis.

Preliminary evaluation of cocarboxylase on myocardial protection of the rat heart.

The presence of cocarboxylase (CC) is essential for the oxidation of pyruvate to acetylcoenzyme A (acetyl-CoA) and its subsequent degradation by means of the Krebs cycle. We compared the effects of various concentrations of CC in a cardioplegic solution on the survival and hemodynamic and metabolic recovery of 23 isolated, working rat hearts subjected to 60 minutes of hypothermic (23 degrees C) ischemic arrest. Group 1 (N = 6) consisted of hearts infused with the basic cardioplegic solution (Tyers' solution with glucose), to which no CC was added. In group 2 (N = 6) CC was added at 0.1 ml/L to the cardioplegic solution. In group 3 (N = 5) CC was added at 1 ml/L, and in group 4 (N = 6) CC was added at 10 ml/L. The cardioplegic infusions were performed at a pressure of 40 mm Hg for 2 minutes just before arrest; 30 minutes later they were performed again for 1 minute. Only two hearts (33.3%) recovered in group 1 whereas five recovered in group 2, five (100%) in group 3, and five (83.3%) in group 4. The recovery of hemodynamic performance as a percentage of preischemic control values showed marked improvement in the CC groups, especially group 3, when compared with group 1. The metabolic variables in the CC groups were also markedly improved, with significantly (p less than .05) decreased levels of tissue lactate and increased levels of creatine phosphate compared with those in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Transfemoral removal of a chronically implanted pacemaker lead: report of a case.

A transfemoral angiographic technique was used to remove a chronically implanted, infected pacemaker wire that could not be withdrawn by using direct traction. The case and a description of the technique are detailed, and the principles of nonsurgical extraction of chronically implanted pacemaker wires are discussed.

Carcinoma of the lung in patients under 40 years of age.

Bronchogenic carcinoma in the young population (40 years of age or less) is reported to present in an advanced stage and to have a virulent course. Between 1969 and 1979, 101 patients (65 men and 36 women) presented with cancer of the lung. Their mean age was 36.2 +/- 3.9 years (range 18 to 40 years). Eighty-seven percent had a history of cigarette smoking. Fifty percent of the patients had a strong familial history of malignancy of several organs. The interval between onset of symptoms and diagnosis was 4.01 +/- 3.48 months (3.56 +/- 3.34 for the surgically treated group and 4.16 +/- 3.53 for the nonoperated or unresectable group). Diagnosis was made at bronchoscopy in 32 patients, during thoracotomy in 30 patients, during nodal biopsy in 28 patients, and on cytologic examination of the sputum in 9 patients. The most common cell types were adenocarcinoma in 39 patients, squamous carcinoma in 29 patients, and oat cell carcinoma in 18 patients. Eighty-six patients (the majority) presented in stage III, whereas 9 were in stage I and 6 were in stage II. Twenty-seven patients (26.7 percent) underwent resection for cure, whereas 18 patients were inoperable at surgery. Eighteen of the surgical patients had adjuvant radiotherapy, and chemotherapy, immunotherapy, or both. The average length of survival for the nonresected patients was 7.12 +/- 5.9 months (range 1 to 36 months) and the actuarial survival was 1.5 percent at 36 months. The survival for the surgically managed patients was 56.1 +/- 52.6 months (range 3 to 168 months) or 48 percent at 36 months. At 46 to 168 months after treatment, the only survivors were 13 patients who were surgically managed. Stage III patients had longer survival after surgery (24.1 +/- 24.6 months to 7.09 +/- 5.90 months; range 3 to 74 months and 1 to 36 months, respectively). The survival at 5 years for patients with stage I disease was 78.8 percent, stage II disease 66.6 percent, and stage III disease, 3.6 percent. Early diagnosis and aggressive surgical management are necessary to improve the survival of patients with bronchogenic carcinoma under 40 years of age.

Clinical experience with subxyphoid pericardial decompression.

Between 1971 and 1981, 108 patients with pericardial effusion were treated by subxyphoid pericardial decompression. 68 patients (63%) had local anesthesia, while general anesthesia was used in 40 (37%). The total group included nonspecific (viral) pericarditis in 35 patients (32.4%), uremic pericarditis in 30 (27.8%); and 20 patients (18.5%) with a malignant etiology, traumatic in ten patients (9.3%), six patients (5.6%) following radiation for malignant disease, and seven patients (6.5%) due to other causes. Echocardiography was diagnostic in all cases. Acute cardiac tamponade necessitated pericardiocentesis as an initial procedure in seven patients (6.5%). Subxyphoid pericardial decompression included drainage of the pericardial fluid and performance of a 5 X 5 cm pericardial window and biopsy of all patients. There were two (1.8%) operative deaths in the general anesthesia group but none in the local anesthesia group. There were no major complication in the local anesthesia group, but one patient in the general anesthesia group, who was severely hypertensive preoperatively, developed hemiplegia on the left side. There were five recurrences (4.6%) requiring total pericardiectomy at a later date. Subxyphoid pericardial decompression under local anesthesia was seen to be a safe and effective procedure for primary decompression and diagnosis of acute or chronic pericardial effusion.

Spontaneous disruption of Ionescu-Shiley bovine pericardial xenograft in the mitral position.

We report a case of spontaneous disruption of the Ionescu-Shiley pericardial xenograft in the mitral position at 3 years and its successful management.

Trocar cannulation of the ascending aorta: a new technique.

An improved technique for cannulating the ascending aorta has been developed and used in 229 consecutive open-heart procedures without complication. Advantages of the method include speed and ease of cannula insertion, elimination of the need for partial-occlusion clamping of the aorta, minimization of the risk of introducing air, minimization of blood loss, and facilitation of distal cannulation in patients with short aortas.

Continuous monitoring of mixed venous oxygen saturation in cardiac surgery.

Serial measurement of mixed venous oxygen saturation is useful in the care of critically ill patients. It is an index of cardiac output and overall tissue perfusion. Previously, lack of refinement of the technology for continuous monitoring of mixed venous oxygen saturation deterred its clinical application. The authors evaluated the Oximetrix ShawTM catheter oximeter system between May 1980 and April 1981 in 84 high-risk and moderately high-risk patients. Fifty-four had undergone only myocardial revascularization while 30 had undergone valvular or combined procedures. In 20 patients with compromised left ventricular function (mean ejection fraction of less than 40%) continuous mixed venous oxygen saturation was compared to hemodynamic parameters in an intraoperative and early postoperative study. The results indicated that satisfactory mixed venous oxygen saturation (more than 65%) correlated with normal hemodynamic measurements including cardiac output and cardiac index. In general, a fall in mixed venous oxygen saturation of more than 10% was noted before the mean blood pressure, heart rate or pulmonary capillary wedge pressure changed. Cardiac output, cardiac index, systemic vascular resistance and left ventricular stroke work index were found to change in association with a change in mixed venous oxygen saturation. A fall (mixed venous oxygen saturation less than 65%) can be related to: (a) abnormal hemodynamic status--reduced cardiac output, hypotension, elevated systemic vascular resistance and arrhythmias, (b) abnormal oxygen demand--shivering, suctioning, positioning and pyrexia and (c) abnormal oxygen supply--anemia, airway obstruction and altered diffusion of oxygen at the alveolar capillary membrane. The Oximetrix system proved reliable. Mixed venous oxygen saturation is a nonspecific indicator of hemodynamic status. Continuous monitoring of the mixed venous oxygen saturation facilitates optimal patient management by immediately alerting intensive care personnel to the development of inadequate tissue perfusion.