Catastrophic antiphospholipid syndrome related to severe ovarian hyperstimulation.

Antiphospholipid syndrome (APS) is a cause of infertility and fetal loss. Ovarian stimulation can induce previously unknown APS. Ovarian hyperstimulation syndrome (OHS) is uncommon but potentially life-threatening, as well as catastrophic APS. A woman that simultaneously developed a severe OHS and a catastrophic APS is described in this paper. Both entities produced thrombotic cardiac and brain thrombosis. A peculiar mechanism of cardiac ischemia is also described. In spite of the life-threatening risk of this situation, the indication for preventive anti-aggregation and/or anticoagulation is not clear.

Nódulo de la Hermana María (José) como forma de presentación de un linfoma no hodgkiniano / Sister Mary Joseph's nodule as non-Hodgkin's lymphoma clinical presentation

No disponible

Tissue production of pro-inflammatory cytokines (IL-1beta, TNFalpha and IL-6) correlates with the intensity of the systemic inflammatory response and with corticosteroid requirements in giant-cell arteritis.

OBJECTIVES: To investigate proinflammatory cytokine expression in temporal arteries from patients with giant-cell arteritis (GCA) and to analyse its relationship with the intensity of the initial systemic inflammatory reaction and response to corticosteroid therapy. METHODS: Quantification of interleukin-1beta (IL-1beta), tumor necrosis factor alpha (TNFalpha), and interleukin-6 (IL-6) mRNA by real-time quantitative PCR in temporal artery samples from 36 patients with biopsy-proven GCA and 11 controls. Immunohistochemical detection of IL-1beta, TNFalpha, and IL-6 in temporal artery sections from 74 patients with GCA and 15 controls. Clinical and biochemical parameters of inflammation as well as the time (weeks) required to reach a maintenance prednisone dose <10 mg/day were recorded. RESULTS: IL-1beta (13.8 +/- 2.5 vs 5.4 +/- 1.3 relative units, P = 0.012) and IL-6 transcripts (34 +/- 13.7 vs 7.8 +/- 4.5 relative units, P = 0.034) were significantly more abundant in patients with a strong systemic inflammatory response compared with those with no inflammatory parameters. Immunohistochemical scores for IL-1beta (2.7 +/- 0.3 vs 1.9 +/- 0.2, P = 0.018), TNFalpha (3.2 +/- 0.2 vs 2.4 +/- 0.3, P = 0.028) and IL-6 (3 +/- 0.2 vs 2.1 +/- 0.3, P = 0.023) were also significantly higher in patients with strong systemic inflammatory reaction. A significant correlation was found between the amount of tissue TNFalpha mRNA and the time required to reach a maintenance dose of prednisone <10 mg/day (r = 0.586, P = 0.001). CONCLUSION: GCA patients with a strong systemic inflammatory response, who have been previously shown to be more resistant to corticosteroid therapy, have elevated tissue expression of proinflammatory cytokines IL-1beta, TNFalpha and IL-6. High production of TNFalpha is associated with longer corticosteroid requirements.

Small-vessel vasculitis surrounding a spared temporal artery: clinical and pathological findings in a series of twenty-eight patients.

OBJECTIVE: Occasionally, a temporal artery biopsy reveals small-vessel vasculitis (SVV) surrounding a spared temporal artery, the significance of which is unclear. We analyzed the final diagnosis in a series of patients with this condition and tried to identify histopathologic features with potential usefulness in predicting the ultimate diagnosis. METHODS: We performed a clinical and histopathologic review of 28 patients in whom SVV surrounding a spared temporal artery was the first histologic finding that led to the diagnosis of vasculitis. For comparison purposes, we analyzed the pattern of small vessel involvement in 30 patients with biopsy-proven giant cell arteritis (GCA). RESULTS: GCA was considered the most likely diagnosis in 12 patients, based on the absence of clinical evidence of additional organ involvement and normal findings on muscle biopsy and electrophysiologic study. Three patients had systemic necrotizing vasculitis (SNV), based on the demonstration of typical lesions on subsequent muscle, nerve, or kidney biopsy. After extensive evaluation, 4 patients remained unclassifiable. Nine patients were incompletely studied. Fibrinoid necrosis was significantly more frequent in patients with SNV (P = 0.0022), whereas involvement of vasa vasorum was more frequent in patients classified as having GCA (P = 0.022). No differences in the pattern of small vessel involvement were found in patients with SVV surrounding a spared temporal artery who were classified as having GCA compared with patients with biopsy-proven GCA. Granulocytes were observed at similar frequency in all conditions. CONCLUSION: SVV may be the only abnormal feature in a temporal artery biopsy and the only histologic evidence of vasculitis. The diagnosis of GCA can be reasonably established in most of these patients when there is no apparent evidence of additional organ involvement. However, when fibrinoid necrosis is observed or the temporal artery vasa vasorum are not involved, SNV must be extensively excluded.

Minimization methods for the one-particle dirac equation.

Taking into account relativistic effects in quantum chemistry is crucial for accurate computations involving heavy atoms. Standard numerical methods can deal with the problem of variational collapse and the appearance of spurious roots only in special cases. The goal of this Letter is to provide a general and robust method to compute particle bound states of the Dirac equation.

[Prospective study of patients who leave the emergency department before being seen by the physician]. / Estudio prospectivo de los enfermos que abandonan un servicio de urgencias antes de ser atendidos por el médico.

BACKGROUND: To define epidemiological characteristics, the main reasons, and outcome of patients who leave the emergency department (ED) without being seen by a physician. PATIENTS AND METHODS: We performed a prospective survey of patients who left the ED before medical visit over a period of 26 consecutive weeks. For every non-visited patient (NV), the next visited patient (V) was included as a control. Clinical and epidemiological data, reasons to leave ED and outcome were obtained from clinical records and personal telephone interview. RESULTS: Out of a total of 21,022 patients who were attended in the ED, 383 (1.8%) were NV. To be under 50-year-old, to come the ED alone, to be previously visited by a community physician, and to previous expect short waiting times for ED visit were associated with higher risk for being NV (p < 0.01, p < 0.01, p < 0.05 and p < 0.0001, respectively). The main reasons noted to leave the ED were: feeling better (35%), feeling too sick to wait longer (30%) and being too angry to wait (25%). Only 46% of the NV looked for medical care in the 72 following hours and 6.5% of them needing to be further to hospital. NV-patients considered as suffering a serious pathology at ED arrival, and those being visited by a community physician previously to go to ED were found to be at increased risk to be subsequently admitted (p = 0.01 and p = 0.001, respectively). CONCLUSIONS: Patients who leave ED department before being seen by a doctor are usually young, literate, have not previously visited their community physician, and consulted for minor complaints. The main reason to leave is their own impression of suffering a minor disease, and less than 50% visit another physician after their leaving, being the rate of hospital admission low. We should be particularly cautious with those patients referred by a community doctor and those identified as to have a seriously affected health status at their arrival at the hospital, since they are at increased risk to be admitted.

Distensión de la vesícula biliar en el recién nacido / Distension of the gall gladder in the newborn

Presentamos 16 casos de distensión de la vesícula biliar en recién nacidos. Se analizan las características clínicas de los pacientes, la forma de evolución y los posibles factores patogénicos. En general, el ayuno y la alimentación parenteral fueron los factores que explican la aparición de este cuadro en el neonato. La evolución fue favorable en todos nuestros casos, lo que nos hace recomendar un manejo expectante (AU)

[Acute abdomen: other initial symptom of abdominal lymphangioma]. / Abdomen agudo: otra forma de debut del linfangioma abdominal.

Lymphangiomas are benign tumors, their growth are slow, customarily without symptoms, their location more frequent are in head or neck and they're diagnosed before the two first life years frequently. Their etiology continues uncertain, being accepted the congenital origin. We report on three cases of abdominal lymphangioma beginning as an acute abdomen. The importance of these cases is based mainly in the low frequency of presentation of these tumors in this location (2-5% of the lymphangiomas) and in their initial symptomatology.

[Age-related changes in the cytolytic activity of aspartyl aminopeptidase in the cerebral cortex of the rat]. / Cambios edad-dependientes en la actividad citosólica de aspartil-aminopeptidasa en la corteza cerebral de la rata.

INTRODUCTION: Recently, neurotoxicity mediated by excitatory amino acids has been considered to be the etiopathogenic basis of various neurodegenerative processes, including aging of the brain. OBJECTIVE: Since the enzyme aspartyl-aminopeptidase (Asp-AP) may play a role in modifying the concentration of the cytotoxic amino acids glutamate and aspartate, we studied the changes in its activity in the rat cerebral cortex, which were possibly related to age. MATERIALS AND METHODS: Homogenates of frontal, parietal, temporal and occipital cortex were obtained from young and old rats. The activity of Asp-AP in these homogenates determined by fluorimetry. RESULTS: Our results showed a significant age-dependent drop in Asp-AP activity in the frontal, parietal and occipital cortices, with little change in the temporal cortex. CONCLUSIONS: These results may be understood as part of a general schedule of age-dependent modifications of the cerebral protease systems.

[Treatment with Ethibloc of lymphangiomas and venous angiomas]. / Tratamiento con Ethibloc de linfangiomas y angiomas venosos.

Lymphangioma and venous angioma are a group of pathological entities which have required surgical treatment since years. Extension, localization and poor delimitation of some lesions have resulted in technical difficulties and serious complications. Our group began the sclerosing therapy with an injection of fibrin adhesive and, due to the lack of response in the first patient, a program with Ethibloc as an alternative substance was developed. We present 10 cases, 4 lymphangiomas and 6 venous angiomas. In 50% of our patients one single session of sclerotherapy was made, in 25% two sessions, and in the rest 25% three. From 10 cases, 4 are still on treatment, complete remission in 5 cases, and good evolution in one case (mixed lymphangioma). As a long-term complication, we have noticed fistulization in 3 cases, and expulsion of the sclerosing agent. In our experience, percutaneous sclerosis with Ethibloc should be the first therapeutic alternative.

[Tracheal stenosis as the presenting form of follicular thyroid carcinoma]. / Estenosis traqueal como forma de presentación de un carcinoma folicular de tiroides.

Follicular carcinoma of the thyroid is an uncommon neoplasm, whose diagnosis is usually established upon evaluating a thyroid nodule. However, on occasions it can be presented with symptoms derived from the adjacent structures' compression, as the trachea, since only it is presented in reduced number of patients with substernal goiter. We present a rare case of a woman 73 years-old, with follicular carcinoma of the thyroid, that consulted for 5 years-old evolution dyspnea and wheezing, without finding alterations in the initial roentgenogram of the chest. We comment the difficulty in the diagnosis of the upper airway obstruction when the roentgenogram of the chest is normal, and we comment the clinical and pulmonary function data that can lead us to suspect this disease.

Desmoplastic supratentorial neuroepithelial tumours of childhood: imaging in 5 patients.

Desmoplastic neuroepithelial tumours are rare supratentorial neoplasms of infancy with a favourable prognosis. We characterised their imaging findings by reviewing the clinical and radiological reports of five affected children. The tumours were massive, predominantly cystic and with preferential frontal and parietal lobe involvement. The cystic component was in the white matter, with no communication with the ventricle. The solid part was superficially, abutting a meningeal surface, and showed intense contrast enhancement. A heterogeneous predominantly solid mass was observed in one patient. Thinning and deformation of the skull adjacent to the tumour was shown in four cases. Peritumoral oedema was absent or moderate. No calcification or haemorrhage were present. Angiography showed a tumour blush from the internal or external carotid arteries in one case each. Follow-up (3 months-9 years, mean 4.5 years) showed no recurrence.

Decrease in cytosolic Aspartyl-aminopeptidase but not in Alanyl-aminopeptidase activity in the frontal cortex of the aged rat.

To test the neurotoxic hypothesis of excitatory amino acids, we evaluated the possible contribution to the free acidic amino acid pool of Aspartyl-aminopeptidase activity in the frontal cortex of adult (3 month old) and aged rats (3 groups of animals aged 26, 29 and 33 months). Aspartyl-aminopeptidase activity showed a significant decrease in the oldest rats (29 and 33 months old) whereas the activity of Alanyl-aminopeptidase, an unspecific enzyme, did not change with age. These data invalidate the idea that excess free acidic amino acids are released by aminopeptidases in the aged rat but do provide evidence of age-related changes in this enzymatic activity. The possible implications of our findings for general alterations in protein degradation are discussed.

Liver accessory lobe torsion in the infant.

A case of vomiting and selective epigastric pain secondary to volvulus of the pedicle of a liver accessory lobe, in an infant, is reported. Ultrasonic findings are useful and probably sufficient for a correct diagnosis.

Influence of temperature on degradation kinetics of ceftriaxone in diluted and undiluted human serum.

The stability of ceftriaxone in undiluted human serum and in human serum diluted 1/20 in 0.1 M phosphate buffer (pH 6.0) was measured at -70, -40, -20, 4, and 37 degrees C. Ceftriaxone in diluted human serum contained at least 90% of the initial activity after 3 months of storage at -20, -40, and -70 degrees C; unbuffered human serum contained 82.41, 84.92, and 88.96% of the initial activity, respectively. Ceftriaxone in unbuffered human serum and in diluted human serum showed 80.33 and 86.25% of the initial activity, respectively, after 55 days at 4 degrees C. After 120 h at 37 degrees C, this antibiotic in unbuffered human serum contained 33.08% of the initial activity, whereas samples of diluted human serum contained more than 60%. Consequently, the stability of antibiotic in human serum diluted 1/20 in 0.1 M phosphate buffer (pH 6.0) is increased.