Somatic education approaches in piano studies: A snapshot of Spanish conservatoire practices.

Somatic education in professional instrumental teaching is an emerging field in Spanish conservatoire culture. Although we find that the Alexander Technique was included in some European institutions since the middle of the XXth Century, this was not the case in the Spanish context. By means of a qualitative study, through document analysis and fifteen in-depth interviews with somatic teachers, the statutory frameworks of professional Piano studies and teaching plans related to somatic education in Spanish conservatoires, the principles that support them and the current practices that are undertaken in professional piano studies were analyzed. We found that there are eclectic approaches and practices in correlation with the background of the teachers in charge of the courses. Four main orientations can be described: somatic education per se; ergonomics and postural technique; body communication, training and technique; and mental and concentration control techniques. Further research to explore the interrelationships between somatic approaches and instrumental teaching would greatly benefit the field.

Renal amyloidosis in a patient with X-linked agammaglobulinemia (Bruton's disease) and bronchiectasis.

PURPOSE: We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis. CASE REPORT: A 38 year-old man was diagnosed with X-linked agammaglobulinemia (Bruton's disease) when he was 3 years old, and he has been treated with parenteral immunoglobulin since then. Eighteen years later, he was diagnosed with central pulmonary bronchiectasis by computerized tomography (CT). In 2008, he gradually developed anemia, edema of lower limbs, and loss of weight. METHOD AND RESULTS: Laboratory studies revealed deterioration of renal function, normocytic normochromic anemia and nephrotic range proteinuria. Hepatitis B and C and HIV serology were negative. Ultrasound and CT of abdomen were normal. A renal biopsy revealed deposits with positive PAS and Congo red staining in glomeruli, interstitium, and vessel's walls. Immunohistochemistry showed positive staining of the A amyloid. Direct immunofluorescence was positive with thioflavin and showed focal and glomerular mesangial IgG deposits, suggesting renal AA amyloidosis. For 2 years the patient conducted pharmacological treatment and follow-up for the Nephrology department with poor prognosis and progression of renal function impairment. In January 2011 he began dialysis treatment with improvement, and he is currently on the waiting list for renal transplantation. CONCLUSION: We present a patient with Bruton's disease and bronchiectasis who developed renal AA amyloidosis a finding rarely reported.

[Anorectal manometry in the neonatal diagnosis of Hirschsprung's disease]. / La manometría anorrectal en el diagnóstico neonatal de la enfermedad de Hirschsprung.

OBJECTIVE: To determine the usefulness of anorectal manometry (AM) in neonatal screening for Hirschsprung's disease (HD). MATERIAL AND METHODS: We review the anomanometric studies of 98 newborn (63 males and 35 females) with clinical suspicion of HD, noting the indications of AM, gestational age, weight, age in days at the test, and whether or not other diagnostic methods were performed. Studied at rest were the pressures (mmHg) in the rectal ampulla (RA), proximal anal canal (PAC), and distal anal canal (DAC), and, in the stimulation phase, the presence or absence of a recto-anal inhibitory reflex (RAIR). In patients with no RAIR, the study was repeated weekly until the end of the first month, and if there was still no RAIR a suction rectal biopsy (SRB) was performed. In these patients and those with signs of intestinal obstruction, a contrast enema was carried out. RESULTS: The indications of AM are: delayed meconium passage, abdominal distension, and/or vomiting in 61.5% of the patients, intestinal obstruction in 16%, constipation in 15.1%, and other causes in 7.4%. The mean gestational age was 35.59 +/- 4.59 weeks, and the weight 2518 +/- 912.91 g. The mean age at the first test was 15.08 +/- 11.33 days. A RAIR was observed at the first study in 65 patients (healthy 54, meconium plug 2, meconium ileus 2, intestinal neuronal dysplasia 1, false negative 1, and other diagnoses 6), and was absent in 27 (HD 20, small left colon syndrome 4, hypoganglionism 1, and false positives 2). In 6 patients the first study was considered invalid. Histological studies confirmed HD in 21 newborn, in 11 of whom the contrast enema showed a transition zone. There were no differences between healthy and HD newborn in the RA, PAC, or DAC resting pressures. The sensitivity of AM for the diagnosis of HD was 95% and its specificity 90.24%. The sensitivity and specificity of rectal biopsy were 100%. The sensitivity of contrast enema was 52.3%, and its specificity 78.6%. CONCLUSIONS: AM is a simple and safe method with high sensitivity and specificity for the neonatal diagnosis of HD. We consider it indicated prior to SRB in every newborn with clinical suspicion of this disease.

La manometría anorrectal en el diagnóstico neonatal de la enfermedad de Hirschsprung / Anorectal manometry in the neonatal diagnosis of hirschsprung's disease

Objetivo. Es conocer la utilidad de la manometría anorrectal (MA)para el screening neonatal de la enfermedad de Hirschsprung (EH). Material y métodos. Se revisan los estudios anomanométricos de 98 neonatos (63 hombres y 35 mujeres) con sospecha clínica de EH. Se valoran las indicaciones de la MA, la edad gestacional, peso, días de vida al test y la realización o no de otros métodos diagnósticos. Se estudia, en reposo, las presiones (mmHg) en la ampolla rectal (AR), cana lanal proximal (CAP) y canal anal distal (CAD), y en la fase de estimulación se investiga la presencia o ausencia del reflejo inhibidor del (..) (AU)

Objective. To determine the usefulness of anorectal manometry(AM) in neonatal screening for Hirschsprung’s disease (HD). Material and methods. We review the anomanometric studies of 98 newborn (63 males and 35 females) with clinical suspicion of HD, noting the indications of AM, gestational age, weight, age in days at the test, and whether or not other diagnostic methods were performed. Studied at rest were the pressures (mmHg) in the rectal ampulla (RA), proximal anal canal (PAC), and distal anal canal (DAC), and, in the stimulation phase, the presence or absence of a recto-anal inhibitory reflex(RAIR). In patients with no RAIR, the study was repeated weekly until (..) (AU)

[A man with lung cancer and tuberculosis: a false positive by positron emission tomography and its clinical repercussions]. / Paciente con cáncer de pulmón y tuberculosis: falso positivo en la PET y su repercusión clínica.

Positron emission tomography (PET) has come to play an increasingly important role in the evaluation of lung cancer patients, both for diagnostic staging and post-treatment follow-up. As is true for other techniques, PET gives false positive and negative results. False positives have been described in the presence of certain active infections and inflammatory lesions, such as tuberculous granulomas, coccidioidomycosis, aspergillosis and histoplasmosis. We report the case of a man whose PET gave a false positive and in whom both lung cancer and tuberculosis were present. A radical change in therapeutic approach was required, making the case interesting.

[Bladder transitional cell carcinoma with metastasis to the maxillary sinus as first symptom]. / Carcinoma de células transicionales vesicales con metástasis en seno maxilar como primer síntoma.

Maxillary sinus metastasis are very uncommon tumors (fifty have been reported). The most frequent ones are renal adenocarcinoma, breast and lung tumors. Up to now there is only a reported case of bladder carcinoma in maxillary sinus. We report a 67 years old male with a right maxillary tumor two months ago. FNA demonstrated a transitional cell bladder tumor. The treatment was chemotherapy. The patient died two months later. We reported some considerations about metastatic tumors of paranasal sinus.

Clinicopathologic study on prognostic markers in IgA nephropathy.

BACKGROUND/AIM: Few prognostic markers have found general acceptance in IgA nephropathy (IgAN). The aim of the present study was to search for significant predictor(s) at the time of biopsy. METHODS: Fifty-five patients with IgAN undergoing evaluation and treatment at our institution were examined regarding clinicopathologic features at the time of renal biopsy and, if possible, at follow-up. Factors predictive of outcome were evaluated. Renal histopathology was quantified using a glomerulosclerosis index (GSI), a tubulointerstitial index (TII), and a crescent index (CI). RESULTS: The serum creatinine concentration (S-Cr) showed positive correlations with proteinuria and serum total cholesterol concentration, as well as with histopathologic findings. Heavy proteinuria (> or =3.0g/24 h) was associated with higher S-Cr and greater severity of pathologic abnormalities than with milder proteinuria. At follow-up, 6 patients progressed to chronic renal insufficiency, in whom the S-Cr increased by at least 50% to reach or exceed 1.5 mg/dl (132.6 micromol/l). By univariate analysis, elevated GSI, TII, and S-Cr, presence of nephrotic syndrome, elevated CI, and elevated total cholesterol were found to be negative predictors, in descending order of odds ratio. In multivariate analysis, however, only TII independently predicted unfavorable outcome. CONCLUSION: Renal biopsy in IgAN may be the most powerful predictor for renal outcome; an advanced tubulointerstitial lesion is unfavorable.

Source of reactive oxygen species in anti-Thy1 nephritis.

In proliferative glomerulonephritis, both macrophages and mesangial cells generate reactive oxygen species (ROS), contributing to the development of glomerular injury. We have attempted to determine which cell produces ROS during anti-Thy1 nephritis (ATN) in rats. The generation of ROS was studied using luminol amplified chemiluminescence (GCL) on isolated glomeruli. Immunohistochemical studies used avidin-biotin complex (ABC) to label macrophages and mesangial cells. Immediately after ATN induction, mesangiolysis and infiltration with ED-1 positive cells (referred to as macrophage) was noted with a peak at day 1. After day 4, mesangial proliferation appeared with a decrease of the ED-1 positive cells and a prominent increase of PCNA positive cells (regarded as mesangial cells). In the early phase of ATN, GCL, reflecting ROS generation, increased along with the appearance of ED-1 positive cells. GCL subsequently decreased as mesangial cells increased. This suggested that macrophage were the principal participants in ROS generation in the early phase of ATN although mesangial cells cannot be completely disregarded in the generation of ROS and development of glomerular injury.

Ultrastructural background of albuminuria in rats with passive Heymann nephritis.

BACKGROUND: Although it is widely known that proteinuria in rats with passive Heymann nephritis (PHN) is prevented by treatment with cobra venom factor (CVF), the precise mechanisms of complement-dependent proteinuria have not been fully elucidated. The aim of this study was to evaluate morphologically whether the size of subepithelial electron-dense deposits (EDDs) contributes to the onset of albuminuria. METHODS: The size of subepithelial EDDs and anionic sites in the lamina rarae externa (LRE) overlaid with subepithelial EDDs were evaluated by ruthenium red and compared between PHN and PHN treated with CVF in rats. RESULTS: Overt albuminuria was present on days 3 and 4 after injection of anti-Fx1A. CVF-treatment of rats with PHN prevented albuminuria (PHN + CVF: n = 6) (53.6 +/- 38.8 vs 1.02 +/- 0.55 mg/day, P < 0.01, on day 4). Rat C3 was detected along the glomerular capillary walls on day 4 post-injection in rats with PHN, but not in rats with PHN + CVF. Subepithelial EDDs were observed in both groups. Quantitative morphometric analysis revealed that CVF-treatment decreased the size of subepithelial EDDs as well as the extent of retraction of glomerular epithelial cells. In both groups the density of anionic sites in the LRE overlaid with EDDs was decreased compared with the LRE without subepithelial EDDs. However, no difference was noted between the two groups. CONCLUSIONS: Depletion of serum complement decreases subepithelial EDDs as well as the number of sites with decreased anionic charge underlying the EDDs. Thus, the size of subepithelial EDDs plays a pivotal role in the onset of albuminuria.

Management of invasive candidal infections: results of a prospective, randomized, multicenter study of fluconazole versus amphotericin B and review of the literature.

We conducted a prospective, randomized, multicenter study comparing fluconazole and amphotericin B in the treatment of candidal infections. One hundred and sixty-four patients (60 of whom were neutropenic) with documented or presumed invasive candidiasis were assigned to treatment with either fluconazole (400 mg daily) or amphotericin B (25-50 mg daily; 0.67 mg/kg daily for neutropenic patients). Clinical response and survival rates were assessed at 48 hours, after 5 days, and at the end of therapy. Overall response rates to fluconazole and amphotericin B were similar (66% and 64%, respectively). There were no differences in response as related to site of infection, pathogen, time to defervescence, relapse, or survival rates between the groups. Adverse effects were more frequent with amphotericin B (35%) than with fluconazole (5%; P < .0001). The results of this study confirm that fluconazole is as effective as but better tolerated than amphotericin B in the treatment of candidal infections.

Cytomegalovirus pneumonia in adult nontransplantation patients with cancer: review of 20 cases occurring from 1964 through 1990.

The objectives of this study were to estimate the frequency of cytomegalovirus (CMV) pneumonia and describe its clinical and radiological presentation in adult nontransplantation patients with cancer. Of the 10,441 autopsies performed at M. D. Anderson Cancer Center (Houston) during the period of January 1964 through December 1990, 9,029 were evaluable. Twenty histopathologically confirmed cases of CMV pneumonia were found, representing a frequency of 2.2 cases per 1,000 autopsies. When the frequency of CMV pneumonia was compared for the periods 1964-1979 (1.5 cases per 1,000 autopsies) and 1980-1990 (4.6 cases per 1,000 autopsies), a statistically significant increase due to an increase in the number of patients with solid malignancies was observed (P < .05). CMV pneumonia is an uncommon diagnosis at autopsy for adult nontransplantation patients with cancer and is usually found in conjunction with a disseminated neoplastic process.

[Epididymal malacoplakia in a heart transplant recipient: clinico-pathologic study of a case]. / Malacoplaquia epididimaria en un paciente con trasplante cardíaco: estudio clínico-patológico de un caso.

OBJECTIVES: An unusual case of malacoplakia is described and the literature reviewed. METHODS/RESULTS: We report on a patient on immunosuppression due to heart transplantation who developed malacoplakia of the epididymis. Patient history and treatment are discussed, with special reference to the differential diagnosis between this condition and tumors.