Papel de las colecciones de piezas anatómicas en la enseñanza de la anatomía patológica / The relevance of anatomical specimens in the teaching of Pathology

La trascendencia de la museología relacionada con la anatomía y la anatomía patológica radica tanto en la conservación de piezas anatómicas naturales o de sus reproducciones, como en la posibilidad de ofrecer un valioso material para fines didácticos e investigadores. Los primeros fundamentos para la enseñanza anatómica fueron los theatrum anatomicum y los «gabinetes anatómicos» de las cátedras de anatomía de la facultades de medicina europeas, a los que sucedieron en siglos posteriores los museos anatómicos y anatomopatológicos. Tras una época de auge durante el siglo xviii, la mayor parte de ellos sufrieron un proceso de decadencia progresiva que llevó a la pérdida de muchos de ellos. En la actualidad se observa un interés creciente en la recuperación y puesta en valor de estas colecciones. Este trabajo muestra una aproximación histórica de su desarrollo y una revisión de la situación actual de los principales museos de España y de Europa

The relevance of museums of anatomy and pathology lies both in the conservation of anatomical specimens and their excellent reproductions and their use in education and research. The teaching of anatomy dates from ancient times, originating in the Theatrum Anatomicum and anatomical cabinets, located in the anatomy lecture rooms of European medical schools. These were followed by museums of anatomy and pathology in successive centuries. However, after a golden period in the XVIII century, there was a progressive decline which eventually led to a dramatic loss of many museums. Currently, there is a growing interest in the recovery and importance of these collections. We present an historical approach to their development and a review of the current situation in the principal anatomical museums of anatomy in Spain and the rest of Europe

[The relevance of anatomical specimens in the teaching of Pathology]. / Papel de las colecciones de piezas anatómicas en la enseñanza de la anatomía patológica.

The relevance of museums of anatomy and pathology lies both in the conservation of anatomical specimens and their excellent reproductions and their use in education and research. The teaching of anatomy dates from ancient times, originating in the Theatrum Anatomicum and anatomical cabinets, located in the anatomy lecture rooms of European medical schools. These were followed by museums of anatomy and pathology in successive centuries. However, after a golden period in the XVIII century, there was a progressive decline which eventually led to a dramatic loss of many museums. Currently, there is a growing interest in the recovery and importance of these collections. We present an historical approach to their development and a review of the current situation in the principal anatomical museums of anatomy in Spain and the rest of Europe.

Infección bronquial crónica: el problema de Pseudomonas aeruginosa / Chronic bronchial infection: the problem of Pseudomonas aeruginosa

La colonización patogénica broncopulmonar y las exacerbaciones que se derivan de ella constituyen las causasmás importantes del deterioro de la función pulmonar en los pacientes con bronquiectasias. Haemophilusinfluezae y Pseudomonas aeruginosa son los patógenos más frecuentes en estos pacientes. El efecto lesivo seproduce por el proceso de inflamación local y el círculo vicioso que se desarrolla por el estímulo antigénico, laliberación de mediadores de la inflamación, la presencia de neutrófilos, el aumento del inóculo bacteriano yla liberación de exoproductos bacterianos. Se ha demostrado que P. aeruginosa afecta a los pacientes con bronquiectasiascon peor calidad de vida, coloniza a los que tienen peor funcionalidad pulmonar y mayor númerode tratamientos antimicrobianos. En las bronquiectasias, al igual que en la enfermedad pulmonar obstructivacrónica (EPOC) o fibrosis quística, P. aeruginosa es capaz de colonizar crónicamente la mucosa respiratoria.Debido al nicho ecológico donde se sitúa P. aeruginosa y a la multitud de ciclos con antimicrobianos a los queson sometidos estos pacientes es fácil que se desarrollen resistencias a los antimicrobianos, favorecidas por laelevada proporción de variantes hipermutadoras que existen. Asimismo, hay que resaltar la forma natural decrecimiento en biopelículas de P. aeruginosa en la superficie mucosa y la contribución que ejerce para su persistencia.El tratamiento antimicrobiano en los pacientes con bronquiectasas con colonización por P.aeruginosa ha de basarse en antimicrobianos o asociaciones de éstos que no pierdan actividad al actuar sobrelas biopelículas(AU)

Pathogenic bronchopulmonary colonizations and the exacerbations produced are among the most importantcauses of reduced pulmonary function in patients with bronchiectasis. The most frequent pathogens in thesepatients are Haemophilus influenzae and Pseudomonas aeruginosa. Lesions are produced by the localinflammatory process and the vicious circle developed by antigen stimulation, the release of inflammatorymediators, the presence of neutrophils, the increase of bacterial inoculum and the release of bacterialexoproducts. P. aeruginosa has been demonstrated to affect the patients with bronchiectasis and poorestquality of life and to colonize those with the poorest pulmonary function and the highest number ofantimicrobial treatments. In bronchiectasis, as in chronic obstructive pulmonary disease (COPD) or cysticfibrosis, P. aeruginosa is able to colonize the respiratory mucosa chronically. Due to the ecological nicheoccupied by P. aeruginosa and the multitude of cycles with antimicrobial agents to which these patients aresubjected, the development of antimicrobial resistance is highly likely, encouraged by the high proportion ofhypermutation variants in existence. Likewise, P. aeruginosa naturally grows in the form of biofilms on themucosal surface, greatly contributing to its persistence. Antimicrobial treatment in patients withbronchiectasis and P. aeruginosa colonization should be based on antimicrobial agents, alone or incombination, that do not lose activity when acting on biofilms(AU)

Diagnóstico microbiológico de las infecciones osteoarticulares / Microbiological diagnosis of bone-joint infections

Las infecciones osteoarticulares son procesos poco frecuentes asociados a un difícil tratamiento medicoquirúrgico y a numerosas complicaciones. Su diagnóstico requiere un abordaje multidisciplinar y la interpretación conjunta de las pruebas radiológicas, de medicina nuclear, de las determinaciones bioquímicas, de los estudios de anatomía patológica y de los resultados microbiológicos. En este sentido, el manejo clínico de estas infecciones requiere un diagnóstico rápido y preciso, que permita instaurar precozmente el tratamiento adecuado para disminuir las complicaciones que se pueden derivar del diagnóstico y tratamiento tardíos. Para ello, es necesario el aislamiento de los microorganismos responsables en cultivo y la determinación de sus patrones de sensibilidad. El diagnóstico microbiológico de las infecciones osteoarticulares tiene limitaciones encabezadas por la escasa sensibilidad de la tinción de Gram y seguidas por la dificultad de la interpretación de los resultados de los cultivos, sobre todo cuando se emplean medios de enriquecimiento, que por otro lado son necesarios al ser en muchas ocasiones infecciones con baja carga microbiana (AU)

Although infrequent, bone-joint infections are associated with difficult clinical and surgical management and severe complications. Diagnosis of bone-joint infections requires a multidisciplinary analysis of the biochemistry, radiology, nuclear medicine, microbiology, and histopathology results. Diagnosis must be rapid and correct so that appropriate medical and surgical treatment can be administered and serious complications avoided. Microbiology studies are indispensable when determining the causal agents and their antimicrobial susceptibility patterns. Microbiological diagnosis of bone-joint infections is limited by the low sensitivity of Gram staining and difficult interpretation of culture results, particularly when enrichment broth is used (low number of microorganisms present in some infections) (AU)

[Microbiological diagnosis of bone-joint infections]. / Diagnóstico microbiológico de las infecciones osteoarticulares.

Although infrequent, bone-joint infections are associated with difficult clinical and surgical management and severe complications. Diagnosis of bone-joint infections requires a multidisciplinary analysis of the biochemistry, radiology, nuclear medicine, microbiology, and histopathology results. Diagnosis must be rapid and correct so that appropriate medical and surgical treatment can be administered and serious complications avoided. Microbiology studies are indispensable when determining the causal agents and their antimicrobial susceptibility patterns. Microbiological diagnosis of bone-joint infections is limited by the low sensitivity of Gram staining and difficult interpretation of culture results, particularly when enrichment broth is used (low number of microorganisms present in some infections).

[Microbiological diagnosis of bacterial lower respiratory tract infections]. / Diagnóstico microbiológico de las infecciones bacterianas del tracto respiratorio inferior.

Microbiological diagnosis of bacterial lower respiratory tract infections has relevant limitations and related controversy, depending on the clinical setting and diagnostic methods used, and its value is contingent on an accurate clinical diagnosis and previous antimicrobial therapy. The limitations reside in a low diagnostic yield of the causative agent and the difficulty of determining the clinical significance of the agents recovered. This report examines the current microbiological diagnostic yield of the main clinical entities and etiological agents, indications for invasive or non-invasive specimen collection procedures, and proper specimen processing and culture in the appropriate media. Criteria regarding specimen suitability and indications for quantitative cultures are established. Criteria for evaluating the results are provided, and the current fast diagnostic techniques are described.

Differences in biofilm development and antibiotic susceptibility among clinical Ureaplasma urealyticum and Ureaplasma parvum isolates.

OBJECTIVES: The aim of this work was to study the ability of clinical isolates of Ureaplasma spp. to form biofilms in vitro and to compare the antibiotic susceptibility of sessile cells and their planktonic counterparts. METHODS: A total of nine Ureaplasma spp. isolates recovered from unrelated male patients diagnosed with urethritis or chronic prostatitis and two isolates isolated from the urine of two healthy volunteers were included. Ureaplasma species identification was performed by 16S rDNA gene amplification and sequencing. Conventional antibiotic susceptibility tests were carried out by the broth microdilution method. Biofilm susceptibility assays were performed following the method proposed by Moskowitz using 10C urea broth medium and confirming bacterial growth by colour shift of the medium. The chi(2) test was applied to analyse the statistical differences between the MIC and the minimal biofilm inhibitory concentration. RESULTS: Isolates were identified as Ureaplasma urealyticum serovar 7 (five isolates), U. urealyticum serovar 13 (four isolates) and Ureaplasma parvum serovar 3 (two isolates). Biofilm formation was observed in 9 out of the 11 strains studied (82%); two isolates of U. urealyticum serovar 13 were non-biofilm formers. Global resistance percentages of planktonic cells compared with sessile cells were different for erythromycin (0% versus 44%, P = 0.02), telithromycin (22% versus 77%, P = 0.02), ciprofloxacin (66% versus 100%), levofloxacin (0% versus 33%) and tetracycline (0% versus 33%). All nine biofilm-forming strains were fully susceptible to clarithromycin in both planktonic and biofilm types of growth. CONCLUSIONS: These results indicate that biofilm formation can protect mycoplasma cells from antibiotics and host defences, favouring their persistence in chronically infected or colonized patients while increasing resistance to antimicrobial agents. Therefore, the capacity to form biofilms by Ureaplasma spp. isolates should be considered when antibiotic treatments are required.

Diagnóstico microbiológico de las infecciones bacterianas del tracto respiratorio inferior / Microbiological diagnosis of bacterial lower respiratory tract infections

El diagnóstico microbiológico de las infecciones bacterianas del tracto respiratorio inferior (TRI) presenta importantes limitaciones y controversias según los diferentes cuadros clínicos y los métodos diagnósticos, y su valor depende, a su vez, de un diagnóstico clínico correcto y de un tratamiento antibiótico previo. Las limitaciones estriban en la baja rentabilidad del aislamiento del agente causal y en la difícil valoración de los microorganismos aislados en relación con su significación clínica. Se examina aquí el rendimiento actual del diagnóstico microbiológico de los principales cuadros clínicos y agentes etiológicos, los procedimientos de recogida invasivos o no invasivos de los diferentes tipos de muestras, y su procesamiento y siembra en medios de cultivo. Se establecen los criterios de aceptación de las muestras y la indicación de realización de cultivos cuantitativos. Se exponen los criterios para la interpretación de los resultados y, por último, se describen las técnicas de diagnóstico rápido actuales (AU)

Microbiological diagnosis of bacterial lower respiratory tract infections has relevant limitations and related controversy, depending on the clinical setting and diagnostic methods used, and its value is contingent on an accurate clinical diagnosis and previous antimicrobial therapy. The limitations reside in a low diagnostic yield of the causative agent and the difficulty of determining the clinical significance of the agents recovered. This report examines the current microbiological diagnostic yield of the main clinical entities and etiological agents, indications for invasive or non-invasive specimen collection procedures, and proper specimen processing and culture in the appropriate media. Criteria regarding specimen suitability and indications for quantitative cultures are established. Criteria for evaluating the results are provided, and the current fast diagnostic techniques are described (AU)

Enterococcal meningitis: a clinical study of 39 cases and review of the literature.

To describe the clinical features and outcome of enterococcal meningitis, we retrospectively reviewed the charts of 39 cases seen at 2 tertiary hospitals during a 25 years and collected 101 additional, previously reported cases for review. Among these 140 cases, there were 82 cases (59%) of postoperative meningitis and 58 cases (41%) of spontaneous meningitis. Eighty-six patients (61%) were adults and 54 (39%) were children. Patients with spontaneous meningitis had a higher frequency of community-acquired infection (50% versus 18%; p < 0.01), severe underlying diseases (67% versus 22%; p < 0.01), and associated enterococcal infection (29% versus 8%; p < 0.01) than patients with postoperative meningitis. The clinical presentation was similar in both groups, but patients with spontaneous infection had a higher frequency of bacteremia (58% versus 12%; p < 0.01), and a lower frequency of mixed infection (9% versus 29%; p < 0.01). Spontaneous meningitis in children was associated with a significantly lower frequency of fever, altered mental status, headache, and meningeal signs (p < 0.01), probably explained by the high proportion of neonates in this age-group. Most infections were caused by Enterococcus faecalis, which accounted for 76% of the isolates identified at the species level. Fifteen of the 25 cases due to Enterococcus faecium were produced by vancomycin-resistant strains. Most patients were treated with ampicillin, penicillin, or vancomycin, with or without aminoglycosides, for a median period of 18 days (range, 1-85 d). Overall mortality was 21%. The mortality rate was higher in spontaneous than in postoperative meningitis (33% versus 12%; p < 0.01), but was similar in patients treated with beta-lactams (18%), glycopeptides (14%), or other antibiotics (25%), as well as in patients treated with monotherapy (16%) or combination therapy (22%). An adverse outcome correlated significantly with advanced age, the presence of severe underlying diseases, associated enterococcal infection, bacteremia, septic shock, and the absence of fever at presentation. Shunt removal was associated with a lower mortality. Multivariate analysis showed that the presence of severe underlying diseases was the only prognostic factor associated with mortality (odds ratio = 6.8, 95% confidence intervals = 2.7-17.5, p < 0.01).