Síndrome de Klippel-Trenaunay en la gestación: a propósito de un caso y revisión de literatura reciente / Klippel-Trenaunay syndrome in pregnancy: A clinical case and review of recent literature

El síndrome de Klippel-Trenaunay es una entidad infrecuente que asocia riesgos, principalmente hemorrágicos y tromboembólicos. Dada la baja incidencia de este síndrome, existe escasa literatura relativa a su manejo obstétrico. Presentamos una revisión de la literatura reciente a propósito de un caso, con el objetivo de sintetizar el manejo obstétrico en pacientes con síndrome de Klippel-Trenaunay. Ante una gestante con esta patología deberá plantearse un manejo multidisciplinar que incluya obstetras, hematólogos y anestesistas, principalmente. Será de gran importancia la realización de estudios de imagen, sobre todo en el tercer trimestre, que ayuden a determinar la vía del parto. Dado el riesgo incrementado de eventos trombóticos, está indicado el uso de medidas profilácticas durante el embarazo y el puerperio en estas pacientes. La evidencia relativa al incremento de complicaciones hemorrágicas en estas pacientes no es tan concluyente; sin embargo, es una complicación que deberemos tener en cuenta para instaurar las medidas terapéuticas necesarias.(AU)

Klippel-Trenaunay syndrome is a rare entity with associated risks, mainly haemorrhagic and thromboembolic. Given the low incidence of this syndrome, there is little evidence on its obstetric management. We present a review of the recent literature about a case, with the aim of synthesizing the obstetric management of patients with Klippel-Trenaunay syndrome. In the case of a pregnant woman with this pathology, multidisciplinary management should be considered, which would mainly include obstetricians, haematologists, and anaesthesiologists. It is very important to perform imaging studies, especially in the third trimester, to help determine the delivery route. Given the increased risk of thrombotic events, the use of prophylactic measures during pregnancy and the puerperium is indicated. The evidence regarding the increase in bleeding complications in these patients is not so conclusive, however it is a complication that we must take into account to establish the necessary therapeutic measures.(AU)

Psychosocial and sexual well-being in breast cancer survivors undergoing immediate breast reconstruction: The mediating role of breast satisfaction.

OBJECTIVE: This study aimed to explore (1) the levels of quality of life (psychosocial, physical and sexual well-being) and breast satisfaction in breast cancer patients (BCP) after immediate reconstruction (IR), considering surgery reason and surgical technique, and (2) the explanatory and predictive capacity of psychosocial well-being on breast satisfaction, and of both on sexual well-being. METHODS: This prospective study included 36 BCP who underwent IR between June 2006 and December 2014. RESULTS: Highest levels of quality of life were found in psychosocial well-being and sexual well-being, with no statistically significant differences by surgery reason or surgical technique in any quality of life indicator or breast satisfaction. Psychosocial, physical well-being and breast satisfaction explained 56.16% of the variance in sexual well-being, where 44.67% was attributed to psychosocial well-being. In addition, breast satisfaction statistically significantly mediated the relationship between psychosocial and sexual well-being, independently of physical well-being. CONCLUSION: Our findings highlight the importance of IR in reducing psychological morbidity and preserving the quality of life and breast satisfaction. Furthermore, this research indicated that psychosocial well-being should be considered a useful personal resource for improving the sexual well-being of BCP undergoing IR both through its direct effect and the mediated effect of breast satisfaction.

Expression of urokinase type plasminogen activator receptor (uPAR) in the bovine oviduct: Relationship with uPA effect on oviductal epithelial cells.

Urokinase type plasminogen activator (uPA) is an oviductal fluid component whose activity is regulated by binding to urokinase type plasminogen activator receptor (uPAR). In this study uPAR and uPA gene expression in bovine oviduct were evaluated and similar expression patterns for both uPAR and uPA mRNAs were observed during the estrous cycle. Immunolocalization of uPAR at the apical zone of epithelial cells suggests that uPA action would be focalized in the oviductal lumen, triggering intracellular signaling pathways. As uPAR expression was also observed in in vitro cultures of oviductal epithelial cells, the effect of uPA was explored using this culture model. Real-time RT-PCR demonstrated that c-fos expression in oviductal cell cultures increases under uPA stimulation. These results suggest that uPA/uPAR binding would be involved in signaling pathways that activate transcription factors and would regulate the synthesis of molecules concerned with the arrangement of a particular oviductal microenvironment.

Colecistectomía laparoscópica de puerto único en un programa de CMA / Single port laparoscopic cholecystectomy in major ambulatory surgery (MAS)

Introducción: La cirugía endoscópica por orificios naturales es una nueva modalidad quirúrgica en fase de desarrollo. La vía más natural para los cirujanos es usar una cicatriz ya existente como es el ombligo. La reciente introducción de trocares diseñados para este fin ha hecho posible su puesta en práctica. Material y métodos: En este estudio presentamos nuestra experiencia preliminar en la colecistectomía laparoscópica con puerto de acceso único umbilical, mediante un estudio prospectivo que incluye a 26 pacientes intervenidos entre enero 2009 y enero 2010. También pretendemos conocer su posible realización en régimen de CMA. Resultados: Todos los pacientes presentaban colelitiasis no complicadas, aunque en 5 se identifico una colecistitis en la cirugía. El tiempo quirúrgico promedio fue de 51,2min. La estancia hospitalaria media fue 25,7h. En el 76,92% de los pacientes el ingreso fue menor de 24h. No hubo ningún reingreso ni complicación intraoperatoria o postoperatoria importante. Conclusiones: A la vista de nuestros resultados la colecistectomía laparoscópica por puerto único favorece su inclusión en un programa de cirugía mayor ambulatoria (AU)

Introduction: Natural orifice endoscopic surgery is a new surgical procedure still in the development phase. The most natural entry for surgeons is to use an already existing scar, such as the navel. The recent introduction of trocars designed for this purpose has made it possible to put this into practice. Material and methods: We present our preliminary experience in single trans‐umbilical incision laparoscopic cholecystectomy, by means of a prospective study which included 26 patients operated on between January 2009 and January 2010. We also attempt to find out whether it can be performed in a MAS programme. Results: All patients had uncomplicated cholelithiasis, although in 5 of them cholecystitis was identified during the surgery. The mean surgical time was 51.2min. The mean hospital stay was 25.7h, and 76.92% of patients were admitted for less than 24h. There were no re-admissions or significant intra-operative or post-operative complications. Conclusions: On looking at our results, single port laparoscopic cholecystectomy could be included in a major ambulatory surgery programme (AU)

[Single port laparoscopic cholecystectomy in major ambulatory surgery (MAS)]. / Colecistectomía laparoscópica de puerto único en un programa de CMA.

INTRODUCTION: Natural orifice endoscopic surgery is a new surgical procedure still in the development phase. The most natural entry for surgeons is to use an already existing scar, such as the navel. The recent introduction of trocars designed for this purpose has made it possible to put this into practice. MATERIAL AND METHODS: We present our preliminary experience in single trans-umbilical incision laparoscopic cholecystectomy, by means of a prospective study which included 26 patients operated on between January 2009 and January 2010. We also attempt to find out whether it can be performed in a MAS programme. RESULTS: All patients had uncomplicated cholelithiasis, although in 5 of them cholecystitis was identified during the surgery. The mean surgical time was 51.2 min. The mean hospital stay was 25.7h, and 76.92% of patients were admitted for less than 24h. There were no re-admissions or significant intra-operative or post-operative complications. CONCLUSIONS: On looking at our results, single port laparoscopic cholecystectomy could be included in a major ambulatory surgery programme.

In vivo and in vitro sperm interaction with oviductal epithelial cells of llama.

Sperm reservoirs in South American Camelids would be crucial for successful fertilization. Since ovulation occurs approximately 36 h after mating, the maintenance of the sperm viability in the oviduct waiting for the ovum is a critical reproductive event. Our study aimed at determining whether the isthmus or the utero tubal junction (UTJ) could function as a sperm reservoir in llama by means of in vivo and in vitro experiments. For the in vivo experiments, the oviducts of adult females with a dominant follicle bigger than 7 mm were examined for the presence of sperm at 6, 18, 24, 28 and 35 h after mating. The results using scanning and transmission electron microscopy showed ultrastructural differences between isthmus and UTJ with respect to (1) predominance of secretory cells in the UTJ and ciliated cells in the isthmus epithelium and (2) cytoplasmic bulbous projection of the secretory cells in the UTJ. Sperm adhered by a mucus-like substance were seen only in the UTJ at 6, 18, 24 and 28 h postmating. Lack of sperm adhered to oviductal mucosa was observed around ovulation (35 h). In vitro experiments demonstrated higher ability of UTJ epithelial cell explants with respect to isthmus explants to bind sperm in a co-cultured system. The anatomical features and the presence of a sperm bonding agent in the UTJ together with the in vitro differential binding of sperm to UTJ explants strongly suggest that both may be feasible mechanisms that facilitate sperm storage in this oviductal region in llama.

Molecular studies in the GJB2 gene (Cx26) among a deaf population from Bogotá, Colombia: results of a screening program.

OBJECTIVE: We conducted a pilot screening program to define the prevalence of non-syndromic deafness and establish the frequency of mutations in the GJB2 gene (Cx26) in a population of children with congenital deafness in Bogotá, Colombia. METHOD: From a cohort of 731 children in 8 institutions for the deaf, we identified 322 (44%) with presumed non-syndromic deafness. These were invited to a more detailed evaluation, but 46 chose not to participate. The remaining 276 individuals received a complete ophthalmological evaluation that was normal in 205 (74.3%) and showed salt and pepper retinopathy in 55 (19.9%) and other ocular abnormalities in 16 (5.8%). A comprehensive medical history, and a detailed physical examination were performed in the 205 children with normal ocular exam. Of these, 93 were found to have acquired deafness and/or associated anomalies and 112 (15.3% of the initial 731 children), non-syndromic deafness. The GJB2 gene was sequenced in these 112 individuals. RESULTS: Based on family history, 59.8% (67/112) of these cases had autosomal recessive non-syndromic sensorineural hearing loss and the remaining 40.2% (45/112) were sporadic, without apparent known cause. We identified three mutations in the GJB2 gene: 35delG, S199F, and 167delT, all of which have been previously reported in the literature, the variant M34T, and the polymorphism V27I. S199F was the most frequent mutation (17.9%), followed by 35delG (17.0%) and 167delT (0.4%). The mutations in the GJB2 gene were present in 50.7% of the autosomal recessive group and in 33.3% of the sporadic cases. CONCLUSIONS: Our pilot study showed that 15.3% of institutionalized deaf children in Bogotá have non-syndromic deafness and among them, the frequency of the S199F mutation was higher than reported in previous studies, whereas the frequency of the 35delG is similar to Caucasian populations. The fact that the S199F mutation was the most frequent allele in our study confirms the fact that the prevalence of GJB2 mutations depends on the ethnic origin. We emphasize the need to follow a strict protocol to identify bona fide cases of non-syndromic deafness among individuals with congenital hearing loss in order to identify the molecular basis of this condition.

Isquemia del tronco celíaco y mesentérica superior tras ingesta de cocaína / Tittle

No disponible

Molecular and clinical characterisation of three Spanish families with maternally inherited non-syndromic hearing loss caused by the 1494C->T mutation in the mitochondrial 12S rRNA gene.

Mutations in the 12S rRNA gene of the mitochondrial genome are responsible for maternally inherited non-syndromic hearing loss (NSHL), and for increased susceptibility to the ototoxicity of aminoglycoside antibiotics. Among these mutations, 1555A-->G is the most prevalent in all populations tested so far. Recently, the 1494C-->T mutation was reported in two large Chinese pedigrees with maternally inherited NSHL. In this study, sequencing of the 12S rRNA gene in a Spanish family with maternally inherited NSHL showed the presence of the 1494C-->T mutation. An additional screening of 1339 unrelated Spanish patients with NSHL allowed the authors to find two other families with the mutation. Audiological data were obtained from 17 confirmed 1494C-->T carriers, which showed that the hearing loss was sensorineural, bilateral and symmetrical, with a remarkable variability in age of onset and severity. Three carriers were asymptomatic. Three affected carriers had a history of treatment with aminoglycoside antibiotics. The mitochondrial genome of one affected person from each of these three families was entirely sequenced, and it was established that they belong to different mitochondrial haplogroups (H, U5b, U6a). The study results further support the pathogenic role of 1494C-->T on hearing, and show that this mutation can be found in different Caucasian mitochondrial DNA backgrounds.

Surgical treatment of esophageal leiomyoma: an analysis of our experience.

INTRODUCTION: leiomyoma is the most common benign esophageal neoplasm. Surgical treatment (enucleation) has traditionally been the therapy of choice. The advent of minimally invasive techniques has produced an increase in endoscopic approaches to the detriment of open surgery. OBJECTIVE: the aim of this study was to compare the results obtained with open surgery and with laparoscopic surgery in this kind of pathology. MATERIAL AND METHODS: we performed a retrospective study of all leiomyomas operated for in our center between 1986 and 2004, and obtained 9 cases of esophageal leiomyoma. Four were women and five men, between the ages of 40 and 70, with a mean age of 53.5 years. The most frequent symptoms were heartburn (5 cases), dysphagia (3 cases), and retrosternal pain (3 cases). Surgery was in all the cases an enucleation. An open approach was performed in 5 cases (3 thoracotomies and 2 laparotomies), and an endoscopic approach in 4 (2 thoracoscopies and 2 laparoscopies). RESULTS: the mean postoperative hospital stay was 5.12 days (range 2-8 days). This was shorter for endoscopic approaches versus open surgery (3.25 vs. 7 days). There was no case of esophageal mucosal perforation or reconversion. No death, intraoperative complication, or tumor relapse was described. Only 2 patients had complications: post-surgical thoracic pain, and intestinal obstruction by adhesions 8 years after surgery. CONCLUSION: enucleation is an easier procedure and constitutes the therapy of choice for esophageal leiomyoma. This approach has to be laparoscopic. We think that muscle borders should be closed after enucleation, and that biopsy is not indicated preoperatively.

Tratamiento quirúrgico del leiomioma esofágico: análisis de nuestra experiencia / Surgical treatment of esophageal leiomyoma: an analysis of our experience

Introducción: el leiomioma es el tumor benigno más frecuentedel esófago. Tradicionalmente el tratamiento quirúrgico de estospacientes consistía en la enucleación. El avance en las técnicasmínimamente invasivas ha provocado un aumento del abordajeendoscópico en detrimento de la cirugía abierta.Objetivo: el objetivo del trabajo fue comparar los resultadosobtenidos por vía abierta y por vía laparoscópica en este tipo depatología.Material y métodos: realizamos un estudio retrospectivo delos leiomiomas intervenidos en nuestro centro entre 1986-2004,obteniéndose 9 leiomiomas esofágicos. Cuatro eran mujeres ycinco varones, con unas edades comprendidas entre los 40-70años, siendo la edad media de 53,5 años. Los síntomas más frecuenteseran pirosis (5 casos), disfagia (3 casos) y dolor retroesternal(3 casos). El tratamiento quirúrgico fue en todos los casos laenucleación. En cinco pacientes se realizó un abordaje abierto (3toracotomías y 2 laparotomías) y en 4 casos se realizó una laparoscopia(2 toracoscopias y 2 laparoscopias).Resultados: la estancia hospitalaria postoperatoria oscila entrelos 2-8 días, con una media de 5,12 días, siendo esta menor en elgrupo en el que se realizó cirugía laparoscópica en comparacióncon el grupo de cirugía abierta (3,25-7 días). No existe ningún casode perforación de la mucosa esofágica ni de reconversión. Tampocose describe ningún caso de mortalidad, complicación intraoperatoriani de recidiva tumoral. Dos pacientes presentan algún tipo decomplicaciones: dolor torácico post cirugía, obstrucción intestinalpor bridas 8 años después de la cirugía.Conclusión: la enucleación es un procedimiento fácilmenterealizable y constituye el tratamiento de elección del leiomiomaesofágico. Actualmente el abordaje debe ser laparoscópico. Somospartidarios del cierre de la muscular y bajo nuestro punto devista la biopsia preoperatoria no está indicada

Introduction: leiomyoma is the most common benign esophagealneoplasm. Surgical treatment (enucleation) has traditionallybeen the therapy of choice. The advent of minimally invasivetechniques has produced an increase in endoscopic approaches tothe detriment of open surgery.Objective: the aim of this study was to compare the resultsobtained with open surgery and with laparoscopic surgery in thiskind of pathology.Material and methods: we performed a retrospective studyof all leiomyomas operated for in our center between 1986 and2004, and obtained 9 cases of esophageal leiomyoma. Four werewomen and five men, between the ages of 40 and 70, with amean age of 53.5 years. The most frequent symptoms were heartburn(5 cases), dysphagia (3 cases), and retrosternal pain (3 cases).Surgery was in all the cases an enucleation. An open approachwas performed in 5 cases (3 thoracotomies and 2laparotomies), and an endoscopic approach in 4 (2 thoracoscopiesand 2 laparoscopies).Results: the mean postoperative hospital stay was 5.12 days(range 2-8 days). This was shorter for endoscopic approaches versusopen surgery (3.25 vs. 7 days). There was no case of esophagealmucosal perforation or reconversion. No death, intraoperativecomplication, or tumor relapse was described. Only 2 patientshad complications: post-surgical thoracic pain, and intestinal obstructionby adhesions 8 years after surgery.Conclusion: enucleation is an easier procedure and constitutesthe therapy of choice for esophageal leiomyoma. This approachhas to be laparoscopic. We think that muscle borders shouldbe closed after enucleation, and that biopsy is not indicated preoperatively

Acute appendicitis in an incarcerated crural hernia: analysis of our experience.

INTRODUCTION: The finding of the vermiform appendix within a crural hernia (Amyand s hernia) is a rare entity whose incidence is not described in the literature. OBJECTIVE: The aim of this study was to report our hospital s experience in this kind of pathology. MATERIAL AND METHODS: Between 1993 and 2004, 4,572 acute appendicitis and 372 incarcerated crural hernia cases have been operated on in our hospital. We studied 6 cases of incarcerated crural hernia with vermiform appendix inside. We analyzed in retrospect the following parameters: age, sex, personal history, clinical manifestations, preoperative diagnosis, surgical technique, mean hospital stay, and outcome. RESULTS: All patients were women with a mean age of 78.8 years. Most frequent clinical manifestations included pain and a mass in the right inguinocrural region, of variable intensity and duration. No clinical, laboratory, or radiographic signs help in reaching a correct preoperative diagnosis. General anesthesia and a crural approach are used in most surgical operations. In all cases an appendectomy was performed via the hernia sac, thus proving the presence of acute appendicitis in four of them (66.67%). A prosthetic mesh was used in 3 cases, and one case of wound infection was found. In the other cases we sutured the hernia ring using prolene. CONCLUSION: The finding of the appendix in an incarcerated crural hernia is a rare entity in old women that is difficult to diagnose preoperatively. Treatment includes appendectomy and herniorraphy. The use of prosthetic mesh is controversial.

Apendicitis aguda en una hernia crural incarcerada: análisis de nuestra experiencia / Acute appendicitis in an incarcerated crural hernia: analysis of our experience

Introducción: la presencia del apéndice vermiforme en el interiorde un saco herniario crural (hernia de Amyand) constituyeuna entidad poco frecuente y cuya incidencia no está descrita enla literatura.Objetivo: el objetivo del trabajo es presentar la experiencia denuestro hospital en este tipo de patología.Material y métodos: entre 1993 y 2004 se han intervenidoen nuestro centro 4.572 pacientes de apendicitis aguda y 372 dehernia crural incarcerada. Del total, se van a estudiar 6 casos dehernia crural incarcerada en cuyo interior se encuentra el apéndicevermiforme, analizándose de forma retrospectiva los siguientesparámetros: edad, sexo, antecedentes personales, clínica de presentación,pruebas diagnósticas preoperatorias, técnica quirúrgicaempleada, días de estancia hospitalaria y evolución.Resultados: todos los pacientes eran mujeres con una mediade edad de 78,83 años. En todos ellos la clínica de presentacióncorresponde a dolor y tumoración en región inguinocrural derecha,de intensidad y duración variables. No se observan signos clínicos,analíticos y radiológicos que nos ayuden a realizar un diagnósticopreoperatorio del cuadro. En la mayor parte de lasocasiones se utiliza anestesia general y la vía de abordaje fue lacrural. En todos los casos se realiza la apendicectomía a través delsaco herniario, confirmándose la existencia de apendicitis agudaen 4 de ellos (66,67%). En 3 casos (50%) se utiliza material protésico,observándose un caso de infección de herida quirúrgica y enlos otros 3 casos se sutura el orifico herniario con puntos sueltosde prolene.Conclusión: la presencia del apéndice en una hernia cruralincarcerada es una entidad poco frecuente de mujeres de edadavanzada y difícil de diagnosticar de forma preoperatoria. El tratamientoes la apendicectomía y herniorrafia. El uso de materialprotésico es controvertido

Introduction: the finding of the vermiform appendix within acrural hernia (Amyand’s hernia) is a rare entity whose incidence isnot described in the literature.Objective: the aim of this study was to report our hospital’sexperience in this kind of pathology.Material and methods: between 1993 and 2004, 4,572acute appendicitis and 372 incarcerated crural hernia cases havebeen operated on in our hospital.We studied 6 cases of incarcerated crural hernia with vermiformappendix inside. We analyzed in retrospect the following parameters:age, sex, personal history, clinical manifestations, preoperativediagnosis, surgical technique, mean hospital stay, andoutcome.Results: all patients were women with a mean age of 78.8years. Most frequent clinical manifestations included pain and amass in the right inguinocrural region, of variable intensity and duration.No clinical, laboratory, or radiographic signs help in reaching acorrect preoperative diagnosis.General anesthesia and a crural approach are used in most surgicaloperations.In all cases an appendectomy was performed via the herniasac, thus proving the presence of acute appendicitis in four ofthem (66.67%). A prosthetic mesh was used in 3 cases, and onecase of wound infection was found. In the other cases we suturedthe hernia ring using prolene.Conclusion: the finding of the appendix in an incarceratedcrural hernia is a rare entity in old women that is difficult to diagnosepreoperatively.Treatment includes appendectomy and herniorraphy. The useof prosthetic mesh is controversial

Progesterone receptors: their localization, binding activity and expression in the pig oviduct during follicular and luteal phases.

Estrogens (E) and progesterone (P) are known to require their respective steroid receptors in order to exert structural and functional effects on the oviduct. Cyclic changes in progesterone receptor (PR) localization in the oviductal tissue of female pigs were determined using an immunohistochemical technique with mouse monoclonal antibody mPRI against PR. The variations observed during the estrous cycle in the progesterone receptor (PR) intensity and proportion between ampulla and isthmus probably reflect different response of these regions to progesterone. Immediately before ovulation, during follicular phase, no staining was observed in either the ampulla or the isthmus stroma. However, a low expression of PR in the epithelium of the ampulla was observed. After ovulation, during luteal phase, PR immunostaining was more intense in the whole oviduct. According to immunohistochemical assays, the binding assays for nuclear and cytosolic PR (PRn and PRc, respectively), by using [3H] R5020 at 4 degrees C for 15 h, also showed a higher specific binding during luteal phase. However, the PR mRNA in the oviduct, analyzed by RT-PCR, showed similar levels at both stages of the estrous cycle. Although this methods could not be quantitative, indicate the possibility that a post-transcriptional control could differentially regulate the PR in the pig oviduct.

Construcción y caracterización de un sensor electroquímico de interés médico y farmacológico / Construction and characterization of a electrochemical sensor of interest medical and pharmacologic

La necesidad en la detección de elementos trazas en los fluidos biológicos y en determinados medicamentos ha incrementado la demanda de técnicas cada vez más sensibles y selectivas para tal fin. En la actualidad se requiere de técnicas de análisis que además de ser sensibles y selectivas abaraten el costo del análisis clínico. La técnica electroquímica de Voltometría de Redisolución Anódica (VRA) ha mostrado ser una técnica bastante adecuada para este propósito, si se utilizan sensores electroquímicos específicos. Iones metálicos como Pb²+, Cu²+ y Zn²+ presentes en muestras de orina y semen previamente pretratadas, así como, iones Pb²+ y Cu²+ en preparaciones farmacéuticas fueron detectados simultáneamente utilizado la técnica VRA con un sensor electroquímico construido de carbón vítreo y modificado electroquímicamente con una película delgada de mercurio en el laboratorio

Concurrent herpes simplex type 1 and varicella-zoster in the V2 dermatome in an immunocompetent patient.

A unique feature of herpesviruses is their ability to establish latent infection within the nervous system by colonizing peripheral sensory ganglia, which results in subsequent episodic outbreaks of infection triggered by precipitating events. Despite the latent nature of both herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) within these sensory ganglia, simultaneous outbreaks of these viruses are uncommon. This is generally attributed to the differing reactivation features of these 2 viruses. Four cases of concurrent HSV-1 and VZV infection are described in the literature. We report concurrent infection of HSV-1 and VZV within the same V2 dermatome in an immunocompetent patient.

[Plasma concentration of biochemical markers in pre-eclampsia-eclampsia and its association with the severity of the disease]. / Concentración plasmática de indicadores bioquímicos en la preeclampsia-eclampsia y su asociación con la severidad de la patología.

UNLABELLED: It has been demonstrated that the concentrations of molecules related to endothelial cell dysfunction, coagulation and vasoconstriction are altered in preeclamptic patients, but they have not been evaluated in their relationship with the severity of preeclampsia. OBJECTIVE: To determine the relationship between the plasmatic concentrations of fibronectin ED1+, antithrombin III, prostacyclin and thromboxane, and the severity of preeclampsia. METHODS: Peripheral blood was collected from 215 women in the third trimester of pregnancy, admitted to the Luis Castelazo Ayala Gynecology and Obstetrics Hospital with mild preeclampsia (n = 103), severe preeclampsia (n = 71), HELLP syndrome (n = 25) or eclampsia (n = 16). Plasma aliquots were stored at -70 degrees C until analysis. Fibronectin ED1+ was measured by ELISA; antithrombin III activity was determined using an automated amidolytic technique, and the concentrations of the stable metabolites 6-keto-prostagiandin F1a and thromboxane B2 were measured by RIA. Statistical analysis included ANOVA and logistic regression. RESULTS: Maternal age was similar in all participants. Prematurity and low birth weight were present in the patients with severe preeclampsia, HELLP and eclampsia. The values for fibronectin were similar among the 4 groups of patients. Antithrombin III activity was significantly lower in the patients with HELLP. In patients with severe preeclampsia and HELLP syndrome, prostacyclin (Pc) and thromboxane (Tbx) concentrations were significantly higher, and the Pc/Tbx ratio was lower than in patients with mild preeclampsia. Those patients who had the highest thromboxane levels and the lowest Pc/Tbx ratio had a higher chance to develop severe preeclampsia or HELLP (5 times), as well as to have premature babies (12 times) than patients with mild preeclampsia. CONCLUSIONS: Our study demonstrates relationships among antithrombin III activity, prostacyclin and thromboxane concentrations, and the severity of preeclampsia. These compounds were significantly more altered in patients with HELLP syndrome, probably due to a higher organic and vascular dysfunction. Plasma determination of these compounds may be valuable as a tool in the screening of preeclampsia, and as an indicator of severity of the disease.

Antisulfatide antibodies in neuropathy: clinical and electrophysiologic correlates.

OBJECTIVE: To investigate the clinical and electrophysiologic characteristics of the neuropathy associated with elevated serum antisulfatide antibodies. METHODS: Clinical, electrophysiologic, morphologic, and laboratory data of 25 patients with significantly elevated (>25,600) antisulfatide antibodies were reviewed. RESULTS: Four groups were distinguished based on clinical and electrophysiologic data: Group 1, eight patients with predominantly small fiber sensory neuropathy (32%); Group 2, five patients with mixed large and small fiber sensory neuropathy (20%); Group 3, seven patients with axonal sensorimotor neuropathy (28%); and Group 4, three patients with demyelinating sensorimotor neuropathy (12%). One additional patient had mononeuritis multiplex and one had ALS. An immunoglobulin M (IgM) monoclonal gammopathy was found in 30% of the patients tested, but not in any of the Group 1 patients with small fiber sensory neuropathy. Serum IgM level was elevated in 12 patients, of whom six had a concomitant monoclonal gammopathy. Morphologic studies in five patients showed predominantly axonal degeneration, with three of the patients also exhibiting additional features of demyelination. CONCLUSIONS: Antisulfatide antibodies are associated with several subtypes of peripheral neuropathy. Predominantly sensory or sensorimotor axonal neuropathies are most common in this series, with the sensory component either small fiber or mixed fiber type. A smaller demyelinating group indistinguishable from patients with chronic inflammatory demyelinating polyradiculopathy was also seen. One third of patients had a concomitant IgM monoclonal gammopathy, and approximately one half had elevated serum IgM.