Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

PURPOSE: To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). METHODS: A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). RESULTS: Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22 months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medically treated (p > 0.05). CONCLUSION: DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.

[Management of congenital adduct clubfoot with the Ponseti technique. Experience at "La Perla" General Hospital]. / Manejo del pie equinovaro aducto congénito con técnica de Ponseti. Experiencia en el Hospital General "La Perla".

UNLABELLED: The purpose of this paper is to present the experience of the hospital using the Ponseti method in patients with congenital adduct clubfoot. MATERIAL AND METHODS: The study was conducted between January 2007 and December 2009. Children of both sexes were included; the Dimeglio classification was applied before surgery and their course was later assessed with the Simons scale when they resumed gait. Patients with postural clubfoot (Dimeglio I) and those with neuromuscular disease (Dimeglio IV) were excluded. Casts were placed as of 15 days of age using the Ponseti technique and then percutaneous tenotomy of the calcaneous tendon was performed in the operating room. RESULTS: Twenty patients (9 girls, 11 boys) and 28 feet were included in the study; they were Dimeglio II (8 children) and III (12 children). Mean age at the time of surgery was 2 months, and mean age at the time of gait assessment was 2 years. Upon applying the Simons scale, 25 feet (89.3%) had satisfactory results and 3 feet (10.7%) unsatisfactory results. Two of the latter underwent percutaneous tenotomy again and in one case the cast was applied again; they evolved properly. CONCLUSIONS: We found in our series that the Ponseti technique is appropriate as definitive treatment for Dimeglio II and III congenital adduct clubfoot.

[Pars plana vitrectomy, phacoemulsification and intraocular lens implantation for the management of cataract and proliferative diabetic retinopathy: comparison of a combined versus two-step surgical approach]. / Vitrectomía pars plana, facoemulsificación e implante de lente intraocular para el manejo de catarata y retinopatía diabética proliferativa: comparación de técnica quirúrgica combinada versus en dos tiempos.

PURPOSE: To report the intra-and postoperative complications and visual acuity outcomes in pars plana vitrectomy (PPV), phacoemulsification and intraocular lens (IOL) implantation in patients with cataract and proliferative diabetic retinopathy (PDR). A comparison of the combined versus two-step surgical approach is given. METHOD: Retrospective uncontrolled interventional clinical trial. Forty-eight eyes of 48 consecutive patients with PDR were included. Twenty-eight (58.3%) eyes with combined surgery and 20 (41.7%) eyes with sequential surgery were analyzed. RESULTS: Postoperative follow-up time was between 6 and 63 months (mean: 18 months). 1) Combined surgery: Preoperative best-corrected visual acuity (BCVA) ranged from 20/200 to hand motions, and postoperative BCVA ranged from 20/30 to hand motions. BCVA improved in 17 eyes (60.7%), while in 7 (25%) eyes there was no change (> or =2 ETDRS lines) in VA, and in 4 (14.3%) eyes BCVA decreased. Postoperative complications included vitreous hemorrhage (VH) in 10 (35.7%) eyes, and fibrinous exudation in 9 (32.1%) eyes. 2) Two-step surgery: Preoperative BCVA ranged from 10/200 to light perception, and from 20/40 to light perception in the postoperative period. Best-corrected visual acuity improved in 15 (75%) eyes, remained the same in 4 (20%) eyes, and decreased in 1 (5%) eye. Postoperative complications included fibrinous exudation in 6 (30%) eyes, and VH in 3 (15%) eyes. CONCLUSION: Combined PPV, phacoemulsification and IOL implantation as well as the two-step procedure are safe and effective for the management of cataract in PDR. Sequential surgery could be advantageous to BCVA outcomes by minimizing postoperative VH, which is significantly more frequent after combined surgery.

Intravitreal bevacizumab (Avastin) for proliferative diabetic retinopathy: 6-months follow-up.

AIMS: To study the effects of intravitreal bevacizumab (Avastin) on retinal neovascularization (RN) in patients with proliferative diabetic retinopathy (PDR). METHODS: Retrospective study of patients with RN due to PDR who were treated with at least one intravitreal injection of 1.25 or 2.5 mg of bevacizumab. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. RESULTS: Forty-four eyes of 33 patients with PDR and a mean age of 57.2-years (range: 23-82 years) participated in the study. Thirty-three eyes (75%) had previous panretinal photocoagulation (PRP). Twenty-seven eyes (61.4%) showed total regression of RN on fundus examination with absence of fluorescein leakage, 15 eyes (34.1%) demonstrated partial regression of RN on fundus examination and FA. Follow-up had a mean of 28.4 weeks (range from 24 to 40 weeks). BCVA and OCT demonstrated improvement (P<0.0001). Three eyes without previous PRP ('naive' eyes) and with vitreous haemorrhage have avoided vitreo-retinal surgery. One eye (2.2%) had PDR progression to tractional retinal detachment requiring vitrectomy, and one eye (2.2%) had vitreous haemorrhage with increased intraocular pressure (ghost cell glaucoma). No systemic adverse events were observed. CONCLUSIONS: Intravitreal bevacizumab resulted in marked regression of RN in patients with PDR and previous PRP, and rapid resolution of vitreous haemorrhage in three naive eyes. Six-months results of intravitreal bevacizumab at doses of 1.25 or 2.5 mg in patients with PDR do not reveal any safety concerns.

Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy.

AIMS: The aim of this study was to report the development or progression of tractional retinal detachment (TRD) after the injection of intravitreal bevacizumab (Avastin) used as an adjuvant to vitrectomy for the management of severe proliferative diabetic retinopathy (PDR). METHODS: The clinical charts of patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 mg bevacizumab before vitrectomy for the management of PDR were reviewed. RESULTS: Eleven eyes (patients) out of 211 intravitreal injections (5.2%) that developed or had progression of TRD were identified. All eyes had PDR refractory to panretinal photocoagulation (PRP). Nine patients had type 1 diabetes mellitus (DM), and two patients had type 2 DM. Patients had a mean age of 39.5 years (range 22-62 years). In the current study, all patients used insulin administration and had poor glycaemic control (mean HbA(1c) 10.6%). Time from injection to TRD was a mean of 13 days (range 3-31 days). Mean best correct visual acuity (BCVA) at TRD development or progression was logarithm of the minimal angle of resolution (LogMAR) 2.2 (range 1.0-2.6) (mean Snellen equivalent hand motions; range 20/200 to light perception), a statistically significant worsening compared with baseline BCVA (p<0.0001). Eight eyes underwent vitrectomy and three patients refused or were unable to undergo surgery. The final mean BCVA after surgery was LogMAR 0.9 (range 0.2-2.0) (mean Snellen equivalent 20/160; range 20/32 to counting fingers), a statistically significant improvement compared with TRD BCVA (p = 0.002). CONCLUSIONS: TRD may occur or progress shortly following administration of intravitreal bevacizumab in patients with severe PDR.

Optical coherence tomography characteristics of full-thickness traumatic macular holes.

PURPOSE: The objective of this paper is to describe the optical coherence tomography (OCT) characteristics of patients with full-thickness traumatic macular hole (TMH) and to correlate them with biomicroscopy findings. METHODS: Twelve eyes of ten consecutive patients with full-thickness TMH participated in this observational retrospective multicentre study. Patients underwent biomicroscopic fundus examination, colour fundus photography, and OCT. RESULTS: Traumatic macular hole was documented with OCT in five women and five men. Mean (range) time between trauma and macular hole (MH) diagnosis was 8.1 (1-24) months. The shape of TMHs was round in 11 (91.7%) eyes. The posterior vitreous was completely detached in six (50%) eyes, and with an operculum in one (8.3%) eye. The common findings seen on OCT were: (1) full-thickness loss of retinal tissue through the hole with sharp edges, perpendicular to the retinal pigment epithelium in five (41.7%) eyes; (2) TMH with an operculum totally detached from the hole's edge in two (16.7%) eyes; (3) presence of epiretinal membrane around of the hole in three (25%) eyes; and (4) presence of abnormalities of the surrounding retina in all (100%) eyes. The OCT characteristics correlated well with biomicroscopic findings, and these characteristics may be predictive for final visual acuity (VA) in TMHs. Only one of the TMHs closed spontaneously in our series. CONCLUSION: Optical coherence tomography complements biomicroscopy in the evaluation of full-thickness TMHs.

Productos naturales con actividad antimicótica / Natural products with antimycotic activity

En las últimas décadas se ha observado no sólo un notable aumento de las infecciones causadas por hongos en todo el mundo sino un incremento de la resistencia farmacológica que han mostrado varias especies de hongos a los diferentes antimicóticos que se utilizan en la práctica médica. Esta situación ha llevado a la búsqueda de nuevos antifúngicos de origen natural. En recursos naturales, como plantas, insectos y organismos marinos y terrestres, se han identificado una serie de moléculas con actividad contra diferentes géneros y especies de hongos de importancia clínica para los humanos, convirtiéndose en alternativa para el desarrollo y la formulación de nuevos fármacos antimicóticos con menores efectos secundarios, mayor espectro de acción y menor costo que los disponibles actualmente para el tratamiento de las infecciones por hongos. En este artículo se presenta una revisión de las principales fuentes naturales de moléculas con actividad antimicótica (AU)

In the past few decades, a worldwide increase in the incidence of fungal infections has been observed and the resistance of some species of fungus to different fungicidals used in medical practice has also risen. This has led to the search for new antimycotics, particularly those obtained from natural sources such as plants, insects, and land and marine microorganisms. In these natural sources, a series of molecules with antifungal activity against different species of fungus of great clinical importance for humans has been found, and these substances have become an alternative for the development and formulation of new antifungals with fewer side effects, a greater spectrum of action and lower cost than those in current use. In this article, we review the main sources of molecules with antimycotic activity obtained from natural sources (AU)

[Natural products with antimycotic activity]. / Productos naturales con actividad antimicótica.

In the past few decades, a worldwide increase in the incidence of fungal infections has been observed and the resistance of some species of fungus to different fungicidals used in medical practice has also risen. This has led to the search for new antimycotics, particularly those obtained from natural sources such as plants, insects, and land and marine microorganisms. In these natural sources, a series of molecules with antifungal activity against different species of fungus of great clinical importance for humans has been found, and these substances have become an alternative for the development and formulation of new antifungals with fewer side effects, a greater spectrum of action and lower cost than those in current use. In this article, we review the main sources of molecules with antimycotic activity obtained from natural sources.

Localization of the initial developmental stages of Loma salmonae in rainbow trout (Oncorhynchus mykiss).

The intracellular microsporidian parasite Loma salmonae affects salmonids of the genus Oncorhynchus and is a significant cause of economic losses in pen-reared Chinook salmon (O. tshawytscha) in British Columbia. Loma salmonae infection is easily recognized by the xenomas that form in the gills, but early stages of infection are difficult to detect in histologic sections. In situ hybridization (ISH), using an L. salmonae-specific digoxigenin-labeled single-stranded DNA probe, was used to detect the parasite during the early stages of infection. Loma salmonae was detected in the gut mucosal epithelium as early as 24 hours postexposure (PE), and it localized in the lamina propria of the intestine within 24 hours of infection. After the parasite was detected in the lamina propria, dividing merogonic stages in infected cells in the heart were detected by ISH as early as 2 days PE, providing the first evidence of parasitaemia and hematogenous distribution of this parasite in infected blood cells. The parasites inside the infected cells appeared to be undergoing merogony as they passed through the heart, indicating that proliferation may start at the site of infection, before the parasite arrives to the gills for their final developmental phase. This is the first time that L. salmonae passage through the intestinal wall and migration to the heart has been visualized; however, the identity of the cells harboring the parasite has yet to be determined.

[Pigment dispersion syndrome in a patient with megalocornea]. / Slndrome de dispersión pigmentaria en paciente con megalocórnea.

CASE REPORT: A case of a patient of 12 years old with megalocornea and bilateral pigment dispersion syndrome is reported. An ultrasound biomicroscopic study was performed with the UBM 840 (Zeiss-Humphrey, 50 MHz) and an iris concavity with an iridolenticular and iridozonular contact was observed. A new exam after pilocarpine instillation drops showed the resolution of the iris concavity, zonular and lenticular contact. DISCUSSION: The anterior chamber configuration of this patient analyzed with ultrasound biomicroscopy allowed us to understand the mechanism of the pigment dispersion syndrome.

Granuloma piogénico: reporte de dos casos de aparición inusual y revisión de la literatura / Pyogenic granuloma: report of two cases and review of the literature

El granuloma piogénico es una lesión benigna, reactiva y multifactorial, que resulta de injurias repetitivas, microtraumatismo e irritación local sobre piel o membranas mucosas. Cuando aparece en la cavidad tiene predilección por la encía vestibular, pero es importante que el odontólogo esté en conocimiento y se familiarice con el hecho de que puede localizarse en otras zonas anatómicas, es por esto que hacemos referencia en el presente artículo de dos casos de localización inusual, conjuntamente con una revisión de la literatura

Nonisotopic detection of Loma salmonae (microspora) in rainbow trout (Oncorhynchus mykiss) gills by in situ hybridization.

Loma salmonae, a microsporidian parasite of salmonids of the genus Oncorhynchus, is a significant cause of economic loss in pen-reared chinook salmon (O. tschawytscha). Final stages of L. salmonae infections are easily recognized by the xenomas that form in the gills during sporogony. However, early prexenoma stages of infection (3 weeks or less after infection) are difficult to detect on histologic slides. An L. salmonae-specific single-stranded DNA probe labeled with digoxigenin was used to detect these prexenoma stages of L salmonae by in situ hybridization in experimentally infected rainbow trout. This method allows detection of the parasite in the gills only 2 weeks after infection, providing a sensitive and specific way of detecting L. salmonae during the early stages of infection.

A preliminary investigation of alternatives to fumagillin for the treatment of Loma salmonae infection in rainbow trout.

The effects of the following six treatments against Loma salmonae, a microsporidian gill pathogen, were examined in rainbow trout: fumagillin (high dose), pyrimethamine + sulphaquinoxaline, albendazole, amprolium, fumagillin (low dose), and metronidazole. The fish were infected by mouth and the treatments were administered at intervals for a period of several weeks. The results were assessed on the basis of (1) delay in the formation of xenomas, and (2) the number of xenomas per gill arch. The first five treatments, in descending order of efficacy, delayed the formation of xenomas (P<0.01), but metronidazole had no such effect. Fumagillin (high or low dose) and albendazole both reduced the number of xenomas present 10 weeks after infection (P<0.01), but the other three treatments did not do so. From these results, both fumagillin and albendazole appeared to be of potential value in controlling L. salmonae infection in trout.

[Long-term follow up of patients with nodal reentry tachycardia who had undergone radiofrequency ablation]. / Seguimiento a largo plazo de pacientes con taquicardia por reentrada nodal a quienes se les realizó una ablación por radiofrecuencia.

INTRODUCTION: The aim of this study was to assess the long term results (minimum of 3 years) of radiofrequency catheter ablation in patients with common (slow-fast) atrioventricular nodal reentrant tachycardia. PATIENTS AND METHODS: Sixty consecutive patients (mean age 56 +/- 16 years, range 14 to 83, 16 men and 44 women) underwent slow pathway (n = 51, Group A) or fast pathway (n = 9, Group B) radiofrequency catheter ablation between January 1992 and March 1994. All patients were followed at 1, 3, 6 and 12 months after ablation with serial examinations and electrocardiograms and the last follow-up was made on April 1997. RESULTS: During a mean follow-up period of 48 +/- 7 months (range 38 to 63) all evaluated patients remained asymptomatic. Eight recurrences were observed at a mean of 1 +/- 2 months (range, 0.5 to 7) after a successful ablation procedure. A second procedure was effective in eliminating the dual atrioventricular nodal pathway in each of them. In Group A patients, the pre-ablation PR interval, at 12 months after ablation and at last follow-up were 122 +/- 11, 124 +/- 13 and 124 +/- 15 ms, respectively. In Group B patients, the pre-ablation PR interval, at 12 months after ablation and at last follow-up were 130 +/- 24, 200 +/- 12, 200 +/- 24 ms, respectively. No significant atrioventricular conduction disturbances in any patient were observed. One patient developed a new onset left bundle branch block and 4 patients died of noncardiac causes. CONCLUSIONS: In patients with atrioventricular nodal reentrant tachycardia, radiofrequency catheter ablation is a safe and effective therapy, with substantial good results that persist during long term follow-up, with a low recurrence rate and without complications during short and long term outcome.

Morphometric assessment of epidermal and mucous-biofilm changes caused by exposure of trout to chloramine-T or formalin treatment.

Juvenile rainbow trout were exposed to therapeutic concentrations of formalin or chloramine-T to assess the effects of these chemicals on the morphology of the piscine epidermis and its mucous coat. Repeated treatment, once weekly for 4 weeks, with either chemical did not affect the mucous coat of the epithelium or the degree of folding of the basal lamina. However, treated fish had increased numbers of highly dense vesicles within the apical portions of epithelial cells. The epidermal mucous cells of chloramine-T-treated fish were significantly smaller than in controls. This effect was not noted in formalin-treated fish. Treatment with either chemical resulted in a significantly thinned epidermis. It is concluded that although chloramine-T and formalin may continue to be useful in the aquaculture industry they cause potentially harmful alterations to fish skin.

Incidence and prognostic significance of right bundle branch block in patients with acute myocardial infarction receiving thrombolytic therapy.

We assessed the incidence and prognostic significance of right bundle branch block (RBBB) in patients with acute myocardial infarction (AMI) receiving thrombolytic therapy. A prospective, one-year follow-up study involving 681 consecutive patients treated with thrombolytic agents for AMI was performed. Seventy-four patients developed RBBB (46% new-onset, 24% old and 30% indeterminate). RBBB was more common in older patients with large anterior AMI. New-onset RBBB were often transient (56%) and 84% of them resolved within 12 h after admission. Complicating events during the hospital phase, such as ventricular arrhythmias and development of heart failure, were more frequent in patients with RBBB. In-hospital and one-year mortality were higher in patients with RBBB (22.9 and 40.5% compared to 7.9 and 12.3% respectively in patients without block, both p<0.001). New-onset, non-transient RBBB were associated with the highest mortality rates (73% at one-year follow-up). By multivariate analysis, RBBB was retained as independent predictor of in-hospital and one-year mortality. We conclude that new-onset RBBB in patients receiving thrombolytic therapy for AMI is often transient. The development of RBBB has a negative and independent prognostic impact on the survival during the hospital phase and at one-year follow-up.

Adaptation of a fluorocarbon-based non-aqueous fixation regime for the ultrastructural study of the teleost epithelial mucous coat.

Studies on the microanatomy of the mucus-rich biofilm surface of normal or damaged teleost skin tissue have been limited because conventional fixation regimes do not effectively retain mucus during tissue preparation. A non-aqueous fixation method, based on a technique devised to retain airway mucous for ultrastructural study, and consisting of the use of an inert perfluorocarbon solvent with osmium teroxide 1%, was successfully used to prepare skin tissues of healthy juvenile rainbow trout. The skin's mucous coat was examined by transmission electron microscopy and the results were compared with those obtained with tissues prepared by a conventional glutaraldehyde-based method. In samples fixed with glutaraldehyde, the cell-surface structures retained were limited to microridges and a poorly discernible glycocalyx layer. In contrast, those fixed by the non-aqueous method had a more clearly demonstrated glycocalyx layer, and a second fibrillar layer, resembling mucus, which was separated from the glycocalyx layer by an electron-lucent zone.

Characterization of telomeric regions from Ustilago maydis.

The isolation of telomeres from the phytopathogenic fungus Ustilago maydis is described. The telomeric repeat from the plant Arabidopsis thaliana, TTTAGGG, cross-hybridizes to Bal31-sensitive fragments of U. maydis DNA and detects many or all of the U. maydis chromosomes separated by pulsed-field gel electrophoresis (PFGE). This telomeric repeat was used to screen a library enriched for chromosome ends. Three clones were isolated which contained the tandemly repeated sequence TTAGGG. This sequence is identical to some known telomere repeats found in humans and other vertebrates as well as in some protozoa and moulds. In addition, the three telomeric clones had an almost identical 376 bp segment of middle-repeated telomere-associated sequences adjacent to the telomeric repeat. This segment hybridized to many or all U. maydis chromosomes separated by PFGE and showed a hybridization pattern in genomic digestions similar to that of the telomeric repeat. These results indicate that in U. maydis the same segment of telomere-associated sequences is located adjacent to the telomeric repeat in many or all chromosomes, which suggests that it may have a common role in chromosome function.

Astrocyte cytoarchitecture in cochlear nuclei of the rat: an immunocytochemical study.

Astrocytes play important roles in the development, maintenance and function of neural circuits. We have studied the astrocytic cytoarchitecture of the adult rat cochlear nuclei using a monoclonal antibody against glial fibrillary acidic protein, a well-known intermediate filament of the cytoskeleton of the glial cells. The cochlear nuclear complex is the first central step in the ascending auditory pathway. The morphology and distribution of astrocytes, as well as the relationship of astroglial processes with neurons, have been found to be different in the three main subdivisions of the cochlear nuclei and could be related to their function.

Synaptophysin immunoreactivity in the cochlear nuclei of mammals: a comparative study.

Synaptophysin is a Ca(2+)-binding glycoprotein located in the presynaptic membrane and synaptic vesicles. This glycoprotein has been also involved in the release of neurotransmitters. The presence of synaptophysin within the cochlear nuclear complex of several animal species was analyzed. Differences in size and neuronal density of the cochlear nuclei were observed between the animal species studied. In fact, cat and rat cochlear nuclei showed a very similar morphology and neuronal distribution, while mouse, hamster and guinea pig exhibited important differences. The morphology and arrangement of synaptic boutons, for each neuronal type considered, were similar among species.