Endometriosis pélvica-linfática simulando: cáncer de ovario avanzado / Pelvic-lymphatic endometriosis simulating: neoplasms of advanced ovary

La endometriosis es una enfermedad que afecta a la mujer en edad fértil. Consiste en tejido endometrial fuera del abdomen. Los estimados actuales indican que fluctúa entre el 2 y el 10 por ciento en la edad reproductiva. Alrededor de un 30 a 40 por ciento de las mujeres con endometriosis no son fértiles, siendo una de las causas de infertilidad femenina. La endometriosis ganglionar es un fenómeno infrecuente. Más raro aún es hallar Endometriosis Linfática - Ganglionar simulando un cáncer de ovario avanzado.

Leishmaniasis as an opportunistic infection in HIV-infected patients: determinants of relapse and mortality in a collaborative study of 228 episodes in a Mediterreanean region.

The clinical presentation of visceral leishmaniasis shares similarities with other geographically specific infectious diseases associated with AIDS in terms of relapsing course and atypical presentation. However, visceral leishmaniasis has not, until now, been included in the AIDS case definition. The aim of this study was to describe the clinical features and determinants for relapse and case-fatality of visceral leishmaniasis in HIV-infected patients from a Spanish Mediterranean area. A chart review was conducted in 16 hospitals in the autonomous communities of Valencia and Murcia (Spain). From 1988 to 2001, a total of 228 episodes of visceral leishmaniasis were diagnosed in 155 HIV-infected patients by the detection of amastigotes in bone marrow aspirates or in other tissue samples. Most patients had advanced HIV disease, with a median CD4(+) lymphocyte cell count of 55 cells x 10(9) l, and 56% of them had a previous AIDS-indicator disease. The median duration of follow-up was 8.4 months. HIV-infected patients with visceral leishmaniasis presented with fever (76%), hepatomegaly (77%), splenomegaly (78%), and varying degrees of cytopenias. Leishmania was detected in atypical sites in 22 (14%) patients. A total of 37 (24%) patients had a relapse of visceral leishmaniasis. Female gender was a risk factor for relapse, whereas administration of secondary prophylaxis for visceral leishmaniasis and a completed therapy for visceral leishmaniasis were protective factors against relapse. A total of 86 (54%) patients died. Independent determinants for survival were CD4(+) lymphocyte cell count, completed therapy for leishmania, and secondary prophylaxis for visceral leishmaniasis. The findings show that, in HIV-infected patients, visceral leishmaniasis occurs in late stages of HIV disease and often has a relapsing course. Secondary prophylaxis reduces the risk of relapse. Visceral leishmaniasis in the HIV-infected population should be included in the CDC clinical category C for the definition of AIDS in the same way that other geographically specific opportunistic infections are included.

[Evaluation of patients who do not visit neurology units]. / Evaluación de los pacientes no presentados a las consultas de neurología.

AIMS: Our aim was to study the relation between non-attendance at neurology units and the delay that exists, as well as the demographic factors that may come to bear on non-attendance. PATIENTS AND METHODS: Data on neurology outpatients over the period between November and December 2002 were collected prospectively. Both patients who were referred for evaluation and those on their first programmed visit were included in the study. RESULTS: The total number of subjects was 1,035, with an average age of 55.31 +/- 19.84 (14-96). Of these, 605 were females and 430 were males, with no significant differences in the age of the two groups. 40% of the cases came from rural areas. 237 (22.9%) did not attend the visit. We found a statistically significant relation between age and non-attendance (t=2.67; p=0.008, Student's t). There was also a relation between not going to the visit and the delay that existed (t=5.84; p=0.000, Student's t). Patients who were referred from the Casualty department missed their visit more often those who were sent by their GP (Pi2=2.4; p=0.07, chi2). The date on which they received the appointment was also related to non-attendance (t=2.55; p=0.011, Student's t). CONCLUSIONS: Non-attendance was associated, above all, with the delay, with youth, being sent from casualty and with the length of time since they received notice of the visit.

Evaluación de los pacientes no presentados a las consultas de neurología / Evaluation of patients who do not attend visits at neurology units

Objetivo. Estudiar la relación entre no comparecer a las consultas de neurología y la demora existente, así como con los factores demográficos que pueden influir en la no comparecencia. Pacientes y métodos. Se recogieron de forma prospectiva los datos de las consultas externas de neurología de los meses de noviembre y diciembre de 2002. Se incluyeron los pacientes que se remitieron para la valoración como primera visita programada. Resultados. El número de pacientes fue de 1.035, con una edad media de 55,31 ± 19,84 (14-96). De éstos, 605 fueron mujeres y 430 hombres, sin diferencias significativas en la edad de ambos grupos. Un 40% de los casos provenían del área rural. No se presentaron 237 (22,9%). Encontramos una relación estadísticamente significativa entre la edad y no comparecer (t = 2,67; p = 0,008, t de Student). También había relación entre no acudir a la consulta y la demora existente (t = -5,84; p = 0,000, t de Student). Los pacientes remitidos desde Urgencias fallaron más que los enviados por el médico de familia (P 2 = 2,4; p = 0,07, c 2). La fecha en la que recibieron la citación se relacionó con la falta de comparecencia (t = -2,55; p = 0,011, t de Student). Conclusiones. La falta de comparecencia se asoció sobre todo con la demora, con la juventud, el procedimiento de Urgencias y con el tiempo desde que se notificó la citación (AU)

Aims. Our aim was to study the relation between non-attendance at neurology units and the delay that exists, as well as the demographic factors that may come to bear on non-attendance. Patients and method: Data on neurology outpatients over the period between November and December 2002 were collected prospectively. Both patients who were referred for valuation and those on their first programmed visit were included in the study. Results. The total number of subjects was 1,035, with an average age of 55.31 ± 19.84 (14-96). Of these, 605 were females and 430 were males, with no significant differences in the age of the two groups. 40% of the cases came from rural areas. 237 (22.9%) did not attend the visit. We found a statistically significant relation between age and non-attendance (t = 2.67; p = 0.008, Student's t). There was also a relation between not going to the visit and the delay that existed (t = -5.84; p = 0.000, Student's t). Patients who were referred from the Casualty department missed their visit more often those who were sent by their GP (P 2 = 2.4; p = 0.07, c 2). The date on which they received the appointment was also related to non-attendance (t = -2.55; p = 0.011, Student's t). Conclusions. Non-attendance was associated, above all, with the delay, with youth, being sent from casualty and with the length of time since they received notice of the visit (AU)

Visceral leishmaniasis in lung transplantation.

Infection by intracellular microorganisms with a special geographic distribution, such as Leishmania spp, has been reported in a limited number of patients undergoing solid-organ transplant (SOT). No cases of Leishmania spp infection in lung transplant patients were found in a review of the literature. In our series of 222 lung or heart and lung transplantations performed from February 1990 to October 2002, two cases of visceral leishmaniasis (VL) were diagnosed and treated with liposomal amphotericin B. All cases reported to date in transplant patients, including the ones discussed here, occurred in people living in or traveling to countries in the Mediterranean area. We therefore consider it advisable to include serological testing for latent infection due to Leishmania spp in pretransplantation screening for our geographical setting, despite the limited return of this strategy.

Nuevo caso de infección por VIH-2 en la Comunidad Valenciana / New case of HIV-2 in the Valencia Community

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[Subacute endocarditis caused by Actinobacillus actinomycetemcomitans]. / Endocarditis subaguda por Actinobacillus actinomycetemcomitans.

BACKGROUND: We describe the cases of endocarditis caused by Actinobacillus actinomycetemcomitans (EAA) observed at our hospital. PATIENTS AND METHODS: We revised clinical records and microbiological documents from patients admitted at our hospital, with A. actinomycetemcomitans in blood cultures occurred from 1972-1998. We used Dukes's diagnostic criterion of infectious endocarditis. RESULTS: Four patients were diagnosed of EAA for twelve years, there were males and two females. Two cases have had valvular prosthesis and three patients suffered a previous odontological manipulation. All cases were clinical subacute presentation. Two patients have had at a distance endocarditis clinical manifestation (neurological deficit and Osler nodules). All patients were febrile and elevation of acute reactants, two cases had inflammatory anemia and one had cardiac failure. We observed growing signs after 7 days of culture and it was necessary, on solid medium, adequate atmosphere and nutritional composition to procure A. actinomycetemcomitans growing. All isolates were susceptible to studied penicillins or aminopenicillins (except one isolate with intermediate susceptibility), aminoglycosides and quinolones. Treatment with penicillin G, lone or combined with aminoglycosides, controlled infection in three patients. No case needed cardiac surgery. CONCLUSIONS: In our experience, EAA is a strange entity and there isn't a previous cardiac disease always. Usually, the place of entrance is a buccal focus. Subacute-chronic course and, sometimes, uncommon, can delay diagnostic during months. Our isolates have an uniform sensibility to penicillins and others betalactamic, anyway aminoglycosides and quinolones, therefore an antibiotic combination of two antibiotics from these families at least could be the choice treatment. Except evolutive complications in some patient, prognostic has been excellent with only antibiotic treatment, without valvular surgery.

[Coronary involvement in Takayasu's arteritis]. / Afectación coronaria en la arteritis de Takayasu.

Takayasu's arteritis is a chronic inflammatory disease that primarily affects young women. Cardiac involvement is infrequent and it includes aortic regurgitation, pericarditis, angor pectoris or myocardial infarction due to coronary narrowing and cardiac heart failure due to coronary involvement and/or high blood pressure. A patient with Takayasu's aortitis and angina pectoris due to severe narrowing of the left coronary arterial ostia is described.

[Urologic manifestations in patients with acquired immunodeficiency syndrome]. / Manifestaciones urológicas en pacientes con el síndrome de inmunodeficiencia adquirido.

In order to know the incidence and nature of urological conditions in the Acquired Immunodeficiency Syndrome, a revision was made of 223 clinical histories from patients admitted to our hospital between 1998 and 1992. Some 24.6% developed urological conditions with prevalence of unspecific urinary infections, though several types of specific infections, immunological, neoplastic, neurourological and nephrological changes were also found as well as other conditions not caused by the disease, such as renal lithiasis. We noted that, although involvement of urinary tract in AIDS is not well defined, its frequency is high, since up to one fourth of patients are affected by different disorders.

[Severe self-limiting hypersensitivity reaction after immunotherapy with intravesical BCG]. / Severa reacción de hipersensibilidad autolimitada tras inmunoterapia con BCG intravesical.

We present the case of a 67-years-old patient diagnosed of superficial vesical transitional carcinoma which, under immunotherapy with intravesical BCG, developed a severe hypersensitivity reaction with spontaneous resolution. We describe several adverse reactions after the administration of intravesical BCG, as well as its diagnostic and therapeutic problems, especially in the cases of hypersensitivity.

[Seminal changes in unilateral cryptorchism: course after orchidopexy. Experimental study]. / Alteraciones seminales en la criptorquidia unilateral: evolución tras orquidopexia. Estudio experimental.

The present study was conducted to determine the reversibility of the seminal alterations following experimental unilateral cryptorchidism in relation to the time orchiopexy is performed. Two groups of 45 Wistar rats were subjected to mechanical unilateral cryptorchidism followed by prepubertal, early and late orchiopexy, respectively. A third group of 45 animals was subjected to a sham operation. We analyzed the semen obtained separately from both epididymal tails of subgroups of 15 animals at 2.5, 5 and 8 months for the number of spermatozoa, percentage of motile spermatozoa, survival time and the number of heads and tails of loose spermatozoa. The statistical analysis of the results by variance analysis showed that the significant reduction of the number of spermatozoa and the percentage of motile forms observed in the ex-cryptorchid testis at age 2.5 months in both groups of animals that were subjected to a testicular retention had been completely recovered at age 5 months. A significant reduction of the percentage of motile spermatozoa at age 2.5 months was observed in the contralateral testis of animals subjected to a longer period of retention. This alteration was also found normalized at age 5 months. In conclusion, experimentally, pre-pubertal orchiopexy preserves fertility at an adult age, regardless of the timing of the procedure.

[Fecundity following prepubertal orchiopexy in unilateral cryptorchism. Experimental study]. / Fertilidad tras orquidopexia prepuberal en la criptorquidia unilateral. Estudio experimental.

Study of fecundation ability following unilateral experimental cryptorchism as a function of the timing of orchiopexy. Two groups of 45 Wistar rats underwent unilateral mechanical cryptorchism and early and late prepuberal posterior orchyopexy, respectively. A third group of 45 rats underwent a dummy intervention. Mating taking place in subgroups of 15 animals at different ages showed that in the experimental animal, and therefore in any non-dysgenetic test, orchiopexy performed at the prepuberal period allows preservation of fecundation ability.

[Porphyria cutanea tarda and human immunodeficiency virus infection]. / Porfiria cutánea tarda e infección por el virus de la inmunodeficiencia humana.

Recently, cases of porphyria cutanea tarda (PCT) have been reported associated with infection due to human immunodeficiency virus (HIV). We presented the cases of three males, former ethanol users, and which have had previously a contact with the Hepatitis B virus. In one of the patients symptomatology appeared after treatment with zidovudine was begun. We suggest that HIV infection associated with other toxic or viral factors could contribute to the early development of a PCT latent until that moment.

[Isolated mesenteric tuberculosis as the first manifestation of AIDS]. / Tuberculosis mesentérica aislada como primera manifestación de SIDA.

We report a case of mesenteric tuberculosis. Two painful abdominal masses and fever were the first manifestation of disease. Diagnosis was obtained by aspirative punction of a mesenteric adenopathy guided by ultrasonography. AIDS risk factors were not recognized by anamnesis but serum HIV antibodies were detected. Thus, extrapulmonary tuberculosis and the finding of HIV-Ab confirmed the diagnosis of AIDS in our patient. It is necessary to assay for HIV-Ab in extrapulmonary tuberculosis, especially when mesenteric tuberculosis is present.