Embolia de arteria carótida común y subclaviobraquial por mixoma. Embolectomía carotídea con éxito / Common carotid and subclavian-brachial artery embolism by mixoma. Successful carotid embolectomy

Introducción. No es frecuente diagnosticar una embolia de carótida a tiempo de tratarse quirúrgicamente. Presentamos un caso de embolia carotídea y subclavia simultánea por mixoma, tratado con éxito en las primeras seis horas. Caso clínico. Mujer de 39 años que consulta por isquemia aguda y grave de mano izquierda, con pulso radial conservado, que presenta simultáneamente un accidente isquémico transitorio hemisférico izquierdo. El ecocardiograma muestra una válvula anterior mitral engrosada y laxa. La arteriografía revela sendas imágenes en carótida común y subclavia izquierdas compatibles con embolia recanalizada y lesiones distales. Se realiza embolectomía urgente de carótida común y humeral de forma simultánea, y se extrae un material trombótico gelatinoso cuyo examen microscópico revela la presencia de celulas estrelladas (lipidic cells), típicas de mixoma. La paciente se recupera sin nuevos eventos neurológicos y con recuperación de la perfusión de la mano. Los estudios cardiológicos posteriores no demuestran restos de trombo o tumor cardíaco. Conclusiones. Aun sin evidencia de tumor cardíaco, el diagnóstico más probable es la embolización de mixoma cardíaco izquierdo. El mixoma es el tumor cardíaco más frecuente y de alto poder embolígeno. Las características del tejido tumoral hacen frecuente encontrar embolias fragmentadas en el mismo eje arterial y lesiones no oclusivas. En esta situación, es posible realizar una embolectomía carotídea para evitar la progresión del émbolo y de los síntomas neurológicos

Introduction. Carotid embolisms are rarely diagnosed in time to treat them surgically. We report a case of simultaneous carotid and subclavian embolism due to myxoma which was successfully treated within the first six hours. Case report. We describe the case of a 39-year-old female who presented due to acute severe ischaemia in the left hand, although the radial pulse was still present, with a transient ischemic attack in the left hemisphere at the same time. Echocardiography studies showed the anterior mitral valve to be thickened and lax. Arteriography images in the left common carotid and subclavian arteries were compatible with a recanalised embolism and distal lesions. An emergency embolectomy was performed simultaneously on both the common carotid and the brachial arteries, and some gelatinous thrombotic matter was removed; a microscopic examination of this material revealed the presence of the lipidic cells that are so typical of a myxoma. The patient recovered with no further neurological events and perfusion of the hand was restored. Further cardiology studies did not show any remains of a thrombus or heart tumour. Conclusions. Despite the lack of evidence for a heart tumour, the most probable diagnosis is embolisation of the left side of the heart due to a myxoma. Myxomas are the most frequent type of heart tumour, with powerful emboligenic properties. The characteristics of tumour tissue mean that it is common to find fragmented emboli in the arterial axis as well as non-occlusive lesions. In this situation, a carotid embolectomy can be performed in order to stem the progress of the embolus and of the neurological symptoms

Corrección endovascular de traumatismos de arteria subclavia y axilar / Endovascular correction of traumatic injuries to the subclavian and axillary arteries

Introducción. Los traumatismos de la arteria subclavia y de la axilar son poco frecuentes, pero de gran importancia por la elevada morbimortalidad que suponen, además de las graves secuelas que se producen por la coexistencia de lesiones asociadas. Los avances de las técnicas endovasculares ponen a nuestra disposición formas de tratamiento menos cruentas que la cirugía convencional. Casos clínicos. Caso 1: varón de 24 años, que sufrió un traumatismo con lesión de arteria subclavia izquierda, en la porción proximal a la arteria vertebral izquierda. La forma de presentación fue con un cuadro de isquemia de la extremidad superior después de sufrir un accidente laboral. Se objetivó, mediante angiografía, rotura intimal de la arteria, que se trató mediante la colocación de stent libre en la arteria subclavia proximal. Caso 2: varón de 52 años, politraumatizado, que sufrió lesión de arteria axilar izquierda con aparición de tumoración pulsátil de gran tamaño, sugestiva de pseudoaneurisma, por lo que se procede a la colocación de stent recubierto, y se sella el punto de fuga. En ambos casos se obtienen buenos resultados radiológicos y sin complicaciones derivadas del procedimiento. Conclusión. A falta de estudios aleatorizados, que ofrezcan resultados a largo plazo, creemos que en casos seleccionados el tratamiento endovascular puede ser una buena opción en el tratamiento de traumatismos de la arteria subclavia y axilar (AU)

Mechanisms other than penicillin-binding protein-2 alterations may contribute to moderate penicillin resistance in Neisseria meningitidis.

Penicillin resistance in Neisseria spp is thought to be generated by the interspecies transfer of genetic material from naturally penicillin-resistant, commensal species. We examined a series of successive transformants with increasing levels of penicillin resistance, obtained by co-cultivation of Neisseria meningitidis derivatives with Neisseria polysaccharea. Our results suggest that, in addition to the well-known decrease in penicillin affinity of penicillin-binding protein-2 (PBP-2), decreased expression of the class 3 porin as well as decreased affinity of PBP-1 may contribute to higher level resistance of N. meningitidis to penicillin G and other beta-lactam compounds.

Transfer of penicillin resistance between Neisseriae in microcosm.

Horizontal gene transfer between commensal and pathogenic Neisseriae is the mechanism proposed to explain how pathogenic species acquire altered portions of the penA gene, which encodes penicillin binding protein 2. These changes resulted in a moderately penicillin-resistant phenotype in the meningococci, whose frequency of isolation in Spain increased at the end of the 1980s. Little has been published about the possibility of this gene transfer in nature or about its simulation in the laboratory. We designed a simple microcosm, formed by solid and liquid media, that partially mimics the upper human respiratory tract. In this microcosm, penicillin-resistant commensal strains and the fully susceptible meningococcus were co-cultivated. The efficiency of gene transfer between the strains depended on the phase of bacterial growth and the conditions of culture. Resistance of penicillin was acquired in different steps irrespective of the source of the DNA. The presence of DNase in the medium had no effect on gene transfer, but it was near zero when nicked DNA was used. Cell-to-cell contact or membrane blebs could explain these results. The analysis of sequences of the transpeptidase domain of PBP2 from transformants, and from donor and recipient strains demonstrated that the emergence of moderately resistant transformants was due to genetic exchange between the co-cultivated strains. Finally, mechanisms other than penA modification could be invoked to explain decreased susceptibility.

[Drug consumption by the elderly: results of population studies]. / Consumo de medicamentos en los ancianos: resultados de un estudio poblacional.

BACKGROUND: To evaluate the magnitude, nature and chronicity of the use of medications on the part of non-institutionalized elderly individuals as well as the complexity of their treatment routine. METHOD: Cross-section study through door-to-door survey of all individuals age 65 or above. Municipality of Villanueva de los Castillejos (Huelva). The surveyor asked the person to show him/her all of the medications he/she was using without overlooking any, recorded the brand name, dosage and frequency with which the medication in question was taken, and the approximate length of time, in months or in years, over which said medication had been taken. Measurement methods were included for the purpose of assessing the complexity of the treatment routine. RESULTS: Information was gathered from 362 subjects (83.8% of the actual population). Of all those surveyed, 83.1% was taking one or more medications daily, for an average (standard deviation) of 2.6 (2.0). Those used most were antihypertensive drugs (41.8%), peripheral vasodilators for circulation to the brain (21.3%), benzodiazepine derivatives (17.4%) and nonsteroid antiinflammatory drugs (14.1%). 91.3% and 46.1% of the subjects who were taking medication daily, had been taking one or more drugs for at least 1 and 5 years, respectively. The medication in question was taken on the average of one to two times a day. Approximately 20% of the population surveyed was taking medication solely when certain symptoms arose, and 7.3% of the drugs were prescribed regularly, but not daily. CONCLUSIONS: The quantity and chronicity of the consumption of medications is high, although comparable to that of other Spanish studies conducted employing similar means and methods. The routine prescribed seems simple for seniors.

[Dependence on self-care and walking of the aged in a rural community]. / Dependencia en el autocuidado y deambulación en los ancianos de una comunidad rural.

OBJECTIVE: To evaluate the dependence on 5 basic daily activities (BDA) and on walking, and their relationship to the frequency of attendance at the family doctor. DESIGN: A crossover study using a home survey of health. SETTING: Town of Villanueva de los Castillejos in Huelva. PARTICIPANTS: Those 65 or over. INTERVENTIONS: The dichotomous form of the Katz Index, with the incontinence item excluded (scores from 0-5), was used. Walking was assessed by the Functional Walking Categories (FWC) of Massachusetts General Hospital. RESULTS: Information on 139 men and 231 women was obtained (85.6% of the actual population). 15.3% (95% CI, 11.3-19.0), 12.4% of the men and 16.9% of the women (p > 0.05), stated their dependence in one or more BDA. 22.5% of the population (95% CI, 18.2-26.8), 8.9% of the men and 30.6% (p = 0.001) of the women, said they found it difficult to walk. CONCLUSIONS: There is a high rate of dependence in the population group. Light dependence is associated with more frequent medical consultations than either independence or severe dependence.

New fimbrial adhesins of Serratia marcescens isolated from urinary tract infections: description and properties.

Fimbriation, hemagglutination and adherence properties were studied in two strains of S. marcescens (ATCC 43820 and 43821) isolated from the urine of two hospitalized patients in two different hospitals. Studies were performed using electron microscopy (EM), fimbrial purification, recombinant DNA and hemagglutination techniques, hydrophobicity and tests of adherence to uroepithelial cells, catheters and glass. In EM, fimbriae of these two strains showed an inner channel and were 11 nm. thick and 0.76-1.08 microns long. Original strains and the clone GH42-pSF192 (recombinant DNA prepared using E. coli GH42 as recipient and the cosmid SuperCos 1 as a vector) versus negative control (E. coli GH42-SuperCos 1) showed mannose-resistant hemagglutination of tanned erythrocytes and yeast, high hydrophobicity (55.4 and 49.6% at 37C versus 22.8%) and high adherence to borosilicate glass (313,000 and 168,000 CFU/cm.2 versus 17,000 CFU/cm.2), catheters (4.7 x 10(6) and 1.0 x 10(6) CFU/cm.2 versus 3.9 x 10(4) CFU/cm.2) and uroepithelial cells (adherence indexes of 3.82 and 3.29 versus 1.25). The properties of the fimbriae studied were different from those previously described in the genus Serratia, and they were designated as MR/T.