Optimización de la exploración eco Doppler mediante la manipulación de los controles del equipo (knobology); segunda parte / Doppler ultrasound exploration optimization by manipulating the controls of the equipment: knobology; part two

La ecografía Doppler es una modalidad diagnóstica que depende de un operador indispensable por disponibilidad, eficacia, coste y no invasividad. Además de conocimientos anatómicos y clínicos, exige un mínimo conocimiento de sus principios físicos y tecnológicos. Este artículo intenta repasar y esquematizar cómo ajustar las principales aplicaciones del equipo en la exploración Doppler mediante los botones y los controles (knobology). Complementa a la primera parte ya editada, en la que se explicaban los ajustes en la exploración en modo B. Realizar una exploración con una postura adecuada, que evite lesiones en el explorador (ergonomía), permite también aumentar nuestro rendimiento laboral. Conocer, entrenar y ajustar las funciones del eco Doppler de forma ordenada teniendo en cuenta al paciente y el estudio indicado hará que nuestras exploraciones sean más sencillas, rápidas, seguras y precisas.(AU)

Doppler ultrasound is an operator-dependent diagnostic modality, essential due to availability, efficacy, costs and non-invasive test. In addition to anatomical and clinical knowledge, it requires a minimum knowledge of its physical and technological principles. This article attempts to review and outline how to adjust the main applications of the equipment in Doppler scanning, using the buttons and controls (knobology). It complements the first part already edited, where the adjustments in the exploration in B mode were explained.Carrying out an examination with a suitable posture, which avoids injuries to the explorer (ergonomics), also allows us to increase our work performance. Knowing, training and adjusting the echo Doppler functions in an orderly manner, considering the patient and the indicated study, will make our examinations easier, faster, safer and more precise.(AU)

Optimización de la exploración eco Doppler mediante la manipulación de los controles del equipo (knobology); primera parte / Doppler ultrasound exploration optimization by manipulating the controls of the equipment: knobology; part one

La ecografía Doppler es una modalidad diagnóstica dependiente de un operador indispensable por disponibilidad, eficacia y costes. además de conocimientos anatómicos y clínicos, exige un mínimo conocimiento de sus principios físicos y tecnológicos. Conocer, practicar, ajustar las funciones del eco Doppler de forma ordenada y en función del paciente y de la exploración indicada harán que nuestras exploraciones sean más sencillas, rápidas, seguras y precisas. este artículo de formación intenta repasar y esquematizar cómo ajustar las principales aplicaciones del equipo mediante los botones y controles del dispositivo ("knobology").(AU)

doppler ultrasound is an operator-dependent diagnostic modality, essential due to its availability, efficacy and costs.in addition to anatomical and clinical knowledge, it requires a minimum knowledge of its physical and technologicalprinciples. the knowledge, training, and set up the functions of the duplex scan in a properly way depending onthe patient and kind of exploration, will make our examinations easier, faster, safer, and more precise. this papertries to review and outline how to adjust the main applications of the equipment using the buttons and controlsof the device (knobology).(AU)

Increasing antibiotic resistance in preservative-tolerant bacterial strains isolated from cosmetic products.

To ensure the microbiological quality, consumer safety and organoleptic properties of cosmetic products, manufacturers need to comply with defined standards using several preservatives and disinfectants. A drawback regarding the use of these preservatives is the possibility of generating cross-insusceptibility to other disinfectants or preservatives, as well as cross resistance to antibiotics. Therefore, the objective of this study was to understand the adaptive mechanisms of Enterobacter gergoviae, Pseudomonas putida and Burkholderia cepacia that are involved in recurrent contamination in cosmetic products containing preservatives. Diminished susceptibility to formaldehyde-donors was detected in isolates but not to other preservatives commonly used in the cosmetics industry, although increasing resistance to different antibiotics (ß-lactams, quinolones, rifampicin, and tetracycline) was demonstrated in these strains when compared with the wild-type strain. The outer membrane protein modifications and efflux mechanism activities responsible for the resistance trait were evaluated. The development of antibiotic-resistant microorganisms due to the selective pressure from preservatives included in cosmetic products could be a risk for the emergence and spread of bacterial resistance in the environment. Nevertheless, the large contribution of disinfection and preservation cannot be denied in cosmetic products.

Increasing antibiotic resistance in preservative-tolerant bacterial strains isolated from cosmetic products

To ensure the microbiological quality, consumer safety and organoleptic properties of cosmetic products, manufacturers need to comply with defined standards using several preservatives and disinfectants. A drawback regarding the use of these preservatives is the possibility of generating cross-insusceptibility to other disinfectants or preservatives, as well as cross resistance to antibiotics. Therefore, the objective of this study was to understand the adaptive mechanisms of Enterobacter gergoviae, Pseudomonas putida and Burkholderia cepacia that are involved in recurrent contamination in cosmetic products containing preservatives. Diminished susceptibility to formaldehyde-donors was detected in isolates but not to other preservatives commonly used in the cosmetics industry, although increasing resistance to different antibiotics (β-lactams, quinolones, rifampicin, and tetracycline) was demonstrated in these strains when compared with the wild-type strain. The outer membrane protein modifications and efflux mechanism activities responsible for the resistance trait were evaluated. The development of antibiotic-resistant microorganisms due to the selective pressure from preservatives included in cosmetic products could be a risk for the emergence and spread of bacterial resistance in the environment. Nevertheless, the large contribution of disinfection and preservation cannot be denied in cosmetic products (AU)

No disponible

Pseudoaneurisma tras autotrasplante renal. Corrección endovascular / Pseudoaneurysm following kidney autotransplantation. Endovascular correction

Introducción. Los pseudoaneurismas son una rara complicación después de un trasplante renal y prácticamente son excepcionales tras cirugía de banco y autotrasplante. En presencia de dichas lesiones se considera obligatoria su corrección con objeto de evitar el riesgo potencial de complicaciones mortales asociadas a la ruptura diferida del pseudoaneurisma. La reparación convencional es un procedimiento complejo que puede verse dificultado por los problemas inherentes asociados a una redirección. Caso clínico. Mujer de 52 años con un pseudoaneurisma de arteria ilíaca desarrollado tras cirugía ex vivo y autotrasplante renal por aneurisma de arteria renal. Las pruebas de imagen pusieron de manifiesto la lesión arterial en la ubicación de un bypass ilíacorrenal concomitante a la cirugía previa. La corrección endovascular del pseudoaneurisma se llevó a cabo mediante la liberación de un stent cubierto. La arteriografía de control mostró la completa exclusión del pseudoaneurisma de arteria ilíaca y la preservación completa del flujo en la arteria renal reconstruida. Conclusión. La exclusión del pseudoaneurisma con preservación completa del flujo del riñón trasplantado pone de relieve la potencial utilidad del tratamiento endovascular en pacientes seleccionados

Introduction. Pseudoaneurysms are a rare complication after a kidney transplant and are practically unknown following bench surgery and autotransplantation. Such lesions must be corrected in order to avoid the potential risk of fatal complications that are associated with the delayed rupture of a pseudoaneurysm. Conventional repair is a complex procedure that can be further complicated by the problems inherent to any intervention involving redirection. Case report. A 52-year-old female with a pseudoaneurysm in the iliac artery that developed after ex vivo surgery and kidney autotransplantation due to an aneurysm in the renal artery. Imaging tests showed the arterial lesion to be situated at the site of an iliac-renal bypass that had been carried out during the previous intervention. Endovascular correction of the pseudoaneurysm was performed by deploying a covered stent. The control arteriography showed the complete exclusion of the pseudoaneurysm in the iliac artery and full preservation of blood flow in the reconstructed renal artery. Conclusion. The exclusion of the pseudoaneurysm with full preservation of flow in the transplanted kidney highlights the potential value of endovascular treatment in selected patients

Paraganglioma de nervio vago / Paraganglioma of the vagal nerve

Introducción. Los paragangliomas de nervio vago son tumores derivados de células de la cresta neural de muy baja incidencia, normalmente benignos y de crecimiento lento. Caso clínico. Mujer de 74 años con masa laterocervical dolorosa, de crecimiento rápido en el último mes con afectación múltiple de pares craneales y de cadena simpáticocervical. Se realizan exploraciones complementarias, tomografía axial computarizada y arteriografía, y se diagnostica paraganglioma cervical. Previamente a la cirugía, se embolizan las ramas de la arteria carótida externa que nutren el tumor y posteriormente se extirpa el tumor, que tiene su origen en el nervio vago, se reseca éste, así como la arteria carótida externa y la vena yugular interna. La anatomía patológica se informa como paraganglioma de nervio vago. No se sobreañaden lesiones neurológicas después de la cirugía. Conclusión. El paraganglioma de nervio vago es el tumor de esta estirpe que presenta mayor afectación neurológica postoperatoria, y esto también depende del tamaño del tumor. La embolización preoperatoria puede ser beneficiosa, pues reduce la vascularización de la masa y, por tanto, el sangrado operatorio. En ocasiones puede llegar a ser necesaria la realización de reconstrucción arterial

INTRODUCTION. Paragangliomas of the vagal nerve are tumours derived from cells in the neural crest that are normally benign, and have low incidence and slow growth rates. CASE REPORT. We report the case of a 74-year-old female with a painful laterocervical mass which grew quickly over the last month with multiple involvement of cranial nerves and the cervical sympathetic chain. Complementary explorations were conducted including computerised axial tomography scans and arteriography, and a cervical paraganglioma was diagnosed. Prior to surgery, the branches of the external carotid artery that nourish the tumour were embolised and the tumour, which has its origins in the vagal nerve, was later removed. This nerve is then resected, as is the external carotid artery and the internal jugular vein. Clinical pathology reported the case as one of vagal nerve paraganglioma. No further neurological lesions occurred after the intervention. CONCLUSION. Of this kind of strain of tumours vagal nerve paraganglioma is the one that has the greatest post-operative neurological involvement, and this also depends on the size of the tumour. Pre-operative embolisation can have beneficial effects as it reduces the vascularisation of the mass and therefore bleeding during surgery. It sometimes becomes necessary to carry out arterial reconstruction

Current trends in cosmetic microbiology

No disponible

No disponible

Molecular analysis of isoniazid and rifampin resistance in Mycobacterium tuberculosis isolates recovered from Barcelona.

We studied the presence of mutations in the whole katG gene and specific regions of the oxyR-ahpC and mabA-inhA regulatory region in 61 Mycobacterium tuberculosis isoniazid-resistant isolates. An 81-bp region of the rpoB gene was also sequenced in 17 rifampin-resistant strains. Alterations in the katG gene were detected in 55% of the isolates. Mutation in codon 315 was the most prevalent (32%). Strains showed a high level of resistance, and most maintained a substantial catalase-peroxidase activity. Three strains with an isoniazid MIC of >or=32 microg/ml lacked catalase-peroxidase activity. Two of them had deletions in the catalytic domain of the KatG protein. One strain with deletion and three strains with mutations in the C-terminal domain showed low-level resistance and conserved the catalase-peroxidase activity. Mutations in the mabA-inhA regulatory region were identified in 32% of the isolates. All had low-level resistance, and the vast majority conserved catalase-peroxidase activity. Seventeen percent of the isoniazid-resistant isolates had no detectable alterations at the studied loci. Resistance to rifampin was associated with mutations in the 81-bp of the rpoB gene in all cases. IS6110 analysis indicated that recent transmission contributed substantially to the emergence of isoniazid- resistant tuberculosis in Barcelona through short transmission chains. A rapid genotypic assay, including the 315-katG codon and the -15 nucleotide of the mabA-inhA regulatory region, may cover 62% of isoniazid- resistant strains in Barcelona. In contrast, the targeting of the 81-bp region of rpoB would detect all our rifampin-resistant isolates.

Direct detection in clinical samples of multiple gene mutations causing resistance of Mycobacterium tuberculosis to isoniazid and rifampicin using fluorogenic probes.

BACKGROUND: This study evaluates a method based on real-time PCR for direct detection in clinical samples of the common mutations responsible for isoniazid and rifampicin resistance of Mycobacterium tuberculosis. METHODS: Six pairs of fluorogenic 5' exonuclease probes (Taqman), mutated and wild-type, were designed for six targets: codon 315 of katG, substitution C209T in the regulatory region of inhA, and codons 513, 516, 526 and 531 of rpoB. RESULTS: A total of 98 clinical samples harbouring resistant bacilli from 55 patients and 126 samples harbouring susceptible bacilli from 126 patients were processed. The isolates from samples were tested for drug susceptibility with the radiometric method and sequenced for the same genetic targets. Among the samples, 93 harboured isoniazid-resistant bacilli. According to the sequencing results, 30 had mutations in katG, 30 in inhA and 33 (35.4%) had no mutations in these targets. All 27 clinical specimens harbouring rifampicin-resistant bacilli showed mutations in rpoB. The detection threshold of this method in detecting target genes in serial dilutions of artificial samples was 1.5 x 10(3) cfu/mL. In clinical samples, the sensitivity ranged from 30.4 to 35.3% for smear-negative samples and from 95.1 to 99.2% for smear-positive samples, with a specificity of 100%. In this study, the overall sensitivity in detecting patients having the target mutations was 74.3%. CONCLUSIONS: The main advantage of the described method is the possibility of detecting rifampicin and isoniazid resistance within 48-72 h after sample collection, with a sensitivity of nearly 100% in smear-positive samples if the chosen target is responsible for the resistance.

Usefulness of a new mycobacteriophage-based technique for rapid diagnosis of pulmonary tuberculosis.

A new mycobacteriophage-based technique (PhageTek MB) was compared with standard culture and staining techniques for diagnosis of pulmonary tuberculosis. A total of 2,048 respiratory specimens from 1,466 patients collected from February 2000 to March 2001 were studied by both (i) conventional methods (direct microscopic examination [auramine-rhodamine fluorochrome], and culture in BacT/ALERT 3D and solid media) and (ii) the PhageTek MB assay. This phenotypic test utilizes specific mycobacteriophages to detect the presence of live Mycobacterium tuberculosis complex organisms within a decontaminated clinical sample. Overall, 205 (10%) specimens were positive for mycobacteria (134 patients): 144 (70.2%) M. tuberculosis isolates and 61 (29.8%) nontuberculous mycobacterium isolates (30 Mycobacterium kansasii, 12 Mycobacterium xenopi, 9 Mycobacterium gordonae, 7 Mycobacterium avium complex, 2 Mycobacterium chelonae, and 1 Mycobacterium fortuitum isolate). PhageTek MB was more likely to give a positive result with specimens in which high numbers of acid-fast bacilli were observed on the smear. The sensitivity, specificity, and positive and negative predictive values of this mycobacteriophage-based technique versus culture for M. tuberculosis were 58.3, 99.1, 83.2, and 96.9%, respectively. PhageTek MB is a rapid (48-h), specific, safe, and easy-to-perform test. According to the prevalence of the disease in the population studied, the test would require improved sensitivity in order to be used as a screening test for routine diagnosis of respiratory tuberculosis in our setting.