[Peritoneal tuberculosis as a complication in a case of unclassifiable myelodysplastic/myeloproliferative disease]. / Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable.

We report the case of a 68-year-old male with a diagnosis of unclassifiable myelodysplatic/myeloproliferative disease (WHO classification), under prolonged steroid treatment and unsuccesful chemotherapy response, who developed progressive asthenia, thoracic pain, minimal efforts dyspnea, and abdominal distension, that initially was suspicious of splenic rupture. Exploratory laparotomy showed multiple peritoneal implants, and a diagnosis of peritoneal tuberculosis was obtained from local biopsy. Definitive diagnosis included a positive result to culture and PCR urine test, together with a possible pleural and splenic tuberculous affectation. Response to tuberculostatic treatment was successful. To the best of our knowledge, this is the first reported case with such characteristics.

Sources of GABAergic input to the inferior colliculus of the rat.

We have studied the GABAergic projections to the inferior colliculus (IC) of the rat by combining the retrograde transport of horseradish peroxidase (HRP) and immunohistochemistry for gamma-amino butyric acid (GABA). Medium-sized (0.06-0.14 microliter) HRP injections were made in the ventral part of the central nucleus (CNIC), in the dorsal part of the CNIC, in the dorsal cortex (DCIC), and in the external cortex (ECIC) of the IC. Single HRP-labeled and double (HRP-GABA)-labeled neurons were systematically counted in all brainstem auditory nuclei. Our results revealed that the IC receives GABAergic afferent connections from ipsi- and contralateral brainstem auditory nuclei. Most of the contralateral GABAergic input originates in the IC and the dorsal nucleus of the lateral lemniscus (DNLL). The dorsal region of the IC (DCIC and dorsal part of the CNIC) receives connections mostly from its homonimous contralateral region, and the ventral region from the contralateral DNLL. The commissural GABAergic projections originate in a morphologically heterogeneous neuronal population that includes small to medium-sized round and fusiform neurons as well as large and giant neurons. Quantitatively, the ipsilateral ventral nucleus of the lateral lemniscus is the most important source of GABAergic input to the CNIC. In the superior olivary complex, a smaller number of neurons, which lie mainly in the periolivary nuclei, display double labeling. In the contralateral cochlear nuclei, only a few of the retrogradely labeled neurons were GABA immunoreactive. These findings give us more information about the role of GABA in the auditory system, indicating that inhibitory inputs from different ipsi- and contralateral, mono- and binaural auditory brainstem centers converge in the IC.

Transient NADPH-diaphorase activity in motor nuclei of the foetal human brain stem.

NADPH-d activity is a marker for neurones which synthesize nitric oxide (NO). In the present paper we study the NADPH-d activity in the human brain stem between 16 and 24 gestational weeks (GW). The adult distribution of NADPH-d containing neurones is established at 24 GW. Between 19 and 21 GW, neurones of the facial, hypoglossal and ambiguus nuclei show transient NADPH-d positivity. Therefore, in the human brain stem there are two chronological patterns of neuronal nitric oxide synthase (NOS) expression, one that appears during prenatal development and persists during the whole life, and another one, present only at a precise foetal moment. The transient NADPH-d activity in motor nuclei suggests that NO is involved in early regulatory processes of the human brain development.

Postnatal development of NADPH-diaphorase activity in the superior colliculus and the ventral lateral geniculate nucleus of the rat.

We have studied the postnatal development of dihydronicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) activity in the superior colliculus (SC) and the ventral lateral geniculate nucleus (LGv) of the rat. We describe two different developmental patterns of NADPH-diaphorase activity. The first pattern, observed in the deep layers of the SC, shows a transient activity during the first week which progressively decreases during the following two weeks. The second pattern is observed in the superficial layers of the SC and in the LGv. They become positive during the first week, their NADPH-d activity increases progressively during the second and third weeks, reaching the adult pattern at the fourth week. On the whole, the developmental chronology of the laminar distribution of NADPH-d in the SC displays an inside-out pattern. Our results suggest that NADPH-d activity may play different roles at different stages of the developing nervous system.

NADPH-d (dihydronicotinamide adenine dinucleotide phosphate diaphorase) activity in geniculo-tectal neurons of the rat.

Retrograde transport of horseradish peroxidase (HRP) and dihydronicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry were used in order to determine whether NADPH-d-positive neurons of the ventral lateral geniculate nucleus (LGv) project to the superior colliculus (SC). Our results show that intensely stained NADPH-d neurons are restricted to the lateral half of the magnocellular division of LGv (LGv-MC), where they represent 50% of the total number of retrogradely labeled neurons. These findings indicate: (1) that LGv provides an important NADPH-d input to SC, and (2) that within the population of geniculo-tectal neurons, which constitute a morphologically well defined neuronal type, there are two different subclasses, one being NADPH-d positive and the other NADPH-d negative.

Estudio de prevalencia de infecciones nosocomiales en una unidad médica de alta especialidad / Study of prevalence of hospital-acquired infections in Medical unit of high speciality

Introducción: En unidades de atención médica de tercer nivel existen factores que propician mayor frecuencia de Infecciones Nosocomiales (IN). Por lo anterior; es fundamental; evaluar periódicamente la sensibilidad de los sistemas de vigilancia epidemiológica; para comprobar su funcionamiento y el logro de objetivos. Objetivo: Conocer la prevalencia puntual de IN de una Unidad Médica de Alta Especialidad; como indicador de las acciones implementadas por la Unidad de Vigilancia Epidemiológica Hospitalaria (UVEH). Así como conocer los factores de riesgo asociados a la prevalencia de IN. Metodología: Es un estudio observacional de tipo transversal. La población estuvo conformada por 383 pacientes hospitalizados. Resultados: Se encontró que el 73.9% tenían procedimientos invasivos terapéuticos. Se identificaron 68 casos con infección nosocomial; lo que corresponde a una prevalecía puntual de 17.8%. Los sitios de IN más frecuentes fueron las bacteremias (38.2%) y neumonías (20.6%). Los microorganismos identificados con mayor frecuencia fueron pseudomona sp; enterobacter aglomerans; serratia marcescens y staphylococo coagulasa negativa; así como Escherichia Coli. Además de ser neonato y lactante otros factores asociados a las IN por RM; fueron el estar inmunocomprometido; el tener catéter venoso por disección; diálisis peritoneal; sonda orogástrica; intubación orotraqueal; ventilación mecánica; nutrición parenteral y el tener una cirugía contaminada. Factores que están significativamente asociados (p = 0.05) al riesgo de IN. Conclusiones: El desarrollo del estudio permitió conocer la prevalencia puntual y caracterizar las IN; como un indicador del funcionamiento de la UVEH; para el establecimiento de medidas de control de infecciones.

Objective: The purpose of this research was to analyze the intIntroduction: Within third level medical attention units, there are factors which lead to a higher frequency of Hospital Infections (HI). Because of this, it is fundamental to assess periodically the epidemiologic surveillance systems sensibilities in order to verify their functionalities as well as the objective achievements. Objective: To assess the prevalence of HI in one high Specialty Medical Units, as an indicator of the actions taken by the Hospital Epidemiologic Surveillance Unit (HESU),and also to assess the risk factors associated with the prevalence of HI. Methodology: Basic observational study with a population of 383 hospitalized patients. Results: We found that 73.9% had invasive processes. We identified 68 cases with Hospital Infection (17.8).The most frequent HI were general bacterial invasions (38.2%) and pneumonias (20.6%).The most frequently identified microorganisms were pseudomona sp, enterobacter aglomerans, serratia marcescens, staphylococcus aureus, and Escherichia coli. Besides to be newborn and nursing other factors associated to IN bt RM they were inmunocomprometed to be, having venous catheter by dissection, peritoneal intubation, mechanical ventilation, parenteral nutrition and having a contaminated surgery, factors that are significantly (p ≤ 0.05) to the risk of IN. Conclusions: This study allowed us assesses and characterize the prevalence of HI as an indicator of the HESU functionality in order to establish infection control measurements.

[Acceptance of recombinant hepatitis B vaccine by health personnel]. / Aceptación de la vacuna recombinante antihepatitis B en el personal sanitario.

OBJECTIVE: To find the level of acceptance of the recombinant anti-Hepatitis B vaccination by our area's health staff as well as the reasons why some staff had not been vaccinated. DESIGN: A descriptive study of a crossover type (cross-sectional), with data-gathering by means of a self-administered questionnaire. SETTING: Primary Care teams (PCT) in Asturias Area III (Avilés county) and their referral hospital. PARTICIPANTS: 379 health workers (115 from PCT and 264 from the referral hospital) from Asturias Area III, with a simple random sample selection based on the Area's staff lists. MEASUREMENTS AND MAIN RESULTS: 34 of the subjects under study stated that they were immune prior to vaccination. Out of those without immunity, and therefore available for vaccination, 77.1% (80.9% doctors, 88.5% nurses and 57.7% auxiliary staff) accepted vaccination. There were no significant differences between PCT and hospital, except for auxiliary staff, for whom there were more vaccinations in the hospital. Doctors and nurses, independently of the work centre, were vaccinated to a significantly greater extent than the auxiliary staff. Among those who were not vaccinated, the main reason for refusing the vaccination was laziness or lack of interest (36.1% in PCT and 44.1% in hospital). CONCLUSIONS: Hepatitis B vaccination in our areas is greater among health staff most exposed to risk of contagion. Despite the high vaccination rate, an important number of staff remain non-vaccinated, mainly because of their own lack of interest. This must be borne in mind when vaccination programmes are being designed.

Nuevos tests diagnósticos en la infección tuberculosa / New diagnostic tests in tuberculous infection

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Tuberculosis peritoneal como complicación en un caso de síndrome mielodisplásico/mieloproliferativo inclasificable / Peritoneal tuberculosis as a complication in a case of unclassificable myelodysplastic/myeloproliferative disease

Presentamos el caso de un paciente de 68 años diagnosticado de síndrome mieloproliferativo/mielodisplásico inclasificable (clasificación OMS), con tratamiento corticoesteroideo prolongado y mala respuesta a terapia citorreductora, que presenta en su evolución un cuadro clínico de astenia progresiva, dolor torácico, disnea a mínimos esfuerzos y distensión abdominal, que hace sospechar inicialmente una rotura esplénica. La laparotomía exploradora pone de manifiesto la existencia de implantes peritoneales múltiples, y la biopsia de éstos es diagnóstica de tuberculosis peritoneal. A ello se añade la positividad del cultivo y la PCR en orina, para Mycobacterium tuberculosis, y la posibilidad de probables afectaciones tuberculosas pleural y esplénica. La respuesta al tratamiento antituberculoso fue favorable. No hemos encontrado en la literatura revisada un caso de características similares

We report the case of a 68-year-old male with a diagnosis of unclassifiable myelodysplatic/myeloproliferative disease (WHO classification),under prolonged steroid treatment and unsuccesful chemotherapy response, who developed progressive asthenia, thoracic pain, minimal efforts dyspnea, and abdominal distension, that initially was suspicious of splenic rupture. Exploratory laparotomy showed multiple peritoneal implants, and a diagnosis of peritoneal tuberculosis was obtained from local biopsy. Definitive diagnosis included a positive result to cultureand PCR urine test, together with a possible pleural and splenic tuberculous affectation. Response to tuberculostatic treatment was successful.To the best of our knowledge, this is the first reported case with such characteristics

Mieloma multiple. Modalidades atipicas. / Multiple myeloma. Atypical modalities

Se muestran dos pacientes que presentan mieloma multiple con un cuadro clinico como se ve en esta enfermedad, pero con un cuadro humoral atipico para estos procesos Se precisan las caracteristicas diagnosticas de estas formas clinicas

Amigdalectomia, apendicectomia y cancer. / Tonsilectomy, appendectomy and cancer

Se analizaron 107 pacientes portadores de algun tipo de neoplasia, que habian sido sometidos a amigdalectomia o a apendicectomia. Se encontro que en 21% de estos pacientes se habia realizado una a ambas de estas intervenciones quirurgicas. Se valoro la importancia de la defensa inmunologica como uno de los factores que intervienen en la proteccion contra el establecimento de los processos neoplasicos, y se propuso que la extirpacion de organos cuya funcion es desconocida, debe someterse a una mejor valoracion

Anemia hemolitica primaquinosensible. / Primaquine-sensitive hemolytic anemia

Se estudiaron dos pacientes que presentaron un sindrome hemolitico despues de la ingestion de primaquina la cual fue administrada para erradicar posible infectacion paludica. Se comprobo una deficiente actividad de la enzima glucosa-6-fosfato-deshidrogenasa (G.6.F.D.) en estos pacientes, por lo que se consideraron como portadores de una anemia de las denominadas primaquinosensibles. Se hicieron consideraciones fisiopatologicas y se recomendo un test de deteccion de la deficiencia de la enzima en los individuos que puedan viajar a zonas paludicas endemica