Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient.

Organ transplant recipients living in endemic regions are at increased risk of Leishmania infections. Visceral leishmaniasis is the most common kind of presentation in the Mediterranean basin. Rarely, Leishmania infantum may cause localized mucosal disease. We present the first case, to our knowledge, of a liver transplant recipient with localized mucosal leishmaniasis. Twenty-two years after transplantation, a painless, very slow growing ulcer appeared on the inner side of the patient's upper lip. A biopsy performed in the community hospital showed non-specific chronic inflammation without neoplastic signs. Because of a high suspicion of malignancy, the patient was transferred to the referral hospital to consider complete excision. The excisional biopsy revealed a granulomatous inflammatory reaction together with intracellular Leishmania amastigotes within macrophages. Leishmaniasis was confirmed by the nested polymerase chain reaction assay. The clinical and laboratory findings did not suggest visceral involvement. The patient received meglumine antimoniate for 21 days without relevant adverse effects.

Application of real-time PCR for the differentiation of Entamoeba histolytica and E. dispar in cyst-positive faecal samples from 130 immigrants living in Spain.

In an effort to improve the diagnosis of intestinal amoebiasis, a real-time PCR has been used for the detection and differentiation of Entamoeba histolytica and E. dispar infections in African or South American immigrants who live in Spain. Faecal samples from all of the 130 subjects had apparently been found to contain E. histolytica/E. dispar cysts by microscopical examination. Using the real-time PCR, E. histolytica DNA was detected in faecal samples from only 10 (7.7%) of the immigrants, with E. dispar DNA detected in the samples from another 117 (90.0%) of the subjects. The use of such PCR in the routine investigation of patients found positive for E. histolytica/E. dispar cysts (by microscopy) is recommended, especially in non-endemic areas.

Low concentrations of nitric oxide increase oxygen affinity of sickle erythrocytes in vitro and in vivo.

The hallmark of sickle cell disease (SCD) is the polymerization of deoxygenated sickle hemoglobin (HbS). In SCD patients, one strategy to reduce red blood cell (RBC) sickling is to increase HbS oxygen affinity. Our objective was to determine if low concentrations of nitric oxide (NO) gas would augment the oxygen affinity of RBCs containing homozygous HbS (SS). Blood containing normal adult hemoglobin (AA) or SS RBCs was incubated in vitro in the presence of varying concentrations of NO up to 80 ppm, and oxygen dissociation curves (ODCs) were measured. In addition, blood was obtained from three AA and nine SS volunteers, before and after breathing 80 ppm NO in air for 45 min, and the ODCs were measured. Exposure of SS RBCs to 80 ppm NO in vitro for 5 min or longer decreased the partial pressure of oxygen at which hemoglobin is 50% saturated with oxygen (P50), an average of 15% (4.8+/-1.7 mmHg mean+/-SE; P < 0.001). The increase in SS RBC oxygen affinity correlated with the NO concentration. The P50 of AA RBCs was unchanged (P > 0.1) by 80 ppm NO. In SS volunteers breathing 80 ppm NO for 45 min, the P50 decreased (P < 0.001) by 4.6+/-2.0 mmHg. 60 min after NO breathing was discontinued, the RBC P50 remained decreased in five of seven volunteers in whom the ODC was measured. There was no RBC P50 change (P > 0.1) in AA volunteers breathing NO. Methemoglobin (Mhb) remained low in all subjects breathing NO (SS Mhb 1.4+/-0.5%), and there was no correlation (r = 0.02) between the reduction in P50 and the change in Mhb. Thus, low concentrations of NO augment the oxygen affinity of sickle erythrocytes in vitro and in vivo without significant Mhb production. These results suggest that low concentrations of NO gas may offer an attractive new therapeutic model for the treatment of SCD.

[Primary localized amyloidosis of glans penis. A new case and review of the literature]. / Amiloidosis primaria localizada en glande peneano. Caso clínico y revisión de la literatura.

Primary localized amyloidosis urinary tract is rare. Localized amyloidosid only glands is a very rare entity. The clinical impression may resemble neoplastic disease but the diagnosis is confirmed by histochemical study. Biopsy of the lesion revealed dermal deposits of amorphous eosinophilic material. A case of patient with primary amyldosis of glands penis is reported. The literature is reviewed and the diagnostic and therapeutic options are discussed. This is the seventh reported case of localized amyloidosis of the glands penis.

[Haemophilus spp. antimicrobial susceptibility in Health Area 6 in Madrid, Spain (2000-2004)]. / Sensibilidad antibiotica de Haemophilus spp. en el Area 6 de la Comunidad de Madrid (2000-2004).

The aim of this study was to assess the antimicrobial susceptibility of 1370 Haemophilus spp. (1051 H. influenzae and 319 H. parainfluenzae) isolated during a 4-year period (July 2000 to June 2004) and to compare the results with other nationwide Spanish surveillance studies. The rate of isolation of H. parainfluenzae was significantly higher in clinical samples from the genitourinary tract (p <0.00001) and skin and soft tissues (p <0.00001), whereas H. influenzae was significantly more frequent in clinical respiratory tract samples (p <0.00001). A total of 46.2% and 31.8% of H. influenzae were isolated in infants and children of 2-6 years old, respectively; whereas 73.3% of H. parainfluenzae was isolated in patients older than age 14. Overall, 22.2% and 18.5% of the H. influenzae and H. parainfluenzae, respectively, were found to produce betalactamase. A total of 1.9% of betalactamase-negative H. influenzae were found to be resistant to ampicillin. Four strains (0.4%) of betalactamase-producing H. influenzae were resistant to amoxicillin-clavulanic acid, all isolated from infants. The rate of ampicillin susceptibility was significantly higher (p <0.01) in H. parainfluenzae than in H. influenzae. All of the 1370 strains of Haemophilus spp. were susceptible to cefotaxime and ciprofloxacin. The susceptibility to clarithromycin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicol and rifampin were 86.9%, 61.5%, 96.7%, 99.1% and 95.2% for H. influenzae versus 81.2%, 55.8%, 76.5%, 90,9% and 733% for H. parainfluenzae. In conclusion, H. influenzae is more resistant to ampicillin and H. parainfluenzae to non-betalactam antimicrobials. All isolates were susceptible to cefotaxime and ciprofloxacin.

Effect of high frequency oscillatory ventilation on fluid filtration rate in isolated perfused rabbit lungs.

We have studied the effect of changing ventilatory frequency (VF) of high frequency oscillatory ventilation (HFOV) on fluid filtration rate (FFR) in twelve isolated rabbit lungs perfused at constant blood flow. Mean pulmonary artery pressure (Ppa), mean left atrial pressure (Pla), airway pressure (Paw), pulmonary vascular resistance (PVR), pH, O2 and CO2 partial arterial pressures (PaO2 and PaCO2) and plasma colloid osmotic pressure (COP), were measured. We ventilated the lungs with a modified Bird Mark 7 ventilator which could achieve HFOV (range 5-30 Hertz). In each experiment VF was randomly varied on ten different occasions, maintaining each variation for ten minutes. The first group of six rabbits was ventilated under normal haemodynamic conditions. The other six rabbits were ventilated after the production of hydrostatic lung oedema. Blood gas exchange in both groups of rabbits was satisfactory. There was no statistically significant correlation between VF and FFR. We conclude that variations in VF using HFOV does not alter lung fluid balance in normal and in hydrostatic oedema rabbit lungs.

High-speed running performance is largely unaffected by hypoxic reductions in aerobic power.

We tested the importance of aerobic metabolism to human running speed directly by altering inspired oxygen concentrations and comparing the maximal speeds attained at different rates of oxygen uptake. Under both normoxic (20.93% O2) and hypoxic (13.00% O2) conditions, four fit adult men completed 15 all-out sprints lasting from 15 to 180 s as well as progressive, discontinuous treadmill tests to determine maximal oxygen uptake and the metabolic cost of steady-state running. Maximal aerobic power was lower by 30% (1.00 +/- 0.15 vs. 0.77 +/- 0.12 ml O2. kg-1. s-1) and sprinting rates of oxygen uptake by 12-25% under hypoxic vs. normoxic conditions while the metabolic cost of submaximal running was the same. Despite reductions in the aerobic energy available for sprinting under hypoxic conditions, our subjects were able to run just as fast for sprints of up to 60 s and nearly as fast for sprints of up to 120 s. This was possible because rates of anaerobic energy release, estimated from oxygen deficits, increased by as much as 18%, and thus compensated for the reductions in aerobic power. We conclude that maximal metabolic power outputs during sprinting are not limited by rates of anaerobic metabolism and that human speed is largely independent of aerobic power during all-out runs of 60 s or less.

[Bacterial conjunctivitis: most prevalent pathogens and their antibiotic sensitivity]. / Conjuntivitis bacteriana: patógenos más prevalentes y sensibilidad antibiótica.

INTRODUCTION: Bacterial conjunctivitis is a self-limiting process, but topical antibiotic treatment is recommended to eradicate the pathogen and reduce symptom duration. Since this treatment is usually empirical and prior cultures are not normally taken, the etiological agents involved in the process are unknown. PATIENTS AND METHODS: A total of 596 conjunctival exudates from pediatric outpatients with a diagnosis of acute conjunctivitis in Medical Area 6 of Madrid, Spain, were studied over 3 years (from 2000 to 2002 inclusive). The patients were divided into three age groups: group 1 (infants), group 2 (2- to 6-year-olds) and group 3 (7- to 14-year-olds). RESULTS: A total of 428 bacteria were isolated. The most prevalent bacteria were Haemophilus influenzae (44.8 %) and Streptococcus pneumoniae (30.6 %) followed by Staphylococcus aureus (7.5 %), S. viridans (7.2 %), Moraxella catarrhalis (6.8 %) and Enterobacteriaceae (4.2 %). In 56 exudates (15.1 %), two or more bacteria were isolated and S. pneumoniae 1 H. influenzae were found in 8.1 % of the cases. By age group, S. aureus was significantly more prevalent (p < 0.0001) in group 3 than in groups 1 and 2. Isolation of Enterobacteriaceae, S. viridans and non-fermentative Gram negative bacilli was significantly more frequent (p < 0.05) in group 1 and isolation of S. pneumoniae (p < 0.05) was significantly more frequent in group 2. S. pneumoniae showed the greatest level of resistance to antibiotics used in eye drops and ophthalmic ointments. Ciprofloxacin, chloramphenicol and rifampin were active in the most prevalent pathogens. CONCLUSIONS: The most prevalent bacteria were H. influenzae and S. pneumoniae. The most active antibiotics in these pathogens were ciprofloxacin, chloramphenicol and rifampin.

[Extracorporeal shock-wave lithotripsy. An established treatment]. / Litotricia extracorpórea por ondas de choque. Un tratamiento establecido.

Extracorporeal shock wave lithotripsy (ESWL) is the most required urinary stone therapy in our country and in the rest of the world. In a way it has replaced the alternative treatments (open surgery, percutaneous nephrolithectomy, ureteroscopy). Nevertheless these therapeutic approaches have still its own indications. Although there is no a definitive agreement, it should be desirable a world-wide consensus where each therapy will have a exactly defined land with all potential of each management improved. We review ESWL technical aspects, its literature-based most accepted indications, adverse bioeffects and last, future improvements are considered.

[Effect of the administration of intralipid on liquid filtration rate and pressure of the pulmonary artery in isolated lung of rabbits]. / Efecto de la administración de Intralipid en la tasa de filtración de líquido y en la presión de la arteria pulmonar en el pulmón aislado de conejo.

INTRODUCTION: We study the effect on Intralipid on pulmonary circulation. METHODS: A 10% infusion of Intralipid was administered at a dose of 0.5/kg in 14 isolated rabbit lungs in which constant blood flow infusion was carried out principally in zone 3. The liquid filtration rate (LFR) and the mean pressure of the pulmonary artery were measured. RESULTS: A constant increase of mean pressure of the pulmonary artery was observed following the infusion (from 12.32 +/- 3.66 cm of H2O to 39.92 +/- 07.68 cmH2O (p < 0.01) which was associated to a significant increase in the rate of liquid filtration (from 0.018 +/- 0.01 g/min to 0.198 +/- 0.04 g/min; p < 0.01). CONCLUSIONS: The administration of Intralipid produces a statistically significant increase of mean pressure of the pulmonary artery and the rate of liquid filtration. This is probably caused by vasoconstriction due to metabolic changes produced by Intralipid on pulmonary circulation.

Effect of hypercapnia on fluid filtration rate during forward and reverse perfusion of isolated rabbit lungs.

Fluid filtration rate (FFR) was measured under predominantly zone-three conditions in isolated rabbit lung perfused at constant flow. During forward and reverse perfusion, alveolar hypercapnia significantly increased mean pulmonary artery pressure but did not change FFR. We conclude that the pulmonary vasoconstriction induced by alveolar hypercapnia occurs on both arterial and venular sides of the pulmonary circulation.

Effect of lipoxygenase and cyclo-oxygenase inhibition on oleic acid-induced lung oedema.

The contribution of cyclo-oxygenase and 5-lipoxygenase metabolites on hemodynamics and oedema formation was investigated in 21 isolated rabbit lungs after a 10 min Oleic Acid (OA) infusion, by recording the changes on Fluid Filtration Rate (FFR) and Pulmonary Artery Pressure (PAP). Lungs (n = 7) were pre-treated with indomethacin (cyclo-oxygenase inhibitor) 50 min prior to OA or with Diethylcarbamazine (5-lipoxygenase inhibitor) (n = 7) or not pre-treated at all (control group, n = 7). The FFR in the indomethacin group was significantly greater than in the control and Diethylcarbamazine (DEC) groups 12 min after OA (7.6 +/- 2.3 mg.min-1 vs. 2.3 +/- 0.8 mg.min-1 and 0.96 +/- 0.8 mg.min-1 respectively) (P < 0.01). The FFR in the control lungs 20 min after OA was significantly greater than the corresponding DEC value (4.2 +/- 0.5 mg.min-1 vs. 1.6 +/- 1.0 mg.min-1) (P < 0.01). Mean Pulmonary Artery Pressure (MPAP) increased both in control and indomethacin groups (16.0 +/- 2.0 Torr to 24.3 +/- 3.7 Torr after 20 min OA and 14.4 +/- 2.5 Torr to 24.6 +/- 3.6 Torr at 10 min after OA, respectively), but MPAP value in DEC group did not significantly change 30 min after OA (14.7 +/- 1.5 Torr to 16.0 +/- 2.3 Torr) (P > 0.05). So we conclude that the selective inhibition of the 5-lipoxygenase metabolites (leukotriene-5hete) may play a protective role in OA induced oedema, whereas the selective inhibition of the cyclo-oxygenase pathway may have a deleterious effect on the hemodynamics and endothelial permeability in our experimental condition.

Inhaled nitric oxide improves survival rates during hypoxia in a sickle cell (SAD) mouse model.

BACKGROUND: The hallmark of sickle cell disease (SCD) is erythrocyte sickling during deoxygenation of the abnormal hemoglobin S (HbS). When HbS is deoxygenated, it aggregates into polymers, resulting in distortion of the erythrocyte structure, producing microvascular thrombosis and ischemia. The transgenic SAD mouse produces three types of human hemoglobin: S, Antilles, and D-Punjab (HbSAD) and provides an animal model for SCD. We studied the effects of nitric oxide (NO) breathing at various doses and time regimens in the presence of severe hypoxia (6% oxygen) using the SAD mouse model. METHODS: Age- and sex-matched control and SAD mice were exposed to 6% oxygen breathing in an environmental chamber and assessed for survival up to 1 h. Animals received different inhaled NO concentrations before and/or during hypoxia. Blood was obtained to evaluate the oxyhemoglobin dissociation curve and measure methemoglobinemia. RESULTS: Pretreatment by breathing NO at 20 ppm by volume in air for 30 min, and continuing to breathe 20 ppm NO during hypoxia resulted in improvement in survival rates in the SAD mouse (75%, n = 8) as compared with control SAD mice (11%, n = 9; P < 0.001). Pretreatment alone or breathing lower doses of NO were not protective. Changes in HbSAD oxygen affinity were not detected with NO breathing, and methemoglobin levels were low in all surviving mice. CONCLUSIONS: Breathing NO produced a rapid, protective effect to severe hypoxic stress in SAD mice. There appears to be a required loading period between NO breathing and its beneficial effect during hypoxic stress, possibly because of the total amount of NO delivered to SAD hemoglobin, blood cell components, and endothelium. NO breathing may be beneficial as a therapeutic intervention in SCD.

Effects of hypothermic perfusion on pulmonary circulation in isolated rabbit lung.

The effects of hypothermic perfusion have been studied by using different perfusates in 24 isolated rabbit lung preparations, divided into three groups: G1, perfused with blood (hematocrit of 10%) and G2 and G3, perfused with erythrocyte-free plasma plus 6% protein in saline. In both G1 and G2 groups left atrial pressures were kept below airway pressure (Zone II conditions), and in G3 it was higher than airway pressure (Zone III conditions). Perfusate flow, pulmonary artery pressure, pulmonary vascular resistance, left atrial pressure, fluid filtration rate, colloid osmotic pressure and temperature were not different (p > 0.1) between G1 and G2 at the beginning of the experiments. Lowering perfusate temperature from 38 degrees C to 28 degrees C produced a significant increase in pulmonary artery pressure and pulmonary vascular resistance in G1 but they decreased in G2 lungs (p < 0.05). Fluid filtration rate increased in both groups during hypothermia. These responses were not inhibited by an alpha-adrenergic receptor blocker or a pulmonary vasodilator. In G3 lungs no changes were observed. The differences in the hemodynamic effects of hypothermia observed in G1 and G2, both in Zone II conditions, could result from the differences in the vessel distention state obtained by each of the perfusate before initiating hypothermia. As perfusate viscosity increase with cold, a greater possibility of vessel distention in G2 lungs occurs. This explains the decrease in pulmonary artery pressure and pulmonary vascular resistance with cold in this group. The increase in fluid filtration rate observed with hypothermia in G1 and G2 may be due to increases in fluid exchange area.

[Results of the application of a health test in a population of immigrants]. / Resultados de la aplicación de un examen de salud en población inmigrante.

OBJECTIVE: To describe the demographic characteristics and the results of a healthcare exam of immigrants. DESIGN: A retrospective descriptive study. SETTING: Rural doctor office of Villafranca del Castillo. Madrid. PATIENTS: All immigrants (n = 76) that came for care between May of 1996 and May of 1998. INTERVENTIONS: History, physical exam and basic laboratory tests. RESULTS: Demographic data: 82% are women with a medium age of 33 years (SD 8.49). Their places of origin are Central America: 70%, Philippines: 20%, Africa: 5% and South America: 3%. 97% of them work as household employees or gardeners. They have been living in Spain for an average time of 56 months. Health data: 21.1% are smokers and 17.1% low risk drinkers. 64.5% lack tetanus vaccine and 11.8% lack both tetanus and rubeola vaccines. Serologic test for HBV are negative in 68.4%. 14.5% have past infection and there are no cases of chronic or active infection. PPD is over 10 mm in 35.5%, and between 5 and 10 mm in 7.9%. Prevalence of active TBC is 0%. Stool culture is positive in 6.5%. Salmonella tiphy is identified in one case. Stool examination for ova and parasites is positive in 42.1% of the patients. Protozoos (88%) are more common than helminths (12%). CONCLUSIONS: This study reveals a selective young and healthy immigrant group. The low presence of hepatitis B and tuberculosis infections are notable. The majority present parasites in stool samples.

Amiloidosis primaria localizada en glande peneano. Caso clínico y revisión de la literatura / Primary localized amyloidosis of glans penis. A new case and review of the literature

La amiloidosis primaria del tracto genitourinario es rara siendo aún más excepcional la afectación única del glande. Generalmente la clínica apunta al diagnóstico de carcinoma de pene y es el examen histológico el que indicará definitivamente el diagnóstico. La Biopsia de la lesión revela depósitos dérmicos de material amorfo eosinofílico. Se presenta el caso de un paciente con amiloidosis primaria en glande. Se realiza revisión de la literatura y se analizan las diferentes actitudes diagnósticas y terapéuticas. Éste es el séptimo caso de amiloidosis primaria localizada en glande descrito en la literatura

Primary localized amyloidosis urinary tract is rare. Localized amyloidosid only glands is a very rare entity. The clinical impression may resemble neoplastic disease but the diagnosis is confirmed by histochemical study. Biopsy of the lesion revealed dermal deposits of amorphous eosinophilic material. A case of patient with primary amyldosis of glands penis is reported. The literature is reviewed and the diagnostic and therapeutic options are discussed. This is the seventh reported case of localized amyloidosis of the glands penis