Prevalence and Causes of Normal Exercise Oximetry in the Calf in Patients with Peripheral Artery Disease and Limiting Calf Claudication.

OBJECTIVE: In patients with claudication, an ankle brachial index (ABI) under 0.90 is considered to be abnormal and a sufficient argument for the arterial origin of exercise induced pain. Exercise transcutaneous oxygen pressure (Ex-tcpO2) can provide evidence of exercise induced regional blood flow impairment (RBFI) and confirm the arterial origin of walking induced pain. The frequency with which calf Ex-tcpO2 remains apparently normal in patients with claudication and abnormal ABI is unknown. Causes of these discrepant results have yet to be analysed. METHODS: A retrospective analysis of 4575 Ex-tcpO2 tests performed on 3,281 patients was conducted. The focus was on patients with a history of calf claudication and ABI under 0.90. Duplicate or non-standard tests were excluded, as were patients with no pain or those able to walk more than 15 minutes (on a treadmill). Searches were conducted for possible explanations of normal calf Ex-tcpO2 in the selected patients. RESULTS: Cardiorespiratory limitation was identified in 50 patients and isolated non-calf ischemia in 36 of the 106 patients selected. There was no obvious explanation during Ex-tcpO2, but clinical improvement after non-vascular treatment or total absence of improvement after a technically successful revascularisation was noted in 12 patients. Four patients were lost on follow up. Four patients improved after revascularisation, which suggests that the Ex-tcpO2 result was false negative. CONCLUSIONS: Ex-tcpO2 is negative in more than 20% of tests performed in patients with an ABI under 0.90 and a history of calf claudication. In most cases, when excluding re-tests and non-limiting or non-calf claudication on the treadmill, non-calf ischemia or a non-vascular limitation occurring during the test were observed. This observation supports both the value of treadmill testing in patients with calf claudication assumed to be of arterial origin (ABI<0.90) and the use of Ex-tcpO2 to detect non-calf ischemia.

Test-retest Reliability of GPS derived Measurements in Patients with Claudication.

OBJECTIVE: In patients with peripheral artery disease (PAD), the different distances between stops and the stop durations recorded with Global Positioning System (GPS) during a 1 hour stroll in the community are highly variable. Nevertheless, the reliability of the greatest community walk distance (greatest distance), the average of walking speeds (average speed) and the durations of stops (average stop durations) have not been studied. DESIGN: Seventeen PAD patients performed two series of evaluations (T1 and T2) within a 1 month period. METHODS: Each series included: a 1 hour stroll in the community with the calculation of the walking impairment questionnaire (WIQ) scores, the measurement of maximal walking distance on a treadmill (MWD on treadmill) and a 1 hour stroll in the community with GPS. The Garmin GPS-60 (Garmin Ltd, Olathe, Kan) receiver was used for all patients. Test-retest reliability of MWD on treadmill, WIQ, and GPS parameters were assessed with intraclass coefficient of correlation (ICC). RESULTS: ICCs are almost perfect between T1 and T2 for greatest distance (ICC = 0.911), average speed (ICC = 0.905), and MWD on treadmill (ICC = 0.992), and substantial for the average WIQ (ICC = 0.794). Correlation of average stop durations was considered substantial (ICC = 0.691). CONCLUSIONS: Despite the previously reported "within stroll" variability of walking bouts for distances, speeds, and stop durations, GPS derived greatest distance and average speed are reliable in PAD patients in test-retest experiments. The GPS appears to be a new tool to assess walking limitation and allows objective clinical investigation.

Red flags for clinical suspicion of eosinophilic granulomatosis with polyangiitis (EGPA).

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA), is a rare ANCA-associated systemic vasculitis. Its overlapping features with other vasculitic or eosinophilic diseases, and the wide and heterogeneous range of clinical manifestations, often result in a delay to diagnosis. OBJECTIVE: To identify red flags that raise a suspicion of EGPA to prompt diagnostic testing and to present an evidence-based clinical checklist tool for use in routine clinical practice. METHODS: Systematic literature review and expert consensus to identify a list of red flags based on clinical judgement. GRADE applied to generate a strength of recommendation for each red flag and to develop a checklist tool. RESULTS: 86 studies were included. 40 red flags were identified as relevant to raise a suspicion of EGPA and assessed by the experts as being clinically significant. Experts agreed that a diagnosis of EGPA should be considered in a patient aged ≥6 years with a blood eosinophil level >1000 cells/µL if untreated and >500 cells/µL if previously treated with any medication likely to have altered the blood eosinophil count. The presence of asthma and/or nasal polyposis should reinforce a suspicion of EGPA. Red flags of asthma, lung infiltrates, pericarditis, cardiomyopathy, polyneuropathy, biopsy with inflammatory eosinophilic infiltrates, palpable purpura, digital ischaemia and ANCA positivity, usually anti-myeloperoxidase, among others, were identified. CONCLUSION: The identification of a comprehensive set of red flags could be used to raise a suspicion of EGPA in patients with eosinophilia, providing clinicians with an evidence-based checklist tool that can be integrated into their practice.

Rainfall and sea level drove the expansion of seasonally flooded habitats and associated bird populations across Amazonia.

Spatial arrangement of distinct Amazonian environments through time and its effect on specialized biota remain poorly known, fueling long-lasting debates about drivers of biotic diversification. We address the late Quaternary sediment deposition that assembled the world's largest seasonally flooded ecosystems. Genome sequencing was used to reconstruct the demographic history of bird species specialized in either early successional vegetation or mature floodplain forests. Sediment deposition that built seasonally flooded habitats accelerated throughout the Holocene (last 11,700 years) under sea level highstand and intensification of the South American Monsoon, at the same time as global increases in atmospheric methane concentration. Bird populations adapted to seasonally flooded habitats expanded due to enlargement of Amazonian river floodplains and archipelagos. Our findings suggest that the diversification of the biota specialized in seasonally flooded habitats is coupled to sedimentary budget changes of large rivers, which rely on combined effects of sea level and rainfall variations.

Hydrogen peroxide impairs GRK2 translation via a calpain-dependent and cdk1-mediated pathway.

Oxidative mechanisms of injury are involved in many neurodegenerative diseases such as stroke, ischemia-reperfusion injury and multiple sclerosis. G protein-coupled receptor kinase 2 (GRK2) plays a key role in G protein-coupled receptor (GPCR) signaling modulation, and its expression levels are decreased after brain hypoxia/ischemia and reperfusion as well as in several inflammatory conditions. We report here that hydrogen peroxide downregulates GRK2 expression in C6 rat glioma cells. The hydrogen peroxide-induced decrease in GRK2 is prevented by a calpain protease inhibitor, but does not involve increased GRK2 degradation or changes in GRK2 mRNA level. Instead we show that hydrogen peroxide treatment impairs GRK2 translation in a process that requires Cdk1 activation and involves the mTOR pathway. This novel mechanism for the control of GRK2 expression in glial cells upon oxidative stress challenge may contribute to the modulation of GPCR signaling in different pathological conditions.

Analysis of polymorphism at site -174 G/C of interleukin-6 promoter region in multiple myeloma.

It is well established that interleukin-6 (IL-6) is an essential growth factor for multiple myeloma (MM) and patients with increased IL-6 levels have a poor prognosis. In healthy subjects, the presence of the C allele at a polymorphic site (-174 G/C) of the IL-6 gene is related to low IL-6 levels. In view of the potential association of this particular polymorphism with IL-6 concentration, and the relevance of IL-6 in MM pathogenesis, the objective of the present study was to investigate the prevalence of IL-6 (-174 G/C) promoter polymorphism and its association with development of MM in Brazilian individuals. We investigated the prevalence of these alleles in 52 patients and 60 healthy subjects (matched by age, sex, and race) of a Brazilian population. Thirty patients were male (42.4%), 24 (46.2%) were white and the median age at diagnosis was 58.5 years (range: 28 to 84 years). To determine the IL-6 (-174 G/C) polymorphism, molecular analysis was performed by polymerase chain reaction followed by endonuclease restriction digestion. The genotype distributions observed in the group of patients were 4% CC, 42% GC and 54% GG. The C allele frequency was 0.25. These results were similar to the control group, suggesting no impact of this polymorphism on the susceptibility to MM.

[Dose intensity received in breast cancer treatment with chemotherapy]. / Intensidad de dosis recibida en el tratamiento quimioterápico del cáncer de mama.

OBJECTIVE: To know relative dose intensity (RDI) in patients with breast cancer treated with chemotherapy. To determine the number of patients where RDI was < 85% of that programmed and the possible cause. METHOD: Retrospective study, four-month selection period. The following were recorded: age, body surface, protocol applied, intention of treatment, frequency of administration of cycles, number of cytostatic treatments previously received and filgrastim administration. The average RDI per patient and protocol was calculated. RESULTS: 110 patients were analysed, the average age of them being 55.4 years (interval: 31-84), average body surface 1.7 m2 (1.3-2.4). Overall average RDI was 91.0% (SD 10.7). 93.8% (10.6), 95.8% (6.3) and 81.9% (18.5) in neoadjuvant, adjuvant and palliative treatments, respectively. 20% of the patients did not reach a RDI = 85% of that programmed, average RDI 69.5% (3.29). A delay in the administration of chemotherapy equal or greater than seven days occurred in 45.4% of the cases, average RDI 80.7% (16.0). In the episodes where the dose was reduced because of toxicity, the RDI was 75.6% (13.6). Significant inverse ratios were obtained with age (p = 0.02) and line of treatment (p = 0.03) with the RDI. In 36.8%, dose reduction was caused by neutropenia; 52.9% received filgrastim. CONCLUSIONS: Most patients received the appropriate RDI. Age, previous treatments and intention of treatment were the variables with the greatest impact on the dose received. The delay in administering the cycle was the most frequent act minimising the toxicity and which least affected the treatment.

[Nasal potential difference test to diagnose cystic fibrosis]. / Prueba de la diferencia de potencial nasal para el diagnóstico de la fibrosis quística.

Cystic fibrosis is usually diagnosed based on suspicion arising from a typical clinical picture and must be confirmed by either a finding of high chloride concentrations in sweat tests on 2 separate days or detection of 2 gene mutations. The nasal potential difference (NPD) test has been proposed to provide evidence of abnormal function of the cystic fibrosis transmembrane conductance regulator (CFTR), a receptor that forms a chloride ion channel. The test is especially useful for patients who have normal chloride concentrations in sweat tests and in whom 2 gene mutations related to cystic fibrosis have not been detected. The NPD test requires 2 electrodes connected to a voltmeter (a Tholy-Medicap device). One is placed on the nasal mucosa of the inferior turbinate and the other is placed subcutaneously on the forearm. A reading less than -40 mV is considered abnormal, as values under that cut point are never found in healthy individuals. Two abnormal NPD findings on separate days are required for a diagnosis of CFTR dysfunction. False negatives arise when the integrity of the epithelium is altered. After application of amiloride, NPD decreases more markedly in cystic fibrosis patients than in healthy individuals and applying isoproterenol or fenoterol after amiloride provokes no response in patients with the genetic defect that prevents chloride ion channel activation.

Canopy cover negatively affects arboreal ant species richness in a tropical open habitat.

We tested the hypothesis of a negative relationship between vegetation characteristics and ant species richness in a Brazilian open vegetation habitat, called candeial. We set up arboreal pitfalls to sample arboreal ants and measured the following environmental variables, which were used as surrogate of environmental heterogeneity: tree richness, tree density, tree height, circumference at the base of the plants, and canopy cover. Only canopy cover had a negative effect on the arboreal ant species richness. Vegetation characteristics and plant species composition are probably homogeneous in candeial, which explains the lack of relationship between other environmental variables and ant richness. Open vegetation habitats harbor a large number of opportunistic and generalist species, besides specialist ants from habitats with high temperatures. An increase in canopy cover decreases sunlight incidence and may cause local microclimatic differences, which negatively affect the species richness of specialist ants from open areas. Canopy cover regulates the richness of arboreal ants in open areas, since only few ant species are able to colonize sites with dense vegetation; most species are present in sites with high temperature and luminosity. Within open vegetation habitats the relationship between vegetation characteristics and species richness seems to be the opposite from closed vegetation areas, like forests.

Plasmablastic multiple myeloma is associated with increased vascular endothelial growth factor immunoexpression.

The biologic basis of the negative prognosis of plasmablastic myeloma is not fully understood. To determine whether histologically aggressive multiple myeloma (MM) is associated with a more angiogenic marrow environment, bone marrow samples from 50 recently diagnosed MM patients were evaluated. Twelve percent (6/50) of patients presented plasmablastic MM, and this feature correlated with moderate/strong intensity of vascular endothelial growth factor staining of plasma cells (P = 0.036). Although plasmablastic MM was not associated with increasing of microvessel density, this new evidence of increased expression of vascular endothelial growth factor on plasmablasts suggests that the adverse prognosis conferred by plasmablastic disease may be due, at least in part, to secretion of this angiogenic cytokine, also suggesting that the subset of MM patients with plasmablastic features may derive particular benefit from antiangiogenic therapies.

Acceleration by chronic treatment with clorgyline of the turnover of brain alpha 2-adrenoceptors in normotensive but not in spontaneously hypertensive rats.

1. The aim of this study was to quantitate and compare the turnover of alpha 2-adrenoceptors in the cerebral cortex of normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats, and its modulation during chronic treatment with the monoamine oxidase (MAO) inhibitor, clorgyline. 2. In SHR, the specific binding of the agonist [3H]-UK 14304 and of the antagonist [3H]-RX 821002 was significantly reduced in the brain (Bmax 15-19% lower) as compared to that in sex- and age-matched WKY rats. In contrast, no significant changes in the Kd values for both radioligands were found between WKY and SHR rats. Therefore, SHR rats offer a genetic model with a lower density of alpha 2-adrenoceptors in the brain. 3. Chronic treatment (21-35 days) with clorgyline (1 mg kg-1, i.p.) markedly decreased the density of brain alpha 2-adrenoceptors ([3H]-UK 14304 binding) in Sprague-Dawley (Bmax reduced by 50%) and in WKY (Bmax reduced by 30%) rats without any apparent change in the affinity of the radioligand. In contrast, the density of brain alpha 2-adrenoceptors in SHR was not down-regulated by chronic clorgyline treatment. 4. The recovery of [3H]-UK 14304 binding after irreversible inactivation by N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ; 1.6 mg kg-1) (an alkylating agent for the alpha 2-adrenoceptor) was assessed in control and clorgyline-treated (1 mg kg-1; i.p. for 7-21 days) WKY and SHR rats to study the process of alpha 2-adrenoceptor repopulation and to calculate receptor turnover parameters. 5. The simultaneous analysis of receptor recovery curves revealed that the turnover of brain alpha2-adrenoceptors in SHR rats was accelerated (k = 0.141 day-1;t 1/2= 4.9 days; r/k =40 fmol mg-1 protein)compared to that in WKY rats (k = 0.085 day-1; tl/2= 8.1 days; r/k = 54 fmol mg-1 protein) and that the reduced density of cortical alpha2-adrenoceptors (Bmax or r/k values) in SHR was probably due to an abnormal higher receptor degradation (delta k = 66%) and not to a decreased receptor synthesis which in fact showed a slight increase (delta r = 24%).6. Treatment with clorgyline (1 mg kg-1, i.p. for 21 days) accelerated the turnover of brain alpha2-adrenoceptors in WKY rats (k = 0.328 days-1; tl/2= 2.1 days; r/k = 29 fmol mg-1 protein) and the greater increase in receptor degradation (delta k = 286%) over receptor synthesis (delta r = 109%) led to down-regulation of receptor density (r/k = 46% lower). In contrast, treatment with clorgyline did not modify significantly the turnover of brain M2-adrenoceptors in SHR (k = 0.192 days-1; t1/2 = 3.6 days;r/k = 39 fmol mg-1 protein), indicating that in this genetic model of hypertension, the desensitized alpha2-adrenoceptors cannot be further down-regulated by clorgyline treatment and that they lack the expected adaptative increase in receptor synthesis.

Brain alpha(2)-adrenoceptors in monoamine-depleted rats: increased receptor density, G coupling proteins, receptor turnover and receptor mRNA.

1. This study was designed to assess the molecular and cellular events involved in the up-regulation (and receptor supersensitivity) of brain alpha(2)-adrenoceptors as a result of chronic depletion of noradrenaline (and other monoamines) by reserpine. 2. Chronic reserpine (0.25 mg kg(-1) s.c., every 48 h for 6 - 14 days) increased significantly the density (B(max) values) of cortical alpha(2)-adrenoceptor agonist sites (34 - 48% for [(3)H]-UK14304, 22 - 32% for [(3)H]-clonidine) but not that of antagonist sites (11 - 18% for [(3)H]-RX821002). Competition of [(3)H]-RX821002 binding by (-)-adrenaline further indicated that chronic reserpine was associated with up-regulation of the high-affinity state of alpha(2)-adrenoceptors. 3. In cortical membranes of reserpine-treated rats (0.25 mg kg(-1) s.c., every 48 h for 20 days), the immunoreactivities of various G proteins (Galphai(1/2), Galphai(3), Galphao and Galphas) were increased (25 - 34%). Because the high-affinity conformation of the alpha(2)-adrenoceptor is most probably related to the complex with Galphai(2) proteins, these results suggested an increase in signal transduction through alpha(2)-adrenoceptors (and other monoamine receptors) induced by chronic reserpine. 4. After alpha(2)-adrenoceptor alkylation, the analysis of receptor recovery (B(max) for [(3)H]-UK14304) indicated that the increased density of cortical alpha(2)-adrenoceptors in reserpine-treated rats was probably due to a higher appearance rate constant of the receptor ((Delta)r=57%) and not to a decreased disappearance rate constant ((Delta)k=7%). 5. Northern- and dot-blot analyses of RNA extracted from the cerebral cortex of saline- and reserpine-treated rats (0.25 mg kg(-1), s.c., every 48 h for 20 days) revealed that reserpine markedly increased the expression of alpha(2a)-adrenoceptor mRNA in the brain (125%). This transcriptional activation of the receptor gene expression appears to be the cellular mechanism by which reserpine induces up-regulation in the density of brain alpha(2)-adrenoceptors.

Effects of the alkylating agent EEDQ on regulatory G proteins and recovery of agonist and antagonist alpha2-adrenoceptor binding sites in rat brain.

The aim of this study was to assess the effect of N-ethoxycarbonyl-2-ethoxy-1,2-dihydroquinoline (EEDQ)-induced alpha2-adrenoceptor inactivation on regulatory G proteins and the recovery of agonist and antagonist binding sites. EEDQ induced a rapid increase in the abundance of rat brain cortical Galphai1/2 proteins (30% at 6 h) which reached a maximum at 4 days (45%) and which then slowly returned (7-30 days) to control values. EEDQ did not alter significantly the levels of Galphai3 and Galphao proteins. By using the standard monoexponential model, the analysis of the recovery of alpha2-adrenoceptor density (6 h-30 days) with [3H]UK 14304 (bromoxidine) and [3H]RX 821002 (2-metoxy idazoxan) in the cerebral cortex did not reveal differences in receptor turnover parameters. However, the recovery of [3H]UK 14304 binding fitted best to a new biphasic recovery model, suggesting the existence of two distinct phases of recovery of agonist sites (r1 and r2 = 15.7 and 7.4 fmol mg protein(-1) day(-1); k1 and k2 = 0.51 and 0.25 day(-1); (t1/2)1 and (t1/2)2 = 1.4 and 2.7 days). In contrast, the recovery of [3H]RX 821002 antagonist sites did not fit to the biphasic model (r = 8.1, k = 0.14, t1/2 = 4.9). Because agonist binding requires coupling to G proteins, the present results suggest that the rapid over-expression of Galphai1/2 proteins induced by EEDQ is related to the biphasic recovery of [3H]UK 14304 binding. The possible implication of the faster recovery of alpha2-adrenoceptor function after EEDQ inactivation is discussed.

No effect of genetic obesity and mazindol on imidazoline I2 binding sites in the brain of Zucker rats.

The density and affinity states of imidazoline I2 binding sites as well as the density of alpha 2-adrenoceptors were quantitated in the brain of lean and obese Zucker rats. No significant differences were obtained between Zucker phenotypes for these receptors in the cerebral cortex and hypothalamus. Moreover, chronic treatment with the anorexic imidazoline derivative, mazindol, did not alter the density of brain imidazoline I2 binding sites. It is concluded that this genetic model of obesity is not associated with abnormal imidazoline I2 binding sites.

[Effectiveness and efficiency of an outpatient clinic for corticosteroid-dependent asthmatics]. / Efectividad y eficiencia de una consulta externa monográfica de asma corticodependiente.

OBJECTIVE: To evaluate the efficacy and efficiency of a specialist outpatient clinic for corticosteroid-dependent asthmatics. The clinic was supervised by the respiratory medicine service of a reference hospital. MATERIAL AND METHODS: The first 20 consecutive patients (mean age 58.1+/- 9.5 years; 14 women, 6 men) treated at a specialist outpatient clinic for corticosteroid-dependent asthmatics were studied, with prospective follow-up of 12.33 +/- 4.6 months. The following variables were examined: a) forced spirometry (FS), b)corticosteroid doses, c) number and cost (NC) of visits to the outpatient clinic, d) NC of FS, e) NC of emergency room visits, f) NC of hospitalizations, g)cumulative cost of health care generated by these patients within the National Health Service of Catalonia (NHSC). The results were compared with those recorded in each patient's history. RESULTS: Findings were a) improved FEV1 (55.1 +/- 21.6% vs.60.1 +/- 21%, p = 0.02); b) decreased corticosteroid use (21.9 +/- 11.2 mg vs. 12.8 +/- 6.0 mg, p < 0.0001);c) statistically significant increase in NC to the outpatient clinic and NC of FS; d) statistically significant decrease in number of visits to emergency services and hospitalizations;e) reduced total cost of health care for these patients borne by the NHSC, which went from 4,400,070 Spanish pesetas to 1,171,157 Spanish pesetas. A hospital deficit of nearly 2,000,000 Spanish pesetas was canceled. CONCLUSIONS: Changing the system for delivering health care to these patients has led to improved care (effectiveness) and a noteworthy reduction in cost (efficiency). We conclude that medical specialists should play an important role in reorganizing the present health care system of the NHSC.

[News about cancer in the press]. / Las noticias sobre el cáncer en los medios de comunicación escrita.

BACKGROUND: News on health and health care are increasingly common in the mass media, and cancer is one of the most prominent topic among these news due to its health impact. MATERIAL AND METHODS: All news published in major newspapers in Catalonia, Spain between April to December 1996 were analysed, together with items from science and health supplements general information and science journals. Types of cancer-related topics, sources of information, the importance of cancer in the news item and the theme of the piece were analysed. RESULTS: During the period analysed, 974 news items were published which dealt with cancer. Of these, cancer was the principal topic in 53.5% of the items published in the national press, and 63.4% of the items published in the regional press. Cancer was the subject of an editorial comment on only four occasions. The source of information was mentioned in 64.8% of the items, and mean number of sources was 1.6. Political institutions were the most frequent source of information in newspapers, while science and health supplements and other magazines tended to cite scientific and health care institutions, as well as scientific journals. Basic research was the most common topic for news (30.3%) in science and health supplements while risk and environmental factors (29.6%) were the most common topics in magazines; environmental and technological risk factors (18,6%) and conflicts with health administrative bodies (16%) were the most frequent topics in the newspapers. CONCLUSION: News about risk factors and their prevention as well as technological and environmental factors related to cancer were among the most important topics published in the general press and magazines, together with conflicts with administrative bodies. Informations related to new therapies were a less frequent topic. Scientific journals have an important role as an information source for mass media together with political and scientific institutions.

[First radiological description of Morgagni's hydatid. Laparoscopic confirmation]. / Première description radiologique de l'existence d'hydatides de Morgagni. Confirmation laparoscopique.

The authors explain the clinical case of a female patient suffering from secondary sterility; she was submitted, among other test, to the H.S.G. in order to study the possibility of a among other tests, to the H.S.G. in order to study the possibility of a cervical failure. The radiological findings obtained of Morgagni's Hydatis, not described previously in literature and their laparoscopic confirmation justify, we believe, its publication.

[Peritonitis in continuous ambulatory peritoneal dialysis. Microbiological and clinical evaluation]. / Peritonitis en diálisis peritoneal contínua ambulatoria. Evaluación microbiológica y clínica.

In 1976, Popovich et al. described a technique of peritoneal dialysis using bottled dialysate. Later Oreopoulos et al. modified the technique by using plastic bags. But peritonitis still is a major and potentially serious complication of peritoneal dialysis. We have evaluated a) microbiologic diagnostic methods for infectious peritonitis, b) incidence of etiologic agents, and c) the evolution during antimicrobial treatment. Eighteen patients with chronic renal failure of diverse causes were followed from initiation of the CAPD program since January 1981 until June 1988. There were 80 episodes of infectious peritonitis during 17 patient-years of dialysis with an overall incidence of peritonitis of 4.7 episodes/patient-year. The total volume centrifuged technique and culture of sediment showed a sensibility of 85% in 73 episodes where cultures were obtained. The 59.1% of episodes of peritonitis were caused by gram negative bacilli; 11.6% were due to Acinetobacter calcoaceticus and Gram positive cocci accounted for 37.3%. These results are different from those found in other countries because most of our patients had received antimicrobial agents which probably changed their body flora, some did not have manual ability, others were of bad hygienic habits and finally, all of them had frequent contact with hospital environment. The species most frequently isolated were coagulase negative staphylococci (12.8%), probably from patients' skin flora. (ABSTRACT TRUNCATED AT 250 WORDS)

[Adenomatoid tumor of the albuginea testis]. / Tumor adenomatoide de albugínea testicular.

We present a rare case of adenomatoid tumour situated in the testicular albuginea. We comment on its treatment, which we are of the opinion should be conservative.

Susceptibility of Enterococcus faecalis to twelve antibiotics, time-kill assays, and high-level aminoglycoside resistance in a university hospital in Argentina.

A total of 201 Enterococcus faecalis strains isolated from different body sites were tested to (i) establish their antibiotic susceptibility pattern; (ii) determine the percentage of strains highly resistant (MIC greater than 2,000 micrograms/ml) to five aminoglycosides and (iii) know if the combination of penicillin or ampicillin plus an aminoglycoside is reliably synergistic for the strains with low-level resistance (MICs ranged from the break point of susceptibility for each aminoglycoside to 2,000 micrograms/ml). Erythromycin exhibited very poor activity with MIC90 greater than 128 micrograms/ml. Pefloxacin and norfloxacin had intermediate activity, inhibiting 50% of isolates at 4 micrograms/ml and 90% at 8 micrograms/ml. Trimethoprim-sulfamethoxazole (1:20) inhibited 94% of isolates at less than or equal to 2 micrograms/ml and 87.6% at less than or equal to 0.5 microgram/ml. Ampicillin, penicillin and piperacillin were the most potent agents studied. Ninety percent of strains were inhibited at 1 microgram/ml of ampicillin and 4 micrograms/ml of penicillin and piperacillin. The E. faecalis isolates were relatively or totally resistant to the aminoglycosides. Ninety six (47.8%) were highly resistant at least to one of them. High level resistance to streptomycin was found in 47.3% of all strains and was the most frequent resistance encountered; amikacin highly resistant strains were the less common and accounted for 4.5%. Low-level resistance to the aminoglycosides ranged from 50.2% (for streptomycin) to 94.5% (for amikacin). Thirty one E. faecalis isolates were selected for 24-time kill-assays. There was a good correlation between resistance to penicillin or ampicillin aminoglycoside synergy in all but 3 strains which were highly resistant. Among the strains with low-level resistance to the aminoglycosides, there was no synergy in 37 (63.8%) of 58 killing assays with each of the aminoglycosides combined with penicillin. These results demonstrate that the susceptibility to 2,000 micrograms/ml of the aminoglycoside does not assure the penicillin or ampicillin aminoglycoside synergism.