Cryptococcoma hipofisiario: un extraño caso de hipofisitis granulomatosa secundaria / Pituitary cryptococcoma: a strange case of secondary granulomatous hypophysitis

Resumen La hipofisitis es una afección con baja incidencia y prevalencia. Asimismo, las infecciones profundas por hongos en pacientes inmunocompetentes también re presentan un fenómeno infrecuente. Más raro aún es el caso que se describe a continuación, en donde se conjugan estos dos elementos mencionados, a saber: cryptococcoma hipofisario o hipofisitis granulomatosa causado por dicho patógeno en un huésped sin altera ción de la respuesta inmune. Luego de una búsqueda realizada en PubMed, existen limitados casos en la literatura médica de hipofisitis granulomatosa por Cryptococcus spp., que simuló por manifestaciones clínicas e imagenológicas un macro adenoma hipofisario. No encontramos informes en los que no haya evidencia de afectación del tejido meníngeo. La etiología micótica está escasamente descrita en las guías de referencia para hipofisitis y creemos que Cryp tococcus spp. debe ser tenido en cuenta en el diagnóstico diferencial de las hipofisitis granulomatosas secundarias dado que es un patógeno ubicuo y el tratamiento es sustancialmente diferente a otras entidades. Cobra mayor relevancia ante la tendencia actual al uso de glucocorticoides sistémicos a altas dosis para el tratamiento de la hipofisitis, que podría haber gene rado mayor daño de no haberse hecho el diagnóstico correcto.

Abstract Hypophysitis is a pathology with low incidence and prevalence. Likewise, deep fungal infections in immuno competent patients also represent a rare phenomenon. Even rarer is the case described below, where these two mentioned elements are combined, namely: pituitary cryptococcoma or granulomatous hypophysitis caused by said pathogen in a host without altered immune response. After research in PubMed, there are limited cases in the medical literature of granulomatous hypophysitis caused by Cryptococcus spp., which simulated a pituitary macroadenoma by clinical and imaging manifestations. We did not find reports in which there is no evidence of involvement of the meningeal tissue. The fungal etiology is scarcely described in the reference guidelines for hypophysitis and we believe that Cryptococcus spp. it should be taken into account in the differential diagnosis of secondary granuloma tous hypophysitis since it is a ubiquitous pathogen and the treatment is substantially different from other entities. It becomes more relevant given the current trend towards the use of high-dose systemic glucocorticoids for the treatment of hypophysitis, which could have generated greater damage if the correct diagnosis had not been made.

Carcinoma adrenocortical en mujeres en edad fértil / Adrenocortical carcinoma in women of reproductive age

Resumen Los carcinomas adrenocorticales son tumores infre cuentes, habitualmente hiperfuncionantes y con una supervivencia global pobre. La edad frecuente de pre sentación se describe en adultos entre 40 a 60 años, con predominio en sexo femenino. Se presentan dos casos inusuales de carcinoma adrenal diagnosticados en mujeres en edad fértil. El primero de ellos se descubrió en el segundo trimestre de gestación, con un cuadro de hipercortisolismo y lesión adrenal localizada, que resolvió con resección completa hacia la semana 20. En el segundo, la paciente debutó con manifestaciones clínicas de virilización rápidamente progresiva, sien do el hiperandrogenismo puro el patrón bioquímico hallado. En ambos casos, a pesar de haberse realizado la resección completa, el Ki67 elevado como principal factor pronóstico condujo a categorizarlas como de "alto riesgo de recurrencia". Asimismo, se ha asociado a la gestación y al patrón secretor de glucocorticoides como factores adicionales de mayor riesgo de recurrencia. Este es particularmente elevado dentro de los dos primeros años posteriores al diagnóstico. Existe aún controversia sobre el uso de mitotane adyuvante en estos pacientes, y su inicio está recomendado hasta los tres meses del postquirúrgico. Sin embargo, la evidencia disponible no permite suponer la falta de eficacia si se utiliza fuera de ese período. Los limitantes, como fueron el curso de la gestación y el puerperio inmediato, así como la difi cultad para el acceso a la medicación en nuestro medio, impidieron el inicio precoz del tratamiento adyuvante en ambos casos, aunque surge la inquietud de si aún sería oportuna su instauración.

Abstract Adrenocortical carcinomas are rare tumors, usually hyperfunctioning, with poor overall survival. Frequent age of presentation is described in adults between 40 and 60 years of age, predominantly female. Two unusual cases of adrenal carcinoma diagnosed in young women are presented. The first one was discovered in the sec ond trimester of gestation, with signs and symptoms of hypercortisolism and localized adrenal lesion, which was resolved with complete resection by week 20 of pregnancy. In the second case, the patient begined with clinical manifestations of rapidly progressive virilization, the biochemical pattern being pure hyperandrogenism. In both cases, despite complete resection, the high Ki67 as the main prognostic factor leaded to categorization as "high risk of recurrence". In addition, pregnancy and glucocorticoid secretory pattern have been associated as additional risk factors of recurrence. This is particularly high within the first two years after diagnosis. There is controversy about the use of adjuvant mitotane in these patients, and the general recommendation is to be started no longer than 3 months after surgery. However, the available evidence does not suggest that its use is ineffective beyond that period. Limitations, such as the course of pregnancy and the immediate puerperium, as well as the difficulty of accessing this medication in our environment, prevented the early initiation of adjuvant treatment with mitotane in both cases, although there is still concern whether its administration would still be appropriate.

Erupción variceliforme de Kaposi en un paciente adulto mayor con desnutrición severa

El eccema herpético o erupción variceliforme de Kaposi, a pesar de ser una infección viral poco frecuente, se considera una urgencia dermatológica, debido a su alto potencial de diseminación, gravedad y mortalidad en adultos. Los pacientes inmunosuprimidos suponen un alto riesgo de colonización cutánea y visceral, además de una mayor probabilidad de presentar otras infecciones causadas por el virus del herpes simple. Se caracteriza por presentar lesiones en piel de tipo vesículas umbilicadas agrupadas o diseminadas que evolucionan a erosiones hemorrágicas perforadas, que se localizan principalmente en cabeza, cuello y tórax; son dolorosas y tardan entre 2-6 semanas en sanar y por lo general se asocian a compromiso sistémico. El diagnóstico es clínico; en caso de duda, se puede utilizar Test de Tzanck, que es una herramienta rápida para confirmar infección por herpes virus; tiene una sensibilidad de 40-80 % y especificidad hasta del 100 %. El manejo consiste en terapia antiviral sistémica; el tratamiento antibiótico está indicado si existe riesgo sobreinfección bacteriana. El tratamiento oportuno de la infección es clave para la evolución hacia la recuperación del paciente.

Eczema herpeticum or Kaposi's varicelliform eruption is a rare viral infection; however, it's considered a dermatologic urgency due to the high potential for dissemination, severity and mortality. Immunosuppressed patients have a high risk of skin and visceral colonization in addition to a higher probability of other infections caused by herpes simplex virus. Kaposi's varicelliform eruption is characterized by vesicopustules, some umbilicated, others eroded and extended in clusters. They may also present hemorrhagic crusts with an erythematous base. The most commonly affected sites are head, neck, and trunk. These lesions are painful, they take from 2 to 6 weeks to heal and are usually associated with systemic signs of infection. Diagnosis is mainly clinical. In case of doubt, the Tzanck allows a rapid diagnostic approach with a sensitivity of 40-80 % and specificity up to 100 % in herpes virus. Antiviral treatment proved to be effective; additional antibiotic treatment is required if there is risk of bacterial infection. The timely treatment of the infection is the key in the evolution towards the recovery of the patient.

Research on relationship between abnormal regulation of histone acetylation and depression in rats / 中国药理学通报

Aim To study the role of histone acetyla-tion and its involvement in the depression-like behav-iors of rats induced by chronic unpredictable stress (CUS ). Methods Thirty male Sprague Dawley (SD ) rats were randomly divided into control group and model group.The method of solitary condition with CUS for consecutive 28 days was used to establish the rat depression model.The open-field test (OFT)and the forced swimming test (FST)were used to evaluate the depressive behaviors of rats;the real time PCR was used to detect the change of HDAC2 mRNA, and Western blot was used to determine the protein expres-sions of H3,H4,acH3 and acH4 in the prefrontal cor-tex and hippocampus of rats.Results Model group showed obvious depression-like behaviors with decrea-sing locomotive activity in OFT (P <0.01 )and in-creasing immobility time in FST (P<0.01),up-regu-lating the mRNA and protein expression of HDAC2 (P<0.0 1 ),and down-regulating the protein expression of acH3 and acH4 (P<0.01)in the prefrontal cortex and hippocampus significantly,compared with control group.Conclusion The mechanism of depressive be-haviors of rats induced by CUS may be associated with down-regulating the level of histone acetylation modifi-cation.

Reversion of BDNF, Akt and CREB in Hippocampus of Chronic Unpredictable Stress Induced Rats: Effects of Phytochemical, Bacopa Monnieri

OBJECTIVE: The aims of the present study were to explore the behavioural effects and to understand the possible mode of action of Bacopa monnieri extract (BME) on chronic unpredictable stress (CUS) induced depressive model and the biochemical alterations such as brain derived neurotrophic factor (BDNF), Akt, cyclic-AMP response element binding (CREB) protein level in the hippocampus of rats. METHODS: We examined the effects of chronic administration of BME on CUS exposed rats for 28 days. Behavioural changes were assessed by sucrose consumption and open field test to assess the effect of BME on CUS-induced depression. The mechanisms underlying antidepressant like action of BME was further evaluated by measuring levels of BDNF, Akt, and CREB in the hippocampus of rat brain and compared with the standard tricyclic antidepressant drug imipramine (20 mg/kg body weight). RESULTS: Exposure to CUS for 28 days produced depression-like behavior in rats, as indicated by significant decreases in sucrose consumption, locomotor activity including decreased BDNF, Akt and CREB levels in the hippocampus. Daily administration of BME at a dose of (80 mg/kg body weight) significantly reverses the behavioral alteration and restored the normal level of BDNF, total and phospho-Akt, total and phospho CREB in the hippocampus of CUS induced rats as compared to vehicle treated control rats. CONCLUSION: These findings suggest that BME ameliorates CUS induced behavioural depression in rats and that can be used as a potent therapeutic agent in treating depressive like behavior.

Experimental study on abnormal expression of TPH2,DDC and MAO-A involved in depression-like behaviors of rats induced by CUS / 中国药理学通报

Aim To investigate the role of tryptophan hydroxylase-2 (TPH2),dopa-decarboxylase (DDC)and monoamine oxidase-A(MAO-A)in depression-like be-haviors induced by chronic unpredictable stress (CUS).Methods 30 male SD rats were randomly di-vided into model group(MG)and control group(CG). Rat depression model was developed by CUS for 28 consecutive days in a solitary condition.The depres-sion-like behaviors of rats were evaluated by open-field test(OFT)and forced-swimming test(FST).The real time PCR and Western blot test were used to determine the mRNA and protein expression of TPH2,DDC and MAO-A in rat telencephalon and hippocampus.Re-sults The movement scores of rats were obviously de-creased in OFT(P<0.01 ).The immobility time was obviously increased in FST (P <0.01 ).The mRNA and protein expressions of TPH2 and DDC were de-creased significantly (P <0.01,P <0.05 )and the MAO-A mRNA and protein expressions were increased significantly(P <0.01,P <0.05 )in telencephalon and hippocampus of MG rats, when compared with those in CG rats.Conclusion The TPH2,DDC and MAO-A in rat telencephalon and hippocampus were closely related with the depression-like behaviors of rats induced by CUS.

Pathogenic Bacteria and Drug Sensitivity of 374 Cases of Children with Staphylococcal Scalded Skin Syn-drome / 中国药师

Objective:To understand the pathogen bacteria detection and drug sensitivity results in the children with staphylococ -cal scalded skin syndrome to provide data for the clinical treatment .Methods: Totally 374 children with staphylococcal scalded skin syndrome treated from January 2010 to June 2015 were selected .The children's wound secretion and blood samples were collected , and bacterial culture and drug sensitivity test were carried out .Results:Totally 223 pathogenic bacteria were detected out in the wound se-cretion samples;17 cases of blood culture were positive with the positive rate of 4.55%;187 strains of staphylococcus aureus were de-tected out;64 strains of MRSA were found out with the MRSA detection rate of 34.22% (64/187).The sensitivities of MSSA and MRSA to common antibacterial drugs were different .The susceptibility rates of MSSA and MRSA to vancomycin , teicoplanin , teicopla-nin and linezolid were all 100.00%.The sensitivity rates of MRSA to penicillin , oxacillin, piperacillin, piperacillin, cefoperazone so-dium, cefazolin, cefuroxime, cefoxitin, azithromycin and clindamycin were all zero .Conclusion: The pathogenic examination of staphylococcal scalded skin syndrome is very important , and antibiotics should be used reasonably according to the results of drug sensi-tivity.

TNF-αmediated activation of IDO pathway involved in mechanism of depression in rats induced by CUS / 中国药理学通报

Aim To investigate the relationship be-tween the depression-like behaviors of rats induced by chronically unpredictable stress( CUS) and the protein expression of tumor necrosis factor alpha( TNF-α) , in-dole-2 , 3-dioxygenase ( IDO ) and 3-hydroxyl amino acid oxygenase( HAAO) . Methods Thirty male Spra-gue Dawley( SD) rats were randomly divided into con-trol group and model group. CUS plus solitary condi-tion were used to establish the depression model. The open field test ( OFT ) and the force swimming test ( FST ) were used to evaluate the depression-like behaviors of rats ;Western blot was used to determine the protein expressions of TNF-α, IDO and HAAO in the prefrontal cortex and hippocampus of rats. Results Model group rats showed obvious depression-like be-haviors with increasing immobile time in FST ( P <0. 01) and decreasing locomotive activity in OFT( P<0. 01 ) , and up-regulating the protein expression of TNF-α, IDO and HAAO in the prefrontal cortex and hippocampus significantly ( P <0. 05 ) , compared with control group rats. Conclusion The depression-like behaviors of rats induced by CUS may be associated with the activation of IDO-HAAO pathway mediated by TNF-α.

Down-regulation of monoamine neurotransmitter synthetase expression involved in CUS-induced depression of rats / 中国药理学通报

Aim To investigate whether chronically un-predictable stress (CUS)-induced depression-like be-haviors of rats is associated with the variant expression of tryptophan hydroxylase (TPH)and tyrosine hydrox-ylase (TH).Methods 30 male SD rats were ran-domly divided into depression model group(MG)and control group (CG),the former was established using CUS plus solitary condition for 28 d,whereas the latter was fed normally as five rats per cage without CUS. The open field test(OFT)and the sucrose preference test were used to evaluate depressive behaviors.Both mRNA and protein expressions of TPH and TH in hip-pocampus and forebrain cortex were determined by re-al-time fluorescent quantitative PCR and western blot (WB),respectively.Results MG rats showed obvi-ous depressive behaviors with much lower locomotive activity and sucrose preference than CG.Meanwhile, the mRNA and protein expressions of TPH and TH also significantly decreased in MG rats,compared with CG rats.Conclusion The depression behaviors of rats in-duced by CUS may be associated with down-regulation of TPH and TH expression.

Antibiotic-resistant genes and multilocus sequencing typing of Pseudomonas aeruginosa / 中国人兽共患病学报

We investigated the antibiotic‐resistant genes and genetic diversity of Pseudomonas aeruginosa from patients in hospital ,the smear samples from hospital and clinic environment ,and from medical staff’ hands respectively in 2011‐2012 in Nanshan District of Shenzhen .Polymerase chain reaction were used to detect the 20 kinds of antibiotic‐resistant genes (TEM , VEB,CARB,OXA,SHV,PER,GES,GTX,SPM,GIM,IMP,VIM,DHA,oprD,Aac(6′)‐Ⅰ ,Aac(6′)‐Ⅱ ,Aac (3′)‐Ⅰ ,A ac(2″)‐Ⅰ ,qacE1‐sull and int‐Ⅰ) .Multilocus sequencing typing was used to analyze the clonal complexes .The 11 kinds resistant genes TEM ,SHV ,IMP ,DHA ,Aac(6′)‐Ⅰ ,Aac(6′)‐Ⅱ ,Aac(3′)‐Ⅰ ,Aac(2″)‐Ⅰ ,qacE1‐sull ,int‐Ⅰand oprD were detected ,for the positive rates respectively ,and which were 8 .1% ,6 .4% ,4 .8% ,9 .7% ,4 .8% ,14 .5% ,9 .7% , 56 .5% ,8 .1% ,and 8 .1% ;the loss rate of oprD gene was 61 .2% .The 19 antibiotic resistance gene profiles existed in 52 Pseudomonas aeruginosa strains .Multilocus sequencing typing found 39 sequence types and 5 clonal complexes in 62 Pseudo‐monas aeruginosa strains ,CC244 and ST856 were dominant .There were some differences of antibiotic resistance gene profiles between different samples ,the Pseudomonas aeruginosa strains from patients carried multiple resistant genes .In our research , the Pseudomonas aeruginosa had the genetic diversity and the dominant clonal complexes existed .

Improving oxidative stress response and reversing abnormal expression of hippocampus NET and 5-HTT involved in anti-depressive effect of venlafaxine / 中国药理学通报

Aim To investigate if anti-depressive effect of venlafaxine was associated with improving oxi-dative stress and expression of hippocampus NET and 5-HTT in rat model induced by CUS. MethodsEighty SD male rats were randomly divided into four groups:model group(MG),normal group(NG), ven-lafaxine-treated normal group ( VNG ) , and venlafax-ine-treated model group ( VMG) . VNG and VMG were given venlafaxine (23. 4 mg·kg-1 ·d-1 ) once daily;NG and MG were given the same volume solvent. Soli-tary condition with chronic unpredicted stress ( CUS ) was taken to establish rat depression model. The force swimming test was used to evaluate the behavior chan-ges of experimental rats. The malondialdehyde ( MDA) level and activity of superoxide dismutase ( SOD ) in serum were determined by biochemical methods. The mRNA and protein expressions of NET and 5-HTT in hippocampus were determined by Real-Time Reverse transcription polymerase chain reaction ( real-time RT-PCR) and Western blot ( WB) , respectively. Results Compared with NG rats, obviously increasing immo-bile time of rats in force swimming test and serum MDA level, as well as significantly decreasing SOD activity in serum was observed with clearly decreasing 5-HTT expression and elevating NET expression in hippocam-pus of MG rats. The treatment of venlafaxine distinctly suppressed changes above from CUS-induced rats. However, significant changes failed to be found in VNG rats. Conclusion The anti-depressive effect of venlafaxine may at least partly involve in improving ox-idative stress/anti-oxidative stress balance and revers-ing abnormal expression of NET and 5-HTT.

Effects of maternal rats exposed to chronic unpredictable stress before pregnancy on the behaviors and brain monamine of their adult male offspring / 中华行为医学与脑科学杂志

Objective To examine the effects of maternal rats exposed to chronic unpredictable stress before pregnancy on the behaviors and brain monamine of their adult male offspring.Methods Sixteen SD rats were divided into chronic unpredictable stress (CUS) group and controls.CUS rats were exposed to 21 days chronic unpredictable stressors ,and the controls were stress-free.Ten days after the last stressor, all the female rats were caged with sexually experienced males of the same strain.Then we performed the following experiments on the two months male progeny, sucrose consumption measuring anhedonia, Morris water maze measuring cognitive function and high performance liquid chromatography detecting the contents of monoamine.Results The sucrose consumption showed that both sucrose intake and sucrose consumption percentage of the control progeny were higher than those of the CUS progeny ( sucrose consumption: ( 10.23 ± 4.12 ) g vs ( 6.48 ± 3.19 ) g; sucrose consumption percentage: ( 85.43 ± 20.15 ) % vs (60.98 ± 24.65 ) % ) (P ＜ 0.05 ).The number of times crossing the removed hidden platform in the CUS progeny ( 1.64 ± 1.69) was significantly fewer than that in the control progeny (4.17±2.29 ) in Morris water maze (P ＜ 0.05 ).The contents of serotonin in the hypothalamus of CUS progeny ( ( 500.17 ± 80.94 ) ng/g tissue) was lower than that of the control progeny ( ( 569.63 ± 50.91 ) ng/g tissue) (P ＜0.05) ,while the norepinephrine in the hippocampus of CUS progeny( (2315.01 ± 1397.12) ng/g tissue) was higher than that of the control progeny( (907.56 ± 207.27) ng/g tissue) (P＜0.05) by high performance liquid chromatography.Conclusions Depression or stressful events before pregnancy of dams result in anhedonia, decreased spatial memory and abnormalities in brain monoamine of their adult male progeny.