Hidradenitis Suppurativa: Estimated Prevalence, Clinical Features, Concomitant Conditions, and Diagnostic Delay in a University Teaching Hospital in Buenos Aires, Argentina. / Hidradenitis supurativa: una aproximación a su prevalencia, características clínicas, comorbilidades y tiempo al diagnóstico, en un hospital universitario de Buenos Aires, Argentina.

BACKGROUND: Hidradenitis suppurativa is a chronic recurrent systemic inflammatory disease that mainly involves large skin folds. It develops when pilosebaceous units become blocked, leading to the formation of painful nodules, abscesses, fistulas, and scarring. The impact of this disease on quality of life is great. OBJECTIVES: To describe the prevalence and clinical features of hidradenitis suppurativa in patients treated at Hospital Italiano de Buenos Aires and determine the frequency of comorbidities and time to diagnosis in this population. MATERIAL AND METHODS: Retrospective descriptive cross-sectional study. Information was extracted from the computerized clinical records of all patients with a diagnosis of hidradenitis suppurativa managed in Hospital Italiano de Buenos Aires between July 2012 and October 2017. RESULTS: Our initial search of the records yielded 180 cases; the diagnosis was confirmed in 66 cases. Sixty-five percent of the patients were women, and the mean age was 37 years. The prevalence of this diagnosis was 0.02%. The armpits, vulva, and groin were the locations most frequently affected. Smoking, overweight, and obesity were the most commonly recorded concomitant conditions. Male sex and perianal and gluteal locations were associated with severity. Time until diagnosis varied widely, ranging from diagnosis at the first visit in some cases to as long as 142 months and 21 visits. CONCLUSIONS: Our findings are consistent with the literature on hidradenitis suppurativa. This is the first Argentinian study to describe the prevalence of this disease as well as the concomitant conditions found and the rate of diagnostic error.

The expression and function of Ca(2+)-sensing receptors in rat mesenteric artery; comparative studies using a model of type II diabetes.

BACKGROUND AND PURPOSE: The extracellular calcium-sensing receptor (CaR) in vascular endothelial cells activates endothelial intermediate-conductance, calcium-sensitive K(+) channels (IK(Ca)) indirectly leading to myocyte hyperpolarization. We determined whether CaR expression and function was modified in a rat model of type II diabetes. EXPERIMENTAL APPROACH: Pressure myography, western blotting, sharp microelectrode and K(+)-selective electrode recordings were used to investigate the functional expression of the CaR and IK(Ca) in rat mesenteric arteries. KEY RESULTS: Myocyte hyperpolarization to the CaR activator calindol was inhibited by Calhex 231. U46619-induced vessel contraction elevated the extracellular [K(+)] around the myocytes, and inhibition of this 'K(+) cloud' by iberiotoxin was needed to reveal calindol-induced vasodilatations. These were antagonized by Calhex 231 and significantly smaller in Zucker diabetic fatty rat (ZDF) vessels than in Zucker lean (ZL) controls. Myocyte hyperpolarizations to calindol were also smaller in ZDF than in ZL arteries. In ZDF vessels, endothelial cell CaR protein expression was reduced; IK(Ca) expression was also diminished, but IK(Ca)-generated hyperpolarizations mediated by 1-EBIO were unaffected. CONCLUSIONS AND IMPLICATIONS: The reduced CaR-mediated hyperpolarizing and vasodilator responses in ZDF arteries result from a decrease in CaR expression, rather than from a modification of IK(Ca) channels. Detection of CaR-mediated vasodilatation required the presence of iberiotoxin, suggesting a CaR contribution to vascular diameter, that is, inversely related to the degree of vasoconstriction. Compromise of the CaR pathway would favour the long-term development of a higher basal vascular tone and could contribute to the vascular complications associated with type II diabetes.

Tuberculous duodenal stenosis: report of two cases.

Duodenal tuberculosis is a rare clinical entity. The authors report and emphasize the lack of special clinical, radiological and endoscopic signs of duodenal tuberculosis. The diagnosis is affirmed, at laparotomy, out of the findings of peritoneal granulations or histology of lymphatic nodes. We report our experience of two cases of duodenal tuberculosis presenting with proximal intestinal obstruction and review the available literature.

Effects of methyl beta-cyclodextrin on EDHF responses in pig and rat arteries; association between SK(Ca) channels and caveolin-rich domains.

BACKGROUND AND PURPOSE: The small and intermediate conductance, Ca2+-sensitive K+ channels (SK(Ca) and IK(Ca), respectively) which are pivotal in the EDHF pathway may be differentially activated. The importance of caveolae in the functioning of IK(Ca) and SK(Ca) channels was investigated. EXPERIMENTAL APPROACH: The effect of the caveolae-disrupting agent methyl-beta-cyclodextrin (MbetaCD) on IK(Ca) and SK(Ca) localization and function was determined. KEY RESULTS: EDHF-mediated, SK(Ca)-dependent myocyte hyperpolarizations evoked by acetylcholine in rat mesenteric arteries (following blockade of IK(Ca) with TRAM-34) were inhibited by MbetaCD. Hyperpolarizations evoked by direct SK(Ca) channel activation (using NS309 in the presence of TRAM-34) were also inhibited by MbetaCD, an effect reversed by cholesterol. In contrast, IK(Ca)-dependent hyperpolarizations (in the presence of apamin) were unaffected by MbetaCD. Similarly, in porcine coronary arteries, EDHF-mediated, SK(Ca)-dependent (but not IK(Ca)-dependent) endothelial cell hyperpolarizations evoked by substance P were inhibited by MbetaCD. In mesenteric artery homogenates subjected to sucrose-density centrifugation, caveolin-1 and SK3 (SK(Ca)) proteins but not IK1 (IK(Ca)) protein migrated to the buoyant, caveolin-rich fraction. MbetaCD pretreatment redistributed caveolin-1 and SK3 proteins into more dense fractions. In immunofluorescence images of porcine coronary artery endothelium, SK3 (but not IK1) and caveolin-1 were co-localized. Furthermore, caveolin-1 immunoprecipitates prepared from native porcine coronary artery endothelium contained SK3 but not IK1 protein. CONCLUSIONS AND IMPLICATIONS: These data provide strong evidence that endothelial cell SK(Ca) channels are located in caveolae while the IK(Ca) channels reside in a different membrane compartment. These studies reveal cellular organisation as a further complexity in the EDHF pathway signalling cascade.

The short-term effect of water-pipe smoking on the baroreflex control of heart rate in normotensives.

UNLABELLED: The aim of this study is to analyse the acute effect of water-pipe smoking on heart rate, blood pressure and the baroreflex control of heart rate. SUBJECTS AND METHODS: Non-invasive continuous methods were used for investigating inter-beat interval (IBI; ms), systolic blood pressure (SBP; mm Hg), diastolic blood pressure (DBP; mm Hg), pulse pressure (PP; mm Hg), mean blood pressure (MBP; mm Hg); baroreflex sensitivity in ms/mm Hg (BRS) and baroreflex sensitivity in Hz/mm Hg (BRSf), were determined by spectral analysis, in 20 normotensive volunteers age of 27+/-6 years (mean+/-S.D.) who served as their own control. The measurements were taken twice. The first measurement was taken before the water-pipe smoking session (this is after >12 h of smoking cessation with a complete stopping of alcohol, coffee or tea consumption). The second measurement was taken during a 5 min period immediately after that session. (In the smoking session the volunteer smokes 5 g Maassel (fruit flavoured tobacco) for a period of 45 min). RESULTS: The inter-beat interval decreased (846+/-100 to 709+/-109 ms, p=0.0003), SBP increased (110+/-13 to 123+/-12 mm Hg, p=0.004), DBP increased (67+/-11 to 81+/-11 mm Hg, p=0.0002), PP decreased (43+/-10 to 41+/-9 mm Hg, p=0.46 ns), MBP increased (82+/-10 to 95+/-11 mm Hg, p=0.0001), BRS decreased (9.16+/-4 to 5.67+/-3 ms/mm Hg, p=0.003) and BRSf (0.013+/-0.005 to 0.011+/-0.004 Hz/mm Hg, p=0.3 ns). CONCLUSIONS: Water-pipe smoking induced a high increase in heart rate, SBP, DBP, MBP and markedly impaired BRS. All of those markers are known as risk factors in cardiovascular diseases, hence it is concluded that water-pipe smoking is not as harmless as is thought.

Thyroid tuberculosis: diagnosis and treatment.

OBJECTIVE: It was the aim of this study to report clinical characteristics and treatment of thyroid tuberculosis (TT). METHODS: During 16 years, 2,426 patients have been operated on the thyroid in the surgical department 'A' in Ibn Sina Hospital, Rabat, Morocco. Anatomopathological results of the removed thyroid were analyzed for evidence of tuberculosis. RESULTS: Eight cases of TT were diagnosed. Five patients had a goiter and 3 patients had an isolated nodule of the thyroid. In one case, fine-needle aspiration cytology gave the diagnosis of TT. This patient had a complete drainage of the abscess. In all other patients, the diagnosis was given after surgery. All patients received additional antituberculous drugs for 6 months, and follow-up was satisfactory. CONCLUSION: TT does not have any consistent symptoms. Fine-needle aspiration is the best method for diagnosis and can result in the avoidance of surgery.

[Clinical case of the month. Peritonitis after spontaneous rupture of pyonephrosis. A case report]. / Le cas clinique du mois. Péritonite secondaire à la rupture spontanée d'une pyonéphrose dans la grande cavité péritonéale. A propos d'un cas.

Peritonitis after spontaneous rupture of pyonephrosis is a rare complication, usually diagnosed intraoperatively. We report the case of a 35 year old woman who was admited for an acute abdomen. Ultrasound showed features of acute peritonitis, with left pyonephrosis, confirmed by a CT-SCAN. Treatment consisted of laparotomy with nephrectomy and abdominal washing and draining. The outcome was favourable.

[Tuberculosis of the thyroid. Diagnosis and treatment]. / La tuberculose de la thyroïde. Diagnostic et traitement.

Thyroid tuberculosis is rare. We present the case of a 25 year-old woman with tuberculosis of the thyroid. Although seldom observed, tuberculosis should be considered in the differential diagnosis of nodular lesions of the thyroid. Diagnosis is made by histological examination and demonstration of the tubercle bacilli from biopsy or aspiration specimen. The efficacy of fine-needle aspiration cytology in diagnosis of tuberculosis of the thyroid is proved. Administration of antituberculous drugs is considered as the treatment of choice. Abscess drainage is sufficient. In rare cases surgery is necessary. The prognosis is good.

[Retro-cost-xyphoid hernia and common mesentery: a case diagnosed in an adult]. / Hernie rétro-costo-xyphoïdienne et mésentère commun: un cas diagnostiqué chez l'adulte.

Authors analysed Morgagni's hernia pathogenesis through a new case associated to a common mesentery position and revealed by respiratory distress after delivery.

[Primary linitis plastica of the rectum]. / La linite plastique primitive du rectum.

One case of primary linitis plastica of the rectum is presented, it is a rare entity presentation in younger patients. The diagnosis was made by excluding the stomach as a primary source by peroperative palpation and fibroscopy examination. Because of potential for local invasion and infiltration, linitis is often detected only at the equivalent of stage C (Astler-Cller). The prognosis is poor, the mean survival time is about 9 months.

Multimodal assessment of the effect of chewing gum on nicotine withdrawal.

The present study was designed to evaluate the usefulness of chewing gum to reduce nicotine withdrawal, craving, and salivary cortisol concentrations during temporary nicotine deprivation. A total of 20 male smokers were studied under conditions when gum was and was not accessible during a 4-hour deprivation period. All subjects smoked an initial cigarette shortly after arrival for the two experimental sessions and were informed that they would be unable to smoke for the remainder of each session. The sessions consisted of each subject watching a movie, then waiting in the lab for two consecutive 30-min intervals. Self-reported nicotine withdrawal and craving were assessed four times and salivary cortisol five times during each experimental session. Results from this study indicate that chewing gum helps with self-reported withdrawal but not craving when a smoker is prevented from smoking. This study also provides preliminary data on the use of salivary cortisol as a physiological marker that may map these self-reports of nicotine withdrawal and craving.

Adrenocortical responses to psychological stress and risk for hypertension.

Excessive and prolonged stress-induced cortisol changes may contribute to or be a marker of essential hypertension. Cortisol is a central component of the stress response, and it interacts with sympathetic and renal mechanisms contributing to increased blood pressure (BP). Although research in individuals with already established hypertension failed to show consistent abnormalities in adrenocortical output, cortisol responses to psychological stress are greater and more persistent in persons at high risk for hypertension relative to low-risk normotensives. Considering the heterogeneous and multifactorial polygenic nature of hypertension and the fact that cortisol affects several BP related processes, and regulates expression of genes involved in BP, it is possible that this hormone is involved in at least a sub-type of hypertension. Recent studies evaluating cortisol tissue sensitivity, cortisol production and cortisol metabolic rate in hypertension-prone persons support the possibility that cortisol may serve as an intermediate phenotype of hypertension. In this review, we discuss components of the stress responses, factors influencing the adrenocortical response, adrenocortical activity in hypertension, and we propose pathways that mediate effects of stress-induced cortisol on BP.

Adrenocorticotropin responses to interpersonal stress: effects of overt anger expression style and defensiveness.

This study evaluated the influence of overt anger expression style and defensiveness on the hypothalamic-pituitary-adrenocortical (HPA) responses to acute psychological stress. These personality traits are thought to modulate the stress cardiovascular response and influence disease risk, however, little is known about their influence on HPA responses. Forty-six young, healthy male volunteers worked on counterbalanced extended public-speaking and mental arithmetic. The sample was dichotomitized into groups low vs. high in anger-out, using Spielberger's Anger-Expression Inventory, and in defensiveness, using the Marlowe-Crown Social Desirability Scale. Serum cortisol and adrenocorticotropic hormone (ACTH) concentrations were measured before and after performing each task. Heart rate (HR) and blood pressures (BP) were obtained continuously in 2-min intervals before, during and after the tasks. Public speaking produced greater adrenocortical and cardiovascular stress responses than mental arithmetic, and the greatest increases in ACTH occurred in subjects high in anger-out and defensiveness. These preliminary findings provide evidence that a mismatch between traits of preferred anger expression style and defensive style produces pronounced adrenocorticotropic responses during socially salient stress.

Additive pressor effects of caffeine and stress in male medical students at risk for hypertension.

The effects of caffeine on blood pressure (BP) and cortisol secretion were examined during elevated work stress in medical students at high versus low risk for hypertension. Among 31 male medical students who were regular consumers of caffeine, 20 were considered at low risk for hypertension (negative parental history and all screening BP < 125/78 mm Hg) and 11 at high risk based on epidemiologic criteria (positive parental history and average screening BPs between 125/78 and 139/89 mm Hg). Cortisol levels and ambulatory BP were measured with and without caffeine during two lectures (low work stress) and two exams (high work stress) in a randomized, double-blind, crossover trial. Caffeine consumption and exam stress increased cortisol secretion in both groups (P < .05). BP increased with caffeine or exam stress in both groups, low versus high risk, respectively (Caffeine: + 5/4 vs + 3/3 mm Hg; Stress: + 4/1 vs + 7/3 mm Hg; P < .05). The combination of stress and caffeine caused additive increases in BP (Low Risk + 9/5 mm Hg, High Risk + 10/6 mm Hg) such that 46% of high-risk participants had average systolic BP > or = 140 mm Hg. This combined effect of stress and caffeine on BP suggests that it may be beneficial for individuals at high risk for hypertension to refrain from the use of caffeinated beverages, particularly at times when work demands and attendant stressors are high. For the same reasons, recent intake of caffeine should be controlled in patients undergoing BP measurement for the diagnosis of hypertension.

Sex differences in pain perception and cardiovascular responses in persons with parental history for hypertension.

We investigated gender differences in cardiovascular and pain responses to the cold pressor (CP) test in persons with positive (PH+) or negative parental history (PH-) for hypertension. Previous work has suggested an attenuated sensitivity to painful stimulation in hypertensive men and more recently in men with parental disposition for hypertension. It is not known whether this hypoalgesic effect is present in PH+ women. In this study, we evaluated differences in pain perception between men and women with PH+ or PH- using an assessment method to measure current as well as delayed pain. Participants rated their pain every 15 s during a 90-s hand CP (0-4 degrees C) and a 90-s post-CP rest period. Systolic and diastolic blood pressures (SBP, DBP) and heart rate (HR) were measured before, during, and after the CP. PH+ and PH- groups did not differ in age, height, weight, education, resting SBP, DBP, or HR. PH+ men showed greater DBP responses to the CP than PH- men, while female groups did not differ in cardiovascular responses to the CP. Although pain ratings during the CP did not differ between groups, post-CP reported pain receded faster in the PH+ men than in the PH- men. PH+ women, on the other hand, tended to report greater pain than PH- women. These findings question the generalizability of the hypoalgesic effects in hypertension-prone women.

Ultrasonographic urinary tract abnormalities in Schistosoma haematobium infection.

OBJECTIVE: Evaluation of ultrasonographic abnormalities with active Schistosoma haematobium infection in Yemeni patients. METHODS: As part of a cooperation between a private hospital and Schistosomiasis Control Project in Yemen, laboratory and ultrasonographic examinations were performed in 158 patients (8 females, 150 males, mean age: 17 years) with active Schistosoma haematobium infection. Upper urinary tract dilation, lower ureter changes and bladder wall abnormalities (thickness, hyperechogenicity and polypoid lesions) were registered. Laboratory findings and ultrasonographic changes were evaluated and assorted according to age groups of the patients. RESULTS: Twenty-eight patients (18%) showed no ultrasonographic morphological lesion. Bladder abnormalities (thickness, hyperechogenicity and polypoid lesions) were found in 130 patients (82%) and upper tract lesions in 86 patients (54%). No upper tract lesions were seen without bladder abnormality. Polyps within the lower ureteric lumen occurred in four patients. In patients with polypoid lesions, higher incidence of severe infection was found. One patient had urinary bladder mass. CONCLUSION: Urinary schistosomiasis has typical sonographic features, however, it may occur also without ultrasonographic morphological lesion. Upper tract lesions seem to develop only with lower tract abnormalities.

Cortisol fluctuates with increases and decreases in negative affect.

Prior studies have reported cortisol secretion to be primarily influenced by negative affect, but less is known about cortisol activity during states of activation involving increased positive affect and decreased negative affect. On separate days, 30 healthy young men experienced: an activating and humorous video; a speech stressor; and a resting control period. Cortisol was measured in saliva before and after each 30-min mood induction. Positive affect (activation) was increased similarly by both the video and the speech compared to rest (p < .0001). Negative affect increased during the speech and decreased during the video (p < .001). Cortisol increased only during the speech (p < .0001). Following the video, however, cortisol was decreased significantly (p < .0001). Rest day cortisol revealed no differences across periods (p > .1). These results suggest that the hypothalamic-pituitary-adrenocortical axis is a dynamic system influenced by changes in negative affect irrespective of the experience of generalized activation.