In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against fungi causing onychomycosis.

BACKGROUND: Onychomycosis is one of the commonest dermatological diseases worldwide. The antifungal activity of current medications varies, and treatment failure occurs in 25-40% of treated patients. AIMS: To evaluate the in vitro antifungal activity of itraconazole, fluconazole, terbinafine and voriconazole against isolates taken from patients with onychomycosis. METHODS: Nail isolates were evaluated according to methods described in the protocols of the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antimicrobial Susceptibility Testing (AFST-EUCAST) and the Clinical and Laboratory Standards Institute (CLS M38-A), and a CLSI M38-A modified technique for dermatophytes. Antifungal agents tested included terbinafine, itraconazole, voriconazole and fluconazole. RESULTS: In total, 103 isolates of Candida species (n = 58), Fusarium species (n = 10), Fusicoccum dimidiatum (n = 4), Scytalidium hyalinum (n = 1) and dermatophytes (n = 30) were evaluated. Itraconazole and voriconazole were the most active agents against Candida species, whereas terbinafine and voriconazole were most potent against dermatophytes. Fusarium species had the highest minimum inhibitory concentration (MIC) values with all antifungal agents. CONCLUSIONS: The aetiological agents of onychomycosis that we found differ from those found in other countries, suggesting that the heat and humidity of the Colombian climate could favour yeast nail infections. The lowest MICs for Candida species (obtained with voriconazole, followed by itraconazole) may be explained by emerging resistant strains. Against dermatophytes, the lowest MICs were obtained with terbinafine, followed by voriconazole. MIC values for the evaluated agents were higher for non-dermatophyte filamentous fungi than for other fungi. As MIC breakpoints have not yet been established for onychomycosis therapies, it remains unclear if in vitro activities of antifungal drugs are predictive of clinical outcome. Well-designed clinical studies are necessary to assist clinicians in choosing the best antifungal agents.

Identification of main risk factors for tubal infertility.

OBJECTIVE: To determine the relationship between some reproductive variables and infertility caused by tubal obstruction. DESIGN: A retrospective, case-control study. SETTING: A tertiary care university hospital that is a referral center for infertility patients. PARTICIPANTS: Subjects were interviewed between March 1990 and December 1991. Cases were 215 consecutively recruited infertile women with either evidence of tubal obstruction found at laparoscopy or hydrosalpinx diagnosed by hysterosalpingography. Women with a history of surgical sterilization were excluded. Controls, selected in the same hospital, were women in the puerperium who had no history of infertility. Two controls were matched by age at the time of tubal obstruction diagnosis to each case. RESULTS: History of pelvic surgery and use of alcohol were significantly associated with the risk of infertility caused by tubal obstruction. The use of barrier, oral, and medroxyprogesterone acetate (MPA) contraceptives was associated with a protective effect. When only women with secondary infertility were analyzed, history of pelvic surgery and number of lifetime sexual partners were significant risk factors, and the previous use of oral contraceptives was the only protective factor. CONCLUSIONS: History of pelvic surgery was the most important risk factor for tubal infertility. All precautions must be taken to avoid infection and adhesion formation when pelvic surgery is performed. In addition, women can be protected from tubal infertility by using barrier, oral, or MPA contraceptive methods.

Prolapso idiopático da valva mitral. Confronto entre a expressão clínica e a ventriculografia / Idiopathic mitral valve prolapse. Confrontation between clinical expression and ventriculography

Foram estudados 30 pacientes, com prolapso da valva mitral, submetida a ventriculografia. O prolapso foi classificado como de tamanho pequeno, medio e grande e a cinetica ventricular catalogada em forma de pe de bailarina, ampulheta e discinesia anterior. As arterias coronarias foram pervias em todos os casos. Em 3 casos (10%) o prolapso foi pequeno, em 18 casos (60%) de media intensidade e em 9 casos (30%), grande. Em 23 casos (76,6%), o ventriculo adquiriu o aspecto de ampulheta; em 5 casos (16,6%), o formato de pe de bailarina e em 2 casos (6,6%) apresentaram discinesia em area anterior do ventriculo esquerdo. Precordialgia tipica foi relatada por 14 pacientes (46,6%), atipica 14 vezes (46,6%) e em 2 casos (6,6%), nao ocorreu dor precordial. Referiram palpitacao em 20 enfermos (66,6%). A ausculta cardiaca foi normal em 10 pacientes (33,3%); 15 casos (50%) apressentaram estalido mesossistolico; associacao de sopro sistolico mitral e estalido ocorreu em 5 casos (16,6%). O eletrocardiograma obtido em repouso foi normal 12 casos (40%), revelou isquemia em area diafragmatica ou anterior por 12 vezes (40%) e alteracao difusa da repolarizacao ventricular em 5 casos (16,6%). Apenas um doente apresentou extra-sistoles ventriculares no eletrocardiograma obtido em repouso. Confronta-se a expressao da discinesia ventricular e a magnitude do prolapso com os sintomas (precordialgia e a palpitacao), assim como com os achados da ausculta cardiaca e do eletrocardiograma

Primary intraventricular choriocarcinoma.

A case of a choriocarcinoma within the third ventricle in an eight-year-old girl is described. The patient died suddenly five days after operation. The post mortem examination showed an intraventricular hemorrhage with obstruction of the foramina of Monroe. An additional case in a 16-year-old young man, with similar location and without necropsy, is described. Discussion of the primary origin and etiology of these tumors is presented.