Polymerase chain reaction detection of BK virus and monitoring of BK nephropathy in renal transplant recipients at the University Hospital La Fe.

INTRODUCTION: Reactivation of BK infection occurs in immunocompromised hosts causing tubulointerstitial nephropathy (BKVN). Approximately 5% of kidney transplant recipients (KTR) develop BKVN, special half of whom lose their grafts. However, BKVN morphologic diagnosis on a renal biopsy is complicated, because the cytopathic changes can sometimes mimic rejection. Thus, BKV DNA-polymerase chain reaction (PCR) assay on serum, urine, and renal tissue is useful for early detection and monitoring of BKV. MATERIALS AND METHODS: We performed routine monthly urine cytologies looking for decoy cells as a marker of virus replication. Then, we performed a qualitative PCR on urine and serum in all recipients (independently of positive or negative cytology). We amplified 3 BK viral genome regions, LT (early transcription region) and VP1 (late transcription region) seeking a more accurate virus detection, and the TCR (control transcription region) region to perform a polymorphism sequence analysis to identify the BK genomic variant. Finally, the BKVN diagnosis was confirmed using renal biopsy. RESULTS: At present, 132 patients have been monitored. Thirteen of 40 (33%) were PCR-urine-positive cases (5 LT+/VP1- and 8 LT+/VP1+), and 10 of 132 (7.5%) were PCR-serum-positive cases (7 LT+/VP1- and 3 LT+/VP1+). When we compared PCR-urine and cytology results, 11 of 40 (27.5%) patients showed a positive cytology, 6 of whom were PCR- urine-positive (1 LT+/VP1- and 5 LT+/VP1+); whereas, 29 patients showed a negative cytology, 7 of whom were PCR-urine-positive(3 LT+/VP1- and 4 LT+/VP1+). Thus, comparison of PCR- urine and cytology results revealed false-positive and false-negative cases. Finally, TCR sequence analysis was performed in 9 patients to identify the BK genomic variants. CONCLUSION: Testing for BKV DNA in urine and serum is a noninvasive early detection assay and monitoring tool.

Angiopaniculitis granulomatosa mamaria / Mammary granulomatous angiopanniculitis

Introducción Las lesiones granulomatosas en la mama constituyen un variado espectro de alteracione que pueden traducir diferentes tipos de afecciones. Material y método: Presentamos una observación clinicopatológica acerca de una paciente de 49 años de edad que mostró lesiones recurrentes, primero en las mamas y más tarde en el muslo y pierna, que se resolvieron de forma espontánea sin ningún tratamiento. Resultados: EL examen citológico por punción de todas las lesiones mostró granulomas no necronizantes. El estudio histológico de la lesión mamaria evidenció una angiopaniculitis granulomatosa mamaria, consistente en la asociación de una angeítis llinfoide y una paniculitis granulomatosa no necronizante. Conclusión: La angiopaniculitis granulomatosa mamaria debe diferenciarse de las llamadas mastitis granulomatosas idiopáticas. El proceso puede simular clínica y radiográficamente un proceso neoplásico. Su curso evolutivo, a pesar de su carácter recurrente, es benigno, siendo considerada por algunos autores como una variedad de la enfermedad de Weber-Christian (AU)

Warthin-like tumor of the thyroid: a papillary carcinoma with mitochondrion-rich cells and abundant lymphoid stroma. A case report.

Papillary carcinoma is the most common form of thyroid carcinoma and, generally, it has a more favorable prognosis than other carcinoma types, although diverse variants or subtypes have been described, some of which appear to have a less favorable prognosis. Recently, a new variant, the so-called "Warthin-like tumor" or "tall-cell variant with extensive lymphocytic infiltration of papillary thyroid carcinoma" with behavior similar to the usual papillary carcinoma, has been described. We present a case with the cytohistological pattern of "Warthin-like tumor" of the thyroid. Immunohistochemistry revealed reactivity at the epithelium lining papillae for antimitochondrial 113-I antibody and also membranous positivity for CD15 (Leu M1). Lymphoid stroma showed an immunoprofile similar to chronic lymphocytic thyroiditis. These findings point to the consideration of "Warthin-like tumor" as being a hybrid neoplasm between the tall-cell variant and oxyphilic papillary carcinoma associated to a lymphoid-rich stroma.

[Pregnancy, breast cancer and tumor infarction]. / Embarazo, cáncer de mama e infartación tumoral.

Breast cancer is infrequently associated with pregnancy. However, such cases often pose diagnostic and treatment problems. The infarction of breast lesions is likewise uncommon, and generally hinders intraoperative morphologic diagnosis. A 33-year-old woman in the 37th week of pregnancy presented with a breast tumoration of progressively increasing size and associating mastalgia. Following fine-needle aspiration and trut-cut biopsy with posterior amplified tumorectomy and axillary dissection, a ductal neoplasm was identified with an infarction affecting 90% of the tumoral surface. The where no axillary adenopathies, and the patient was estrogen receptor-negative. An analysis is made of this rare association of pregnancy and infarcted breast cancer, with an evaluation of the role of fine-needle aspiration and/or gestation may play in the occurrence of tumor infarction.

[Aeromonas spp. isolated from human feces. Species and pathogenicity factors]. / Aeromonas spp. aisladas de heces humanas. Especie y factores de patogenicidad.

The role of Aeromonas genus as a primary intestinal pathogen is still a matter of controversy. We have studied the isolation of Aeromonas spp. from human stools samples, looking for the production of pathogenic factors and its relationship with different species. From a total of 471 strains isolated, 241 were A. caviae, 127 A. sobria, 89 A. hydrophila and 14 non-typable strains. The pathogenic factors production was studied in a bacteria-free filtrate from a 18 hours trypticase-soy broth culture. Enterotoxin production was assessed by suckling-mice test, cytotoxin production by using Hela cells monolayer and hemolysin production by double dilution from the filtrate, plated in microdilution plates, against rabbit red-blood cells. Enterotoxin production test was positive for A. sobria, A. hydrophila and A. caviae in 81.1%, 62.9% and 7.0% of strains respectively. Cytotoxin production was also positive for these species in 96.6%, 76.4% and 4.1%, and hemolysin production was positive in 95.3%, 70.7% and 2.4% of the strains respectively.

[Induction of a double nodal pathway in dogs by transcatheter ablation with high frequency currents]. / Inducción de una doble vía nodal en el perro por ablación transcatéter con corrientes de alta frecuencia.

A dog weighing 15 kg and anesthetized with intravenous sodium thiopental was subjected to transcatheter ablation of the AV junction with high-frequency currents, in order to induce a partial alteration in AV conduction (first degree AV block). Two conventional bipolar electrode-catheters were introduced through the right femoral vein and used one for atrial pacing and the other for His bundle recording and current delivering. The catheter used for ablation was situated in the AV junction where the distal monopolar recording of the His bundle electrogram showed an A/V ratio close to one in the presence of His bundle deflection. Three discharges were delivered under continuous electrocardiographic monitoring. The output power used was 15 watts and current application time was up to five seconds after attaining complete AV block; 1:1 AV conduction was quickly restored on concluding discharge. After the second discharge, a discontinuous nodal function curve of the dual AV nodal pathway type was obtained (absent in control and after first discharge studies). Following the third discharge the conduction through the slow pathway was abolished. The study was repeated after four weeks, an a dual AV nodal pathway type curve similar to that found during the acute phase was obtained. The histologic findings showed a collagen scar partially replacing nodal tissue and creating a partial septation of the AV node. To conclude: The structural alterations of the AV node may induce a dual AV nodal pathway response.

Induction of complete AV block in dogs by transcatheter ablation using high-frequency current: an alternative to direct-current high energy shock.

The utility of high-frequency current applied through the distal electrode of a conventional electrode-catheter for altering atrio-ventricular conduction was studied in 18 anaesthetized dogs. Following adequate unipolar His bundle recording, current was applied over periods of 20-30 s, with an output power of 30 W. Complete AV block was achieved in all dogs (four dogs on the third attempt, five on the second, and nine on the first). Ten of the dogs were killed after four hours of continuous ECG monitoring (Group I); examination revealed circumscribed spheroidal myocardial lesions at the base of the right atrium over the posterior tricuspid valve; no thrombus formation was encountered. The remaining eight dogs (Group II) were kept alive for three months during which complete block persisted in all cases. The histologic study showed partial replacement of AV nodal and His bundle tissues and myocardium by fibrous tissue. In conclusion, electro-catheter ablation using high-frequency energy is effective for producing complete AV block. The resulting lesions are circumscribed. This method may prove to be an alternative to the transcatheter DC shock for ablation of the AV conduction system.

Cholesterol oxygenated derivatives induce erythrocyte accumulation and endothelium alterations in the aorta of rats. Turnover of endothelial cells in the apparently intact areas remains unchanged.

In this work we have studied the effect of cholesterol autooxidation derivatives on the aortic endothelium of rat. Endothelial alterations were evident after 24 h treatment. Areas showing many spindle shaped nuclei and focal accumulation of erythrocytes were observed. Moreover, in some preparations areas with destroyed and missing endothelium were observed. Autoradiography using 3H-thymidine does not show differences in the mitotic activity between control and treated animals in those areas showing apparently intact endothelium. Therefore, we conclude that cholesterol derivatives present ability to produce important lesions in aortic endothelium and that this effect is similar to that described when cholesterol is used.

Prostacyclin production and lipid peroxidation in the aorta of rats fed with cholesterol autoxidation products.

The stable metabolite of prostacyclin 6-keto PGF1 alpha originating from the (1-14C) arachidonic acid, and lipid peroxidation expressed as thiobarbituric acid-reacting substance (TBARS) were studied in the aorta of rats fed a diet enriched in 2% w/w cholesterol autoxidation products for 24 hours prior to sacrifice. A slight increase was found in the amount of TBARS as well as in the conversion of (1-14C) arachidonic acid to 6-keto PGF1 alpha. These results suggest that in aorta there exists a protection mechanism which acts to increase the production of prostacyclin.