Mácula eritematosa dolorosa en el tobillo de una mujer joven / Painful erythematous macular lesion in the ankle of a young woman

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Strong spatial segregation between wildcats and domestic cats may explain low hybridization rates on the Iberian Peninsula.

The European wildcat (Felis silvestris silvestris) is an endangered felid impacted by genetic introgression with the domestic cat (Felis silvestris catus). The problem of hybridization has had different effects in different areas. In non-Mediterranean regions pure forms of wildcats became almost extinct, while in Mediterranean regions genetic introgression is a rare phenomenon. The study of the potential factors that prevent the gene flow in areas of lower hybridization may be key to wildcat conservation. We studied the population size and spatial segregation of wildcats and domestic cats in a typical Mediterranean area of ancient sympatry, where no evidence of hybridization had been detected by genetic studies. Camera trapping of wild-living cats and walking surveys of stray cats in villages were used for capture-recapture estimations of abundance and spatial segregation. Results showed (i) a low density of wildcats and no apparent presence of putative hybrids; (ii) a very low abundance of feral cats in spite of the widespread and large population sources of domestic cats inhabiting villages; (iii) strong spatial segregation between wildcats and domestic/feral cats; and (iv) no relationship between the size of the potential population sources and the abundance of feral cats. Hence, domestic cats were limited in their ability to become integrated into the local habitat of wildcats. Ecological barriers (habitat preferences, food limitations, intra-specific and intra-guild competition, predation) may explain the severe divergences of hybridization impact observed at a biogeographic level. This has a direct effect on key conservation strategies for wildcats (i.e., control of domestic cats).

Coincidence of Tracheobronchomegaly (Mounier-Kuhn Syndrome) and Juvenile Idiopathic Arthritis.

Mounier-Kuhn syndrome (MKS) or tracheobronchomegaly includes clinical and radiographic findings of tracheobronchial dilatation and recurrent respiratory infections. MKS is a very rare pathology, especially in the paediatric age group which makes it a diagnostic challenge. A 4-year-old girl suffered from dyspnea, recurrent respiratory infections and joint pain. Chest radiography detected peribronchial reinforcement and CT-scan revealed extended tracheal dilatation and bronchiectasis. In addition to MKS our patient was diagnosed with juvenile idiopathic arthritis (JIA) and scleroderma. MKS can be caused by congenital disorder or acquired aetiology. Several connective tissue diseases have been associated with MKS but no cases of JIA or scleroderma are described previously. Our case illustrates that patients who suffer from recurrent respiratory infections with unsatisfactory evolution and unspecific chest X-ray alteration, MKS always has to be considered in the differential diagnosis particularly in patients who suffer from connective tissue diseases.

Elastosis perforante serpiginosa en pacientecon enfermedad de Wilson tratadacon penicilamina / Elastoris perforans serpiginosa in a patient with Wilson’s disease treated

La Elastosis Perforante Serpiginosa pertenece al grupo de enfermedades perforantes, es una patología poco frecuente que aparece en edades tempranas,infancia o edad adulta precoz. Casi la mitad de los casos se relacionan con diferentes alteraciones genéticas o tratamientos prolongados con penicilamina.Las lesiones son pápulas queratósicas de 2-5mm que se disponen con un patrón serpiginoso o anular, siendo el cuello y flexuras las localizaciones másfrecuentes. Las principales características anatomopatológicas son la hiperplasia y la eliminación transepidérmica de tejido elástico.Presentamos una paciente de 48 años, con Enfermedad de Wilson en tratamiento con D-penicilamina, que consultó por lesiones anulares de repeticióny resolución espontánea (AU)

Elastosis Perforans Serpiginosa belongs to perforating diseases of the skin. It is a rare condition that appears in early ages, childhood or early adult age.Almost half of the cases are related to different genetic alterations or prolonged treatments with penicillamine.The lesions are queratotic papules of 2-5mm with serpiginous or annular pattern, and the neck and the flexures are the most frequent locations. Theprincipal anatomopathologic characteristics are hiperplasic and transepidermal elimination of elastic fiber.We show a patient with 48 years old, with Wilson’s disease in treatment with D-penicillamine, who consulted by annular repetitive lesions and spontaneousresolution (AU)

[Prognostic significance of the implantation of a temporary pacemaker in patients with acute myocardial infarction]. / Significado pronóstico de la implantación de marcapasos transitorio en pacientes con infarto agudo de miocardio.

OBJECTIVE: Indication of temporary pacemakers in patients during acute myocardial infarction was widely studied in the pre-thrombolytic era without having determined whether the generalization of fibrinolysis might have changed the overall incidence and significance of temporary pacemakers. Our aim was to determine the incidence and the prognostic significance of insertion of temporary pacemakers in patients with acute myocardial infarction. PATIENTS AND METHODS: In a study involving 1,239 patients consecutively admitted to hospital with acute myocardial infarction we studied clinical characteristics and prognosis depending on temporary pacemaker insertion or not. We performed an univariate analysis on in-hospital mortality and those selected variables were introduced in to a logistic regression analysis. RESULTS: A temporary pacemaker was indicated in 55 patients (4.4%), prophylactically in 22% and therapeutically in 78%. Temporary pacemakers were inserted in 55% of the patients with advanced AV block and in the 10% of the patients with bundle-branch block. Pacemaker insertion was associated with higher number of affected leads in the ECG, and higher CK peak, regardless of the association with thrombolysis. The following complications were more often observed in patients with temporary pacemakers: atrial fibrillation, heart failure, right bundle-branch block, advanced atrioventricular block and in-hospital mortality (45.4 vs 10.2%; p < 0.001). Need for a temporary pacemaker was less frequent in patients treated with thrombolytics compared with those not treated (3.0 vs 6.1%; p < 0.02). Pacemaker insertion had an independent value for predicting in-hospital mortality (OR = 5.51; 95% CI, 2.71-11.19). CONCLUSION: The insertion of a temporary pacemaker in acute myocardial infarction is less frequent nowadays than on the pre-thrombolytic era. Pacemaker insertion is associated with higher indices of infarct extension and in-hospital mortality, having independent prognostic value on the in-hospital mortality.

Tumor estromal CD34+ de localización en yeyuno. Presentación de un caso que se inicia con hemorragia digestiva / Jejunal CD34+ stromal tumor: report of case presenting as gastrointestinal hemorrhage

Se presenta el caso de un varón que tras estudio de una hemorragia digestiva no filiada con técnicas endoscópicas fue diagnosticado por angiografía selectiva y TAC de lesión sangrante en primeras asas yeyunales, que resultó ser un tumor estromal CD34+ sin diferenciación neural o miógena. Se analizan las características ultraestructurales e inmunohistoquímicas de los diferentes grupos de tumores estromales del tracto gastrointestinal, así como la dificultad diagnóstica cuando éstos se localizan en intestino delgado y requieren actitud terapéutica agresiva por presentar hemorragia (AU)

Incidence, clinical characteristics, and prognostic significance of right bundle-branch block in acute myocardial infarction: a study in the thrombolytic era.

BACKGROUND: Whereas the significance of right bundle-branch block (RBBB) in acute myocardial infarction was extensively studied in the prethrombolytic era, a possible change in the overall incidence and meaning of RBBB as a consequence of thrombolytic therapy is not well known. METHODS AND RESULTS: A multicenter, prospective study of 1238 patients consecutively diagnosed with acute myocardial infarction and admitted to three coronary care units was conducted. ECGs during the acute phase and clinical events until discharge and 1-year follow-up were monitored. In the 135 (10.9%) patients in whom RBBB was found, there were 51 (37.8%) new cases, 46 (34.1%) old cases, and 38 (28.1%) cases with an indeterminate time of origin. New RBBB was permanent in 26 and transient in 25 patients. RBBB was isolated in 76 (56%) and bifascicular in the remaining 59 (44%) patients. The following complications were more frequently associated with RBBB than non-RBBB patients: heart failure, 24% versus 46% (P<.001); use of pacemaker because of atrioventricular block, 3.6% versus 11% (P<.001); and 1-year mortality, 17.6% versus 40.7% (P<.001). Early mortality was significantly higher for new RBBB (43.1%, P<.001) than for old (15.5%) and indeterminate (15.3%) RBBB. These figures for 1-year mortality were 58.8% (P<.001), 35.5 (P<.01), and 23% (NS), respectively. Permanent and transient RBBB had different mortality rates: early mortality, 76% versus 8%, and 1-year mortality, 84% versus 32% (P<.001 for both). For isolated RBBB versus bifascicular block, early mortality was 14.4% versus 40.6%, and 1-year mortality was 30.2% versus 54.2% (P<.05 for both). Multivariate analysis showed an independent prognostic value of RBBB for early and 1-year mortality. CONCLUSIONS: The overall meaning of RBBB in acute myocardial infarction has not changed in the thrombolytic era, although a higher rate of new and transient RBBB and a lower rate of bifascicular block may represent a beneficial effect of thrombolytic therapy.

[The prognostic significance of complete atrioventricular block in patients with acute inferior myocardial infarct. A study in the era thrombolytics]. / Significación pronóstica del bloqueo auriculoventricular completo en pacientes con infarto agudo de miocardio inferior. Un estudio en la era trombolítica.

INTRODUCTION AND OBJECTIVES: Complete atrioventricular block (CAVB) during inferior acute myocardial infarction (AMI), characterizes a high-risk subgroup of patients. This study was designed to determine the incidence and meaning of CAVB associated with inferior AMI and their peculiarities in relation to thrombolytic therapy. METHODS: Prospective and multicenter, involving 605 patients consecutively admitted with inferior AMI. We studied clinical characteristics and complications occurring during hospitalization and one-year follow-up were monitored. RESULTS: CAVB was found in 57 (9.4%) patients and was more frequently associated with: right ventricular involvement (35% vs 10%; p < 0.001), higher indexes of infaret size: ST elevated ECG leads (4.67 +/- 1.67 vs 4.1 +/- 1.4; p < 0.01) and peak of creatinkinase (2,219 +/- 1,543 vs 1,589 +/- 1,203; p < 0.01). Patients with CAVB had a higher incidence of cardiogenic shock (14% vs 5%; p < 0.05) and in-hospital mortality (21% vs 8.7%). CAVB had an independent value for predicting in-hospital mortality (odds ratio 2.7, 95% confidence interval, 1.3-5.5). CAVB appeared more frequently in the first hour of evolution (91% vs 41%; p < 0.01); its duration was shorter than 6 hours in a higher ratio (80% vs 5%; p < 0.01), and in- hospital mortality was lower (8.5 vs 40.9%; p < 0.05), in patients receiving thrombolytic treatment compared with patients without this treatment. CONCLUSIONS: CAVB is a relatively frequent complication of inferior AMI and is often associated with larger infarcts, high incidence of complications and mortality. Earlier appearance, shorter duration and fewer in-hospital mortalities seem to characterize those CAVBs occurring in patients treated with thrombolytics.

Synthesis and histamine H(1)-receptor antagonist activity of 4-(diphenylmethyl)-1-piperazine derivatives with a terminal heteroaryl or cycloalkyl amide fragment.

New 4-(diphenylmethyl)-1-piperazine derivatives with a terminal heteroaryl or cycloalkyl amide fragment were synthesized and evaluated for their antihistaminic, anticholinergic and antiallergic activities. Tested compounds were found to be moderate to potent in vitro (guinea-pig ileum) histamine H(1)-receptor antagonists. Derivatives with a four methylene chain (1e-1h) were as potent in vivo (capillary permeability in rats) as cetirizine; the heteroaryl derivatives 1e and 1h were found to be the most active agents. These compounds displayed only weak in vitro (guinea-pig ileum) muscarinic M(3)-receptor antagonist activity. Compounds 1e and 1g were about 100 times more potent than ketotifen in preventing the compound 48/80-induced histamine release from rat peritoneal mast cells. Derivatives 1e, 1f and 1h did not modify the spontaneous motor activity in rats at 100 mg/kg po. Compound 1e has been selected for further studies.

[A tiapride and ketamine combination in short duration anesthesia]. / Asociación de tiapride y ketamina en anestesia de corta duración.

Tiapride was used as premedication on a series of 16 patients subsequently submitted to general anesthesia with ketamine. In order to compare the effects of tiapride on the incidence of visionary dreams, hallucinations and dyslepsic syndrome brought about by, this series was compared with 2 further series of patients premedicated with dihydrobenzoperidol plus fentanyl (15 patients) and diazepam plus haloperidol (11 patients). Effectiveness was evaluated by means of a 10 point recovery scale (1: rate of sedation; 2: anterior amnesia; 3: comprehensiveness and collaboration test; 4: space sense and time orientation; 5: Bender test; 6: dysleptic syndrome; 7: sick feeling and vomit; 8: subjective status; 9: recovery quality; 10: dreams and hallucinations) at 15, 30 and 60 minutes after the administration of the different premedications. General tolerance was evaluated by continuous quantification of vital signs: pulse rate, EKG and systolic, diastolic and mean blood pressures. The effects were analysed with ANOVA one-way, Newman-Keuls and t-paired tests. Premedication with 7.5 mg/kg of tiapride significantly reduced the incidence of dreaming, provided the necessary sedation and appropiate postoperative analgesia and rapid recovery of psychomotor coordination with no obvious alterations in haemodynamic parameters attributable to the selective blocking action of the dopaminergic receptors. The association tiapride-ketamine may be useful in anesthesia for day-case surgery.

[Childhood shigellosis: clinical and microbiological characteristics]. / Shigellosis infantil: características clínicas y microbiológicas.

Authors present a retrospective study on 89 cases of pediatric shigellosis detected between 1983-1987. Most frequent isolated strain was S. sonnei with 67.4% and S. flexneri with 31.4% cases. 73.9% of all isolements were marked between the months october-december. Mean age of patients was 4.4 years and 44.9% of them need not to be hospitalized. Only 3.3% of patients presented a clinical syndrome of bacillar disentery with blood and mucus. Strains were resistent to ampicilin in 84.2% and to thrimetoprim-sulphimethosaxol in 80.9% of cases.