The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency.

OBJECTIVE: To find out if there is a relation among the diameter of the great saphenous vein (GSV) when it is incompetent, the clinical gravity of the varicose syndrome and the type of insufficiency of the saphenofemoral junction (SFJ) in patients with chronic venous insufficiency (CVI) by means of duplex exploration. METHODS: The sample included 145 extremities, 38 normal as a control group and 107 with incompetence of the GSV. According to the results of the Valsalva and Parana manoeuvres in the SFJ, they were distributed into four groups. The diameter of the GSV and the clinical state according to the clinical, aetiological, anatomical and pathological element classification were recorded for each group. RESULTS: Statistically significant differences were obtained for the diameter and the clinical state in patients with positive manoeuvres with regard to other groups. The diameter was greater and the clinical state more severe (C4, C5 and C6) when two manoeuvres were positive. CONCLUSIONS: The presence of both positive manoeuvres in the SFJ is related to severe clinical states and greater diameters of the GSV, allowing the establishment of a prognosis of the CVI and the most suitable surgical approach.

[Evaluation of cerebral blood perfusion in patients undergoing carotid endarterectomy using densitometric analysis of conventional cranial CT]. / Evaluación de la perfusión cerebral mediante análisis densitométrico de la tomografía craneal en pacientes sometidos a endarterectomía carotídea.

OBJECTIVE: To evaluate the efficacy of densitometric analysis of cranial CT imaging in the measurement of areas with low cerebral blood flow and lack of hemodynamic reserve in patients undergoing carotid endarterectomy. PATIENTS AND METHODS: 40 consecutive patients undergoing carotid endarterectomy have been included in the study. All of them had preoperative cranial CT, pre and postoperative basal and acetazolamide SPECT. Cranial CT imaging after digitalization and computer processing were obtained with 4 densitometric patterns: 1). normal cerebral blood perfusion; 2). ischemic or low brain blood perfusion (patron I); 3). parenchyma without cerebral hemodynamic reserve (patron nR), and 4). brain infarction. RESULTS: 32 out of 40 (80 %) patients had abnormal densitometric patterns: 19 nR patterns (47.5 %), 11 I pattern (27.5 %) and 2 established brain infarction. The correlation between densitometric cranial TC imaging and SPECT was 92% when analyzing areas with hypoperfusion (S: 96.5 %; E: 82 %). Cranial CT detected 12/13 of patients who lacked cerebral hemodynamic reserve in the SPECT analysis (S: 74 %; E: 92 %; Vpp: 95 %). CONCLUSIONS: There is a good correlation between analysis of densitometric cranial TC imaging and SPECT in determining low cerebral blood flow areas and lack of cerebral hemodynamic reserve. This method could help to improve carotid surgery indications in patients with carotid stenosis.

Spontaneous acute abdominal aortic dissection.

A case of spontaneous acute infrarenal aortic dissection, with extension to the right common iliac artery and proximally to just below the origin of the renal arteries is presented. This dissection did not involve the visceral vessels nor the iliac system. The diagnosis was made with ultrasonography and computed tomography, without the need for angiography, and confirmed during surgical intervention, in which, prosthetic replacement of the affected segment was carried out.

Usefulness of molecular genetic markers in the typing of Salmonella enterica serovar Enteritidis causing a food-borne outbreak.

A combination of serotyping-phagetyping and three molecular genetic markers (plasmid analysis, chromosomic DNA restriction pattern and ribosomal RNA gene restriction pattern or ribotyping) was used in the typing of Salmonella enterica causing a food-borne outbreak. The isolates analysed, 29 from stools and eight from foods, belonging to serovar Enteritidis-phagetype A, carried a 36-MDa plasmid, showed a similar DNA restriction pattern and the same ribopattern. These data indicate that only one strain was involved. The DNA pattern and ribopattern of this strain were indistinguishable from the patterns of a serovar Enteritidis-phagetype A strain which has caused salmonellosis in Asturias, Spain, since, at least, 1984.

Gonorrhea in women prostitutes: clinical data and auxotypes, serovars, plasmid contents of PPNG, and susceptibility profiles.

Eighty-nine women prostitutes who underwent clinical and microbiologic examination were found to have gonococcal infection. The median age was 22; 92.1% were from urban areas. Nearly all the women prostitutes refrained from barrier methods (92.1%) and had contact with several partners (91.0%). The most frequent clinical findings were leukorrhea (50.6%), cervicitis (20.2%), and pelvic inflammatory disease (PID) (18.0%). Eighty-one women prostitutes (93.1%) had experienced a previous STD, with Chlamydia trachomatis (34.8%), Trichomonas vaginalis (30.3%), Neisseria gonorrhoeae (29.2%), and Ureaplasma urealyticum (23.6%) as the most frequent microorganisms isolated. Microorganisms associated with N. gonorrhoeae were isolated, mainly T. vaginalis (40.4%), C. trachomatis (31.5%), and Mycoplasma hominis (21.3%). For N. gonorrhoeae, the most frequent auxotypes were prototrophic (67.4%) and Proline (Pro)-dependent (14.6%); 2.2% of the strains were non-auxotypable. Beta-lactamase production was detected in three strains (3.4%) belonging to the auxotype/serovar: Lys/IA, Prototrophic/IB, and Pro/IB. The two former produced the 3.2-MDa "African" plasmid; the latter produced two plasmids (the 4.5-MDa "Asian" and the 24.5-MDa transfer plasmid.

[Intestinal parasitosis of the canine population in the principate of Asturias]. / Parasitosis intestinal en la población canina del Principado de Asturias.

A study is made of coprological samples from 354 dogs, 252 of them male and 102 female. Parasitism was found in 94 dogs (26.5%), of which 14 (15%) showed two or more associated parasites. The Councils with the highest degree of parasitism were: Peñamellera Baja (77.7%), Ribadedeva (57.1%), Castropol (53.8%), Ribadesella (50%), Piloña (46.6%), and Tapias de Casariego (44.4%). The parasites most frequently isolated were: Anciostoma Caninum (19.2%), Trichuris vulpis (8.2%), Cystoisospora canis (3%), Toxocara spp. (1.1%), and Toxascaris leonina (1.1%). The difference in the degree of parasitism in females over 1 year of age (26.6%), and of males over 1 year of age (19.6%) is statistically significant (p greater than 0.05). No eggs were found of Taenia spp., which points to the positive effects of the measures taken against the hydatid cyst, based on the biannual administration of Praziquantel to the canine population.

Plasmid profile analysis as a tool for characterization of epidemic Shigella sonnei strains.

The usefulness of plasmid profile analysis as a marker to determine the strain number of Shigella sonnei implicated in an epidemic outbreak and its prevalency in our community was studied. We could define two multirresistant strains and determine that the drug resistance was plasmid mediated in both. One strain carried a tra- plasmid which encoded (Sm, Sd)r, the other one carried two tra+ plasmids which encoded (Ap-Cb, Sm, Sd)r and (Sm, Km-Nm, Sd, Tp)r respectively. These strains and some coisolates collected during the later phase of the outbreak carried cryptic plasmids which showed similar electrophoretic mobilities.

Plasmid-mediated fosfomycin resistance is due to enzymatic modification of the antibiotic.

The molecular mechanism of plasmid-mediated resistance to fosfomycin is described. The antibiotic was inactivated intracellularly and remained inside the cells. Modification was also obtained from cell extracts and was not energy dependent. The modifying enzyme seems to have sulfhydryl groups in its active center.

[Prevalence and dispersion of plasmids conferring fosfomycin resistance in enterobacteria]. / Prédominance et dispersion des plasmides conférant la résistance á la fosfomycine chez des entérobactéries.

The mechanisms of resistance to fosfomycin which, at the present, predominate among clinical isolates of Serratia marcescens as well as the incidence and dispersion of For plasmids among other species of Enterobacteriaceae were studied. It was found that that 23 of the 29 strains under study phenotypically behaved as glp T- mutants, another as glp T- and uhp- and five of them showed no alterations in their transport system. Self-transferable plasmids involved in For were isolated from the latter. For plasmids were also found in strains of Klebsiella pneumoniae but not in other enterobacteria. Plasmids were studied in order to establish their resistance phenotype, molecular weight and incompatibility group. The data obtained along with the restriction pattern allow us to conclude that the trait For is linked to, at least, two different replicons.

Transfer of drug-resistance plasmids by conjugation from nosocomial strains of Serratia marcescens to Escherichia coli in biological fluids of human origin.

Six independent isolates of multi-resistant Serratia marcescens associated with nosocomial infections were examined for their ability to transfer drug-resistance plasmids by conjugation to Escherichia coli in biological fluids of human origin, such as normal and pathological urine, faeces, blood plasma and ascitic fluid. Luria broth was used as a control. Positive transfer was found in all media assayed. The different patterns of linked transferable resistance found in the transconjugants corresponded to the phenotypic expression of five plasmids. The frequencies of transfer varied with plasmid types and media employed. The culture media did not affect the phenotypic expression of the plasmids.

Plasmid-determined resistance to fosfomycin in Serratia marcescens.

Multiple-antibiotic-resistant strains of Serratia marcescens isolated from hospitalized patients were examined for their ability to transfer antibiotic resistance to Escherichia coli by conjugation. Two different patterns of linked transferable resistance were found among the transconjugants. The first comprised resistance to carbenicillin, streptomycin, and fosfomycin; the second, and more common, pattern included resistance to carbenicillin, streptomycin, kanamycin, gentamicin, tetracycline, chloramphenicol, sulfonamide, and fosfomycin. The two types of transconjugant strains carried a single plasmid of either 57 or 97 megadaltons in size. Both of these plasmids are present in parental S. marcescens strains resistant to fosfomycin. The 57-megadalton plasmid was transformed into E. coli.

The action of fosfomycin on the growth of Pseudomonas aeruginosa.

A study was made of the effect of the inoculum size and the culture conditions on the MIC of a strain of Pseudomonas aeruginosa that was sensitive to fosfomycin. The increase of the inoculum and the conditions which favour the cellular multiplication considerably increase the MIC. Phosphates inhibit the action of the antibiotic. Fosfomycin produces a logarithmic decrease in the number surviving 1 h after being added; the bacterial lysis measured by the decrease in the OD depends on the medium and is hardly noticeable in ordinary broth. In a minimum medium the antibiotic does not affect the growth. The determination of the variation in the consumption of oxygen is a rapid and accurate method of evaluating the effect of fosfomycin. A spontaneous mutant glpT was isolated which was more than 128 times more resistant than the isogenic parental strain. The growth curves of this mutant, the sensitive parental strain and a naturally resistant strain that was isolated in a patient were similar to each other in complex media. In synthetic media the naturally resistant strain shows shorter phases of latency, but the generation times are analogous. This would seem to indicate that the resistance to fosfomycin in P. aeruginosa has no influence on the speed of growth.