Collagen Type IV Alpha 5 Chain in Bronchiolitis Obliterans Syndrome After Lung Transplant: The First Evidence.

INTRODUCTION: Bronchiolitis obliterans syndrome (BOS) is the most common form of CLAD and is characterized by airflow limitation and an obstructive spirometry pattern without parenchymal opacities. The protein signature of BOS lesions concerns extracellular matrix organization and aberrant basement membrane composition. In this pilot study, we investigated the presence of COL4A5 in the serum of patients with BOS. METHODS: 41 patients who had undergone LTX were enrolled. Of these, 27 developed BOS and 14 (control group) were considered stable at the time of serum sampling. Of BOS patients, serum samples were analysed at the time of BOS diagnosis and before the clinical diagnosis (pre-BOS). COL4A5 levels were detected through the ELISA kit. RESULTS: Serum concentrations of COL4A5 were higher in pre-BOS than in stable patients (40.5 ± 13.9 and 24.8 ± 11.4, respectively, p = 0.048). This protein is not influenced by comorbidities, such as acute rejection or infections, or by therapies. Survival analysis also reveals that a higher level of COL4A5 was also associated with less probability of survival. Our data showed a correlation between concentrations of COL4A5 and FEV1 at the time of diagnosis of BOS. CONCLUSION: Serum concentrations of COL4A5 can be considered a good prognostic marker due to their association with survival and correlation with functional parameters.

Persistence and variation in microstructural design during the evolution of spider silk.

The extraordinary mechanical performance of spider dragline silk is explained by its highly ordered microstructure and results from the sequences of its constituent proteins. This optimized microstructural organization simultaneously achieves high tensile strength and strain at breaking by taking advantage of weak molecular interactions. However, elucidating how the original design evolved over the 400 million year history of spider silk, and identifying the basic relationships between microstructural details and performance have proven difficult tasks. Here we show that the analysis of maximum supercontracted single spider silk fibers using X ray diffraction shows a complex picture of silk evolution where some key microstructural features are conserved phylogenetically while others show substantial variation even among closely related species. This new understanding helps elucidate which microstructural features need to be copied in order to produce the next generation of biomimetic silk fibers.

Tromboelastografía: evaluación global de la coagulación: aplicaciones en el periodo perioperatorio / Thromboelastography: overall evaluation of coagulation: perioperative applications

La tromboelastografía es un método diagnostico de uso relativamente reciente, enfocado a evaluar de forma global la coagulación. Este método ha evolucionado con rapidez hacia el uso frecuente en la clínica, y es de utilidad para la evaluación de coagulopatías y como guía para la intervención; además, se ha encontrado que su implementación rutinaria conlleva la disminución en el uso de transfusión de hemoderivados y, consecuentemente, en los costos y complicaciones asociadas a su administración. Este reporte de casos en pacientes del Hospital Universitario de San Ignacio describe situaciones clínicas alternas a las de uso común, en las cuales el uso de la tromboelastografía aporta un excelente complemento diagnóstico y guía terapéutica en el perioperatorio.

Thromboelastography is a relatively new diagnostic method designed for a global evaluation of coagulation. This method has rapidly evolved and is frequently used in the clinic for the evaluation of coagulopathies and as guide for intervention; furthermore, its routine application on a daily basis reduces the need for transfusion ofhemoderivatives, and consequently lessens the costs and complications thereof. This case report of patients from the San Ignacio University Hospital, describes infrequent clinical situations in which the use of thromboelastography provides an excellent diagnostic aid and treatment guide during the perioperative period.

Mandibular solitary plasmocytoma of the jaw: a case report.

Plasma cell tumors are lymphoid neoplasms with an uncontrolled proliferation of B cells. These are divided into localized forms (solitary bone plasmocytoma -SBP- and extramedullary plasmocytoma -EP-) and disseminated forms (multiple myeloma-MM-). The SBP is a rare and controversial disease. The aim of this article is the analysis of this entity based on the presentation of a 64-year-old man without previous medical history, with a mass in the left mandibular angle extending to the parotid region on the same side. The panoramic radiography, computed tomography and magnetic resonance imaging showed an osteolytic lesion 6.5 x 5 x 6.7 cm in the mandibular angle with infiltration of the masticator space and left parotid region. The normality of the extension study, and histopathological examination confirmed the diagnosis of SBP. The patient received treatment with radiotherapy with good outcome.

[Buccal mucosa urethroplasty in anterior urethral strictures]. / Uretroplastia con mucosa oral en estenosis de uretra anterior.

UNLABELLED: Buccal mucosal graft can be used for succesfull repair in both pendulous and bulbar strictures. MATERIAL AND METHODS: We present our experience with buccal mucosal graft repair in 8 patients with onlay patch that varies from 4 to 16 cm. in length. Three pendulous, two bulbar and three panurethral strictures were repaired. These patients were observed for 36 to 60 months. RESULTS: No stricture recurrences were observed. Only one patient had lower lip paresthesia for six months.

Uretroplastia con mucosa oral en estenosis de uretra anterior / Buccal mucosa urethroplasty in anterior urethral structures

Los injertos de mucosa oral pueden ser utilizados para la reparación satisfactoria de estenosis de uretrapéndula y bulbar. Material y métodos: Presentamos nuestra experiencia con injertos de mucosa oral en 8 pacientes. La longitud del injerto fue entre 4 y 16 cm. Se han realizado tres uretroplastias en uretra péndula, dos en uretrabulbar y tres panuretrales. El seguimiento ha sido entre 36 y 60 meses. Resultados: No se han observado recurrencias. Un paciente refirió parestesias en el labio inferior durante seis meses (AU)

Buccal mucosal graft can be used for succesfull repair in both pendulous and bulbar strictures. Material and methods: We present our experience with buccal mucosal graft repair in 8 patients with onlay patch that varies from 4 to 16 cm. in length. Three pendulous, two bulbar and three panurethral strictures were repaired. These patients were observed for 36 to 60 months. Results: No stricture recurrences were observed. Only one patient had lower lip paresthesia for six months (AU)

The 11 March 2004 Madrid terrorist attacks: the importance of the mortuary organisation for identification of victims. A critical review.

On the morning of 11 March 2004, Madrid lived the worst terrorist attack in its modern history, resulting to 191 people killed and more than 1,800 injured. The attacks evidenced a series of significant deficiencies in forensic task planning, especially in using standardised post-mortem data forms and gathering ante-mortem medical and dental data, responsible for the delay in identifying corpses in the worst state, which had to wait for DNA analysis. Fortunately, the ultimate result can be considered satisfactory, given the rapid response of the forensic team in examination and identification of the large number of victims (80% of the victims were identified within 40 h), consequence of a good mortuary organization in the Pavilion 6 of the Madrid Trade Fair (IFEMA), the professional fervor whereupon the different involved professionals acted, some personal initiatives and the good general state of most of the corpses.

Fisiopatología, Prevención y Tratamiento de la Mucositits oral inducida por Quimioterapía y Radioterapía / Physiopathology and prevention and treatment of oral mucositis induced by chemotherapy and radiotherapy

La mucositis oral es una complicación frecuente y potencialmente severa de la terapia antineoplásica. Algunas de las manifestaciones básicas que se encuentran dentro de las descripciones clínicas comprenden el eritema, la descamación, formación de úlceras, el sangrado, y los exudados. Con el incremento de la capacidad de manejo de otros efectos tóxicos causados por la terapéutica oncológica, la incidencia de mucositis ha aumentado como resultado de regímenes más agresivos. La incidencia de esta patología se ve evidentemente aumentada en pacientes llevados a trasplante de médula ósea, en esquemas terapéuticos que usan infusiones continuas y en terapias para tumores de acbeza y cuello que tienen una asociación concominante entre radioterapia y quimioterapia. La morbilidad de la mucositis puede llegar a ser importante y se estima que los pacientes que tienen una asociación entre mucositis y neutropenia tienen un riesgo relativo de septicemia que es aproximadamente cuatro veces mayor que sin mucositis. El 15 por ciento de los pacientes tratados con radioterapia en cavidad oral y en faringe requieren una hospitalización posterior por complicaciones infecciosas en mucosas, relacionadas al tratamiento. Se ha visto qque los pacientes con neeoplasias hematólogicas desarrollan con mayor frecuencia mucositis comparados con los pacientes que tieenen tumores sólidos. Otra condición asociada a la mucostitis que altera de manera considerable la calidad de vida del paciente el dolor que usualmente es continuo y que incrementa con la deglución.Esta revisión ha sido el producto de una búsqueda hasta cierto punto sistemática de literatura, a la que intentamos aproximarnos con la mirada más crítica posible y ha sido una interseante primera aproximación a un tema de gran interés y controversia. Lo contradictorio e insuficiente de los datos hallados en la literatura al respecto del tratamiento de la mucositis inducida por radioterapia y quimioterapia no deja de ser desconcertante. Por ser ésta condición muy frecuente en los pacientes con cáancer, se supondría que debería haber sido más estudiada y tal vez resuelta.Es pues necesario hipotetizar más al respecto, y estimular a aquellos que trabajamos con pacientes afectados por el cáncer a plantear estudios cooperativos y prospectivos relacionados con esta patología parea tal vez con ellos aportar datos de utilidad para nuestra institución.

[Prevalence of antimicrobial resistance in enterococci isolated from blood in Madrid (1994-1995)]. / Prevalencia de resistencia antimicrobiana en enterococos aislados de sangre en Madrid (1994-1995).

BACKGROUND: The aim of this study was to evaluate the antimicrobial resistance of enterococci isolated from blood samples in three hospitals in Madrid (Spain) from 1994 to 1995. METHODS: One hundred strains, 83 Enterococcus faecalis, 15 E. faecium, and 2 E. durans, isolated from January 1994 to April 1995 were studied. The minimum inhibitory concentrations (MIC) of 11 antimicrobians were determined by the agar dilution method. RESULTS: Four percent of the strains were resistant to ampicillin and 7% to penicillin. Ninety-two percent were sensitive to vancomycin. The percentage of strains with a high level of resistance (HLR) to some aminoglucoside was 60%. HLR was observed to gentamycin in 41%, to streptomycin in 46% and to kanamycin in 58% of the strains. Half of the isolates were resistant to the fluoroquinolones tested. HLR was significantly associated with aminoglucosides with HLR (MIC > or = 16 mg/l) to fluoroquinolones in the strains studied (p < 0.001). CONCLUSIONS: The incidence of resistance to ampicillin and vancomycin is low and very high to aminoglucosides and fluoroquinolones. There is also a very significant association between HLR to fluoroquinolones and HLR to aminoglucosides.