Alterations in epididymal sperm maturation caused by ageing.

The epididymis is an organ that performs all the biochemical changes responsible for sperm maturation. During ageing, histological alterations in the epididymis and decreased protein synthesis have been found. This might affect the sperm maturation process. The aim of this study was to determine if the changes in the epididymis during ageing might cause alterations in sperm maturation. Wistar rats of 3-4months old (young) and 18-21months old (old) were used. The testosterone concentration was determined and the epididymides were dissected and divided in three regions: caput, corpus, and cauda. The tissues were used for histological processing and sperm extraction. Testosterone concentration decreased 34% in the old animals compared to the young ones. The distribution of mannose, sialic acid, and N-acetylglucosamine in the glycocalyx of the sperm membrane of old animals was different from that of young animals. The same occurred with phosphatidylserine externalisation and protein phosphorylation at tyrosine residues. Epididymis histology in old animals showed tubular and cellular degeneration. Our results suggest that ageing affects maturational markers, likely due to alterations in the epididymis as a result of the testosterone decrease associated with ageing.

Intususcepción eecocólica e invaginación del ciego en un canino: reporte de caso / Cecocolic intusuusception and invagination of the cecum in a dog: case report

Se expone el caso de un perro mestizo de Fox Terrier que presentaba diarrea sanguinolenta que no mejoró al tratamiento inicial; se detectó a la palpación una masa a nivel del colon, que se confirmó con un estudio radiográfico de tránsito intestinal; también, se diagnosticó un megacolon. Se decidió realizar una laparotomía exploratoria donde se encontró una intususcepción cecocólica y la invaginación del ciego, el procedimiento quirúrgico realizado consistió en hacer tiflectomia y enteroanastomosis término-terminal; luego de este procedimiento, el paciente se recuperó completamente del cuadro intestinal que presentaba.

A case is presented of a mestizo Fox Terrier dog than presented diarrhea with blood and the initial treatment didn't achieved any improve; with palpation it was determinate a mass to the colon, which was confirmed after performing the routine clinical testing and radiographic studies of intestinal transit; also, megacolon is diagnosed. Exploratory laparotomy was performed at it was found cecocolic intussusepction and the cecum invagination, the surgical procedure developed was typhlectomy and of end-to-end intestinal anastomoses; after the procedure, the patient was completely recovered to the intestinal disease.

Evidencia de cambios clínicos y radiográficos en implantes oseointegrados de superficie maquinada y modificada, 3-12 meses de seguimiento / Evidence of clinical and radiographic changes in machined and modified surface osseointegrated implants. 3 to 12 months follow up

En este estudio se realizó una evaluación clínica y radiográfica entre un grupo de pacientes con implantes de superficie maquinada y otro grupo con superficie modificada para determinar si existe alguna diferencia significativa que justifique la utilización de una u otra superficie; para ello se trabajó con dos tipos de implantes de la casa comercial Lifecore®, un grupo con 30 implantes de superficie maquinada o lisa (SuperCAT®) y 30 implantes de superficie modificada o rugosa (RBM®), de conexión externa, tipo tornillo, para la restauración de diente único. El procedimiento quirúrgico se realizó de acuerdo con las recomendaciones del fabricante y a los seis meses se realizó la cirugía de destape y se colocó una restauración temporal. Se siguieron los parámetros de Roos y colaboradores (1997) para la evaluación clínica y radiográfica. Se obtuvo el 100% de oseointegración de los implantes para ambos grupos. La pérdida ósea promedio fue de 0,78 mm. No se encontraron diferencias estadísticamente significativas en la evaluación clínica y radiográfica entre los dos grupos de implantes de superficie maquinada o modificada para la restauración de diente único.

The aim of this study is to undertake a clinical and radiographic evaluation between two different patient groups: machined versus modified surface, to find out if there is statistically significant difference that support the use of implants with different surface properties. Sixty screw, external hex connection implants were examined: one group with 30 machined surface implants (SuperCAT®), and a second group with 30 implants with modified surface (RBM®), for restoring a single tooth. The surgical procedure was performed according with the manufacturer’s protocol. After six months the second phase surgery was performed and the temporary restoration was placed. At this point, the first radiographic evaluation was made. The Roos et al (1997) parameters were followed for the clinical and radiographic evaluation. A 100% of osseointegration was accomplished in both groups. The average marginal bone loss was 0.78 mm, without significant differences between the groups. All implants were reported as success grade 1, with no complications. There are not significant differences between the two groups of machined and modified implant surfaces for single tooth restoration.

Residual pulmonary abnormalities in adult patients with chronic paracoccidioidomycosis: prolonged follow-up after itraconazole therapy.

Itraconazole effectively controls active paracoccidioidomycosis but appears not to hinder lung fibrosis. Clinical records and chest radiographs from 47 itraconazole-treated patients with prolonged posttherapy follow-up (mean follow-up period, 5.6 years) were analyzed; the radiographs were interpreted following pneumoconiosis standards that consider the lungs as 6 fields and grade damage according to the number of fields involved. Infiltrative lesions were observed at diagnosis in 93.6% of the patients. Fibrosis was observed in 31.8% of the patients at diagnosis and had not cleared at the end of the observation period in any of these patients. Fibrosis also developed de novo in 11 patients (25%), so that by the end of the follow-up period it was seen in 53.2% of patients overall. Fibrosis correlated with severity of infiltrates at diagnosis: fibrosis was present in 83% of patients with very severe infiltration and in 12.5% of patients with minor infiltration. Among patients with severe infiltration, fibrosis was present in 30%; this increased (to 75%) when bullae were concomitantly present at diagnosis. Prompt initiation of treatment is necessary to avoid the development of fibrosis.

Characteristics of sleep apnea syndrome in tetraplegic patients.

OBJECTIVE: To include a larger number of tetraplegics than in previous studies, in order to more reliably characterize the pathogenesis and predisposing factors of sleep apnea in tetraplegia. METHODS: Sleep breathing data and oxymetric values were investigated in 50 randomly selected tetraplegic patients and discussed in context with age, gender, BMI, neck circumference, type and height of lesion, time after injury, spirometric values and medication. A non-validated short questionnaire on daytime complaints was added. RESULTS: Thirty-one patients out of 50 had an RDI > or =15, defined as sleep disordered breathing (SDB); 24 of them combined with an apnea index of 5 or more, these cases were diagnosed as sleep apnea syndrome (SAS). SAS was apparent in 55% and 20% of the studied men and women, respectively. Regression analyses showed no significant correlation between RDI and lesion level, ASIA impairment scale or spirometric values. In contrast, a significant correlation between RDI and age, BMI, neck circumference and time after injury could be shown. Kruskal-Wallis test for dichotomous non-parametric factors, such as gender, cardiac medication and daytime complaints, showed significant differences with regard to RDI. In contrast to able-bodied people with SAS, daytime complaints were only present in tetraplegic patients with severe pathology (RDI>40). CONCLUSION: Incidence of SAS is high in tetraplegia, particularly in older male patients with large neck circumference, long standing spinal cord injury and under cardiac medication. As tetraplegics with RDI between 15 and 40 reported no daytime complaints and often have normal BMI, these tetraplegics are not clinically suspicious for SAS. The increased use of cardiac medication in tetraplegics with SAS may implicate a link between SAS and cardiovascular morbidity, one of the leading causes of death in tetraplegia.

[Resistance of Plasmodium falciparum to 3 antimalarials in Turbo (Antioquia, Colombia), 1998]. / Resistencia de Plasmodium falciparum a tres fármacos antimaláricos en Turbo (Antioquia, Colombia), 1998.

In 1998 we determined in vivo and in vitro the frequency and the degree of resistance of Plasmodium falciparum to the three antimalarials (chloroquine, amodiaquine, and sulfadoxine/pyrimethamine) most utilized in the municipality of Turbo (in the area of Urabá, Antioquia, Colombia), in a sample representative of the population with malaria. We carried out clinical and parasitological analyses over a 14-day period using the standard test recommended by the World Health Organization. In vivo, P. falciparum showed resistance to chloroquine, amodiaquine, and sulfadoxine/pyrimethamine, with a frequency of 97%, 7%, and 13%, respectively. In vitro, the corresponding figures were 21%, 23%, and 9%, respectively. For chloroquine the level of agreement between the in vivo and in vitro results was 23%.

Central nervous system paracoccidioidomycosis. Report of a case successfully treated with itraconazol.

Paracoccidioidomycosis (PCM) is a primary pulmonary infection that often disseminates to other organs and systems. Involvement of the central nervous system (CNS) is rare and due to the fact that both clinical alertness and establishment of the diagnosis are delayed, the disease progresses causing serious problems. We report here a case of neuroparacoccidioidomycosis (NPCM), observed in a 55 year-old male, who consulted due to neurological symptoms (left hemiparesis, paresthesias, right palpebral ptosis, headache, vomiting and tonic clonic seizures) of a month duration. Upon physical examination, an ulcerated granulomatous lesion was observed in the abdomen. To confirm the diagnosis a stereotactic biopsy was taken; additionally, mycological tests from the ulcerated lesion and a bronchoalveolar lavage were performed. In the latter specimens, P. brasiliensis yeast cells were visualized and later on, the brain biopsy revealed the presence of the fungus. Treatment with itraconazole (ITZ) was initiated but clinical improvement was unremarkable; due to the fact that the patient was taking sodium valproate for seizure control, drug interactions were suspected and confirmed by absence of ITZ plasma levels. The latter medication was changed to clonazepam and after several weeks, clinical improvement began to be noticed and was accompanied by diminishing P. brasiliensis antigen and antibody titers. In the PCM endemic areas, CNS involvement should be considered more often and the efficacy of itraconazole therapy should also be taken into consideration.

Estudio comparativo en cirugía perirradicular entre la técnica convencional y técnicas para la regeneración ósea / A comparative study in periradicular surgery between the conventional technique and techniques for bone regeneration

Se pretendió comprobar la eficacia de dos materiales de regeneración ósea como terapia coadyuvante en la cirugía perirradicular y su efecto sobre la cicatrización en los tejidos periapicales. Se seleccionaron 28 pacientes (30 sitios quirúrgicos) distribuidos en tres grupos: grupo A, técnica convencional; grupo B, técnica convencional más membrana no bioabsorbible (Gore-Tex Augmentation) y grupo C, técnica convencional más membrana y material sintético de relleno del tipo hidroxiapatita bioabsorbible (OsteoGen). Se realizaron evaluaciones clínicas y radiográficas inmediatamente antes de la cirugía inicial, luego una semana y cada tres meses después de la operación, hasta los 12 meses. Se hicieron dos evaluaciones histológicas (inicial y 12 meses). Los resultados muestran cicatrización completa (100 por cien) clínica y radiográfica para el grupo C, con reportes histológicos de hueso trabecular para todos los casos. Para el grupo B, se observa cicatrización radiográfica completa en 66.66 por ciento de los casos, incompleta en 11.11 por ciento e incierta en 22.22 por ciento, con resultados histológicos de hueso trabecular en 62.5 por ciento, tejido conjuntivo cicatrizal en 12.5 por ciento y granuloma en 25 por ciento de los casos. En el grupo A se presenta cicatrización radiográfica completa en 44.44 por ciento, incompleta en 44.44 por ciento y fracaso en 11.11 por ciento, con reporte de granuloma en 50 por ciento, tejido conjuntivo cicatrizal en 25 por ciento y hueso trabecular en el 25 por ciento de los casos. Se concluye que la técnica convencional presenta alta probabilidad de recidiva y que la utilización de material de regeneración ósea del tipo membrana no bioabsorbible e hidroxiapatita bioabsorbible mejoran la predecibilidad de la cicatrización clínica, radiográfica e histológicamente

Nuevos enfoques en cirugía perirradicular: revisión de la literatura / New approaches in periradicular surgery: review of the literature

Cuando se genera una lesión periapical como consecuencia de un proceso inflamatorio crónico y posterior necrosis pulpar, se hace necesaria una terapia encaminada a eliminar el agente etiológico primario, lo que frecuentemente se resuelve exitosamente con un tratamiento endodóntico convencional. Sin embargo, en algunas casos persiste un estado inflamatorio manifestándose una patología periapical, que puede ser un granuloma o quiste perirradicular con o sin presencia de tractos sinuosos. Cuando la infección no puede ser erradicada por vía ortógrada, está indicada una cirugía endodóntica. La regeneración del defecto óseo periapical a veces no se da debido a migración del epitelio bucal o del tejido conjuntivo gingival hacia el defecto óseo, evitando la formación de hueso trabecular normal y haciendo necesarias nuevas cirugías de reentrada. La literatura reporta recientes materiales de obturación radicular terminal y elementos de regeneración tisular guiada para mejorar la predecibilidad del tratamiento quirúrgico. Sustituyendo la amalgama como material convencional de relleno transapical se encuentran actualmente los nuevos materiales derivados del óxido de zinc y eugenol (IRM y Super EBA) y últimamente el MTA o agregado de trióxidos minerales y como materiales de RTG se encuentran membranas bioabsorbibles, materiales sustitutos de hueso (hidroxiapatitas, hueso liofilizado) e injertos de periostio autólogo libres y pediculados

Detection of the 70-kilodalton histoplasma capsulatum antigen in serum of histoplasmosis patients: correlation between antigenemia and therapy during follow-up.

Histoplasmosis is an important systemic fungal infection, particularly among immunocompromised individuals, who may develop a progressive disseminated form which is often fatal if it is untreated. In such patients, the detection of antibody responses for both diagnosis and follow-up may be of limited use, whereas the detection of Histoplasma capsulatum var. capsulatum antigens may provide a more practical approach. We have recently described an inhibition enzyme-linked immunosorbent assay (ELISA) for the detection in patients' sera of a 69- to 70-kDa H. capsulatum var. capsulatum-specific antigen which appears to be useful in diagnosis. To investigate its potential for the follow-up of histoplasmosis patients during treatment, antigen titers in the sera of 16 patients presenting with different clinical forms of histoplasmosis were monitored at regular intervals for up to 80 weeks. Sera from four of five patients with the acute form of the disease showed rapid falls in antigenemia, becoming antigen negative by week 14 (range, weeks 10 to 16). Sera from four patients with disseminated histoplasmosis showed falls in antigen levels; three of them became antigen negative by week 32; the fourth patient became negative by week 48. In contrast, antigen titers in four of six AIDS patients with the disseminated form of the disease remained positive throughout follow-up. Sera from only one patient who presented with the chronic form of the disease were analyzed, and this individual's serum became antigen negative by week 9. The inhibition ELISA is shown to be of particular use in the monitoring of non-AIDS patients with the acute and disseminated forms of the disease and may complement existing means of follow-up.

Antigenemia in patients with paracoccidioidomycosis: detection of the 87-kilodalton determinant during and after antifungal therapy.

Serological diagnosis and follow-up of paracoccidioidomycosis (PCM) patients have relied mainly on the detection of antibody responses by using techniques such as complement fixation (CF) and immunodiffusion. We recently described a novel inhibition enzyme-linked immunosorbent assay (inh-ELISA) which proved to be useful in the diagnosis of PCM via the detection of an 87-kDa determinant in patient sera (B. L. Gomez, J. I. Figueroa, A. J. Hamilton, B. Ortiz, M. A. Robledo, R. J. Hay, and A. Restrepo, J. Clin. Microbiol. 35:3278-3283, 1997). This test has now been assessed as a means of following up PCM patients. A total of 24 PCM patients, classified according to their clinical presentation (6 with the acute form of the disease, of whom two had AIDS, 12 with the multifocal form of the disease, and 6 with the unifocal form of the disease), were studied. The four human immunodeficiency virus-negative patients with acute PCM showed a statistically significant decrease in circulating antigen levels after the start of antifungal therapy. Antigen levels in this group became negative by our criteria (

Micosis de los senos paranasales: descripción de seis casos / Paranasal sinus mycosis: description of 6 clinical cases

La afeccion micotica de los senos paranasales ha aumentado en los ultimos años, tanto bajo la forma de sinusitis alergica como de tipo invasivo y no invasivo, de tipo colonimnte. Se analizan en forma retrospectiva, seis casos de micosis en senos paranasales; dos de ellos con mucormicosis y los cuatro restantes con aspergillosis. Cinco de los pacientes fueron diagnosticados por examen directo y uno de ellos, por estudio histopatologico. Fue posible aislar el agente etiologico en dos casos, en uno de mucormicosis y en otro de aspergillosis. Los pacientes con mucormicosis presentaban una enfermedad de base y no fue posible salvarlos, a pesar del manejo quirurgico y del tratamiento con anfotericina B. Los cuatro casos de aspergillosis se observaron en pacientes inmunocompetentes; la sintomatologia era similar a una sinusitis cronica, pero en dos de ellos, el TAC mostro calcificaciones que hicieron sospechar la enfermedad. Los cuatro pacientes se recuperaron despues de cirugia endoscopica y de la administracion de itraconazole

Paracoccidioidomycosis and AIDS: report of the first two Colombian cases.

The records of the first two Colombian patients with AIDS and paracoccidioidomycosis are presented. Both patients were males and had no known risk factors for HIV although in the past they had worked in the field where they could have been infected with the fungus. They exhibited the juvenile type of disease with multiple organ system involvement and symptoms of short duration. They were deeply immunodepressed as indicated by less than 100 CD4 T lymphocytes per mL; however, serologic tests revealed circulating anti-Paracoccidioides brasiliensis antibodies and in one patient the first diagnostic clue came from such tests. In one case, the mycosis preceded the AIDS diagnosis while in the other, both pathologies were discovered simultaneously. Antimycotic therapy with itraconazole was administered for over 10 months, with an initial dose of 200 mg/day followed by 100 mg/day; marked improvement of the mycotic signs and symptoms was soon noticed an there have been no signs of relapse. The patients improvement was also due to the combined retroviral treatment that was instituted. In spite of the rarity of the AIDS-paracoccidioidomycosis association, physicians practicing in endemic areas should consider the presence of the mycosis in immunosuppressed patients, since a prompt diagnosis and institution of combined antimycotic-anti-retroviral treatments would result in patient improvement and survival. It appears possible that the longer survival time of today's AIDS patients would give the quiescent fungus the opportunity to revive, multiply and cause overt disease.

Primary human prostate cancer cells harboring p53 mutations are clonally expanded in metastases.

Recent studies suggest a role for p53 in prostate cancer progression. Although p53 mutations in primary prostate cancer tissues are relatively infrequent, they occur at significant levels in metastatic disease. Here we describe a novel approach to the molecular analysis of p53 in paired specimens of primary and metastatic prostate cancer that results in quantitative estimates of the extent of clonal expansion. In 20 pairs with 1 or both specimens p53 immunopositive and in 6 pairs with both specimens immunonegative, the frequency of mutations was estimated by microdissection of the cancer from fixed and sectioned tissues, isolation of the DNA followed by PCR amplification of p53 genomic fragments, and cloning of the PCR products into plasmid vectors. At least 90 clones/tissue specimen were screened for mutations by single-strand conformational polymorphism analysis. DNA from abnormally migrating single-strand conformational polymorphism samples was sequenced to confirm mutations. Missense mutations in exon 5, 7, or 8 were detected in 9 of 20 immunopositive pairs and in 1 of 6 immunonegative pairs. A marked heterogeneity of mutations in primary prostate cancer was apparent. The frequency of p53 mutations was greater in the metastases than in the primary tumors. In three immunopositive pairs, the same p53 mutation was demonstrated at a low frequency in the primary tumor but was demonstrated at a greater frequency in the metastasis, indicating relatively limited clonal expansion of cells harboring specific p53 mutations in the primary tumor, yet significant clonal growth at metastatic sites as determined by this novel method.

[The value of immunological assays in the diagnosis of meningeal histoplasmosis]. / Valor de las pruebas inmunológicas en el diagnóstico de la histoplasmosis meníngea.

INTRODUCTION: Between 1985 and 1995, 3,860 cerebrospinal fluid (CSF) samples from patients with mycotic meningitis were analyzed. METHODS: Direct examination, cultures, complement fixation (CF) and immunodiffusion (ID) with Histoplasma capsulatum were carried out. RESULTS: Seventy four samples from 31 patients (three of them with AIDS) were reactive at the immunological assays. Cultures were positive in five patients. In 26 patients the clinical diagnosis together with positive CSF assays gave indirect evidence of meningeal histoplasmosis. ID and CF reactivity were 93.5% and 100% respectively. For 23 patients who had simultaneous examination of blood and CSF the double positivity was 78.2%. CONCLUSIONS: Because of the direct isolation of Histoplasma capsulatum is a difficult one, the diagnosis of subacute or chronic meningeal histoplasmosis may be confirmed by indirect immunological assays.

Disseminated histoplasmosis in children: the role of itraconazole therapy.

OBJECTIVES: To describe the clinical characteristics and laboratory diagnosis of seven children with disseminated histoplasmosis and evaluate the effectiveness of itraconazole therapy in this severe form of the mycosis as well as to determine the long term results of such treatment. METHODS: The diagnosis of histoplasmosis was based on the direct observation of Histoplasma capsulatum var. capsulatum and/or on the isolation of the fungus from pathologic materials; the results of the serologic tests were taken into consideration. Chest roentgenograms also contributed to the diagnosis. PATIENTS: The patients were seven rural children, five girls and two boys, ages 1 to 14 years (mean, 4.6), with a confirmed diagnosis of disseminated histoplasmosis and who had no underlying disease other than malnourishment. RESULTS: The seven children experienced a subacute febrile syndrome for 4 months accompanied by anorexia, weight loss and signs of reticuloendothelial involvement such as lymph node hypertrophy, hepatomegaly and/or splenomegaly. The lung revealed roentgenographic alterations consisting mainly of nodular infiltrates. All patients received itraconazole orally in a mean dosage of 7.2 mg/kg/day, for variable periods (3 to 12 months), depending on the individual response and the toxic effects of the medication. One of the patients who was improving after 1 month of treatment was taken from the hospital by his guardian against medical advice and died shortly afterward. The remaining six patients responded to the treatment with marked clinical improvement and showed negative cultures and decreases in anti-H. capsulatum antibody titers after 3 months of treatment. Only one patient, the youngest and most severely affected child, exhibited hepatotoxicity, which subsided when itraconazole was discontinued. Extended follow-up studies revealed no relapses. CONCLUSION: The results of this study indicate that itraconazole is effective for treatment of disseminated childhood histoplasmosis. More studies should be performed to determine the most appropriate dosage and the optimal duration of itraconazole treatment in children.

Development of pulmonary fibrosis in mice during infection with Paracoccidioides brasiliensis conidia.

Pulmonary fibrosis is a feared sequelae of paracoccidioidomycosis. We sought to determine if mice exposed to Paracoccidioides brasiliensis conidia would develop pulmonary fibrosis. BALB/c mice were infected intranasally with P. brasiliensis conidia and sacrificed at regular intervals. One lung was sectioned for histopathology and sections were stained with haematoxylin and eosin, trichromic and argentic stains; the other lung was homogenized and cultured to determine the viability of the fungus. One week post-challenge, only small peribronchial foci were apparent. After 4 weeks, reticular fibres appeared disorganized and disrupted. Six to 8 weeks later peribronchial infiltrates were larger and appeared surrounded by reticular fibres; thick collagen I fibres were noticed in the infiltrated areas at this time. On weeks 10-12, infiltrates were confluent and reticular fibres were concentrated around the inflammatory foci; collagenization was apparent. Observations up to 16 weeks revealed diffuse involvement of the lung parenchyma with extensive collagenization. Lung cultures were always positive. We suggest that inhalation of P. brasiliensis conidia induces adverse lung responses leading to changes in the proportion of collagen fibres I and III.