Axillary vein thrombosis as a manifestation of rapidly progressive neuropathic arthropathy of the shoulder associated with syringomyelia.

Neuropathic arthropathy is a destructive joint disease associated frequently with loss of proprioception. Syringomyelia (with or without Arnold-Chiari malformation) is characterized by slow progression over many years; the joints involved most frequently are the shoulders and elbows. Neuropathic arthropathy of the hand is rare, and clinical features are vasomotor problems, digital ulcers, thickening of the fingers, and painless subluxation of the finger joints. We report an unusual case of neuropathic arthropathy of the shoulder and hands, associated with syringomyelia without Arnold-Chiari malformation. Neuropathic arthropathy of the shoulder was rapidly progressive, and axillary vein thrombosis was the first manifestation; however, neuropathic arthropathy of the hands was unrecognized for 7 years, and painless ulceration of the fingers with spontaneous amputation of the terminal phalanx and Raynaud phenomenon were the initial manifestations. To our knowledge, this is the first report of a patient with this constellation of findings.

Central nervous system paracoccidioidomycosis: case report and review.

Paracoccidioidomycosis is a systemic infection caused by a dimorphic fungus (Paracoccidioides brasiliensis). The most common lesions frequently occur in the bucopharinx mucosa. Other lesions occur in the adrenal glands, liver, bone, gastrointestinal tract, lungs and nervous system. We report here a case of neuroparacoccidioidomycosis. The patient was a 49 year-old male, who consulted due to neurological symptoms (cephalalgia, speech difficulty and one tonic clonic seizure with urinary incontinence) of eight months duration. Upon physical examination it was observed an emaciated male with nail clubbing, a skin ulcer with raised edges and a crusted bottom of 4 x 2 cm in diameter located in the right supraclavicular region and an ulcerated lesion in the left tonsil with edema. The rest of the physical examination reveled a discrete left side hemiparesis and pulmonary rales in the left hemitorax. The fungus was identified through direct examination of cerebrospinal fluid (CSF). The histopathology of suprarenal, lungs, brain and skin showed multiple paracoccidioidal granulomas. To the best of our knowledge, this is the third case reported in the literature. We review the literature on the pathogenesis and prevalence of neuroparacoccidioidomycosis.

Central nervous system paracoccidioidomycosis: case report and review

Paracoccidioidomycosis is a systemic infection caused by a dimorphic fungus (Paracoccidioides brasiliensis). The most common lesions frequently occur in the bucopharinx mucosa. Other lesions occur in the adrenal glands, liver, bone, gastrointestinal tract, lungs and nervous system. We report here a case of neuroparacoccidioidomycosis. The patient was a 49 year-old male, who consulted due to neurological symptoms (cephalalgia, speech difficulty and one tonic clonic seizure with urinary incontinence) of eight months duration. Upon physical examination it was observed an emaciated male with nail clubbing, a skin ulcer with raised edges and a crusted bottom of 4 × 2 cm in diameter located in the right supraclavicular region and an ulcerated lesion in the left tonsil with edema. The rest of the physical examination reveled a discrete left side hemiparesis and pulmonary rales in the left hemitorax. The fungus was identified through direct examination of cerebrospinal fluid (CSF). The histopathology of suprarenal, lungs, brain and skin showed multiple paracoccidioidal granulomas. To the best of our knowledge, this is the third case reported in the literature. We review the literature on the pathogenesis and prevalence of neuroparacoccidioidomycosis

[Telomerase activity in peripheral blood leukocytes from patients with essential hypertension]. / Actividad de la telomerasa en leucocitos de sangre periférica de pacientes con hipertensión arterial esencial.

BACKGROUND AND OBJECTIVE: Primary or secondary activation of the immune mechanisms that lead to proliferation and dysfunction of specific cellular groups appears to be involved in the pathogenesis and complications of essential hypertension. In view of the evidence that, on one hand, telomeric length determines the replicative capacity and life span of cells and, on the other hand, idiopathic hypertensive patients have peripheral white cell replicative disorders, we decided to investigate the relationship between the influence of telomerase activity in peripheral leukocytes as an indirect marker of telomeric length and the presence of arterial hypertension. PATIENTS AND METHOD: Telomerase activity in peripheral white blood cells was measured in healthy individuals, in effectively treated hypertensive patients and in a non-well controlled hypertensive group. White blood cells were separated through a density gradient, then lysed and their DNA amplified by a polimerase chain reaction (PCR). Telomerase activity was determined with an ELISA specific kit. RESULTS: The white blood cell count was higher in the hypertensive than the control group (p < 0.05). Telomerase activity was positive in all three groups but higher in patients under 45 year-old with bad controlled hypertension as compared with healthy individuals and patients under 45 year-old with well controlled hypertension (p < 0.05); in the latter group, telomerase activity was significantly lower than in the other groups (p < 0.05). CONCLUSIONS: Our results indicate that there exists a relationship between telomerase activity in peripheral leukocytes, the proliferation of these white blood cells and the presence of essential arterial hypertension.

Actividad de la telomerasa en leucocitos de sangre periférica de pacientes con hipertensión arterial esencial / Telomerase activity in peripheral blood leucocytes from patients with essential hypertension

FUNDAMENTO Y OBJETIVO: La activación primaria o secundaria de mecanismos inmunes, que lleva a una disfunción y/o proliferación de poblaciones celulares específicas, se ha implicado en la patogenia y/o complicaciones de la hipertensión arterial esencial. En vista de que la longitud de los telómeros determina el período de vida de una célula y que se han observado alteraciones replicativas en los leucocitos de sangre periférica de pacientes con hipertensión arterial esencial, investigamos la relación entre la actividad de la telomerasa en los leucocitos de sangre periférica, como un indicador del acortamiento telomérico, y la presencia de hipertensión arterial. PACIENTES Y MÉTODO: Determinamos la actividad de la telomerasa en leucocitos de sangre periférica aislados de controles normales, pacientes con hipertensión esencial controlada y no controlada. Los leucocios de sangre periférica se aislaron por gradiente de densidad, se lisaron y su ADN se amplificó por el método de reacción en cadena de la polimerasa (PCR). La actividad de la telomerasa se midió por un ELISA específico. RESULTADOS: El recuento de leucocitos fue significativamente mayor en los pacientes con hipertensión esencial en comparación con el de los individuos sanos (p < 0,05). La actividad de la telomerasa fue significativamente mayor en pacientes menores de 45 años con hipertensión no controlada, comparada con la de los individuos sanos y con los pacientes menores de 45 años con hipertensión controlada (p < 0,05). En este último grupo, la actividad de la telomerasa fue significativamente menor con respecto a los otros dos (p < 0,05). CONCLUSIONES: Nuestros resultados indican que existe una relación entre la actividad de la telomerasa en los leucocitos de sangre periférica, la proliferación de estos leucocitos y la presencia de hipertensión arterial esencial (AU)

[Mucormycosis. Report of 3 cases]. / Mucormicosis. Reporte de tres casos.

Mucormycosis is an acute and often fatal infection caused by a fungus of the Mucorales order of the Zygomycetes class. There are various clinical types, usually associated with an underlying disorder. The rhinocerebral mucormycosis is usually seen in diabetics, especially in ketoacidosis, but may also appear in healthy people. We report three cases of mucormycosis diagnosed since april 1987 through january 2001 at the Dr. Domingo Luciani Hospital, Caracas, Venezuela. Two of them had diabetes and one was apparently healthy. The most common clinical presentation of mucormycosis was the rhinocerebral infection, seen in the two diabetic patients, both of them had cavernous sinus thrombosis one with involvement of the carotid artery. The other patient with sinus involvement had no predisposing factors. All patients were treated with amphotericin B and two of them had surgical debridement of involved tissue. We emphasize the importance of an early clinical diagnosis and treatment with surgical debridement of infected tissue combined with amphotericin B.

Mucormicosis. Reporte de tres casos / Mucormycosis. Report of 3 cases

Mucormycosis is an acute and often fatal infection caused by a fungus of the Mucorales order of the Zygomycetes class. There are various clinical types, usually associated with an underlying disorder. The rhinocerebral mucormycosis is usually seen in diabetics, especially in ketoacidosis, but may also appear in healthy people. We report three cases of mucormycosis diagnosed since april 1987 through january 2001 at the Dr. Domingo Luciani Hospital, Caracas, Venezuela. Two of them had diabetes and one was apparently healthy. The most common clinical presentation of mucormycosis was the rhinocerebral infection, seen in the two diabetic patients, both of them had cavernous sinus thrombosis one with involvement of the carotid artery. The other patient with sinus involvement had no predisposing factors. All patients were treated with amphotericin B and two of them had surgical debridement of involved tissue. We emphasize the importance of an early clinical diagnosis and treatment with surgical debridement of infected tissue combined with amphotericin B.