Hallazgos de neuroimagen en una serie de 14 pacientes con cefalea tratados con parche hemático epidural / Neuroimaging findings in a series of 14 patients witch headache for spontaneous intracranial hypotension treated with epidural blood patch

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Supernumerary ring chromosome: an etiology for Pallister-Killian syndrome?

Characterization of marker chromosomes before the introduction of array CGH (aCGH) assays was only based on their banding patterns (G, C, and NOR staining) and fluorescent in situ hybridization techniques. The use of aCGH greatly improves the identification of marker chromosomes in some cases. We describe an atypical case of Pallister-Killian syndrome (PKS) detected at prenatal diagnosis with a very unusual cytogenetic presentation: a supernumerary ring chromosome including two copies of 12p. A similar anomaly described in a postnatal patient suggests ring chromosome as a possible cause of PKS. Extra ring chromosomes might be a more common etiology for PKS than previously thought, given the difficulty in their characterization before the advent of aCGH.

Bacteriemia por Salmonella enteritidis como debut clínico de síndrome de inmunodeficiencia adquirida / Salmonella enteritidis bacteraemia as clinical onset of acquired immune deficiency syndrome

Presentamos un caso de una paciente de 38 años, que acudió a urgencias por cuadro de insuficiencia respiratoria aguda severa y fue ingresada en la Unidad de Cuidados Críticos con la sospecha diagnóstica inicial de neumonía adquirida en la comunidad producida por gérmenes atípicos, que se complicó con un síndrome de distrés respiratorio agudo. Este pudo ser tratado con ventilación mecánica no invasiva. A las 48h de su ingreso se informó del crecimiento de bacilos gramnegativos en los hemocultivos, identificados posteriormente como Salmonella enteritidis. Esta información, unida a la linfopenia que presentaba la paciente, sugería un estado de inmunodepresión, por lo que se realizaron pruebas serológicas que resultaron positivas para VIH. Fueron instaurados tratamientos antimicrobianos basados en los hallazgos microbiológicos y la evolución clínica de la paciente fue favorable(AU)

The case is presented of a 38 year-old patient who was admitted in the Emergency Department due to a severe acute respiratory failure and who was transferred to the Critical Care Unit with a suspected initial diagnosis of community acquired pneumonia caused by an atypical microorganism, which was complicated with an acute respiratory distress syndrome. This was able to be treated with non-invasive mechanical ventilation. At 48hours after admission, the growth of Gram negative bacilli in the blood culture was reported, which was subsequently identified as Salmonella enteritidis. This information, along with the lymphopenia suffered by the patient, suggested an immunodepressed state, thus serological tests were performed which showed positive for HIV. Antibiotic treatment was started based on the microbiological findings, with a favourable clinical outcome for the patient(AU)

[Salmonella enteritidis bacteraemia as clinical onset of acquired immune deficiency syndrome]. / Bacteriemia por Salmonella enteritidis como debut clínico de síndrome de inmunodeficiencia adquirida.

The case is presented of a 38 year-old patient who was admitted in the Emergency Department due to a severe acute respiratory failure and who was transferred to the Critical Care Unit with a suspected initial diagnosis of community acquired pneumonia caused by an atypical microorganism, which was complicated with an acute respiratory distress syndrome. This was able to be treated with non-invasive mechanical ventilation. At 48 hours after admission, the growth of Gram negative bacilli in the blood culture was reported, which was subsequently identified as Salmonella enteritidis. This information, along with the lymphopenia suffered by the patient, suggested an immunodepressed state, thus serological tests were performed which showed positive for HIV. Antibiotic treatment was started based on the microbiological findings, with a favourable clinical outcome for the patient.

[Pulmonary torsion complicating lobectomy: report of 2 cases]. / Torsión pulmonar como complicación de una lobectomía pulmonar, descripción de dos casos.

We report 2 cases of pulmonary torsion discovered during the early postoperative recovery of patients who had undergone lobectomy. Early diagnosis, based on chest radiography and confirmed by computed tomography, meant we were able to avoid major surgical resection and the development of further complications. Pulmonary torsion is a rare but potentially serious abnormality. Prompt diagnosis is the key to preventing tissue injury and complications such as necrotizing pneumonitis, thromboembolic disease, or septic shock. Among the diagnostic tests that can be carried out if there is good reason to suspect torsion, we emphasize simple chest radiography and fiberoptic bronchoscopy, supported by computed tomography or arteriography, even though a firm diagnosis requires surgical exploration of the affected lung. Definitive treatments range from reversing the torsion and securing the lung to resecting the lung if the parenchymal tissue has been fully compromised.

Torsión pulmonar como complicación de una lobectomía pulmonar, descripción de dos casos / Pulmonary torsion complicating lobectomy: report of 2 cases

Descripción de dos casos de torsión pulmonar enpacientes intervenidos de lobectomía por neoplasia pulmonar.Se muestran dos pacientes que sufrieron complicaciónde torsión de lóbulo pulmonar tras realizarselobectomía pulmonar aparecida en el postoperatorioinmediato. Se realizó el diagnóstico precoz mediante unaradiografía del tórax y la confirmación mediante unTAC, que indicó la toracotomía la cual evitó mayorresección quirúrgica y aparición de otras complicaciones.La torsión pulmonar es una alteración infrecuentepero de potencial gravedad. El diagnóstico precoz es devital importancia para evitar el compromiso tisular yprevenir complicaciones como neumonitis necrotizante,enfermedad tromboembólica o shock séptico. Entre laspruebas diagnósticas que pueden llevar a la alta sospechadiagnóstica destacamos la radiología simple de tóraxy fibrobroncoscopia, apoyadas por la tomografía axial ola arteriografía, aunque el diagnóstico definitivo es laexploración quirúrgica del parénquima afecto. El tratamientodefinitivo abarca desde la simple detorsión y fijacióndel pulmón, hasta resección pulmonar o neumonectomíasi el compromiso tisular es completo(AU)

We report 2 cases of pulmonary torsion discoveredduring the early postoperative recovery of patients whohad undergone lobectomy. Early diagnosis, based onchest radiography and confirmed by computedtomography, meant we were able to avoid major surgicalresection and the development of further complications.Pulmonary torsion is a rare but potentially seriousabnormality. Prompt diagnosis is the key to preventingtissue injury and complications such as necrotizingpneumonitis, thromboembolic disease, or septic shock.Among the diagnostic tests that can be carried out ifthere is good reason to suspect torsion, we emphasizesimple chest radiography and fiberoptic bronchoscopy,supported by computed tomography or arteriography,even though a firm diagnosis requires surgicalexploration of the affected lung. Definitive treatmentsrange from reversing the torsion and securing the lungto resecting the lung if the parenchymal tissue has beenfully compromised(AU)

Rigidez de descerebración transitoria en el contexto de hipoxemia y administración de propofol, midazolamflumacenilo y remifentanilo-naloxona / No disponible

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Cefalea postpunción dural tras anestesia subaracnoidea en un programa de cirugía mayor ambulatoria / No disponible

Objetivo: Evaluar la incidencia de cefalea postpunción dural en pacientes sometidos a cirugía mayor ambulatoria bajo anestesia espinal intradural. Material y métodos: Estudio retrospectivo y descriptivo de9.992 pacientes intervenidos en un periodo de 9 años. Se cuantifican la relación de CPPD-tipo de aguja empleada, así como el consumo de agujas espinales por año de estudio. Se valoró por las consultas e ingresos al Servicio de Urgencias de los casos de CPPD según criterios de Jones. El método estadístico empleado fue la t de Student para las variables cuantitativas y la (..) (AU)

Objective: To evaluate the ratio of headaches after dural puncture (PDPH) in patients undergoing intradural spinal anaesthesia for ambulatory surgery. Material and methods: We undertook a retrospective and descriptive study of 9,992 patients over a period of 9 years. The relationship between PDPH and the type of needle used, as well as the consumption of spinal needles per year of study, were quantified. We evaluated the number of cases of PDPH through the consultations and admissions to the Emergency Service according to the Jones’ criteria. The statistical methods used were: Student’s t test for the quantitative variables and chi-squared test of frequencies for the qualitative variables. Results: The incidence of PDPH was 0.60%. The average age of PDPH appearance was 43.12 ± 15.62 years, with a predominance of the feminine sex (63,3%). The incidence of PDPH when using a 22-G Quincke type needle was superior, with statistically significant differences, with respect to the rest of needles. The PDPH was severe in 58% of the cases. The evolution of the migraine in most of the cases (91%) was benign with medical treatment. Conclusions: The progressive reduction in the number of days of hospitalization, accentuated, in the last years, with the new organizational models for surgical assistance has lead to the appearance, in primary medicine, of clinical problems usually found only in hospitalized patients. The PDPH is characterized bya front occipital headache that gets worse when in the upright position in surgical patients undergoing spinal anaesthesia, and is benign and self-limited when treated with conventional medication (AU)

[Acute opiate tolerance and postoperative hyperalgesia after a brief infusion of remifentanil managed with multimodal analgesia]. / Tolerancia aguda a opioides e hiperalgesia postoperatoria tras breve infusión de remifentanilo controlados con analgesia multimodal.

Postoperative analgesia may be complicated by the occurrence of acute opiate tolerance and hyperalgesia. We present the case of a patient who underwent gynecological surgery that was complicated by intense pain in the immediate postoperative period. The pain was attributed to the development of acute opiate tolerance caused by the brief infusion of a high dose of remifentanil. The opiate tolerance was complicated by tactile hyperalgesia at the site of the surgical wound. Pain management with the usual dose of nonsteroidal anti-inflammatory drugs associated with a high dose of morphine (50 mg administered in less than 2 hours) produced no analgesic or adverse effects. The pain was finally brought under control by epidural perfusion of ropivacaine and fentanyl and subsequently maintained with multimodal analgesia.

Epidemiological aspects of vertigo in the general population of the Autonomic Region of Valencia, Spain.

CONCLUSION: Vertigo, defined as an illusion of unequivocal rotatory motion, is a common symptom in the general population that frequently requires individuals to seek medical attention in a primary care centre. OBJECTIVES: To evaluate the annual incidence of patients who suffer vertigo, and to examine some of the variables associated, in a sample of the general population of the Autonomic Region of Valencia, Spain. SUBJECTS AND METHODS: The study was designed as an observational, incidence study. The study area included six primary care centres with a total population of 10760 inhabitants. The parameters studied were age, sex, working status, de novo presentation or recurrent vertigo crisis. RESULTS: A total of 191 patients (17.8 patients per 1000 inhabitants) sought medical attention because of vertigo over the year of the study. Of these, 82 patients (7.6 per 1000 inhabitants) experienced vertigo for the first time, a de novo crisis. Women were more often affected and the crises occurred more frequently in individuals between 50 and 60 years of age. The work status had influence on the results obtained.

The C-class chemokine lymphotactin costimulates the apoptosis of human CD4(+) T cells.

Clonal expansion of activated T cells is controlled by homeostatic mechanisms leading to cell death of a large proportion of the cells. The CD3/TcR pathway induces cell death, mostly when triggered in the absence of costimulatory signal. The unique T cell-specific chemokine of the C class, lymphotactin (Lptn), has recently been shown to inhibit the production of Th1-type lymphokines in human CD4(+) T cells. The present study shows the ability of Lptn to costimulate the death of CD4(+) T lymphocytes triggered through CD3/TCR. The Lptn-mediated increased cell death exhibited characteristic features of apoptosis, as mainly determined by DNA fragmentation and exposure of an apoptotic-specific mitochondrial antigen. This apoptosis was dependent on Fas/FasL signaling, was not rescued by addition of interleukin 2, and proceeded with a predominant processing of both initiator procaspase-9 and effector procaspase-7. These caspase activities were further evidenced by specific cleavage of poly(ADP-ribose) polymerase (PARP) and CD3/TCR zeta-chain, but not DNA fragmentation factor (DFF45). This study demonstrates that the functional repertoire of Lptn in the regulation of human CD4(+) T-lymphocyte activation includes the ability to costimulate apoptosis.

The interferon-inducible Staf50 gene is downregulated during T cell costimulation by CD2 and CD28.

It is well established that interferons (IFN) exert potent regulatory effects on the immune system. We have recently isolated a new IFN-induced human cDNA coding for a member of the Ring finger B-box/B30.2 subfamily that localizes to the chromosome band 11p15. We have named it Staf50. We show in this report that Staf50 is expressed in resting T cells in the absence of exogenous IFN treatment and is strongly repressed during T cell activation by anti-CD28 and anti-CD2 monoclonal antibodies (mAb) at both messenger and protein levels. In addition, we show that several members of the Ring finger B-box/B30.2 subfamily, including the 52-kDa SSA/Ro autoantigen, localize to the same chromosome band, 11p15, and are upregulated by IFN. These data led us to define a family of IFN-induced genes clustered on chromosome 11p15 that may be involved in T cell regulatory processes.

The C-class chemokine, lymphotactin, impairs the induction of Th1-type lymphokines in human CD4(+) T cells.

Chemokines are involved in the regulation of leukocyte migration and for some of them, T-cell costimulation. To date, the only direct property of lymphotactin (Lptn), the unique member of the C class of chemokines, consists of T-cell chemoattraction. This report describes a novel function for Lptn in human T-lymphocyte biology, by demonstrating the direct ability of Lptn to both inhibit and costimulate CD4(+) and CD8(+) T-cell activation, respectively. Lptn but not RANTES inhibited CD4(+) T-cell proliferation, through a decreased production of Th1 (interleukin [IL]-2, interferon [IFN]-gamma) but not Th2 (IL-4, IL-13) lymphokines, and decreased IL-2R alpha expression. Transfections in Jurkat cells showed a Lptn-mediated transcriptional down-regulation of gene-promoter activities specific for Th1-type lymphokines, as well as of nuclear factor of activated T cells (NF-AT) but not AP-1 or NF-KB enhancer activities. This suppressive action of Lptn could be compensated by overexpression of NF-ATc but not NF-ATp. CD4(+) T-cell proliferation was completely restored by exogenous IL-2 or reversed by pertussis toxin, wortmannin, and genistein, suggesting the involvement of multiple partners in Lptn signaling. In contrast to CD4(+) cells, Lptn exerted a potent costimulatory activity on CD8(+) T-cell proliferation and IL-2 secretion. These data provide important insights into the role of Lptn in differential regulation of normal human T-cell activation and its possible implication in immune response disorders. (Blood. 2000;96:420-428)

CD28 co-stimulation results in down-regulation of lymphotactin expression in human CD4(+) but not CD8(+) T cells via an IL-2-dependent mechanism.

Chemokines are key molecules in promoting leukocyte migration and, for some of them, T cell adhesion and activation. Lymphotactin, which is the unique known member of the C class of chemokines, is produced by and acts on T lymphocytes, but the requirement of co-stimulatory pathways such as CD28 for its expression is largely unknown. CD28 plays a dominant role in the amplification of T cell proliferation, survival and cytokine production. In this report, we demonstrate that human lymphotactin expression, at both the mRNA and protein levels, is optimally induced by CD3/TCR activation alone, whereas CD28 co-stimulation turns off this expression. This down-regulation is not attributable to secondary activation via CTLA-4, the alternative counter-receptor of B7 ligands. Only the CD4(+) and not the CD8(+) subset is directly affected by this negative regulation. Transcript destabilization can be ruled out as a mechanism by which CD28 down-regulates lymphotactin expression. However, such down-regulation can be partly induced by IL-2 and abrogated by blocking IL-2/IL-2 receptor interaction. This particular profile of lymphotactin expression is not in line with the prevailing dogma of up-regulation of cytokine gene expression by CD28 co-stimulation, and represents a new CD28-mediated regulatory mechanism for lymphotactin expression.

Antiinflammatory activity of some extracts from plants used in the traditional medicine of north-African countries (II).

Aqueous, ethanol and chloroform extracts from Corrigiliola telephiifolia, Echinops spinosus, Kundmannia sicula, Tamarindus indica and Zygophyllum gaetulum were evaluated for antiinflammatory properties in mice (ear oedema induced by arachidonic acid) and rats (subplantar oedema induced by carrageenan) after topical or i.p. administration, respectively. Our results showed that all the plants exhibit antiinflammatory activity, since at least one extract from each plant was active in one of the experimental models. Whereas all the extracts of Corrigiliola telephiifolia and Echinops spinosus were highly active on all the experimental models assayed (values of inflammation inhibition well above 50%), poorer activity profiles were recorded in Kundmannia sicula, Tamarindus indica and Zygophyllum gaetulum. These results support the traditional uses for these plants but indicate that the active principles in the chloroform extracts are probably more active and/or are contained in larger concentrations than the principles in the polar extracts used in the traditional medicine of North-African countries.

Specific Th1 cytokine down-regulation associated with primary clinically derived human immunodeficiency virus type 1 Nef gene-induced expression.

HIV-1 infection is associated with a progressive and functional decline in the CD4+ lymphoid Th1 subset. Here, we propose that the HIV nef gene product may function as a specific regulator of Th1 cytokine production. By use of a T cell-specific inducible expression system, we show that upon T cell activation, induced nef expression down-regulated both IL-2 and IFN-gamma production in a dose-dependent manner, whereas IL-4, IL-9, IL-13, IL-8, and TNF-alpha production remained unaffected. In addition to this, independent transfected clones expressing various nef genes, including nef sequences amplified directly from an HIV-1 primary clinical isolate, displayed a similar pattern of cytokine expression. The specific Th1 impairment induced by nef, therefore, seems to be an important and conserved feature of HIV-1 infection and may represent a significant function of this viral gene in AIDS pathogenesis.