Lesión fibrótica en cicatriz de mastectomía: ¿estamos ante una recidiva? / Fibrotic lesion in a mastectomy scar: is this a recurrence?

El uso de la radioterapia para el cáncer de mama ha mejorado sustancialmente las tasas de supervivencia para esta enfermedad1;sin embargo, una consecuencia de esto son las complicaciones inducidas por el tratamiento en pacientes que cada vez son máslongevas. Décadas después de la irradiación de la pared torácica, puede desarrollarse una osteomielitis inducida por la radiaciónde inicio muy tardío, causada por osteorradionecrosis2. Es una complicación sumamente infrecuente pero descrita en la literatura. (AU)

The use of radiation therapy for breast cancer has substantially improved survival rates for this disease1; however, one consequenceof this is treatment-induced complications in patients who are increasingly living longer. Decades after chest wall irradiation, verylate-onset radiation-induced osteomyelitis, caused by osteoradionecrosis, can develop2. This is a very rare but a described complication in the literature. (AU)

Complicaciones hemorrágicas de la nefrolitotomía percutánea: valor del tratamiento endovascular precoz / Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management

Introducción y objetivos: La hemorragia secundaria a la fístula arteriovenosa (FAV) o al pseudoaneurisma (PA) es una complicación poco frecuente de la nefrolitotomía percutánea (NLPC). El objetivo de este estudio es evaluar las complicaciones hemorrágicas (CH) tras la NLPC y los resultados del tratamiento endovascular.Materiales y métodosEntre mayo de 2009 y diciembre de 2019 se realizaron en nuestro centro 1.335 NLPC por litiasis renal. Analizamos la incidencia de CH tempranas y tardías, el tratamiento administrado, la necesidad de embolización posterior y los datos clínicos y analíticos de los pacientes.ResultadosUn total de 59 (4,4%) pacientes presentaron CH, y todos fueron tratados con arteriografía y embolización selectiva (AES) para controlar el sangrado. Se observó hematoma perirrenal en 38 pacientes (64%).En cuanto a los hallazgos angiográficos, hubo 32 (54%) PA, 8 (14%) FAV, 4 (7%) extravasaciones por laceración vascular y 15 (25%) PA combinadas con FAV. En un caso, fueron necesarios 3 procedimientos para controlar la hemorragia. En 30 pacientes (51%) no se requirió transfusión de sangre, mientras que en 29 (49%) se transfundió una media de 1,3 unidades. La mediana de seguimiento fue de 24±21 meses.El intervalo de tiempo medio entre la NLPC y la AES fue de 7,3±4,9 días. Un total de 24 (41%) pacientes reingresaron tras el alta debido a una CH tardía que requería AES. La demora entre el reingreso y la AES fue de 4,8±4,6horas de media.ConclusiónLas CH tempranas y tardías tras la NLPC pueden ser mayores. El tratamiento con AES tras la detección precoz es un método efectivo y mínimamente invasivo que evita múltiples transfusiones de sangre, en muchos casos insuficientes. (AU)

Introduction and objectives: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment.Materials and methodsBetween May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients.ResultsA total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%).Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months.Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average.ConclusionEarly and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment. (AU)

Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management.

INTRODUCTION AND OBJECTIVES: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS: Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS: A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24 ±â€¯21 months. Mean time interval between PCNL and ASE was 7.3 ±â€¯4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8 ±â€¯4.6 h in average. CONCLUSION: Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.

Hemorrhagic complicationes after percutaneous nephrolithotomy: The importance of an early endovascular management. / Complicaciones hemorrágicas de la nefrolitotomía percutánea: valor del tratamiento endovascular precoz.

INTRODUCTION AND OBJECTIVES: Hemorrhage due to arteriovenous fistula (AVF) or pseudoaneurysm (PA) is a rare complication after percutaneous nephrolithotomy (PCNL). The objective of this study is to evaluate hemorrhagic complications (HC) after PCNL and the results of their endovascular treatment. MATERIALS AND METHODS: Between May 2009 and December 2019, 1335 PCNL were performed in our center for kidney stone disease. We analyzed the incidence of early and late HC, their management, the need for subsequent embolization, as well as clinical and analytical data of these patients. RESULTS: A total of 59 (4.4%) patients presented HC. Bleeding was managed with arteriography and selective embolization (ASE). Perirenal hematoma was seen in 38 patients (64%). Regarding angiographic findings, there were 32 (54%) PA, 8 (14%) AVF, 4 (7%) extravasations due to vascular laceration and 15 (25%) PA combined with AVF. In one case, 3 procedures were required to control the bleeding. In 30 patients (51%) blood transfusions were not necessary, while in 29 (49%), a mean of 1.3 units were transfused. Median follow-up was 24±21 months. Mean time interval between PCNL and ASE was 7.3±4.9 days. A total of 24 (41%) patients were readmitted after discharge due to late HC requiring ASE. Delay between readmission and ASE was 4.8±4.6hours in average. CONCLUSION: Early and late HC after PCNL can be severe. Rapid identification and treatment with ASE is an effective and minimally invasive and avoids multiple blood transfusions which in many cases constitute an insufficient treatment.

Características clínicas de la cabeza del nervio óptico en recién nacidos sanos / Clinical features of optic nerve head in healthy newborns

OBJETIVO: Determinar el tamaño y características clínicas del disco óptico en recién nacidos sanos a término. METODOLOGÍA: Estudio descriptivo, observacional, transversal y retrospectivo basado en expedientes clínicos completos de recién nacidos en el Hospital Ángeles de Pedregal (Ciudad de México) entre mayo y agosto del 2015. Las medidas del disco óptico y las características clínicas fueron obtenidas de fotografías digitales y evaluadas por dosexpertos. Para los datos obtenidos utilizamos el cálculo de frecuencias, medias y desviación estándar con el programa SPSS versión 17.0 para Windows. RESULTADOS: Tuvimos un total de 121 pacientes y 121 ojos elegidos, 65 fueron varones. El diámetro vertical promedio fue de 1,60 ± 0,17 mm, el diámetro horizontal de 1,13 ± 0,13mm, el área de disco óptico de 1,43± 0,26 mm2, la excavación de 0,25 ± 0,11. El color del anillo neurorretiniano era naranja en 116 (95,9%) ojos. La lámina cribosa no era visible en ningún paciente, en 90 ojos (74,4%) la aparición de los vasos en la papila era central y nasal en los restantes. En 38 ojos (31,4%) estuvo presente la arteria ciliorretiniana. La presencia de un anillo peripapilar hiper- e hipopigmentado se evidenció en 114 ojos (94,2%). CONCLUSIÓN: El promedio de área del nervio óptico es 1,43 ± 0,26 mm2, ligeramente superior a lo reportado por otros autores; la excavación promedio es menor a 0,3, como se informa en la literatura y llama la atención que todos los ojos tienen un anillo peripapilar hiperpigmentado e hipopigmentado

OBJECTIVE: To determine the size and clinical features of the optical disc in healthy term infants. METHODOLOGY: Descriptive, observational, cross-sectional, and retrospective study based on complete medical records of newborns at the Angeles Pedregal Hospital, Mexico DF, from May to August 2015. The measurements of the optical disc and clinical features were obtained from digital photographs and evaluated by 2experts. Frequencies, means and standard deviation were calculated using the SPSS version 17.0 for Windows. RESULTS: The study included a total of 121 patients and 121 eyes. There were 65 males. The mean vertical diameter was 1.60±0.17mm, horizontal diameter 1.31±0.13mm, optical disc area 1.43±0.26mm2, and cup to disc ratio 0.25±0.11. The neuroretinal ring colour was orange in 116 (95.9%) eyes. The cribriform plate was not visible in any patient, and in 90 (74.4%) eyes the appearance of the vessels in the papilla was central, and nasal in the rest. The cilioretinal artery was present in 38 (31.4%) eyes. A hyper- and hypo-pigmented peripapillary ring was observed in 114 eyes (94.2%). CONCLUSION: The mean area of the optic nerve is 1.43±0.26mm2, slightly higher than previously reported. The mean cup to disc ratio is less than 0.3, as reported in the literature, and it is noteworthy that all eyes have a hyper-pigmented and hypo-pigmented peripapillary ring

Clinical features of optic nerve head in healthy newborns. / Características clínicas de la cabeza del nervio óptico en recién nacidos sanos.

OBJECTIVE: To determine the size and clinical features of the optical disc in healthy term infants. METHODOLOGY: Descriptive, observational, cross-sectional, and retrospective study based on complete medical records of newborns at the Angeles Pedregal Hospital, Mexico DF, from May to August 2015. The measurements of the optical disc and clinical features were obtained from digital photographs and evaluated by 2experts. Frequencies, means and standard deviation were calculated using the SPSS version 17.0 for Windows. RESULTS: The study included a total of 121 patients and 121 eyes. There were 65 males. The mean vertical diameter was 1.60±0.17mm, horizontal diameter 1.31±0.13mm, optical disc area 1.43±0.26mm2, and cup to disc ratio 0.25±0.11. The neuroretinal ring colour was orange in 116 (95.9%) eyes. The cribriform plate was not visible in any patient, and in 90 (74.4%) eyes the appearance of the vessels in the papilla was central, and nasal in the rest. The cilioretinal artery was present in 38 (31.4%) eyes. A hyper- and hypo-pigmented peripapillary ring was observed in 114 eyes (94.2%). CONCLUSION: The mean area of the optic nerve is 1.43±0.26mm2, slightly higher than previously reported. The mean cup to disc ratio is less than 0.3, as reported in the literature, and it is noteworthy that all eyes have a hyper-pigmented and hypo-pigmented peripapillary ring.

Contribución de la temperatura fría y el sabor ácido en la intervención fonoaudiológica de la disfagia orofaríngea / Contribution of cold temperature and sour taste in speech and language intervention of oropharyngeal dysphagia

El fonoaudiólogo es el principal profesional en la rehabilitación no farmacológica y no quirúrgica del usuario con disfagia. Su participación es fundamental tanto para el aminoramiento del riesgo de aspiración o penetración laríngea, como para mejorar o restaurar la función deglutoria. Para este fin, posee opciones terapéuticas directas e indirectas, cuya elección y aplicación dependerá de la patología que curse el usuario, las redes que posea para su recuperación y la motivación intrínseca del mismo. Entre las estrategias de intervención indirecta se encuentra el Tratamiento Sensorio-Motor Oral (OSMT, por sus siglas en inglés), el cual pretende producir una aceleración en el desencadenamiento del proceso deglutorio mediante la ejercitación de los músculos orofaciales en conjunto con diferentes estímulos sensoriales (específicamente la temperatura fría y el sabor ácido). La presente revisión tiene por objetivo dilucidar si la utilización de la temperatura fría y el sabor ácido son útiles como mecanismo de intervención indirecta de la disfagia. Se concluye que las acciones propuestas son efectivas simplemente como mecanismos compensatorios en el proceso deglutorio, puesto que modifican las características del bolo alimenticio e incrementan momentáneamente las sensaciones intraorales.

The speech-language pathologist (SLP) is the main professional in the nonpharmacological and non-surgical rehabilitation of patients with dysphagia. Their role is essential for both reducing the risk of aspiration or laryngeal penetration and improving or restoring the swallowing function. To this end, the SLP has direct and indirect therapeutic options, whose choice and application will depend on the patient’s condition, support networks, and their intrinsic motivation. As part of the indirect intervention strategies, the oral sensorymotor treatment (OSMT) aims to exercise the orofacial muscles, and introduce sensory input by the application of cold temperature and sour taste to increase the triggering speed of the swallowing reflex. This review seeks to determine whether the use of cold temperature and sour taste are effective indirect mechanisms for treating patients with dysphagia. It is concluded that the proposed actions in this review are useful simply as compensatory mechanisms in the swallowing process, as they modify the bolus properties and increase, temporarily, the intra-oral sensations.

Evaluación del cocimiento de diferentes biovariedades de Caesalpinia spinosa (tara) frente a cepas de Staphylococcus aureus sensibles y resistentes a oxacilina / Evaluation of different biovarieties of Caesalpinia spinosa (tara) poaching against oxacillin sensitive and resistant Staphylococcus aureus strains

Objetivos: Comprobar la actividad antimicrobiana de tres biovariedades de tara frente a cepas de Staphylococcus aureus sensibles y resistentes a oxacilina. Diseño: Estudio descriptivo, prospectivo, analítico. Institución: Instituto de Medicina Tropical Daniel A. Carrión, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú. Material biológico: Tres biovariedades de tara y cepas de Staphylococcus aureus. Intervenciones: Se evaluó 31 cepas de S. aureus oxacilina sensibles y 29 resistentes, aislados de muestras clínicas, frente a tres cocimientos de tara de las zonas de Huamanga, Huarochirí y Tarma. Se preparó el cocimiento de tara y se impregnó discos en blanco para utilizarlos como un antibiograma por disco difusión. Principales medidas de resultados: Diámetro de los halos de inhibición. Resultados: Los tres cocimientos presentaron actividad antimicrobiana frente a las cepas de Staphylococcus aureus; el cocimiento de Huamanga presentó mayor halo de inhibición frente a cepas sensibles y resistentes. El cocimiento de Huarochirí mostró mayor halo de inhibición en cepas oxacilino resistentes que sensibles; la diferencia fue significativa. El cocimiento de Huarochirí tuvo una actividad menor y fue significativa, frente a los cocimientos de Huamanga y Tarma. Conclusiones: El cocimiento de Huarochirí presentó menor actividad que los de Huamanga y de Tarma...

Objectives: To determine three taraÆs biovarieties antimicrobial activity against oxacillin sensitive and resistant Staphylococcus aureus strains. Design: Descriptive, prospective, analytical study. Setting: Instituto de Medicina Tropical Daniel A. Carrion, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru. Biologic material: Three tara biovarieties and Staphylococcus aureus strains. Interventions: Thirty-one S. aureus oxacillin-sensitive strains and 29 oxacillin-resistant strains isolated from clinical samples were studied against three tara varieties obtained in Huamanga, Huarochiri and Tarma. TaraÆs poaching was prepared and blank discs were soaked in to use as antibiogram by disc difussion. Main outcome measures: Inhibition halos diameter. Results: All three poachings showed antimicrobial activity against Staphylococcus aureus strains; HuamangaÆs poaching displayed larger inhibition halo against sensitive and resistant strains. HuarichiriÆs poaching showed significant larger inhibition halo in oxacillin-resistant strains than in sensitive ones. HuarochiriÆs poaching had less significant activity as compared with Huamanga and Tarma poachings. Conclusions: HuarochiriÆs poaching exhibited less activity compared with those from Huamanga and Tarma...

16S partial gene mitochondrial DNA and internal transcribed spacers ribosomal DNA as differential markers of Trichuris discolor populations.

Comparative morphological, biometrical and molecular studies of Trichuris discolor isolated from Bos taurus from Spain and Iran was carried out. Furthermore, Trichuris ovis isolated from B. taurus and Capra hircus from Spain has been, molecularly, analyzed. Morphological studies revealed clear differences between T. ovis and T. discolor isolated from B. taurus but differences were not observed between populations of T. discolor isolated from different geographical regions. Nevertheless, the molecular studies based on the amplification and sequencing of the internal transcribed spacers 1 and 2 ribosomal DNA and 16S partial gene mitochondrial DNA showed clear differences between both populations of T. discolor from Spain and Iran suggesting two cryptic species. Phylogenetic studies corroborated these data. Thus, phylogenetic trees based on ITS1, ITS2 and 16S partial gene sequences showed that individuals of T. discolor from B. taurus from Iran clustered together and separated, with high bootstrap values, of T. discolor isolated from B. taurus from Spain, while populations of T. ovis from B. taurus and C. hircus from Spain clustered together but separated with high bootstrap values of both populations of T. discolor. Furthermore, a comparative phylogenetic study has been carried out with the ITS1and ITS2 sequences of Trichuris species from different hosts. Three clades were observed: the first clustered all the species of Trichuris parasitizing herbivores (T. discolor, T. ovis, Trichuris leporis and Trichuris skrjabini), the second clustered all the species of Trichuris parasitizing omnivores (Trichuris trichiura and Trichuris suis) and finally, the third clustered species of Trichuris parasitizing carnivores (Trichuris muris, Trichuris arvicolae and Trichuris vulpis).

Trichuris suis and Trichuris trichiura are different nematode species.

In this paper, a morphological and biometrical study by optical microscopy and scanning electronic microscopy (SEM) of Trichuris suis isolated from different hosts (Sus scrofa domestica and Sus scrofa scrofa) and Trichuris trichiura isolated from chimpanzee, has been carried out. Our results demonstrate the existence of typical pericloacal papillae in both species. Biometrical parameters of T. suis and T. trichiura overlapped but males and females of T. trichiura tended to be shorter and thinner than those of T. suis. Our results suggest that T. suis and T. trichiura cannot be differentiated using standard procedures as morphological and biometrical determinations. Thus, the ITS1-5.8S-ITS2 region of the ribosomal DNA was sequenced to allow a differentiation between T. suis and T. trichiura on genetic level. The ITS1 and ITS2 sequences derived from T. trichiura eggs isolated from feces of primates (Colobus guereza kikuyensis and Nomascus gabriellae) showed clear differences to the respective sequences of T. suis derived from eggs of different porcine hosts. The 5.8S gene was similar between the two species. Sequences obtained from different populations of the same species showed no significant differences indicating that the ITS1-5.8S-ITS2 sequences reported in this study are representative for T. trichiura and T. suis, respectively. Phylogenetic relationships have been determined attending to the ITS1 and ITS2 sequences from different species of the genus Trichuris. In conclusion, T. trichiura and T. suis are considered to be closely related but genetically different species. Both species can be easily and reliably distinguished by a PCR-RFLP analysis of the ITS1 and ITS2 sequences with different restriction enzymes.

Cytochrome oxidase subunit 1 and mitochondrial 16S rDNA sequences of Trichuris skrjabini (Tricocephalida: Trichuridae).

The partial mitochondrial cytochrome c-oxidase subunit 1 gene (cox 1) and partial mitochondrial 16S ribosomal DNA of Trichuris skrjabini (Baskakov 1924) isolated from Capra hircus have been amplified and sequenced. The analyses of multiple sequence alignments of mitochondrial 16S rDNA and cox 1 of T. skrjabini revealed high homology with those of Trichinella species. For the first time, the mitochondrial DNA gene sequences of one species of trichurid nematode have been cited.

Prevalencia de Streptococcus beta hemolítico en pacientes con faringoamigdalitis aguda, en un hospitalde la ciudad de Chachapoyas, Amazonas / Prevalence of beta hemolytic Streptococcus in patients with acute pharyngoamigdalitis in a Chachapoyas, Amazonas hospital

Introducción: En Chachapoyas hay numerosos pacientes con faringoamigdalitis aguda y cuadros clínicos con las complicaciones no supurativas que causa el Streptococcus pyogenes. Diseño: Estudio transversal. Lugar: Hospital I Higos Urco, EsSalud, Chachapoyas, Amazonas, e Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos. Participantes: Pacientes con faringoamigdalitis aguda. Intervenciones: A 148 pacientes, seleccionados aleatoriamente, que acudieron al consultorio externo de otorrinolaringología por presentar cuadros clínicos compatibles con faringoamigdalitis aguda, se les tomó muestras de secreción faringoamigdaliana con hisopos y, usando el medio de transporte Amies con carbón (Difco), fueron enviados al Instituto de Medicina Tropical Daniel A. Carrión, en donde fueron procesados. Principales medidas de resultados: Presencia de Streptococcus beta hemolítico y otras bacterias cultivables. Resultados: Las enterobacterias fueron las más aisladas (49,1 por ciento) de los cultivos positivos. Solo 5 Streptococcus beta hemolíticos fueron aislados: un Streptococcus pyogenes, tres Streptococcus agalactiae y un Streptococcus del grupo G, los cuales fueron sensibles a los betalactámicos, macrólidos y lincosamidas. Conclusiones: Se sugiere realizar estudios complementarios con el dosaje de antiestreptolisina O.

Introduction: There are numerous Chachapoyas patients with acute pharyngoamigdalitis and clinical non suppurative complications caused by Streptococcus pyogenes. Design: Transversal study. Setting: Hospital I Higos Urco, EsSalud, Chachapoyas, Amazonas, and Instituto de Medicina Tropical Daniel A. Carrion, Universidad Nacional Mayor de San Marcos. Participants: Patients with acute pharyngoamigdalitis. Interventions: One hundred and forty-eight randomized outpatient subjects attending an ear, nose and throat office for clinical symptoms compatible with acute pharyngoamigdalitis had a sample of pharynx and tonsils taken with a cotton swab and sent in Amies with carbon medium (Difco) to the Instituto de Medicina Tropical Daniel A. Carrion to be processed. Main outcome measures: Presence of beta hemolytic Streptococcus and other bacteriae. Results: Positive cultures revealed mainly Enterobacteriae (49,1 per cent). Only 5 beta hemolytic Streptococcus were isolated: one Streptococcus pyogenes, three Streptococcus agalactiae and one group G Streptococcus, all sensitive to betalactamics, macrolides and lincosamides. Conclusions: We suggest to do complementary studies with antiestreptolysin O determination.

Determination of Trichuris skrjabini by sequencing of the ITS1-5.8S-ITS2 segment of the ribosomal DNA: comparative molecular study of different species of trichurids.

Adults of Trichuris skrjahini have been isolated from the cecum of caprine hosts (Capra hircus), Trichuris ovis and Trichuris globulosa from Ovis aries (sheep) and C. hircus (goats), and Trichuris leporis from Lepus europaeus (rabbits) in Spain. Genomic DNA was isolated and the ITS1-5.8S-ITS2 segment from the ribosomal DNA (rDNA) was amplified and sequenced by polymerase chain reaction (PCR) techniques. The ITS1 of T. skrjabini, T. ovis, T. globulosa, and T. leporis was 495, 757, 757, and 536 nucleotides in length, respectively, and had G + C contents of 59.6, 58.7, 58.7, and 60.8%, respectively. Intraindividual variation was detected in the ITSI sequences of the 4 species. Furthermore, the 5.8S sequences of T. skrjabini, T. ovis, T. globulosa, and T. leporis were compared. A total of 157, 152, 153, and 157 nucleotides in length was observed in the 5.8S sequences of these 4 species, respectively. There were no sequence differences of ITS1 and 5.8S products between T. ovis and T. globulosa. Nevertheless, clear differences were detected between the ITS1 sequences of T. skrjabini, T. ovis, T. leporis, Trichuris muris, and T. arvicolae. The ITS2 fragment from the rDNA of T. skrjabini was sequenced. A comparative study of the ITS2 sequence of T. skrjabini with the previously published ITS2 sequence data of T. ovis, T. leporis, T. muris, and T. arvicolae suggested that the combined use of sequence data from both spacers would be useful in the molecular characterization of trichurid parasites.

Efficacy of intrathecal morphine in the treatment of baclofen tolerance in a patient on intrathecal baclofen therapy (ITB).

STUDY DESIGN: Case report. OBJECTIVES: A case report of tolerance to intrathecal baclofen therapy (ITB) treated with intrathecal morphine ('baclofen holiday'). SETTING: Institut Guttmann, Neurorehabilitation Hospital of Barcelona, Spain. CASE REPORT: A 30-year-old female patient is described with incomplete paraplegia below T6 on the left side and below T8 on the right side, ASIA B, caused by trauma occurring 12 years previously, in whom an intrathecal system had been implanted for baclofen infusion 10 years ago. The patient showed tolerance to baclofen therapy and was treated with intrathecal morphine infusion for 2 weeks. Baclofen infusion resulted in adequate control of spasticity.

Phylogenetic relationships in rhinonyssid mites (Acari: Rhinonyssidae) based on ribosomal DNA sequences: insights for the discrimination of closely related species.

The complete internal transcribed spacer 1 (ITS1), 5.8S rDNA and ITS2 region of the ribosomal DNA from 11 species of rhinonyssid mites ( Tinaminyssus columbae, T. minisetosum, T. sartbaevi, T. bubulci, T. melloi, T. streptopelioides, Sternostoma fulicae, S. boydi, S. strandtmanni, S. turdi, Rhinonyssus tringae) were sequenced to assess the utility of this genomic region in resolving taxonomic questions in this group and to estimate phylogenetic relationships between species. Two different geographic locations of T. melloi and T. streptopelioides were analyzed to detect intraspecies variation. Our study shows that ribosomal sequences can help to discriminate between T. melloi and T. sartbaevi, which are morphologically very close and difficult to separate by classic methods. The resulting phylogenetic tree shows some differences from the current taxonomy of the family Rhinonyssidae. This study appeals for the revision of the taxonomic status of S. boydi and closely related species which parasitize aquatic birds and suggests the synonymy of S. boydi and S. strandtmanni, despite the different hosts of the two mites.

Determination of Trichuris muris from murid hosts and T. arvicolae (Nematoda) from arvicolid rodents by amplification and sequentiation of the ITS1-5.8S-ITS2 segment of the ribosomal DNA.

Trichuris muris has been isolated from murid hosts ( Apodemus sylvaticus and Mus musculus) and Trichuris arvicolae from arvicolid rodents in Barcelona, Spain. Genomic DNA was isolated and the ITS1-5.8S-ITS2 segment from the ribosomal DNA (rDNA) was amplified and sequenced using polymerase chain reaction techniques. The ITS2 of both populations isolated from Apodemus and Mus was 382 nucleotides in length and had a GC content of about 60.73%, while the ITS2 of T. arvicolae was 442 nucleotides in length and had a GC content of about 59.8%. Furthermore, the ITS1 of Trichuris from murids was 448 nucleotides in length and had a GC content of about 56.47%, while T. arvicolae was 446 nucleotides in length and had 57.62% of GC content. A total of 161 and 173 nucleotides were observed along the 5.8S gene of T. murisand T. arvicolae, respectively; This difference in nucleotides was due to the insertion of a DNA segment (transposon) in the 5.8S sequence of the latter species. Slight intraindividual and intraspecific variations were detected in the rDNA of both species. The presence of microsatellites was observed in all of the individuals assayed. Sequence analysis of the internal transcribed spacers and the 5.8S gene demonstrated no sequence differences between T. muris isolated from both of its murid hosts. Nevertheless, clear differences were detected between the ITS2, ITS1 and 5.8S gene of T. muris and T. arvicolae. This corroborates the existence of two separate Trichuris species in murid and arvicolid hosts. Furthermore, a phylogenetic analysis was carried out and endonucleases restriction maps were elaborated for both species.

Interobserver reproducibility in reporting on 99mTc-DMSA scintigraphy for detection of late renal sequelae.

UNLABELLED: This study was designed to evaluate the interobserver variability in reporting on 99mTc-dimercaptosuccinic acid (DMSA) scanning performed 6 mo after an acute episode of pyelonephritis for the detection of late renal sequelae. METHODS: Forty-six children were selected, who had early and late DMSA studies for evaluation of acute pyelonephritic lesions as well as sequelae. Three observers reported independently and separately on the early and late DMSA scans and, in a second step, on the late scan in the presence of the early scan. Interobserver reproducibility was evaluated for the early DMSA scan, the late DMSA scan alone, and the late DMSA scan with the early scan for comparison. RESULTS: Complete agreement between the three observers was reached in 75%, 78%, and 77% for the early DMSA scan, the late DMSA scan alone, and the late DMSA scan with the early scan for comparison, respectively. CONCLUSION: Interobserver reproducibility was high and was comparable for both early and late DMSA scintigraphy.

Phylogenetic relationships in rhinonyssid mites (Acari: Rhinonyssidae) based on mitochondrial 16S rDNA sequences.

A 390 bp region of the 16S rDNA gene was sequenced from six species of rhinonyssid mites (Tinaminyssus columbae, T. minisetosum, Sternostoma turdi, S. sternahirundo, S. fulicae and Ptilonyssus euroturdi) and two subspecies (Tinaminyssus melloi melloi and Tinaminyssus melloi streptopeliae) to examine the level of sequence variation and the taxonomic levels to show utility in phylogeny estimation. Furthermore, two different geographic locations of T. m. melloi and T. m. streptopeliae were analyzed to detect variation between populations. Molecular data revealed the existence of two distinct groups in the genus Tinaminyssus parasitic on columbiform birds. These results are in agreement with those reported by some authors using morphological characters. Sternostoma turdi parasitizing aerial birds appeared to be phylogenetically separated from other species of this genus isolated from aquatic birds. Moreover, our study addresses the validity of the subspecies status of T. melloi streptopeliae. This region of the mitochondrial 16S rDNA gene is a useful marker for inferring phylogenetic relationships among closely related rhinonyssid species, but not for more distantly related taxa.

[Salivary gland scintigraphy en Sjogren syndrome and its relation with the result of lip biopsy. Comparative study with a control population]. / Utilidad de la cintigrafía de glándulas salivales en el síndrome de Sjögren y su relación con el resultado de la biopsia de labio. Estudio comparativo con una población control.

BACKGROUND: Salivary gland scintigraphy allows a non invasive, morphological and functional assessment of parotid and submaxillary salivary glands. AIM: To describe the main features of salivary gland scintigraphy in patients with Sjögren syndrome, rheumatic fibromyalgia and normal controls and compare the results with lip biopsy. PATIENTS AND METHODS: Sixty one normal controls, 66 patients with Sjögren syndrome and 18 patients with rheumatic fibromyalgia were studied. For the diagnosis of Sjögren syndrome and fibromyalgia rheumatica, the Modified European and American College of Rheumatology criteria were used, respectively. Lip biopsies were obtained in 52 patients with Sjögren syndrome. Scintigraphy was done with a gamma camera and computer after the administration of 99mTc-pertechnetate, obtaining images during 30 min and creating time/activity curves. Scintigraphy was classified as normal, with mild or severe alterations. RESULTS: Scintigraphy was normal in 74% of control subjects and in 26%, it had mild alterations. In 72% of patients with rheumatic fibromyalgia, scintigraphy was normal whereas in 28%, it had mild alterations. In 27% of patients with Sjögren syndrome, scintigraphy was normal, in 27% it had mild alterations and in 46%, severe alterations. There was a positive and significant correlation between pathological alterations of salivary glands and scintigraphic alterations (r = 0.642, p < 0.001). CONCLUSIONS: Severe scintigraphic alterations of salivary glands strongly support the diagnosis of Sjögren syndrome. Mild alterations are non specific and a normal scintigraphy does not exclude the diagnosis.

Characterization of Chabertia ovina by isoenzyme gel electrophoresis: comparative study with Oesophagostomum venulosum.

The glucose-6-phosphate dehydrogenase (G6PD, EC.1.1.1.49), glucose phosphate isomerase (GPI, EC.5.3.1.9), and malate dehydrogenase (MDH, EC.1.1.1.37) isoenzymatic patterns of Chabertia ovina were determined by starch-gel electrophoresis. The G6PD and GPI isoenzymatic patterns were characterized by the existence of three phenotypes: (1) a single and slow anodic band, (2) a single and fast anodic band, and (3) a large spot matching its migration with bands 1 and 2. These three phenotypes may be explained as the existence of only one gene locus for the G6PD and GPI in C. ovina. Allelic frequencies and the Hardy-Weinberg test were determined. This test indicated that the population was not in Hardy-Weinberg equilibrium. The MDH isoenzymatic pattern of C. ovina was characterized by the presence of two bands with anodic and cathodic migration. Furthermore, comparative isoenzyme studies were carried out between Oesophagostomum venulosum and C. ovina. The different G6PD, GPI, and MDH isoenzymatic patterns observed for the two species allowed us to distinguish them and, therefore, to use isoenzymatic patterns as a diagnostic tool to discriminate these species.