Crescentic glomerulonephritis due to linear IgA anti-glomerular basement membrane disease: report of a rare case.

Anti-glomerular basement membrane (GBM) disease is a rare and severe vasculitis that affects the glomerular and pulmonary capillaries and has an incidence of less than 2 cases per million individuals per year. Anti-GBM disease is mediated by autoantibodies against the α3 chain of type IV collagen. In the majority of cases, the autoantibodies are of the immunoglobulin G (IgG) class, with rare cases being mediated by immunoglobulin M (IgM) or immunoglobulin A (IgA); there are less than 15 IgA-mediated cases reported in the literature worldwide. The classic form of this disease manifests with rapidly progressive glomerulonephritis (RPGN), with or without pulmonary hemorrhage, and the diagnosis consists of identifying high titers of autoantibodies in the serum and/or deposited in the tissues. IgA antibodies are not identified in routine immunoassay tests, and renal biopsy with immunofluorescence is essential for diagnosis. We present a case of RPGN due to anti-GBM disease with linear IgA deposition, whose diagnosis was made exclusively by renal biopsy and with an unfavorable prognosis.

Crescentic glomerulonephritis due to linear IgA anti-glomerular basement membrane disease: report of a rare case

Anti-glomerular basement membrane (GBM) disease is a rare and severe vasculitis that affects the glomerular and pulmonary capillaries and has an incidence of less than 2 cases per million individuals per year. Anti-GBM disease is mediated by autoantibodies against the α3 chain of type IV collagen. In the majority of cases, the autoantibodies are of the immunoglobulin G (IgG) class, with rare cases being mediated by immunoglobulin M (IgM) or immunoglobulin A (IgA); there are less than 15 IgA-mediated cases reported in the literature worldwide. The classic form of this disease manifests with rapidly progressive glomerulonephritis (RPGN), with or without pulmonary hemorrhage, and the diagnosis consists of identifying high titers of autoantibodies in the serum and/or deposited in the tissues. IgA antibodies are not identified in routine immunoassay tests, and renal biopsy with immunofluorescence is essential for diagnosis. We present a case of RPGN due to anti-GBM disease with linear IgA deposition, whose diagnosis was made exclusively by renal biopsy and with an unfavorable prognosis.

Comparison of three PET methods to assess peritoneal membrane transport.

The peritoneal equilibration test (PET) is the most widespread method for assessing water and solute transport across the peritoneal membrane. This study compared three methods: traditional PET (t-PET), mini-PET, and modified PET (mod-PET). Non-diabetic adults (n=21) who had been on peritoneal dialysis (PD) for at least three months underwent t-PET (glucose 2.5%-4 h), mini-PET (glucose 3.86%-1 h), and mod-PET (glucose 3.86%-4 h) to determine dialysate-to-plasma concentration ratio (D/P) for creatinine and dialysate-to-baseline dialysate concentration ratio (D/D0) for glucose. Agreement between methods regarding D/P creatinine and D/D0 glucose was assessed using analysis of variance (ANOVA), Pearson's correlation coefficient, and Bland-Altman analysis. D/P creatinine differed between t-PET and mini-PET (P<0.001) and between mod-PET and mini-PET (P<0.01) but not between t-PET and mod-PET (P=0.746). The correlation of D/P creatinine with t-PET vs mod-PET was significant (r=0.387, P=0.009) but not that of t-PET vs mini-PET (r=0.088, P=0.241). Estimated bias was -0.029 (P=0.201) between t-PET and mod-PET, and 0.206 (P<0.001) between t-PET and mini-PET. D/D0 glucose differed between t-PET and mod-PET (P=0.003) and between mod-PET and mini-PET (P=0.002) but not between t-PET and mini-PET (P=0.885). The correlations of D/D0 glucose in t-PET vs mod-PET (r=-0.017, P=0.421) or t-PET vs mini-PET (r=0.152, P=0.609) were not significant. Estimated bias was 0.122 (P=0.026) between t-PET and mod-PET, and 0.122 (P=0.026) between t-PET and mini-PET. The significant correlation of D/P creatinine between t-PET and mod-PET suggested that the latter is a good alternative to t-PET. There was no such correlation between t-PET and mini-PET.

Comparison of three PET methods to assess peritoneal membrane transport

The peritoneal equilibration test (PET) is the most widespread method for assessing water and solute transport across the peritoneal membrane. This study compared three methods: traditional PET (t-PET), mini-PET, and modified PET (mod-PET). Non-diabetic adults (n=21) who had been on peritoneal dialysis (PD) for at least three months underwent t-PET (glucose 2.5%-4 h), mini-PET (glucose 3.86%-1 h), and mod-PET (glucose 3.86%-4 h) to determine dialysate-to-plasma concentration ratio (D/P) for creatinine and dialysate-to-baseline dialysate concentration ratio (D/D0) for glucose. Agreement between methods regarding D/P creatinine and D/D0 glucose was assessed using analysis of variance (ANOVA), Pearson's correlation coefficient, and Bland-Altman analysis. D/P creatinine differed between t-PET and mini-PET (P<0.001) and between mod-PET and mini-PET (P<0.01) but not between t-PET and mod-PET (P=0.746). The correlation of D/P creatinine with t-PET vs mod-PET was significant (r=0.387, P=0.009) but not that of t-PET vs mini-PET (r=0.088, P=0.241). Estimated bias was −0.029 (P=0.201) between t-PET and mod-PET, and 0.206 (P<0.001) between t-PET and mini-PET. D/D0 glucose differed between t-PET and mod-PET (P=0.003) and between mod-PET and mini-PET (P=0.002) but not between t-PET and mini-PET (P=0.885). The correlations of D/D0 glucose in t-PET vs mod-PET (r=−0.017, P=0.421) or t-PET vs mini-PET (r=0.152, P=0.609) were not significant. Estimated bias was 0.122 (P=0.026) between t-PET and mod-PET, and 0.122 (P=0.026) between t-PET and mini-PET. The significant correlation of D/P creatinine between t-PET and mod-PET suggested that the latter is a good alternative to t-PET. There was no such correlation between t-PET and mini-PET.

Ultrastructural and functional aspects of the spermatheca in the American harlequin bug, Murgantia histrionica (Hemiptera: Pentatomidae).

The spermatheca of Murgantia histrionica (Hahn) was investigated using fluorescence, scanning and transmission electron microscopy. The aim of the study was to elucidate the structure of this organ, pointing out differences between mated and unmated females. Results have shown an elaborated cuticular structure associated with muscular and glandular tissues. The spermatheca is joined with the common oviduct by the spermathecal duct, forming a thin saccular dilation through two consecutive invaginations. The distal part of the organ is formed by a series of two communicating cuticular chambers. The first cylindrical-shaped chamber, corresponding to the coiled region, is wrapped by longitudinal muscular fibers suspended between two cuticular flanges. The contractions of these fibers compress a deformable zone of the cylinder, pumping the sperm toward the spermathecal duct. Without contractions the cylinder results to be isolated from the proximal part of the spermatheca by means of a valve. The second chamber, corresponding to the spermatheca, is made of two parts: a truncated-conical sub chamber, with a constant cuticular thickness, bearing on itself the distal flange, where muscular fibers are attached. The second part is a bulb-like structure wrapped in a glandular epithelium. The secretory units are composed by two cells: a secretory cell and an associated duct cell. Every evacuating duct shows a little reservoir just after the terminal apparatus, and converge inside the distal bulb after a tortuous path. The functional implications of this structure in the reproductive biology of M. histrionica are discussed.

Ultrastructural and functional aspects of the spermatheca in the american harlequin bug, Murgantia histrionica (Hemiptera: Pentatomidae)

The spermatheca of Murgantia histrionica (Hahn) was investigated using fluorescence, scanning and transmission electron microscopy. The aim of the study was to elucidate the structure of this organ, pointing out differences between mated and unmated females. Results have shown an elaborated cuticular structure associated with muscular and glandular tissues. The spermatheca is joined with the common oviduct by the spermathecal duct, forming a thin saccular dilation through two consecutive invaginations. The distal part of the organ is formed by a series of two communicating cuticular chambers. The first cylindrical-shaped chamber, corresponding to the coiled region, is wrapped by longitudinal muscular fibers suspended between two cuticular flanges. The contractions of these fibers compress a deformable zone of the cylinder, pumping the sperm toward the spermathecal duct. Without contractions the cylinder results to be isolated from the proximal part of the spermatheca by means of a valve. The second chamber, corresponding to the spermatheca, is made of two parts: a truncated-conical sub chamber, with a constant cuticular thickness, bearing on itself the distal flange, where muscular fibers are attached. The second part is a bulb-like structure wrapped in a glandular epithelium. The secretory units are composed by two cells: a secretory cell and an associated duct cell. Every evacuating duct shows a little reservoir just after the terminal apparatus, and converge inside the distal bulb after a tortuous path. The functional implications of this structure in the reproductive biology of M. histrionica are discussed.

Malformacion de Chiari tipo 1. Revision de la literatura / Chiari malformations type 1. Literature review

El estudio de las manifestaciones clinicas y evaluar las diferentes modalidades de tratamiento quirurgico y sus resultados en todos los casos. Material y metodo: se realizo una revision critica y sistematica de la literatura en base a los criterios de la medicina basada en la evidencia (MBE), el metodo implico: estrategia de busqueda bibliografica, criterios de cribado y exclusion de estudios, analisis y sintesis de los resultados relevantes de los articulos seleccionados. La revision se realizo a partir de 1983 a 2003, utilizandose la base MEDLINE, en terminos de MeSH (Medical Subject Healing). Se seleccionaron 17 de 77 articulos. Resultados: de los 18 articulos revisados identificamos 7 con poblacion pediatrica, cinco del grupo C y dos del grupo D, se incluyeron un total de 108 pacientes, con siringomelia asociada en el 27.7 por ciento y el principal sintoma fue la cefalea 21.78 por ciento; de los articulos con poblacion mixta fueron 11, cinco del grupo B, tres del grupo C y 2 del grupo D, se incluyeron 614 pacientes, con siringomelia asociada en 53.74 por ciento y el principal sintoma fue la alteracion sensitiva en 47.01 por ciento. El principal procedimiento quirurgico realizado fue la craniectomia suboccipital 86.8 y 95.5 respectivamente, seguido por laminectomia 76.19 y 55.5 por ciento , y duroplastia en 62.85 y 33 por ciento. Durante la evaluacion postoperatoria con una mejoria clinica del 77 al 100 por ciento en los articulos de poblacion pediatrica y del 80 a 97.2 en los de poblacion mixta (AU)

Malformacion de Chiari tipo 1. Revision de la literatura / Chiari malformations type 1. Literature review

El estudio de las manifestaciones clinicas y evaluar las diferentes modalidades de tratamiento quirurgico y sus resultados en todos los casos. Material y metodo: se realizo una revision critica y sistematica de la literatura en base a los criterios de la medicina basada en la evidencia (MBE), el metodo implico: estrategia de busqueda bibliografica, criterios de cribado y exclusion de estudios, analisis y sintesis de los resultados relevantes de los articulos seleccionados. La revision se realizo a partir de 1983 a 2003, utilizandose la base MEDLINE, en terminos de MeSH (Medical Subject Healing). Se seleccionaron 17 de 77 articulos. Resultados: de los 18 articulos revisados identificamos 7 con poblacion pediatrica, cinco del grupo C y dos del grupo D, se incluyeron un total de 108 pacientes, con siringomelia asociada en el 27.7 por ciento y el principal sintoma fue la cefalea 21.78 por ciento; de los articulos con poblacion mixta fueron 11, cinco del grupo B, tres del grupo C y 2 del grupo D, se incluyeron 614 pacientes, con siringomelia asociada en 53.74 por ciento y el principal sintoma fue la alteracion sensitiva en 47.01 por ciento. El principal procedimiento quirurgico realizado fue la craniectomia suboccipital 86.8 y 95.5 respectivamente, seguido por laminectomia 76.19 y 55.5 por ciento , y duroplastia en 62.85 y 33 por ciento. Durante la evaluacion postoperatoria con una mejoria clinica del 77 al 100 por ciento en los articulos de poblacion pediatrica y del 80 a 97.2 en los de poblacion mixta

Rápida eficacia de terbinafina oral en onicomicosis de los pies: experiencia clínica multicéntrica / Rapid efficacy of oral terbinafine in foot onychomycoses: multicentric clinical experience

Se presenta la experiencia clínica multicéntrica Chile-Uruguay en el tratamiento de la onicomicosis de los pies con Terbinafina oral administrada por 3 meses y en un período de observación postratamiento de 6 meses. Se incluyen 102 pacientes, 43 hombre y 59 mujeres, con una edad promedio de 50 años, que presentaban un cuadro clínico de onicomicosis de los pies, el que fue confirmado por la presencia de dermatofitos en el cultivo micológico inicial (73,5 por ciento trichophyton rubrum). Se seleccionó la uña más comprometida, en la que se evaluaron onicólisis, engrosamiento ungueal, cambio de coloración e inflamación paroniqueal como parámetros clínicos y la evaluación micológica se hizo por examen directo y cultivo. La uña seleccionada tuvo un crecimiento estadísticamente significativo tanto en la fase de tratamiento como la de postratamiento. Los signos clínicos mejoraron durante todo el seguimiento y el 73 por ciento a 86 por ciento de los pacientes alcanzó mejoría total de estos parámetros a los 9 meses de seguimiento. Los exámenes micológicos se fueron negativizando progresivamente, alcanzando en la evaluación final a los 9 meses un 85,9 por ciento y un 90,5 por ciento para exámenes directos y cultivos negativos, respectivamente. Recaídas con cultivos micológicos positivos fueron observadas en 3 pacientes (5 por ciento ). El medicamento fue bien tolerado y los efectos adversos mas frecuentes fueron los gastrointestinales en 11 pacientes. No hubo alteraciones de los parámetros bioquímicos hepáticos. En conclusión, la terbinafina aparece como un nuevo antimicótico de alta eficacia en un corto período de tratamiento