Cutaneous leishmaniasis by Leishmania infantum: behind granulomatous lesions of unknown aetiology.

BACKGROUND: Cutaneous leishmaniasis (CL) is underestimated in Spain as in other European countries due to the polymorphism of its clinical manifestations and histopathological features discouraging doctors from suspecting leishmaniasis. Mucosal manifestations (ML) are misdiagnosed due to the fact that they often mimic cancer. OBJECTIVES: Given that leishmaniasis may be masked as different granulomatous diseases in Leishmania infantum endemic areas, the aim of this study was to verify this misdiagnosing and contributes to the improvement of CL/ML diagnosis. METHODS: A retrospective study involving formalin-fixed paraffin-embedded tissue biopsies with histopathological features of granulomatous lesions of unknown origin (GLUO) detected in 17 patients. This study included 13 patients with CL that was used as positive controls, nine patients with other confirmed diseases used as negative controls and seven patients with histological features suggestive of CL or ML without confirmation. Molecular analysis was blindly performed using two different PCR techniques. RESULTS: The PCR detected 15 CL cases in which the diagnosis was neither clinically nor histologically suspected. Leishmaniasis was confirmed in seven suspected patients in whom the classical techniques failed to detect the parasite. L. infantum was identified in all cases. A systematic review of CL cases in GLUO patients from European countries identified 45 reported cases. CONCLUSIONS: In L. infantum endemic areas, a high percentage of GLUO are due to Leishmania infection. The main consequences are delayed diagnosis and underestimation of the real incidence. PCR performed on paraffin-embedded tissue proved to be a reliable tool for diagnosis of CL/ML and must be performed routinely in any granulomatous dermatitis, even when the morphological features are no stereotypical of leishmaniasis.

Anisakiasis intestinal diagnosticada por enteroclisis / Intestinal anisakiasis diagnosed by enteroclysis

La anisakiasis es una parasitación frecuente en nuestro medio y que da lugar a cuadros de dolor abdominal que pueden simular otras patologías, incluyendo situaciones quirúrgicas (apendicitis o peritonitis), pero generalmente autolimitadas. Presentamos un caso de una paciente de 48 años con dolor abdominal agudo, febrícula y hallazgos patológicos en TAC (propios de un cuadro inflamatorio intestinal), en la que la realización de una enteroclisis fue capaz de identificar larvas de Anisakis. La paciente evolucionó favorablemente con tratamiento conservador y el patrón radiológico volvió a la normalidad. En nuestro caso, la posibilidad de contar con una técnica radiológica objetiva que sirvió de ayuda al diagnóstico proporcionó datos muy útiles en el manejo de la paciente. Se revisan las características clínicas y radiológicas de la enfermedad (AU)

Anisakiasis is a common infestation in our setting that produces abdominal pain that can simulate other diseases including surgical conditions (symptoms of acute abdomen, mimicking appendicitis or peritonitis), but it is generally a self-limiting process. We report a case of a 48-year-old female with acute abdominal pain, fever and pathological findings on the CT scan (inflammatory bow condition). Anisakis larvae could be identified by the enteroclysis. The patient evolved favorably with conservative treatment and radiologic intestinal pattern returned to normal. The possibility of a radiological technical to assist in the diagnosis provided very useful data in the management of our patient. The radiological and clinical features of the disease are reviewed (AU)

Leucemia de células natural killer agresiva y presencia del virus de Epstein Barr

No disponible

[Descriptive study of bladder tumors in the district of Levante-Alto Almanzora]. / Estudio descriptivo de los tumores vesicales en la comarca del Levante-Alto Almanzora.

We present our series of operater bladder cancers in this District and the annual incidence in the period 1996 at 1998, as web as they are distributed by sex, age and smoking in the population; neoplasic stage and relapse were also studied. 61 patients were treated and un found global half incidence of 19.8 for 10(5) inhabitant-year (h-a), while for sexes it was of 4.22 for 10(5) h-y for women and of 15.58 for 10(5) h-y males. 78.69% was male with a masculinity rate of 3.69. The most frequent age group was starting from the seventh decade with 50.81% of our series. There was 36% of intervened patients that they were smoking, while 29.5% had relationship with other factors of risk like hydrocarbons and pesticidas. The superficial tumors were the most frequent with 86.88% of the cases, on the other hand the undifferentiated neoplastics was not very frequent with 13.21%, increasing these neoplastics with the age. In the follow up there were relapses in 36% of the people, being bigger in the T1 of our series. The occupational factors in this district can explain the high frequency in the female sex, although analytic studies are needed to check it.

Estudio descriptivo de los tumores vesicales en la Comarca del Levante-Alto Almanzora / Descriptive study ob bladder cancer in District the Levant-High Alamanzora

Se presentan los tumores vesicales intervenidos en esta Comarca y la incidencia anual en el periodo 1996 a 1998, así como se distribuyen por sexo, edad y hábito tabáquico en la población; también se estudiaron el estadio tumoral y la recidiva. Se han tratado 61 pacientes con una incidencia media global de 19,8 por 10 5 habitantes-año (h-a), mientras que por sexos fue de 4,22 por 10 5 h-a para mujeres y de 15,58 por 10 5 h-a para varones. El 78,69 por ciento fue-ron varones, con una razón de masculinidad de 3,69. El grupo de edad más frecuente fue a partir de la séptima década con un 50,81 por ciento de nuestra serie. Hubo un 36 por ciento de pacientes intervenidos que eran fumadores, mientras que un 29,5 por ciento habían estado expuestos a otros factores de riesgo como hidrocarburos y pesticidas. Los tumores superficiales fueron los más frecuentes con el 86,88 por ciento de los casos, por el contrario aquellos con histología indiferenciada fueron poco frecuentes con el 13,21 por ciento, aumentando estas neoplasias con la edad. En el seguimiento hubo recidivas en el 36 por ciento de los sujetos, siendo mayor en los T1 de nuestra serie. Los factores ocupacionales en esta zona pueden explicar la elevada frecuencia en el sexo femenino, aunque se necesitan estudios analíticos para comprobarlo (AU)

[Sertoli cell tumor of the testis]. / Tumor testicular de células de Sertoli.

Sertoli cell tumors (TCS) derivated from sex-cord estroma cells, are an uncommon variety of testicles neoplasms. A 66 year-old patient that came to the consultation for an increased scrotum of size present. Ultrasound viewed a hipoecoic nodule capable with testicular tumor, more secondary hidrocele. After undergoing the standard treatment, by means of groin radical orchiectomy, its pathologic analysis identified the lesion as Sertoli cell tumor conventional. The pathologic features that best correlate with a clinically benign course are as follows: a lower size tumor to 5 cm, mild nuclear atypia, a mitotic rate of less than 5 mitosis per 10 high power fields, and absent necrosis. Our case presented with these features. Follow-up of these neoplasms should be prolonged by the unusual of its presentation and a small percentage of cases are clinically malignant.

Tumor testicular de células de Sertoli / Sertoli's cell testicle tumour

Los tumores de células de Sertoli (TCS) derivados de los cordones sexuales del estroma gonadal, son una variedad infrecuente de las neoplasias testiculares. Presentamos un paciente de 66 años que vino a la consulta por un escroto aumentado de tamaño. En la exploración ecográfica presentó un nódulo hipoecoico compatible con tumor testicular, más hidrocele secundario. Después de someterse al tratamiento estándar, mediante orquiectomía radical inguinal, el informe histopatológico fue de TCS clásico. Existen criterios histopatológicos que informan de la benignidad de estas lesiones, como son: un tamaño tumoral inferior a 5 cm, atipia nuclear leve, índice mitótico inferior a 5 por 10 campos de gran aumento y no existir necrosis. Nuestro paciente se presentó con estas características. El seguimiento de estas neoplasias debe ser prolongado por lo inusual de su presentación y porque existe el riesgo de malignización en un porcentaje pequeño de enfermos (AU)

The systemic vasodilatory action of protamine: is it inhibited or mediated by heparin?

UNLABELLED: The administration of protamine to neutralize the circulating heparin is common practice in cardiovascular surgery. The use of this drug is sometimes associated with hemodynamic alterations of varying degree and intensity (systemic hypotension, pulmonary hypertension and even cardiogenic shock). An intrinsic action of protamine has been suggested to be the cause of these vascular reactions. This action is blocked when protamine forms a complex with heparin, although in other cases it appears that the heparin-protamine complex is the factor responsible for these hemodynamic alterations. The aim of this experimental study was to characterize the vasodilatory action of protamine on the systemic circulation, determining whether or not it is dose-dependent; to analyze the role of endothelium; and to evaluate whether this vasodilatory effect is modified by the presence of heparin. MATERIALS AND METHODS: The abdominal aorta was dissected from eight New Zealand rabbits and then sectioned into vascular rings for study in an organ chamber. Mechanical disruption of endothelium was performed on some rings (n = 14). Once submaximal contraction was reached (ClK 80 mM), protamine sulfate with a final concentration in the organ chamber of 80-400 micrograms/ml was added to one of the groups (n = 12). In the second group (n = 12), equal concentrations of protamine were tested in the presence of heparin at a final concentration of 100 U/ml. RESULTS: The mean vasodilatation reached in the group of rings exposed only to protamine was 95.4 +/- 1.5% with respect to the submaximal contraction induced with ClK. In the second study group, the rings were exposed to protamine at equally increasing concentrations (80-400 micrograms/ml) but with the presence of heparin in the organ chamber. The mean vasodilatation in this group was 90 +/- 1.5. No statistically significant differences in vasodilatation were found between this group and the protamine without heparin group. On the other hand, in the endothelium-denuded rings (n = 14) exposed to isolated protamine and to protamine-heparin, no vasodilatory response was observed. CONCLUSION: Our results show that the administration in vitro of protamine induces endothelium-dependent vasodilatation of the systemic circulation. Likewise, this relaxing effect mediated through endothelium is not blocked when protamine forms a complex with heparin in comparable concentrations of both drugs. Based on these preliminary findings, we believe that in high-risk patients the prevention of systemic vasodilatation and cardiovascular collapse produced by protamine should move towards the use of other substances that can neutralize the anticoagulant effect of heparin or towards pre-medication guidelines that prevent these secondary effects in the case of protamine administration.

Relationship between P-glycoprotein expression and cyclosporin A in kidney. An immunohistological and cell culture study.

P-glycoprotein (P-gp), encoded in humans by the mdr-1 gene, acts physiologically as an efflux pump to expel hydrophobic substances from cells. This glycoprotein is closely related to multidrug resistance in tumor cells and can be modulated by cyclosporin A (CsA). We investigated the relationship between CsA and P-gp in 52 renal allograft biopsies and in cultures of Madin-Darby canine kidney (MDCK) renal tubule cells to determine whether the intrarenal accumulation of CsA or chronic stimulation with the drug modified the expression of P-gp. Expression of P-gp and CsA was analyzed by immunohistochemistry. Immunostaining was evaluated semiquantitatively. Modulation of P-gp in MDCK cells after chronic stimulation with CsA for 7, 30, and 60 days was analyzed by flow cytometry. P-gp and CsA immunostaining in renal post-transplant biopsies showed considerable overlap in all cases (Spearman's test, r = 0.577, P < 0.001). After 7 days in vitro, the number of cells expressing P-gp increased progressively; a further increase in mean fluorescence was found after 60 days (P < 0.001, Student's t-test). Our findings suggest that in non-neoplastic cells, CsA may stimulate P-gp as a mechanism of detoxification. Individual differences in the adaptive responses to glycoprotein may be responsible for the appearance of nephrotoxicity or a CsA-resistant rejection reaction in cases of overexpression on lymphocytes and macrophages.

Immunohistochemical study of 30 cases of cyclosporin A-induced gingival overgrowth.

Immunohistochemical techniques were used to study the presence of cyclosporin A (CsA) and leukocyte subsets in 30 gingival biopsies of renal transplant subjects with gingival overgrowth (GO). Statistical analysis revealed significant differences in the total number of inflammatory cells determined by monoclonal antibody CD45, the monocyte/macrophage (CD68) subset, the plasmatic cells (EMA), and the total of T-lymphocytes (CD3) (P < 0.001, Student t test) between the treated subjects and the healthy control group. Differences were found in the helper/inducer T lymphocytes CD4 (P < 0.001 Student t test) and cytotoxic/suppressor T lymphocyte (CD8) (P < 0.01, Student t test) subsets between both groups. The CD4/CD8 ratio was greater in the transplant subjects than in the control group (1.82 +/- 0.16 versus 1.35 +/- 0.05 respectively) (P < 0.05 Student t test). There was no significant difference in the populations CD16+, CD57+, and CD20+. The CD45+ CD4+, and CD68+ cells increased in number along with the degree of GO. The number of epithelial cells/mm2 which displayed a deposit of CsA increased in accordance with the degree of GO (P < 0.05, Kruskal-Wallis's test). Likewise, the intraepithelial deposit of CsA in the GO region was found to be related to the inflammatory infiltrate CD4+, CD8+, and CD68+ (r = 0.7432; r = 0.7346; r = 0.77005, respectively). Our findings suggest that the intraepithelial deposit of CsA and the inflammatory infiltrate play a predominantly pathogenic role and are both related to the degree of GO.