[Clinical manifestations of neurocysticercosis]. / Manifestaciones clínicas de la neurocisticercosis.

INTRODUCTION: Cysticercosis is a common parasitic infection caused by the larval phase of the Taenia solium, it infects humans as well as pigs. Considered an endemic parasitosis in developing countries including Latin America, Asia and Africa. Clinical manifestations of the disease can be influenced by ambient factors, host individualities and the infectious agent itself. Neurocysticercosis can be asymptomatic or present with various signs and symptoms that can vary in severity. OUTLINE: This review is focused on analyzing the various presentations of Neurocysticercosis throughout different age groups, and special populations. We found asymptomatic presentations to be the most common form, followed by various grades of severity including in its most severe form death. The most common alterations include: epilepsy (60-90%), intracraneal hypertension (14-27%), as well as neuropsychiatric symptoms (5-52%), and focal neurological deficits (4-19%). The heterogeneity of the clinical scenario relies upon parasite factors (number, localization and stage of central nervous system [CNS] disease), host particularities (gender, age and immunologic response), and finally environmental factors. CONCLUSIONS: The most common form of infection is asymptomatic although there are various forms of clinical manifestations that rely upon different factors including environment, host response and the parasite itself.

Manifestaciones clínicas de la neurocisticercosis / Clinical manifestations of neurocysticercosis

Introducción. La cisticercosis es una enfermedad parasitaria causadapor la fase larvaria de Taenia solium que afecta tanto a humanoscomo a cerdos. Esta parasitosis es endémica en países en desarrollolocalizados en América Latina, Asia y África. Las manifestacionesclínicas de esta enfermedad dependen de factores relacionados alambiente, hospedero y el agente. La neurocisticercosis puede presentarsede manera totalmente asintomática o mostrar signos y síntomasque varían desde leve a severos.Desarrollo. En esta revisión se analizaron las manifestacionesclínicas de la neurocisticercosis en adultos, niños y poblaciones especiales,tales como ancianos, embarazadas y pacientes con supresióninmune. La mayoría de los individuos infectados son asintomáticos ylos que presentan sintomatología pueden tener un cuadro clínico variable,desde síntomas leves hasta severos, que conducen a la muerte.Las principales manifestaciones clínicas incluyen la epilepsia (60-90%),hipertensión endocraneana (14-27 %), manifestaciones neuropsiquiátricas(5-52 %) y alteraciones neurológicas focales (4-19 %). Laheterogeneidad del cuadro clínico depende de los factores relacionadoscon el parásito (el número, localización y estadio de los parásitosen el sistema nervioso central [SNC]), el hospedero (género, edad ytipo de reacción inmunológica) y el medio ambiente.Conclusiones. La mayoría de los individuos infectados son asintomáticos.Las manifestaciones de esta enfermedad son heterogéneasy dependen de factores relacionados al ambiente, hospedero yel agente (AU)

Introduction. Cisticercosis is a common parasitic infectioncaused by the larvarian phase of the Taenia solium, it infects humansas well as pigs. Considered an endemic parasitosis in developingcountries including Latin America, Asia and Africa. Clinicalmanifestations of the disease can be influenced by ambientfactors, host individualities and the infectious agent itself. Neurocisticercosiscan be asymptomatic or present with various signsand symptoms that can vary in severity.Outline. This review is focused on analyzing the variouspresentations of Neurocysticercosis throughout different agegroups, and special populations. We found asymptomatic presentationsto be the most common form, followed by various gradesof severity including in its most severe form death. The mostcommon alterations include: epilepsy (60-90 %), intracranealhypertension (14-27 %), as well as neuropsychiatric symptoms(5-52 %), and focal neurological deficits (4-19 %). The heterogeneityof the clinical scenario relies upon parasite factors (number,localization and stage of central nervous system [CNS] disease),host particularities (gender, age and immunologicresponse), and finally environmental factors.Conclusions. The most common form of infection is asymptomaticalthough there are various forms of clinical manifestationsthat rely upon different factors including environment, hostresponse and the parasite itself (AU)

Supranormal natriuretic response to volume expansion in vagotomized and renal-denervated rats.

1. To investigate the participation of both vagal cardiopulmonary baroreceptor activity and efferent renal sympathetic nerve activity (ERSNA) in the natriuretic response to saline volume expansion (SVE), three series of experiments were undertaken in anaesthetized rats. 2. In the first two series of experiments, the natriuretic (series A) and ERSNA (series B) responses to SVE were evaluated in both sham operated and cervical bilateral vagotomized rats. The acute experiment consisted of two baseline (BL) periods, treatment (sham control (CTR) or real cervical bilateral vagotomy), a volume expansion phase (Ringer's solution, 10% bodyweight) and a postexpansion phase. The results of these two series indicate that vagotomy significantly enhances basal ERSNA (37 +/- 8%; P < 0.05 vs BL) and significantly attenuates the renal sympathoinhibitory response (by approximately 50%; P < 0.05 vs CTR) but not the natriuretic response to SVE, suggesting the potential expression of a vagotomy induced compensatory natriuretic mechanism. 3. To assess this, the natriuretic response to SVE was evaluated in chronic sham operated or renal denervated groups of rats in which vagotomy was or was not performed (series C). There were no differences among groups in either systemic haemodynamics or plasma protein concentration. Vagotomy plus chronic renal denervation induced a supranormal natriuretic and diuretic response (approximately 30%; P < 0.01) to SVE when compared with similar natriuretic and diuretic responses of the remaining groups. 4. These data support the idea that, in intact rats on a normal sodium diet, neither cardiopulmonary baroreceptors nor renal nerves are necessary for the elimination of an acute intravenous isotonic sodium load and indicate that during SVE the activation of vagal cardiopulmonary baroreceptors exerts an inhibitory effect on both ERSNA and the expression of a natriuretic mechanism. Such a natriuretic mechanism is expressed only when SVE is induced in vagotomized rats (compensating for the vagotomy mediated antinatriuretic effects of an enhanced ERSNA), but is unmasked only when, in addition, renal nerves are chronically transected. All of this offers an efficient element of safety in eliminating an acute isotonic sodium load when cardiopulmonary baroreceptors are severed.

Analysis of water from the Space Shuttle and Mir Space Station by ion chromatography and capillary electrophoresis.

Drinking water and condensate samples collected from the US Space Shuttle and the Russian Mir Space Station are analyzed routinely at the NASA-Johnson Space Center as part of an ongoing effort to verify water quality and monitor the environment of the spacecraft. Water quality monitoring is particularly important for the Mir water supply because approximately half of the water consumed is recovered from humidity condensate. Drinking water on Shuttle is derived from the fuel cells. Because there is little equipment on board the spacecraft for monitoring the water quality, samples collected by the crew are transported to Earth on Shuttle or Soyuz vehicles, and analyzed exhaustively. As part of the test battery, anions and cations are measured by ion chromatography, and carboxylates and amines by capillary electrophoresis. Analytical data from Shuttle water samples collected before and after several missions, and Mir condensate and potable recovered water samples representing several recent missions are presented and discussed. Results show that Shuttle water is of distilled quality, and Mir recovered water contains various levels of minerals imparted during the recovery processes as designed. Organic ions are rarely detected in potable water samples, but were present in humidity condensate samples.

Enhanced increase of plasma sodium pump inhibitory activity to saline expansion in vagosympathectomized and anaesthetized dogs.

To investigate whether plasma sodium pump inhibitory activity is controlled by cardiopulmonary and aortic baroreceptors, mean arterial pressure, right atrial pressure, sodium and water balances, plasma renin activity, plasma aldosterone concentration and plasma antinatriferic activity (PAA; plasma sodium pump inhibitory activity) were determined before, during and after Ringer volume expansion (10% of body wt) in anaesthetized dogs. Animals were studied with intact reflexes (CTR, n = 7) and after acute cervical bilateral vagosympathetic denervation (VGT, n = 8). With the exception of PAA, none of the parameters were different between groups before, during or after Ringer volume expansion. The PAA (microA cm-2) was similar for both groups before expansion and before either sham (CTR) or vagosympathectomy (VGT) was performed (CTR = 3.6 +/- 0.4 vs. VGT = 4.3 +/- 0.3). Compared to baseline, PAA at the end of the volume expansion phase increased in both groups (CTR = 6.1 +/- 0.8, P < 0.05; VGT = 9.1 +/- 0.7, P < 0.0005); however, this PAA value was significantly greater in the VGT group than in the CTR group (P < 0.01). At the end of the post-expansion phase, PAA levels returned toward baseline in both groups (CTR = 4.4 +/- 0.5 vs. VGT = 4.8 +/- 0.2; n.s. vs. baseline); however, this PAA value in the CTR group was not significantly different from its pak value. The present data confirm that PAA is increased in response to saline volume expansion, and suggest that PAA synthesis and/or release is under inhibitory vagosympathetic control during saline volume expansion.

[Gastric pseudotumor caused by varices]. / Pseudotumor gástrico por varices.

A case is presented of a variceal gastric pseudotumor demonstrated by angiography. The literature is reviewed and the authors underline the importance of including varices in the differential diagnosis of submucosal gastric tumor.

Tracheal laceration with massive subcutaneous emphysema: a rare complication of endotracheal intubation.

Our patient sustained a laceration of the membranous portion of the trachea associated with massive subcutaneous emphysema after an apparently uneventful intubation. The patient was successfully operated on within seven hours. The importance of prompt diagnosis and treatment in the event of this rare complicatoin and the different causative factors are discussed.

Segmental pulmonary angiography in the critically-ill patient using a flow-directed catheter.

Selective pulmonary angiography was performed using a flow-directed, balloon-tipped catheter in 20 consecutive intensive care unit patients requiring heart catheterizations on the right side for hemodynamic monitoring. No morbidity was encountered from this procedure. Adequate quality balloon-occlusion angiographs were obtained with a portable chest roentgenogram in 17 (85 percent) but appeared normal in only 12 (60 percent), seriously limiting the usefulness of this technique in the diagnosis of occult pulmonary embolisms. With this technique, the catheter tip was found to be in a segmental pulmonary artery anterior to the left atrium (zone I) in 30 percent of the patients. From these findings, we conclude that not infrequently the catheter tip was situated in zone I anterior to the left atriums. Slective pulmonary angiography using a flow-directed, balloon-tipped catheter proved useful in demonstrating the precise location of the catheter tip. When this is the case, the catheter tip should be relocated to a segment below the left atrium (zone III) in patients requiring positive end-expiratory pressure because the "wedge" pressure measured in zone I may not accurately reflect left atrial pressure.

Severe hypoxemia secondary to pulmonary embolization treated successfully with the use of a CPAP (continuous positive airway pressure) mask.

We describe a patient who was admitted with acute onset of dyspnea and pleuritic chest pain. The patient was in acute hypoxic respiratory failure documented by arterial blood gas levels. The severe hypoxemia was refractory to 100 percent O2 administration. The cause of the patient's sudden deterioration was a pulmonary embolus documented by angiography. The patient was managed successfully with heparin therapy. A continuous positive airway pressure (CPAP) mask corrected the severe hypoxemia, which otherwise would have required a more invasive method of respiratory support.

Bile duct carcinoma mimicking chronic liver disease.

In a case of cholangiocarcinoma involving the bifurcation of the common duct, the association with striking intermittence of jaundice and with signs of chronic liver disease presented a diagnostic enigma. Disappearance of jaundice does not rule out the diagnosis of bifurcation tumors and may be misleading. Adequate demonstration of the biliary tree, best achieved with percutaneous transhepatic cholangiography, is essential for early diagnosis of this entity.