Unusual osteolytic midline lesion of the skull: benign osteoblastoma of the parietal bone

The authors report the case of a 5-year-old girl who presented with a parietal midline sub-scalp lesion. Skull radiographs demonstrated a lytic lesion surrounded by a sclerotic rim that resembled a dermoid cyst of the cranium. Histopathological analysis proved that the lesion was a benign osteoblastoma. As in other calvarial masses of uncertain nature, after diagnostic workup, we recommend surgical excision both for diagnosis and for treatment.

Septic arthritis of the shoulder due to Streptococcus agalactiae

The authors report a case of septic arthritis of the shoulder-joint due to group B beta-hemolytic Streptococci (Streptococcus agalactiae) in a 63-year-old female patient. These germs are a major cause of meningitis and septicemia in newborns and pregnant women. In adults, men and nonpregnant women, they have been a rare cause of septic arthritis.

Oxidative stress in rodent closed duodenal loop pancreatitis

CONCLUSION

Production of excited oxygen species is earlier in the liver than in the pancreas and could contribute to damage in a reflux model. Treatment with SOD could attenuate 59% light emission in pancreas, but did not modify serum enzyme levels or pancreatic edema, resulting as an insufficient isolated therapy. Unexpectedly, it was found an increased plasma antioxidant capacity that was related to total bilirubin levels, and declined at late stages probably denoting other circulating antioxidant consumption.

BACKGROUND

Oxidative stress has been shown to play a role in different models of acute pancreatitis, although it has not been studied in the severe necrohemorrhagic model produced by closed duodenal loop pancreatitis.

METHODS

We studied Sprague Dawley female rats in two groups: a closed duodenal loop pancreatitis group and a control, sham-operated group. In order to evidence the oxygen excited species production, in situ spontaneous chemiluminescence from living and naturally perfused pancreas and liver was measured at 0, 0.5, 1.5, 3, 6, 12, and 24 h after the duodenal ligature. Blood pancreatic amylase and aminotransferases levels were determined as expression of tissue damage in pancreas and liver. At the same time, plasma antioxidant capacity was measured by the peroxyl radical trapping capability of plasma samples compared to that of Trolox (synthetic analog of vitamin E), and results are expressed as Trolox equivalence. Bovine superoxide dismutase (SOD) was administered to attenuate oxygen free radicals activity at the beginning of the peroxidation chain and also as a therapeutic tool.

RESULTS

The experimental procedure induced a severe pancreatitis, as evidenced by pancreatic enzymes that rose markedly in the early hours of disease and remained heightened throughout the experiment. The results show early light emission from the liver at 3 h and peak levels at 12 h, whereas in the pancreas, luminescence increased at 6 h and doubled later at 12 h, both returning to control levels at 24 h.

[Primary gastric lymphoma in an HIV positive patient]

We report the case of a young male patient, VIH (+), who was admitted in our hospital with severe epigastric pain. Endoscopical and histological diagnosis was primary gastric non-Hodgkin lymphoma without Helicobacter pylori. The patient was treated with chemotherapy by CHOP scheme (6 cycles), with high clinical improvement and endoscopical and histological regression of the lesion. We comment some features of this peculiar association.

Cervical dystonia due to spinal cord ependymoma: involvement of cervical cord segments in the pathogenesis of dystonia

We report a patient with a progressive motor disorder dominated by pyramidal signs in all four extremities and cervical dystonia in the form of torticollis, who had imaging features of cervical cord tumor on magnetic resonance imaging (MRI) scanning. Ependymoma was the final diagnosis by histology. Cervical dystonia presenting as a manifestation of an identified focal central nervous system (CNS) lesion is infrequent. We believe our patient to be the first adult example of cervical cord tumor giving rise to cervical dystonia. Adding this entity to the list of differential diagnosis of torticollis is considered, and its mechanisms are discussed.

[Current and suitable organization of the Basque Health System. Opinion of the managing level]

Osasuna Zainduz (caring our health), a planned change tor the public health care services, is being implemented in the Basque Country. A questionnaire discriminant terms passed to all the managers of the Basque Health Service is analysed to assess its actual and optimum organizational culture. We looked at significant differences between means, comparing actual and optimum profiles. All the differences of means were highly significant (P < 0.00001); performance based salaries (6.19) and identification with the organization (5.82) were the highest. New management styles based on information and communication, tolerance with conflicts and risks, as well as support from managers were identified through regression analysis as key success criteria for such our organization.

Dengue fever with thrombocytopenia: studies towards defining vulnerability of bleeding

PURPOSE

To define the period of greater vulnerability of bleeding in patients with Dengue fever in reference to the onset of their constitutional symptoms and the laboratory abnormalities.

PATIENTS AND METHODS

In a retrospective study we reviewed the records of all patients admitted to San Pablo Medical Center in 1991 with a diagnosis of Dengue Fever or Hemorrhagic Dengue. All patients with a platelet count of less than 125,000 were included for analysis. The exclusion criteria included the presence of systemic disorders which may influence the platelet count, and patients without documentation regarding the presence of constitutional symptoms suggestive of viral illness.

RESULTS

A total of 101 patients were analyzed of which only 74 were included in the study. All patients had fever and chills; skin rash, asthenia and general malaise was seen in over 50% of patients. Over 70% of patients had recovery of their platelet count, and most had their maximal thrombocytopenia within the 5th day and 8th day from the onset of constitutional symptoms. Leukopenia was seen in over 70% of patients with its lowest level within the 5th and 8th day from the onset of the constitutional symptoms. Significantly prolonged partial thromboplastin time was seen in 11% of the patients. Proteinuria was seen in 22% of the patients, 38% of which had it within the first 4 days of the onset of constitutional symptoms and also noted on the 5th and 6th day. Alteration in liver enzymes were noted in 47% of patients, with a maximal severity distributed in all time frames. Hypoalbuminemia was present in 28% of the patients, of these 67% presented within the first 4 days from the onset of constitutional symptoms. The pulse rate was usually normal in spite of the patient's dehydration and fever.

CONCLUSIONS

We identified three phases that define the sequence of events seen in the majority of patients with Dengue Fever and Thrombocytopenia. These are: 1. proteinuria and hypoalbuminemia; 2. maximal cytopenia; 3. bradycardia and liver enzyme elevation. We believe this information is useful in the management of patients with Dengue Fever and thrombocytopenia.

Pubic osteolysis simulating a malignant lesion: case report

A case of posttraumatic osteolysis of the pubic bone simulating a malignant lesion in a 55-year-old woman is reported. A review of the literature revealed that all reported cases occurred in post-menopausal women, associated with radiologic evidence of osteoporosis and a history of slight trauma. Biopsy was performed because of the possible malignant nature of the lesion, which should be suspected in all post-menopausal women with a destructive lesion of the pubic bone.

Bacteriological study of surgical knives: is the use of two blades necessary?

Scalpel blades used in 115 operations were studied bacteriologically. In each case the knife used for skin incision was discarded immediately after the incision and a fresh knife was used to complete the operation. The scalpel blades were cultured in enriched thioglycolate and incubated at 37 degrees C. Readings were taken at 24 and 48 h. From positive cultures, colonies were isolated directly in solid media, and the germ was identified using routine tests. Results showed that there was no bacteriological evidence to justify the use of different blades for skin incision and deep dissection.

Plants used in Guatemala for the treatment of dermatophytic infections. 2. Evaluation of antifungal activity of seven American plants

From 52 plants screened for antifungal activity, 26 (50%) were active against dermatophytes. This paper reports further evaluation of seven American plants against four pathogenic fungi (Aspergillus flavus, Epidermophyton floccosum, Microsporum gypseum and Trichophyton rubrum), the part showing most activity, the best solvent and, in three cases, the minimal inhibitory concentration (MIC) against the fungus in pure culture. Antifungal activity was confirmed in all of the plants, but not all parts; the most active parts were the bark and leaves. The most active species were Byrsonima crassifolia, Cassia grandis, Gliricidia sepium and Malpighia glabra. Diphysa robinioides, Rhizophora mangle and Cassia occidentalis were less active. The most susceptible fungi were E. floccosum and T. rubrum; A. flavus was not susceptible. Ethanol was usually the best solvent and the MIC of C. grandis, C. occidentalis and D. robinioides was 50 micrograms/ml.

[Amplification of 2 different gene segments of Mycobacterium tuberculosis and its usefulness in the diagnosis of tuberculosis]

The infection caused by Mycobacterium tuberculosis is highly prevalent in our country and is considered an emergent pathology in developed countries. The amplification of specific gene segments with diagnostics purposes is an alternative to identify fastidious and slow growing infective agents, being Mycobacterium tuberculosis one of them. Two polymerase chain reactions (PCR) directed to the amplification of a 294bp gene segment encoding a portion of a 65KD heat shock protein and 317 bp gene segment of a repetitive DNA segment (IS 6110) of Mycobacterium tuberculosis, have a sensibility of 80 to 91.3% and a specificity of 83.9 to 100% when used in the identification of Mycobacterium tuberculosis in 2 group of clinical samples, both compared to Koch's culture and or Ziehl-Neelsen stain. The diagnostic procedure is particularly useful in diagnosis of tuberculosis of extrapulmonary origin.

Treatment with recombinant alpha-interferon of chronic hepatitis C in anti-HIV-positive patients

A pilot study of chronic hepatitis C treatment was conducted in 14 patients (13 had chronic active hepatitis and 1 had liver cirrhosis). All patients were asymptomatic for the human immunodeficiency virus (HIV) type 1 (mean CD4 count of 584 +/- 283 cells/mm3). Patients received 9 MU rIFN-alpha 2A per day for three months. After this, patients received 9 MU three times weekly for three months, 6 MU for another three months on the same protocol, and finally 3 MU again three times weekly for the last three months. After the first month of ALT treatment in 9 patients (64%) returned to normal; a significant decrease in ALT levels was observed with respect to the pretreatment values (mean of 42 IU/l, range 15-75 vs 152 IU/l, range 69-355; P < 0.01). Of the 9 patients who completed the treatment period, 5 had a complete response, and 4 of these 5 continued with normal ALT values during follow-up (sustained response) while the other patient relapsed within one month after cessation of therapy. The remaining 4 patients were non-responders (including one case with a break-through of the response). HCV-RNA was not detectable in 3 of the 5 responders at the end of therapy while during follow-up viral RNA became undetectable in the other 2 patients. 2/4 non-responder patients had detectable HCV-RNA during follow-up. Liver histology improved in all the patients. No changes were observed in the immunological status or HIV infection.

Daily rhythm of aspartate aminopeptidase activity in the retina, pineal gland and occipital cortex of the rat

The levels of specific soluble aspartyl aminopeptidase activity were assayed in retina, occipital cortex, anterior pituitary, posterior pituitary, pineal gland and serum of adult male rats, using Asp-2-naphthylamide as substrate, in a 12:12 h light:dark cycle (7-19 h light). Significant diurnal variations appeared in retina, pineal gland, occipital cortex and serum. In addition, different patterns of diurnal variation of the enzymatic activity were observed in the tissues analyzed. A regular increase of the activity was noticed at the end of the dark period in all the tissues as a common feature, except in serum, in which the enzymatic activity reached a peak in the middle of the light period, decreasing progressively during the dark hours. After the last hours of darkness, the pattern of variation in the activity differed in each tissue. These diurnal variations in aspartyl aminopeptidase activity could reflect the functional status of its putative endogenous substrates, such as angiotensin II, and it may also suggest the existence of differential regulatory mechanisms associated with each location.

Circadian rhythm in Leu-beta-naphthylamide hydrolysing activity in selected photoneuroendocrine areas of adult male rats

Soluble Leu-beta-naphthylamide hydrolysing activity (arylamidase activity) was assayed in retina, superior cervical ganglia, several brain areas and serum of adult male rats, at different time points of a 12:12h light:dark cycle (from 7h to 19h light). The results demonstrated a left or right biased asymmetrical distribution of this activity depending on the time point studied: While the levels of activity were significantly higher in the left retina than in the right one at 10h of the light period, these were predominant in the right side, at 01h of the dark period. In addition, this activity was higher in the left hypothalamus at 13h of the light period. No asymmetries were disclosed in the rest of time points and structures studied. On the other hand, this activity demonstrated a diurnal variation in the left anterior hypothalamus and total posterior hypothalamus but no periodic variation was evidenced in right anterior hypothalamus or the rest of zones studied. These results may reflect the role of this activity regulating the functional status of its susceptible endogenous substrates.

Septic arthritis in heroin addicts

Over a 6-year period (1982 to 1988), 36 episodes of septic arthritis were diagnosed in 35 heroin addicts from Barcelona, Spain. Thirty (86%) were men and five (14%) were women, with a mean age of 24 years (range, 14 to 39). Twenty-nine episodes (80%) were monoarticular and seven (20%) were oligoarticular. The sacroiliac (16 cases), sternoclavicular (8), hip (5), and shoulder (4) joints were most frequently infected. Staphylococcus aureus and Pseudomonas aeruginosa were the etiological agents in 75% and 11% of episodes, respectively. Response to antibiotic treatment was good in 32 cases (90%), eight patients needed surgical drainage, and none died. We conclude that septic arthritis in heroin addicts localizes predominantly in axial joints. In our geographic area, infection with S aureus is more frequent than with gram-negative rods such as P aeruginosa or Serratia marcescens, which are most frequently found in reports from the United States.

[Subcellular distribution of soluble and membrane-bound aminopeptidase in the left and right hemispheres of young and adult rats]

The levels of soluble and membrane-bound aminopeptidase activities were assayed in subcellular fractions from young (1 month old) and adult (5 month old) left and right rat brains, using Leu-, Arg- and Asp-2-naphthylamide as substrates. Both soluble Leu- and Arg-aminopeptidase activities showed the highest levels in the synaptosomal fraction in the two groups of rats. The highest levels of membrane-bound Leu- and Arg-aminopeptidase activities were found in the microsomal fraction of the two ages studied. There were no differences between the two ages in soluble Leu- and Arg- aminopeptidase activities. However, a significant decrease in both membrane-bound activities was evidenced in the synaptosomal fraction of adult rats. The young rats showed the highest soluble and membrane-bound levels of Asp-aminopeptidase activity in the microsomal fraction but no differences among fractions were found at 5 months of age. The soluble Asp-aminopeptidase activity of the homogenate and the mitochondrial fraction was significantly increased in adult animals when compared to that of younger ones. Finally, no differences between left and right brains, in soluble or membrane-bound activities, were found neither in young animals nor in the adult ones.