[Clinical characteristics and epidemiologic study of a listeriosis outbreak in Grand Canary]

BACKGROUND AND METHODS

Human infections caused by Listeria monocytogenes often present as sporadic cases without any epidemiological relationship among them; however they also appear as outbreaks that are usually detected by an increase in the number of cases diagnosed by hospitals of the geographic area. Between December 1991 and May 1993, twenty four cases of listeriosis were detected in three hospitals of Las Palmas de Gran Canaria; and they were classified as an outbreak. Our report describes its clinical, epidemiological and microbiological aspects.

RESULTS AND CONCLUSIONS

Twenty four cases of listeriosis were diagnosed, 12 occurred in pregnant women or neonates (5 and 7 respectively) and 12 in non pregnant adults. All adult infections were community-acquired. The incidence rate was, for the epidemic area, 76.3 cases per million population during the period considered (18 months). Among non pregnant adults, 9/12 patients had some underlying disease and 9/12 presented CNS affection (meningitis and/or cerebritis). In the group of pregnant women, 4 cases occurred in the second trimester and fetal loss was caused; one case was detected in the third trimester and four weeks later the patient delivered an unaffected infant. All cases of neonatal listeriosis presented as early-onset sepsis. Of the 24 strains of L. monocytogenes, 21 were serotype 4, two were serotype 1 and one was not typeable. Strains from 12 patients were available for epidemiological analysis, seven of which corresponded to the same pattern and there were three more different patterns.

Febrile ulceronecrotic Mucha-Habermann disease: a case report and review of the literature

A 32-year-old male with febrile ulceronecrotic Mucha-Habermann disease (FUMHD) responsive to methotrexate is reported. This is a severe variant of pityriasis lichenoides et varioliformis acuta characterized by the acute onset of a widespread ulceronecrotic cutaneous eruption together with high fever and systemic involvement. To our knowledge, only 13 patients with FUMHD have been reported to date.

Brain single-photon emission tomography with technetium-99m hexamethylpropylene amine oxime in adolescents with initial-stage schizophrenia

The objective of this study was to search for regional cerebral blood flow (rCBF) abnormalities in adolescents with initial-stage schizophrenia by means of brain single-photon emission tomography (SPET) using technetium-99m hexamethylpropylene amine oxime (HMPAO). SPET studies were performed on a homogeneous sample of 15 carefully selected adolescents with a recent diagnosis of schizophrenia, and without previous electroconvulsive or antipsychotic drug treatment. Computed tomography (CT) and electro-encephalographic (EEG) studies were performed in all patients. Qualitative and semiquantitative analysis of 99mTc-HMPAO SPET studies showed an impaired rCBF in 12 patients (80%). The most common pattern was a decreased uptake of 99mTc-HMPAO in the frontal lobes, usually in the left hemisphere. Conventional and quantitative EEG was positive in 12 (80%) and 15 (100%) patients, respectively. CT findings were positive in two patients (13%). There was a high level of concordance between SPET and EEG results and between SPET and clinical features (P>0.05). This study suggests that previously untreated patients in the first stages of schizophrenia present functional abnormalities that are revealed by brain SPET.

A locally made mucus aspirator

Examination of nasopharyngeal aspirate for the presence of viral antigens in children with acute lower respiratory tract infections is a standard procedure in establishing a viral aetiology. In the absence of other sophisticated methods such as lung puncture or trans-tracheal aspiration, mucopus aspirated from the nasopharynx can be used even to identify caustive organisms. Here, it is essential to perform a microscopic examination in addition to culture. The disposable mucus aspirators used in other countries are expensive and are not practical for routine use in our country. This paper describes how a mucus aspirator was turned out with low cost heat resistant materials that are locally available. The aspirator is steam sterilisable and can be used with a disposable F8 gauge feeding tube. The cost of one aspirator is about Rs. 100.

[Late hereditary degenerative sensorineural hearing loss associated with IgA mesangial glomerulonephritis of probable autosomal dominant heredity]

We studied four generations of a Canary Islands family presenting a tardive heredodegenerative hearing loss, associated with IgA mesangial glomerulonephritis, of probable autosomal dominant heredity. With respect to the family, we revised Alport's syndrome, for possible transmission associated with X chromosome, as well as heredodegenerative hearing loss associated with renal pathology of autosomic transmission currently described; we differentiate these hearing losses from our case study, and we discuss the pathogeny of the auditive affection in the said hereditary syndromes. Lastly, we stress the autoimmune hypothesis because of the IgA nephropathy association in the family case, and we list the characteristics of the syndrome described.

A comparative binding of platinum anti-tumour compounds to plasma proteins in the rat (in vivo) and mouse (in vitro)

Plasma protein binding of 195mPt-labelled cisplatin, carboplatin and iproplatin has been studied in vivo in rat and in vitro in mouse, using both electrophoresis and trichloroacetic acid precipitation. After intravenous injection plasma clearance rates were biphasic for all 3 compounds, (t1/2 alpha, 13-17 min) but cisplatin was retained thereafter longer than the others. By 5 min, gel electrophoresis showed protein labelling with all 3 drugs but none involved low mol.wt. proteins (< 16 kDa). At 2 h a notable proportion of the protein bound platinum was associated with the latter components. There was a general resemblance between the distribution patterns of cisplatin and carboplatin whereas iproplatin showed a persistent retention of the label with time to higher mol. wt. proteins. From in vitro incubation with mouse plasma, rates of interaction respectively were cisplatin t1/2 alpha, 35 min, beta 8 h, carboplatin t1/2, 44 h and iproplatin t1/2, 104 h. By electrophoresis the protein bound fraction pattern (1 h) was again similar for cisplatin and carboplatin with virtually no binding to low mol. wt. proteins. After 24 h these were now involved to a high degree (40%). Iproplatin showed relatively marked binding to proteins of higher mol. wt. but no transfer with time to the low mol. wt. protein zone. A possible explanation is the need for in vivo metabolism for this compound as manifest in the rat. It is suggested that the significance of interaction with low mol. wt. proteins merits further investigation in relation to the antitumour and toxicological actions of these drugs.

Therapy with fluconazole for tinea corporis, tinea cruris, and tinea pedis

We treated 20 patients who had tinea corporis and/or tinea cruris and 20 patients who had tinea pedis with oral fluconazole. All patients were given a single 150-mg dose of fluconazole upon entry into the study; at that time, and at each follow-up visit, clinical signs and symptoms were evaluated and mycological and laboratory examinations were performed. If clinical and/or mycological cure or significant improvement in a patient's condition was not evident at the 7-day follow-up visit, a second dose of fluconazole (150 mg) was given. A maximum of four doses, one week apart, were given. A long-term evaluation of the efficacy of fluconazole in the treatment of these infections was performed 28-30 days after the last dose was administered to each patient. For the treatment of tinea corporis and/or tinea cruris, 70% of patients required two doses, 20% required three doses, and 10% required four doses. At the long-term follow-up visit the clinical and mycological response rates were determined to be 95% cure and 5% relapse. For the treatment of tinea pedis, 20% of the patients required two doses, 20% required three doses, and 60% required four doses. For these patients, the long-term clinical response rates were 70% cure and 30% improvement; mycological response rates were 75% eradication, 10% persistence of infection, and 15% relapse. This treatment was well tolerated; no adverse effects or clinically significant laboratory abnormalities were reported.

Variation in hypothalamic gonadotrophin-releasing hormone content, plasma and pituitary LH, and in-vitro testosterone release in a long-distance migratory bird, the garden warbler (Sylvia borin), under constant photoperiods

Changes in concentrations of hypothalamic gonadotrophin-releasing hormone (GnRH), pituitary and plasma LH, testicular mass, in-vitro release of testosterone, body mass and migratory activity were measured in male garden warblers (Sylvia borin) kept from November to June under a constant photo-period of 12.8 h. Under such conditions garden warblers gradually change from the photorefractory to the photosensitive state and gonadal recrudescence then occurs. Hypothalamic GnRH content was low from December to March, but increased in April to reach the highest levels in June. The spontaneous increase in GnRH was paralleled by increases in pituitary LH content, testicular mass and in-vitro testosterone release. Body mass decreased 1 month and nocturnal activity 2 months before the spontaneous increase in GnRH. Ovine LH increased in-vitro testosterone release over basal release at all times. The results suggest that in garden warblers (1) changes in hypothalamic GnRH content can occur under constant photoperiodic condition, (2) the gradual change from the photorefractory to the photosensitive state is not characterized by a gradual increase in hypothalamic content of GnRH (cf. starlings), and (3) Leydig cells are capable of testosterone release even during the photorefractory state.

Failure of repeated blood patch in the treatment of spinal headache

The management of a persistent, incapacitating postdural puncture headache that required four consecutive autologous epidural blood patches is presented. Inadequate blood volumes, early patching and steroid in the epidural space are considered as possible causes of failure. Other associated problems and interventions are briefly discussed.

Counterion diffusion in heparin solutions

The physiological importance of heparin is due to its strong interaction with bivalent counterions, especially Ca2+. A diffusional approach of this property is presented in this article: the observable is the self-diffusion coefficient of the counterions, as a function of the ratio of the polyelectrolyte over the added salt concentrations. All the results are in agreement with a simple "quasi-chemical model" in which two different states are assumed for the counterions: "free" or "bound." The proportions of these two types of ions are calculated according to the distribution function of the counterions around the polyion. We assume that those of counterions located at a distance closer than a, the characteristic distance, are bound; the others are free. The ionic distribution function is evaluated by a numerical integration of a cell model Poisson-Boltzmann equation. Finally, this model leads to a very good agreement with the experimental results, if the radius of heparin polyion is assumed to be 6 and 10 A.

An autoradiographic study of the intrarenal localisation and retention of cisplatin, iproplatin and paraplatin

The intrarenal localisation of platinum following the intravenous administration of platinum-195m-labelled cisplatin, iproplatin and paraplatin was studied using autoradiography. Following injection of cisplatin, platinum was distributed throughout the kidney even up to 14 days after treatment. In the case of iproplatin and paraplatin rapid platinum clearance was noted from the glomeruli, blood vessels and renal medulla within 2 h of administration. Relative cortical and medullary platinum radionuclide concentrations for all three agents were determined by Chalkley grid analysis. This showed greater relative concentrations of platinum in the cortex at increasing times following iproplatin and paraplatin compared with cisplatin. It is suggested that the lower renal toxicity of iproplatin and paraplatin than of cisplatin may be due to reduced platinum retention within the pars recta.

Factors influencing the sensitivity of two human bladder carcinoma cell lines to cis-diamminedichloroplatinum(II)

A two-fold difference in sensitivity to cis-diamminedichloroplatinum(II) (cisplatin), as judged by colony forming assays, has been demonstrated in two human bladder carcinoma continuous cell lines. Approximately twice as many DNA-DNA interstrand cross-links (ISL) and a 2-fold greater inhibition of DNA synthesis occurred in the more sensitive T24 cell line than in the RT112 cell line after exposure to the same concentrations of cisplatin. Equitoxic concentrations of cisplatin resulted in similar extents of ISL and inhibition of DNA synthesis in both cell lines. Although drug uptake was identical, twice as much cisplatin was bound to the DNA of T24 cells than RT112 cells. However after equitoxic concentrations of cisplatin the DNA from both cell lines was platinated to a similar extent. In addition, levels of glutathione (GSH), glutathione reductase (GR) and total glutathione-S-transferases (GST) were higher in the less sensitive RT112 cell line.

[Lethal osteogenesis imperfecta. Anatomopathologic (optical and structural) study of 8 autopsy cases]

A pathologic review of lethal osteogenesis imperfecta was performed based in nine cases and mainly concerning eight cases with total postmortem study. One of the cases was classified as type III while all other were of type II. Emphasis is made on the high rate of prematurity, small for date and podalic presentation at birth. In those six cases of lower age lung hypoplasia was present. Well known findings in membranous or enchondral bones were confirmed in this series. Long bones showed characteristic bowings related to the nutrient artery point of entry. Among bone collagen fibres some of them were anomalous in shape or thickness but with normal striation. The only anomaly detected at the cartilaginous epiphysis was the increased wideness of the vascular channels because the existence of loose connective tissue and multivacuolated cells of unknown significance. At the growth plates the vascular channels were too much widened and of abnormal distribution. The proliferative and columnar zones showed poor cellular population and some condrocytes were abnormally vacuolated. The perichondrial ossification groove of Ranvier was absent or underdeveloped in all bones studied coexisting with epiphyseal-metaphyseal deformities. In our present cases, ocular, dental, dermal, cardiac valves and hepatic alterations have been detected. The weight increase and haematopoiesis of the liver was correlated to the hyperplasia and fibrosis of the bone marrow.

Surgery for morbid obesity in a provincial centre

Forty-eight patients underwent surgery for morbid obesity, 20 had gastric bypass and 28 had gastric partitioning or stapling. Gastric bypass was effective in producing satisfactory weight loss. There were few long term sequelae. However, it was complex and difficult technically, with a substantial mortality--three deaths. Gastric partitioning was simpler and safer, no mortality or serious complications but it was less reliable in producing satisfactory weight loss. Eleven patients showing no sign of getting within 20 percent of their ideal weight; this includes four with staple disruption. A small stomach syndrome is produced with transient qualitative limitation of overeating. A degree of motivation and dietary reform is necessary to produce the qualitative changes that the dumping symptoms, associated with gastric bypass, compel. Important features of management are careful selection and counselling pre operatively and regular follow up by both surgeon and dietitian.

[Seckel's syndrome: a form of chondrodysplasia? (author's transl)]

The true entity of Seckel's (bird headed dwarfism) has been hardly questioned due to the variety of malformations reported in these patients. However all cases reported have in common: dwarfism, bird head, microcephaly, mental retardation and malformations of different kinds. All these features must be present for the correct diagnosis. In two cases of Seckel's syndrome, full diagnostic features and post-mortem findings are reported. Special emphasis is made on the neuropathologic lesions. For the first time in the literature, changes in the epiphyseal tibial cartilage (with histochemical and EM studies) are described and correlated to dwarfism. Based on morphological data the authors propose Seckel syndrome as a condrodysplasia.

[Mucoepidermoid tumour in an eight-year-old boy (author's transl)]

Report of a bronchial mucoepidermoid tumour, in a eight years old boy. This is the first report of this kind of tumour in the pediatric age in the Spanish literature. The clinical and radiological features are considered as well as the usefulness of endoscopy in the diagnosis of bronchial tumours in children. The pathologic findings, differential diagnosis and the surgical treatment performed are discussed. These tumours are of low grade malignancy with an excellent prognosis as is confirmed by the follow-up of the present case without recurrences or metastasis after nine years.

[Dysplasia epiphysialis hemimelica (author's transl)]

The first report of dysplasia epiphysialis hemimelica in the spanish literature is presented. The case has peculiar clinical features as the early presentation (two months) and to involve lower and upper extremities. On X-ray examination exostosis and calcium deposits were shown on the most affected epiphysis. Microscopically an osteochondroma, anomalous vascular channels, non hitherto described, were detected, as well as multivacuolated cells into them although ultrastructural and histochemical studies were carried on the precise nature of these cells could not be established. The possible pathogenetic significance of these findings is discussed.