First helminthological data on the Iberian adder, Vipera seoanei

The helminth fauna present in the gut contents of Iberian adders, Vipera seoanei (Squamata: Viperidae), were characterised and analysed in respect to biological and eco-geographic factors that may affect the occurrence and diversity of helminths in this species. A total of 317 samples of preserved stomachs and intestines, covering the distributional range of V. seoanei, were examined. Similar to other Vipera species from the Iberian Peninsula, the helminth fauna was also impoverished in V. seoanei, but unlike other Vipera species from Central and East Europe, helminths were mostly found in adult vipers, and occurred in vipers located at the periphery of the species range, characterised by low elevation, high temperature and precipitation levels, and abundant pastures.

ANALYSIS BY SCANNER OF TRACKS PRODUCED BY RADON ALPHA PARTICLES IN CR-39 DETECTORS

The most used passive detectors for Radon measurement are the CR39s, both for the good stability of the material and for the practicality of use. But, commercial reading systems are expensive and not always fast. The aim of the present work was the development of a method for a rapid, efficient and economic evaluation of the result of the indoor Radon measurement performed with CR39 detectors. The analysis and acquisition of detector images were performed using a photo scanner and the free ImageJ software. Several groups of CR-39 detectors were exposed, developed and analysed. Calibration curve was obtained in a wide range of exposure values (200-12 000 kBq·h·m -3) to allow the procedure to be applied in all possible measurement environments. Furthermore, a statistical study was carried out on the shape and size of nuclear tracks after chemical development. The dependence of the track size on Radon exposure was effective in showing the trace saturation effect as well.

Mathematical and geophysical methods for searching anomalies of the Radon signal related to earthquakes

A detailed analysis of a time-series of the Radon (222Rn) specific activity is carried out to identify anomalies that can be correlated with earthquakes occurrence in the monitored area. New hybrid methods are developed for this purpose and the advantages of each single component method are exploited. These methods are applied to two-years data series recorded continuously in the soils of a site within the seismo-volcanic area of Phlegrean Fields (Naples-Italy). Since the measurement system distinguishes and separately measures the 222Rn and 220Rn, an alternative estimation of the remote fraction of the gas and its anomalies has been also performed using the 220Rn trend. The results of different methods are compared to recognize and to highlight Radon anomalies. Clear relationships have been found between anomalies and earthquakes of local origin and selected according to a specific formula of the earthquake preparation zone. The effectiveness of the methods and the goodness of the results are established by the high values of the cross correlation factors between the anomalies and the occurrence of the earthquakes.

[Bacteremia caused by Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. A retrospective study of 7 years]

OBJECTIVE

Bacteremia caused by Klebsiella pneumoniae carbapenemase-producing strains (Kp-KPC) is associated with high mortality. The hypothesis of our work is that there was an increase in the levels of resistance to different antimicrobials in Kp-KPC isolated from bacteremia.

METHODS

Retrospective and descriptive study in two periods: Period 1 (P1) 2010-2014 and period 2 (P2) 2015-2016. We included patients ≥18 years old with bacteremia caused by Kp-KPC in a General Hospital. We defined active drug (AD) if it was in vitro susceptible and in the case of meropenem if it had a MIC ≤ 8 mg/L in combination treatment.

RESULTS

Fifty episodes of bacteremia caused by Kp-KPC were analyzed in 45 patients. (P1: 21 and P2: 29). The following variables were similar in both periods: median age (53 vs. 52 years); male sex (45 vs. 62%); site of infection: primary bacteremia (52 vs.45%), bacteremia associated with catheter (24 vs.17%), and other (24 vs. 38%). During P2 there was a significant increase in colistin resistance (28 vs. 69%) (p <0.01), an increase in MIC to meropenem ≥ 16 mg/L (74 and 97%) (p = 0.02), and decrease in tigecycline resistance (29 vs. 4%) (p = 0.02). The overall mortality was 40 in P1 and 32% in P2 (p=0.7). There was not difference in mortality when the definitive treatment was with an active antimicrobial vs. two active antimicrobials, as well as between the different antimicrobials used.

CONCLUSIONS

There was a significant increase in bacteremia caused by Kp-KPC and the level of colistin resistance and MIC to meropenem. Overall mortality was high in both periods.

SIGNAL DECOMPOSITION AND ANALYSIS FOR THE IDENTIFICATION OF PERIODIC AND ANOMALOUS PHENOMENA IN RADON TIME-SERIES

This work concerns continuous monitoring of radon and thoron specific activity in soil gas within the framework of identifying possible anomalies. It is based on the analysis of a medium-term data record obtained from soil gas in an area of geophysical interest. The RaMonA spectrometric system is also used to measure the climatic parameters and a specific analysis of the alpha spectra is performed to better determine the alpha lines intensity. Since radon emission is also influenced by meteorological parameters, it is mandatory to differentiate the changes due to the deep phenomena. Different procedures are utilized to reach the above objective: statistical analysis using the Empirical Mode Decomposition technique, the Multiple Linear Regression method and the Remote Radon Estimation by using of the thoron trend to eliminate the locally produced radon fraction. The results of such methods are compared to recognize and to highlight radon anomalies.

Thirty years after Chernobyl: Long-term determination of 137Cs effective half-life in the lichen Stereocaulon vesuvianum

It has been widely shown that nuclear fallout includes substances, which accumulate in organisms such as crustaceans, fish, mushrooms and lichens, helping to evaluate the activity concentration of contaminants accumulated on a long time. In this context, radiocaesium deposited in soil following the Chernobyl accident on 26 April 1986 is known to have remained persistently available for plant uptake in many areas of Europe. Studies on the lichen Stereocaulon vesuvianum show the plant's high capacity to retain radionuclides from the substrate and the air. After the Chernobyl accident, starting from September 1986, at the Radioactivity Laboratory (LaRa) of the University of Naples Federico II, four monitoring campaigns to evaluate the activity concentration of four isotopes of the two elements caesium and ruthenium (¹³⁴Cs, ¹³⁷Cs, ¹⁰³Ru and ¹⁰⁶Ru) were carried out until 1999. This study allowed the effective half-life of ¹³⁴Cs and ¹³⁷Cs to be estimated. Twenty-eight years after the accident, in December 2014, a further sampling was carried out; only ¹³⁷Cs was revealed beyond the detection limits, measuring activity concentrations ranging from 20 to 40 Bq/kg, while the other radionuclides were no longer observed due to their shorter half-life. The last sampling allowed more precise determination of the effective half-life of ¹³⁷Cs (6.2 ± 0.1 year), due to the larger dataset on a large time period.

Track counting and thickness measurement of LR115 radon detectors using a commercial image scanner

An original optical method for track counting and film thickness determination of etched LR115 radon detectors was developed. The method offers several advantages compared with standard techniques. In particular, it is non-destructive, very simple and rather inexpensive, since it uses a commercial scanner and a free software. The complete analysis and the calibration procedure carried out for the determination of radon specific activity are reported. A comparison with the results of spark counting defines the accuracy and the precision of the new technique.

222Rn+220Rn monitoring by alpha spectrometry

Controlled 222Rn+220Rn mixed atmospheres have been realised introducing calibrated sources in a stainless steel chamber. An electrostatic alpha monitor internal to the chamber has been used for an accurate discrimination of alpha peaks due to the products of the two isotopes. In the chamber, different specific activities are achieved in order to test the response of the internal reference instrument and to evaluate the possible interferences due to contemporary presence of both radon isotopes. Results show that: (i) the atmospheres are very stable, (ii) the monitor is adequate for their control because the various alpha lines are well evaluated and (iii) using Tyvek® filter, the efficiency of monitor is stable and constant vs. activity.

Radon measurements and effective dose from radon inhalation estimation in the Neapolitan catacombs

In this study, the indoor radon activity concentrations have been measured in the Neapolitan catacombs using LR115 detectors. The detectors were exposed for two quarters, one in the warm season and the other in the cold. This has allowed one to evaluate the seasonal variations of concentrations, while the diurnal variations were evaluated performing continuous measurements by a Radim 5 monitor. The authors found that radon concentrations were lower in winter than in summer. Based on their values, taking into consideration the working hours in the catacombs and the equilibrium factor of 0.4, the effective dose to workers was estimated.

Dependence of the LR-115 radon detector calibration factor on track density

The reliability and accuracy of the methodology based on using LR-115 track detectors for radon measurements have been studied by determining the dependence of their calibration factors on radon exposure at levels reaching 13 MBq m(-3) h. This factor results not constant and demonstrated a decreasing exponential trend vs. exposure that has been explained in terms of the saturation effect and verified using a numerical simulation. This dependence does not affect the parameter that normalizes track density vs. film thickness. This parameter results constant and equal to - 0.30±0.02 cm(-2)/µm in the 300-8000 kBq h m(-3) exposure range.

Gamma dose rate measurements in dwellings of Campania region, South Italy

A survey of gamma exposure in dwellings of Campania region, southern Italy has been performed using Thermo Luminescent Dosimeters (TLD). In each dwelling TLDs were exposed for six months in the room where the inhabitant spent most of their time, generally the bedroom or living room. The arithmetic mean was found to be 264 ± 111 nGy/h, after the subtraction of the cosmic contribution. The effects of building materials and geographic location were also examined. Using UNSCEAR model, the annual effective dose due to indoor gamma radiation was evaluated and it was found to be 1.3 mSv/y, that is higher than Italian national average of 0.4 mSv/y.

First direct measurement of the 17O(p,γ)18F reaction cross section at Gamow energies for classical novae

Classical novae are important contributors to the abundances of key isotopes, such as the radioactive (18)F, whose observation by satellite missions could provide constraints on nucleosynthesis models in novae. The (17)O(p,γ)(18)F reaction plays a critical role in the synthesis of both oxygen and fluorine isotopes, but its reaction rate is not well determined because of the lack of experimental data at energies relevant to novae explosions. In this study, the reaction cross section has been measured directly for the first time in a wide energy range E(c.m.)~/= 200-370 keV appropriate to hydrogen burning in classical novae. In addition, the E(c.m.)=183 keV resonance strength, ωγ=1.67±0.12 μeV, has been measured with the highest precision to date. The uncertainty on the (17)O(p,γ)(18)F reaction rate has been reduced by a factor of 4, thus leading to firmer constraints on accurate models of novae nucleosynthesis.

AIDS dementia complex: incidence, clinical profile and impact of zidovudine treatment*

This study aimed to determine the incidence of AIDS dementia complex (ADC), the clinical data which distinguish it from other neurological complications of HIV infection, and the impact of zidovudine (AZT) therapy on the appearance and course of this condition. Data on the neurological complications of HIV patients treated at a community hospital from 1988 to 1992 were collected prospectively. Out of 500 AIDS patients treated at the hospital, there were 142 patients with neurological complications, with an average of 1.42 complications/patient There were 23 patients diagnosed as having ADC; with an estimated incidence of 4.6%, it was the most frequent neurological complication, after cerebral toxoplasmosis. Age was higher in patients with ADC as first manifestation of AIDS with respect to ADC patients with previous AIDS diagnosed. Compared with the group of patients suffering from other neurological complications, patients with ADC showed significant differences in several biological markers of progression to AIDS, such as hemoglobin, hematocrit, global lymphocyte count, serum β2-microglobulin and serum IgA. CD4 count was similar in both groups. Ten ADC patients had been treated previously with AZT. Dementia continued progressing in seven of these patients and remained stable in three. Of the other 13 cases not treated previously with the drug, eight received AZT therapy, and a favourable response was obtained in three patients (p = 0.068). ADC represents a major neurological complication in AIDS patients. AZT therapy may delay the appearance of ADC, but not prevent it. A trend towards a favourable response to AZT was observed in ADC patients who had not been treated with it previously.

Tests of shielding effectiveness of Kevlar and Nextel onboard the International Space Station and the Foton-M3 capsule

Radiation assessment and protection in space is the first step in planning future missions to the Moon and Mars, where mission and number of space travelers will increase and the protection of the geomagnetic shielding against the cosmic radiation will be absent. In this framework, the shielding effectiveness of two flexible materials, Kevlar and Nextel, were tested, which are largely used in the construction of spacecrafts. Accelerator-based tests clearly demonstrated that Kevlar is an excellent shield for heavy ions, close to polyethylene, whereas Nextel shows poor shielding characteristics. Measurements on flight performed onboard of the International Space Station and of the Foton-M3 capsule have been carried out with special attention to the neutron component; shielded and unshielded detectors (thermoluminescence dosemeters, bubble detectors) were exposed to a real radiation environment to test the shielding properties of the materials under study. The results indicate no significant effects of shielding, suggesting that thin shields in low-Earth Orbit have little effect on absorbed dose.

Stellar and primordial nucleosynthesis of 7Be: measurement of 3He(alpha,gamma)7Be

The 3He(alpha,gamma)7Be reaction presently represents the largest nuclear uncertainty in the predicted solar neutrino flux and has important implications on the big bang nucleosynthesis, i.e., the production of primordial 7Li. We present here the results of an experiment using the recoil separator ERNA (European Recoil separator for Nuclear Astrophysics) to detect directly the 7Be ejectiles. In addition, off-beam activation and coincidence gamma-ray measurements were performed at selected energies. At energies above 1 MeV a large discrepancy compared to previous results is observed both in the absolute value and in the energy dependence of the cross section. Based on the available data and models, a robust estimate of the cross section at the astrophysical relevant energies is proposed.

Helminth infracommunities of a population of the Gran Canaria giant lizard Gallotia stehlini

A survey of gastro-intestinal helminth communities of Gallotia stehlini (Sauria: Lacertidae) from Gran Canaria island (Canary Archipelago, Spain), was conducted to determine the prevalence, abundance and species diversity of intestinal parasites in these lizards. Pharyngodonid nematodes were the most common intestinal helminths, three species being Gallotia specialists. Helminth infracommunities of G. stehlini were rich and appear to be closer to the interactive end of the continuum isolationist–interactive helminth communities, according to the high values of helminth diversity. It is the first case of a saurian reptile showing this kind of diverse helminth infracommunity, produced by a large size, a wide-ranging plant diet and exposure to helminths with direct life-cycles.

Cognitive function and dissociative disorder status among veteran subjects with chronic posttraumatic stress disorder: a preliminary study

Twenty-seven veteran subjects with chronic posttraumatic stress disorder (PTSD) were evaluated for dissociative disorders. Ten subjects met criteria for one or more dissociative disorders, and 17 subjects did not meet dissociative disorder criteria. Neurocognitive profiles of the two groups differed in several areas, with veterans meeting diagnostic criteria for both PTSD and a dissociative disorder and demonstrating considerably greater deficits in attention, autobiographical memory, and verbal memory than PTSD subjects without comorbid dissociative disorder diagnosis.

Activation measurement of the 3He(alpha,gamma)7Be cross section at low energy

The nuclear physics input from the 3He(alpha,gamma)7Be cross section is a major uncertainty in the fluxes of 7Be and 8B neutrinos from the Sun predicted by solar models and in the 7Li abundance obtained in big-bang nucleosynthesis calculations. The present work reports on a new precision experiment using the activation technique at energies directly relevant to big-bang nucleosynthesis. Previously such low energies had been reached experimentally only by the prompt-gamma technique and with inferior precision. Using a windowless gas target, high beam intensity, and low background gamma-counting facilities, the 3He(alpha,gamma)7Be cross section has been determined at 127, 148, and 169 keV center-of-mass energy with a total uncertainty of 4%. The sources of systematic uncertainty are discussed in detail. The present data can be used in big-bang nucleosynthesis calculations and to constrain the extrapolation of the 3He(alpha,gamma)7Be astrophysical S factor to solar energies.

Defective signalling in salivary glands precedes the autoimmune response in the non-obese diabetic mouse model of sialadenitis

The spontaneous non-obese diabetic (NOD) mouse model of Sjögren's syndrome provides a valuable tool to study the onset and progression of both the autoimmune response and secretory dysfunction. Our purpose was to analyse the temporal decline of salivary secretion in NOD mice in relation to the autoimmune response and alterations in various signalling pathways involved in saliva secretion within each salivary gland. A progressive loss of nitric oxide synthase activity in submandibular and parotid glands started at 12 weeks of age and paralleled the decline in salivary secretion. This defect was associated with a lower response to vasoactive intestinal peptide in salivary flow rate, cAMP and nitric oxide/cGMP production. No signs of mononuclear infiltrates or local cytokine production were detectable in salivary glands in the time period studied (10-16 weeks of age). Our data support a disease model for sialadenitis in NOD mice in which the early stages are characterized by defective neurotransmitter-mediated signalling in major salivary glands that precedes the autoimmune response.

Relationship between diet and helminths in Gallotia caesaris (Sauria: Lacertidae)

Diet and helminth fauna were analysed in Gallotia caesaris, a small lacertid lizard endemic to El Hierro (Canary Islands, Spain) in order to study the evolutionary and functional relationships between the two traits. This species is omnivorous but consumed a high proportion (82.13%) of plant matter including not only seeds but also leaves and other vegetative parts. Helminth fauna included many helminth species typical of herbivorous reptiles. Both herbivory and helminth presence were higher than expected for a lizard of its size. Comparison with other lacertids suggests that both traits result from an adaptation to insular conditions but that some "evolutionary time" to develop them is needed. Canarian Gallotia lizards, a separate lineage evolving for a long time in insularity, constitutes the most advanced lacertid group in this way. Nevertheless, results for G. caesaris indicate that helminth fauna also changes seasonally tracking variation in diet (and herbivory) throughout the year, which suggests a dynamic interaction between diet and helminth parasites.

The influence of environmental parameters in electrostatic cell radon monitor response

To better understand the influence of air parameters such as pressure, humidity and temperature on the counting efficiency of a radon monitor based on solid state silicon detectors and radon daughter electrostatic collection, a number of experimental and theoretical studies have been performed. This study has been carried out using a multiparameter acquisition system used to monitor radon, temperature, pressure and relative humidity. Results show that air humidity and temperature inside the cell influence radon daughter collection in a significant way. For the tested cell, a decrease of the 218Po counting efficiency vs. humidity and temperature increase was measured in the ranges from 10% to 90% and from 15 degrees C to 35 degrees C, respectively. These effects were also theoretically studied by using Monte-Carlo software, which takes into account electrostatic collection of radon daughters in the cell, by considering the recombination process as a function of climatic parameters. A satisfactory agreement was obtained between experimental measurements and theoretical calculations.

Accumulation history of radionuclides in the lichen Stereocaulon vesuvianum from Mt. Vesuvius (south Italy)

The fruticose lichen Stereocaulon vesuvianum, growing on the slopes of Mt. Vesuvius (south Italy), was used as a biomonitor of 134Cs, 137Cs, 103Ru and 106Ru derived from the April 26 1986 Chernobyl nuclear reactor accident. Samples were taken at five different quotes (370, 490, 580, 780 and 960 m a.s.l.) and four successive dates (October 1986, December 1986, October 1987 and May 1999). At the first sampling, the concentrations (as Bq kg(-1) dry weight) ranged between 460 and 1020 for 134Cs, 1330 and 2500 for 137Cs, 90 and 200 for 103Ru and 360 and 710 for 106Ru, values generally lower in respect to those measured in soil and higher plants. Of the total 137Cs measured only 14% was due to 1950s and 1960s nuclear weapons tests fallout. Highest average activities of all nuclides were observed at the quote of 960 m and significant correlation (0.7<r(2)<0.9) with altitude was found for 106Ru and 137Cs values. The time span between the first two samplings (38 days) was enough to highlight only the decay of 103Ru (T1/2=40 days). At sampling performed 1 year later (October 1987) only 134Cs, 137Cs, and 106Ru were observed. Thirteen years after the Chernobyl incident (May 1999), although a decrease was obvious with time, the 137Cs content in lichen thallus was still appreciable (270-570 Bq kg(-1) dw). Experimental results from the first three samplings yield effective residence time of 0.98+/-0.07, 5.9+/-0.3 and 1.6+/-0.1 years for 106Ru, 137Cs and 134Cs, respectively. The last sampling of May 1999 allowed to achieve a more precise determination of lifetime of 137Cs (6.1+/-0.4 years).

Gun use, attitudes toward violence, and aggression among combat veterans with chronic posttraumatic stress disorder

Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) have been frequently reported to exhibit high levels of aggression and violent behavior. In this study, gun collection and use habits, attitudes toward violence, and self-reported levels of aggression were compared between veterans with chronic PTSD and non-PTSD veterans with equivalent histories of alcohol and substance abuse. PTSD patients reported different attitudes toward violent crime, higher levels of self-reported aggression, and a significantly higher incidence of potentially dangerous firearm-related behaviors than comparison subjects.

Host-parasite relationships of Zootoca vivipara (Sauria: Lacertidae) in the Pyrenees (North Spain)

The helminths infesting the common lizard, Zootoca vivipara (Jacquin, 1787), were studied with special attention to the relations between the number of nematodes, Oswaldocruzia filiformis (Goeze, 1782), and the size, sex and age class of the host. The possible seasonality of the parasite intensity and the relationship with the feeding habits of the host were also tested. Helminth infracommunities of Z. vivipara were depauperate with lizards harbouring only two species, the trematode Plagiorchis molini (Lent et Freitas, 1940) and the nematode O. filiformis. A positive correlation between host size and the number of O. filiformis was found for female Z. vivipara. However, no correlation was detected between intensity and sex or age class. The feeding habits of Z. vivipara, the isolation of the population studied and the low level of interaction with other reptilian or amphibian species are suggested as the causes of the depauperate helminth infracommunities found in this lacertid lizard.

Economic impact of HIV protease inhibitor therapy in the global use of health-care resources

OBJECTIVE

To evaluate the clinical and economical impact of the introduction of HIV protease inhibitor (PI) therapy in the current clinical care of HIV-infected patients.

METHODS

Cohort study with 155 HIV-infected patients with a full year of follow-up before and after the introduction of PI by June 1998. The setting was a large urban tertiary teaching hospital in Madrid, Spain. The main outcomes measures were clinical and immunological evolution, pharmacy, out-patient, emergency room and in-patient medical costs evaluated by diagnostic-related group classification, and the global economic costs of clinical care in HIV-infected patients (AIDS and non-AIDS).

RESULTS

The cost of PI therapy was compensated fully by savings related to reduction of the number, length and severity of hospital admissions in AIDS cases. In contrast, more modest clinical effects with increased costs were observed in non-AIDS cases. Globally, there was an increase of about 20% in the total health-care costs of HIV-infected patients (P < 0.01).

CONCLUSIONS

PI therapy is highly cost-effective in AIDS patients. Its value in less severely immunosuppressed patients requires further evaluation.

[99m Tc-MIBI scintigraphy compared to mammography in the diagnosis of breast cancer in dense, operated and young women breasts]

Breast scintimammography with 99mTc-MIBI has proven to be a useful complement to mammography in the diagnosis of breast cancer in the female population. Although the mammography, along with a physical examination, is the backbone of breast cancer diagnosis, there are groups of patients in whom the mammography has an even lower specificity.

OBJECTIVE

Our study has aimed to assess the usefulness of breast 99mTc-MIBI scintimammography in those situations in which the mammography was indeterminate, such as, in dense breasts, young females or breasts with architectural distortion after surgery or radiation therapy.

MATERIALS AND METHODS

We studied 109 females with mammographically dense breasts, 8 young females under 30 and 24 patients who had undergone previous surgery or radiation therapy. All cases were studied to rule out breast cancer. Final diagnosis was established with excisional biopsy.

RESULTS

In dense breasts MIBI scintimammography sensitivity was 88% and the mammography one 81%. MIBI scintimammography specificity was 90% and the mammography 28%. In young females MIBI scintimammography sensitivity was 100% and the mammography 50%, MIBI scintimammography specificity 100% and the mammography 20%. In previous surgery, MIBI scintimammography sensitivity was 80% and the mammography 80%, MIBI scintimammography specificity 100% and the mammography 42%.

CONCLUSION

Breast scintimammography with 99mTc-MIBI is an excellent diagnostic technique with high specificity. Undoubtedly it is complementary to mammography in those cases where mammography has major limitations such as dense breasts, young females and breasts with severe scarring after surgery or radiation therapy.

[Usefulness of the quantification of (99M)Tc-MIBI uptake in breast neoplasms in the preoperative assessment of tumor aggressiveness]

(99m)Tc-MIBI has been proposed as an imaging diagnostic method in a large variety of human malignant tumors. At present, the mechanism by which (99m)Tc-MIBI is uptaken and concentrated by the malignant cells is not totally known. Some mammary neoplasms do not show any uptake of (99m)Tc-MIBI. This study aims to determine if there is any correlation between the uptake of (99m)Tc-MIBI by the tumor and the different histopathological parameters involved in tumoral aggressiveness. To do so, we have studied 100 patients with breast cancer. All of them underwent a breast scintimammography with (99m)Tc-MIBI with semiquantitative analysis by means of a tumor-to-background ratio calculated in every projection. After surgery, an experienced pathologist determined tumor size, axillary lymph node metastases, histological grade (Scarff Bloom Richardson) (SCBR), nuclear grade, mitotic index, presence of cellular atypia and estrogen and progesterone receptor expression.

RESULTS

A statistically significant correlation (p < 0.005) has been found between tumor-to-background (T/B) ratios of (99m)Tc-MIBI uptake and tumor SCBR histological grade. A correlation between (99m)Tc-MIBI uptake and the mitotic index, cellular atypia and nuclear grade has also been found. No correlation was found in our study with tumor size, hormone receptor expression or axillary lymph node metastases.

CONCLUSIONS

(99m)Tc-MIBI uptake in breast cancer is correlated with the tumoral differentiation grade: the smaller the tumoral cellular differentiation (greater aggressiveness), the greater the uptake. On the other hand, no correlation was found between the uptake of (99m)Tc-MIBI and the classical pathological parameters that define tumoral aggressiveness, such as size and axillary lymph node metastasis.

[Usefulness of quantification and visual analysis of the uptake of (99m)Tc-MIBI in the diagnosis of mammary lesions]

OBJECTIVE

Scintigraphy studies with (99m)Tc-MIBI are widely used in the diagnosis of non-invasive breast cancer and their results have been verified by many studies. However, the scintigraphic technique produces erroneous false negative and positive results. This study aims to verify how the different characteristics of the uptake of (99m)Tc-MIBI (intensity, size, morphology, etc.) can help to increase sensitivity and specificity of breast scintigraphy.

MATERIALS AND METHODS

We have studied 201 patients (84 breast cancer and 117 benign lesions). All of them underwent a breast scintigraphy with (99m)Tc-MIBI and anatomopathological study. A semiquantitative analysis (by T/F indexes) and visual study were performed in the lesions that presented radiodrug uptake.

RESULTS

Eleven false positive results and 8 false negative results were obtained in the study of the 201 patients. The analysis of the T/F indexes did not demonstrate any significant differences between the benign and malignant lesions (p>0,05). There is a statistically significant correlation (p<0.05) between the tracer uptake morphology and the AP diagnosis and between the localization of the lesion in a breast quadrant and the uptake intensity.

CONCLUSIONS

Quantification of (99m)Tc-MIBI uptake by T/F indexes does not provide any conclusive data on the lesion's malignancy, however, a more detailed analysis of the characteristics of the tracer uptake would permit us to make the correct diagnosis and would reduce the false positive and negative results of this technique.

Description of Acanthotrema armata n. sp. (Trematoda: Heterophyidae) from Larus audouinii (Aves: Laridae), with an amended diagnosis of the genus Acanthotrema Travassos, 1928

Acanthotrema armata n. sp. (Trematoda: Heterophyidae) is described from the gut of Larus audouinii Payraudeau (Aves: Laridae) caught on the Chafarinas Islands in the southwestern Mediterranean (Spain). This trematode differs from other species of Acanthotrema Travassos, 1928 in having two spined, sclerotised pieces in the ventrogenital sac and in the position of the genital pore. Parastictodora Martin, 1950 is considered a synonym of Acanthotrema. As the diagnosis of the genus Acanthotrema was based only on its type-species, it is amended to include the characteristics of the new species and those attributed to Parastictodora.

Helminth communities in Audouin's gulls, Larus audouinii from Chafarinas Islands (western Mediterranean)

A survey of intestinal helminth communities of Audouin's gulls Larus audouinii, from their breeding colonies in Chafarinas Islands, western Mediterranean, Spain was conducted to determine the abundance and species diversity of intestinal parasites of these birds. The sample of 58 gulls harbored intestinal helminth infracommunities composed of species that are gull generalists, including the digeneans Cardiocephalus longicollis, Knipowitschiatrema nicolai, Condylocotyla pilodora, and Aporchis massiliensis, and the cestode Tetrabothrius cylindraceus. Two nematodes are waterfowl generalists (Cosmocephalus obvelatus and Paracuaria adunca), whereas the digenean Acanthotrema armata is an Audouin's gull specialist. The relative high values of species richness and diversity of the helminth infracommunities are comparable to those of other gulls (Larus philadelphia, Larus canus), probably reflecting the specialized, nonselective fish diet of L. audouinii.

[Invasive aspergillosis in patients with human immunodeficiency virus infection diagnosed by necropsy: the contribution of 4 cases and review of the literature]

BACKGROUND

Invasive aspergillosis is an infrequent clinicopathological entity which is difficult to diagnose (since it requires tissue samples, normally of the lung where the pathogenic effect of the fungi may be seen) and thus an important number of cases are not found until necropsy. In patients with human immunodeficiency virus (HIV) infection the real incidence has not been clearly defined and may be higher than reported.

MATERIAL AND METHODS

We herein present a series of necropsy reviews performed over a five year period (January 1993 to December 1997) in the Hospital Universitario San Carlos in Madrid (Spain) in patients with HIV infection. In the patients who presented invasive aspergillosis a collection protocol of clinical, analytical and radiologic data was undertaken.

RESULTS

Over this period necropsic studies were performed in 23 patients with HIV infection. Of these 4 (17.3%) presented invasive aspergillosis; 3 with disseminated involvement. Premortem diagnosis was not performed in any of the cases. The risk factors included: 3 had a CD4 count of less than 50, two were receiving glucocorticoids and only 1 had severe neutropenia. In 2 another opportunistic lung infection was also observed.

CONCLUSIONS

Invasive aspergillosis is an entity witch is found on autopsy with relative frequency in patients with HIV infection with severe immunodepresion. Other opportunistic infections may also coincide and it may not be associated with neutropenia, glucocorticoid treatment, which are considered as classical risk factors for invasive aspergillosis.

[Bacteremia by Staphylococcus aureus: analysis of 311 episodes]

BACKGROUND

The aim of this study was to set up the differences between nosocomial and community acquired S. aureus bacteremia, to identify the features of the patients at high risk of endocarditis and to define the characteristics of the patients with methicillin resistant S. aureus (MRSA).

METHODS

We prospectively studied 311 cases of S. aureus bacteremia detected at our hospital during a four-year period.

RESULTS

Nosocomial acquisition of bacteremia was found in 63% of the cases, 45% of which were caused by MRSA. Nosocomial bacteria generally presented in older patients with more severe underlying conditions and a higher prevalence of invasive procedures than patients with the community-acquired disease. Likewise, the primary focus of infection was identifiable in most of the nosocomial episodes and mortality was also higher. Endocarditis presented in 19% of the bacteremia episodes and almost 90% of patients with endocarditis were intravenous drug users (IDU). The risk of endocarditis in this group was 64% whereas it was only 3% in non-IDU patients. Overall mortality was 33% and mortality directly due to the bacteremia was 22%.

CONCLUSIONS

IDU patients were at high risk of endocarditis but most had a favourable outcome. Bacteremia was community-acquired in these patients and they rarely presented MRSA bacteremia. Patients with previous valvular diseases were at high risk of endocarditis and had a high mortality. Non-IDU patients with community-acquired bacteremia were at a low risk of endocarditis, regardless of whether a primary focus of infection had been identified or not. Mortality was lower in this group than in patients with nosocomial bacteremia and there were no cases of MRSA bacteremia. Mortality was higher in patients treated with vancomycin than in patients treated with other antibiotics active against S. aureus.

Simultaneous intestinal leishmaniasis and mycobacterial involvement in a patient with acquired immune deficiency syndrome

Gastrointestinal involvement is reported in approximately 50% to 93% of patients with human immunodeficiency virus. It is frequently the result of coinfection with several microorganisms. Selective Leishmania intestinal involvement presents with atypical symptoms for visceral leishmaniasis, and may appear as a relapse or as the first manifestation of the disease. The authors present a patient with acquired immune deficiency syndrome who has a history of treated leishmaniasis and gastrointestinal infection by showed Mycobacterium avium intracellulare (MAI). After the new onset of abdominal pain, an intestinal biopsy showed the presence of both MAI and Leishmania in duodenum. Intestinal infection by Leishmania must be included in the differential diagnosis in patients with a previous history of leishmaniasis or travel to an endemic area.