Gestación heterotópica espontánea

Heterotopic pregnancy is the combination of intrauterine and ectopic pregnancy. This potentially fatal condition rarely occurs in spontaneous conception cycles and consequently its diagnosis requires a high index of suspicion. We report a case of heterotopic pregnancy in a 30-year old primipara with no known risk factors who presented with acute abdominal pain due to a spontaneous heterotopic pregnancy. The ectopic pregnancy was resected via laparoscopy. After surgery, the intrauterine pregnancy was uneventful.     

Platelet-rich plasma serotonin levels in tension-type headache and depression

We measured platelet-rich plasma (PRP) serotonin in patients suffering from tension-type headache, before and after treatment with amitriptyline, comparing them with a healthy control group and patients with untreated depression. We evaluated the severity of headache and depression in each group. PRP serotonin levels were higher in patients with headache than in controls and depressed patients. We observed a fall of PRP serotonin in patients with tension-type headache to similar levels after treatment as the depressed group. This fall was correlated with the improvement of headache but not with depression scales. Our data suggest that the rise of platelet serotonin levels in tension-type headache is related to pain and not depression.     

Usefulness of contrast material in MR of patients with neurofibromatosis type 1.

PURPOSEOur objective was to determine the usefulness of routine administration of contrast material in brain MR imaging for the evaluation of areas of probable myelin vacuolization and neoplasms in patients with neurofibromatosis type 1 (NF-1).METHODSWe retrospectively reviewed 112 consecutive contrast-enhanced brain MR studies obtained over a period of 7 years in 109 symptomatic and asymptomatic patients compiled from two institutional NF-1 data bases. MR studies were analyzed for areas of probable myelin vacuolization, with attention to degree of enhancement and its impact on lesion detection and characterization. Usefulness of contrast material was graded as 0 = not useful, 1+ = somewhat useful, and 2+ = useful.RESULTSOf 112 studies, 45% (n = 49) were normal. In the remaining 63 studies, 88 regions of probable myelin vacuolization and 52 tumors were identified. Enhancement was not observed in any regions of probable myelin vacuolization. Enhancement was present in 31% of tumors, and, of these, was found to be useful in 44%, somewhat useful in 12%, and not useful in 44%. For enhancing tumors, contrast agent was useful for lesion detection in 19% and for lesion characterization in 25%.CONCLUSIONContrast administration is useful in baseline MR studies to maximize tumor detection and characterization, to add confidence to the diagnosis of benign probable myelin vacuolization, and to document stability of neoplasms on follow-up examinations.     

Hypertrophic pulmonary osteoarthropathy in acquired immunodeficiency syndrome. Case report and review

We describe a case of hypertrophic pulmonary osteoarthropathy (HPOA) in an adult patient with acquired immunodeficiency syndrome (AIDS). This is the ninth case of HPOA associated with AIDS in adults, reported in the literature. The presence of pulmonary tuberculosis was also suspected, based on clinical grounds. Cases of clubbing associated with AIDS infection are reviewed.     

Patient follow-up is a major problem at genetics clinics

Children with genetic diseases must be followed for long periods of time to seek new findings. Other patients require further check-ups and studies to be diagnosed. Some patients never return for medical care after the first consultation, which may have serious consequences. We reviewed 400 medical charts of patients with genetic disease to analyze overall attendance to the genetics clinic, investigate some of the causes of failure to seek medical advice, and determine the differences between those first seen as outpatients or as inpatients. The mean follow-up period was 8.3 months (range 0-79), and the average number of visits was 2.8 (range 1-16). Forty eight percent of the cases first seen as inpatients were evaluated only once and 14% twice; while 22 and 21% of the 300 cases first seen as outpatients attended once and twice, respectively (P = 0.0). Appointment keeping was apparently not affected by the presence or absence of diagnosis. Overall, 97 patients were discharged, 7 died, 55 continued on follow-up, 62 attended other hospital services-but not genetics-and 179 were completely lost to follow-up. Diagnosed patients were counseled more frequently than undiagnosed patients (62 vs. 5%); and 71% of the diagnosed patients first seen as outpatients but only 36% of undiagnosed cases first seen as inpatients were counseled, differences between these two groups were significant (P = 0.005). We conclude that keeping the patient with genetic disease on follow-up is a difficult task. New educational strategies must be planned to improve this worrisome situation.     

Seasonal abundance of fleas (Siphonaptera: Pulicidae, Ceratophyllidae) on wild rabbits in a semiarid area of northeastern Spain

This paper reports the annual dynamics of wild rabbit fleas in a study site located in the Middle Ebro Valley, northeastern Spain. Fleas collected directly from wild rabbits included the species Spilopsyllus cuniculi (Dale), Xenopsylla cunicularis (Smit), Echidnophaga iberica (Ribeiro, Lucientes, Osácar, and Calvete), Caenopsylla laptevi (Beaucournu, Gil-Collado and Gilot), and Pulex irritans (L.). Monthly collections of adult and larval fleas made from within the first meter of selected burrow entrances also yielded fleas belonging to the same five species. Larval specimens of X. cunicularis, E. iberica, and C. laptevi were also found. Spilopsyllus cuniculi, a winter species that can only breed during the rabbit breeding season, was common on hosts from November to April. Xenopsylla cunicularis and E. iberica were summer species, whereas C. laptevi was abundant during the autumn and winter. Xenopsylla cunicularis and E. iberica larvae were found in burrows only during April and May, whereas those of C. laptevi were collected from October to January. The data suggested that X. cunicularis and E. iberica might diapause during the egg stage whereas C. laptevi diapauses during the pupal stage.     

The effects of an enhanced inflammatory reaction on the surface properties of cast Biomer

The ability of a biomaterial to withstand the rigors of the harsh biologic environment is an important consideration when considering a material for long-term biomedical applications. Using a cage implant system, the effects of an intense inflammatory reaction on cast Biomer have been investigated. The inflammatory response to cast Biomer was greatly increased by coimplanting Biomer films with a cytotoxic poly(vinyl chloride) (PVC) in rats for a period of 21 days. Cast Biomer films were characterized by weight, advancing contact angle with water in air, attenuated total reflectance infrared spectroscopy and scanning electron microscopy (SEM). The analyses were performed before any treatment, after autoclaving and sonication, and after 21 days implantation with the cytotoxic (PVC) in rats. The results of the study indicated that cast Biomer does not undergo significant chemical degradation when subjected to the effects of an intense inflammatory reaction for 21 days. Implantation does, however, lead to rearrangement that results in a more polar and hydrophilic surface, suggesting that the polymer adapts to the hydrophilic environment of the inflammatory exudate.     

A new syndrome of triphalangeal thumbs and brachy-ectrodactyly

Two Mexican families in which a total of 17 persons exhibited the same pattern of limb malformations are described. The syndrome is characterized by triphalangeal thumbs and brachydactyly affecting the index fingers and the third toes. The clinical findings are variable and the inheritance is autosomal dominant. The syndrome, to the best of our knowledge, has not been described before.