Isolation of M. tuberculosis in abdominal specimens

The isolation of mycobacteria in abdominal specimens during a 10 years period is presented. Twenty-three clinical cases have been reviewed; patients were divided in three groups: 1) Peritoneal and intestinal tuberculosis. 2) Pulmonary tuberculosis with isolation of M. tuberculosis in feces, and 3) Miliary tuberculosis. We emphasize the low yielding of bacilloscopy, the low number of colonies in cultures and the importance of the microbiological study of abdominal specimens in the confirmatory diagnosis. The predominant symptoms of peritoneal tuberculosis were abdominal pain and distention and fever. The study of the ascitic fluid showed in most of the cases lymphocytic exudate and the pathological study of biopsies showed granulomas with caseous necrosis. Three patients had another associated abdominal disease. Isolation of M. tuberculosis in feces does not invariably mean the presence of intestinal tuberculosis. We confirm the frequent association of disseminated tuberculosis and HIV1 infection.     

Myocardial infarct immediately after a normal exercise test

Two cases of myocardial infarction immediately following a normal stress testing, are described. The incidence and possible pathophysiological mechanisms are discussed. In one of the patients it was difficult to establish the pathophysiological mechanism which was the cause of the ischemic event. In the other, the coronary arteriography revealed only minimal obstructive disease. Therefore, coronary vasospasm with thrombus formation as a cause of the infarction ia an interesting speculative possibility in view of the angiographic findings. Acute myocardial infarction after a normal electrocardiographic response to maximal exercise testing is extremely rare, and the precise pathophysiologic mechanism that leads to his complication is not clear.     

Compliance of the respiratory system in infants born at high altitude

Populations living at high altitude are known to have a number of distinctive physiologic traits, including an increase in lung volume and compliance. We asked whether the factors that result in the increased compliance of high altitude natives were sufficiently expressed in utero that an increase in respiratory system compliance (Crs) could be detected at birth. Measurements were performed at about 1 day after birth on 34 infants born in La Paz, Bolivia (3,600 m, Pb about 495 mm Hg) and 36 born in Santa Cruz (400 m, Pb about 735 mm Hg). All infants were full-term and healthy, with body weights of at least 2,700 g. We measured Crs from expirations within the tidal volume range by the multiple occlusion method. Breathing pattern was measured from the spirometric record, and an index of chest wall distortion was obtained from the ratio of volume and abdominal displacement during spontaneous breathing and relaxations against closed airways. Rib cage and abdomen dimensions did not differ between the two groups. Crs values in Santa Cruz were similar to those previously obtained in Montreal and in other Caucasian infant populations at low altitudes. Crs was 33% and Crs/kg 37% greater (p less than 0.001) in the high altitude group, which included equal numbers of Amerindians and Mestizos of European ancestry. Dynamic elevation of the end-expiratory level was similar in both groups. Ventilation/kg and the distortion ratio were slightly yet significantly higher in the high altitude infants, suggesting an increased ventilatory drive.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intestinal and gastric cystoid pneumatosis associated with duodenal stenosis

We present a case of pneumatosis cystoides of the stomach and intestine, secondary to peptic pyloric ulcer with duodenal stenosis. Clinical symptoms consisted of abdominal pain and intense vomiting; diagnosis was suspected in the radiologic examination of the abdomen (plain film), which showed and abnormal pattern of gas distribution, and later confirmed by barium contrast. The surgical correction of the underlying cause made the lesion disappear. We also review the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of this rare condition.     

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is very rare, and only 139 cases have been described in all the world literature. We present one case of primary malignant melanoma of the esophagus in a 76-year-old woman who reported the symptoms of dysphagia and recent weight loss; the radiography showed a large polypoid mass filling the entire lower half of the esophagus, dark brown-black in the endoscopy. Histologic analysis demonstrated the existence of a malignant melanoma infiltrating the esophageal mucosa, composed of anaplastic cells with abundant brown pigment which had positive immunoreactivity for the S-100 protein.     

Clinical evolution of patients treated with aripiprazole long-acting injectable: a preliminary,prospective, observational study

Abstract

Objective: To evaluate the effectiveness of 6-month treatment with aripiprazole long-acting injectable (LAI) in improving psychotic symptoms, social functioning and side effects and reducing co-administered antipsychotic drugs.

Methods: Multicentre, observational, prospective study that enrolled 53 patients with diagnosis of schizophrenia spectrum disorders who initiated or switched to aripiprazole LAI. The effectiveness of aripiprazole LAI was assessed through the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersogelser scale for side effects, the Global Assessment of Functioning and the Clinical Global Impression-Schizophrenia (CGI-SCH).

Results: Upon treatment with aripiprazole LAI, patients significantly improved all the domains of PANSS (p?<?.05). Adverse event severity significantly improved after a 6-month aripiprazole LAI treatment (p?<?.05). Differences from baseline to month 6 in Global Assessment of Functioning score were significant (p?=?.0002). The proportion of severely ill patients decreased upon treatment with aripiprazole LAI (CGI-SCH scale). Prolactin levels were normalised after a 6-month treatment (from 43.0 to 14.7?ng/mL). Co-administered antipsychotic drugs significantly decreased after a 6-month treatment with aripiprazole LAI.

Conclusion: A 6-month treatment with aripiprazole LAI improved the clinical status of our patients without modifying their metabolic profile, and allowed the reduction of co-administered antipsychotic drugs.

• Practice implications

• Long-acting injectable antipsychotics are effective treatment options for the maintenance of patients with schizophrenia and related disorders, and to ensure treatment adherence. This study describes the evolution of patients over six months of treatment with aripiprazole long-acting injectable. The results from this study support previous data on the efficacy and safety of this atypical antipsychotic. This study may be of wide interest to the community of psychiatrists and may help clinicians optimise treatment adherence in patients with schizophrenia spectrum disorders.

• Key points

• Aripiprazole long-acting injectable is an atypical antipsychotic intended to improve treatment adherence and prevent relapses.

• This multicentre prospective study evaluated the effectiveness of aripiprazole long-acting injectable over six months of treatment on the control of a comprehensive set of clinical variables.

• Clinical rating scales showed that treatment with aripiprazole long-acting injectable improved clinical symptoms and social functioning, and reduced the severity of adverse events.

• Aripiprazole long-acting injectable contributed to the maintenance of adequate metabolic profiles and the normalisation of prolactin levels.

• Patients significantly decreased co-administered antipsychotic drugs after 6-month treatment with aripiprazole.

     

Testosterone Levels Are Decreased and Associated with Disease Duration in Male Spinocerebellar Ataxia Type 2 Patients

The Cerebellum - Spinocerebellar ataxia type 2 (SCA2) is a progressive neurodegenerative disorder due to an unstable expansion of a CAG repeat in the ATXN2 gene. Despite clinical and experimental...     

Expression of protocadherin-γC4 protein in the rat brain

It has been proposed that the combinatorial expression of γ-protocadherins (Pcdh-γs) and other clustered protocadherins (Pcdhs) provides a code of molecular identity and individuality to neurons, which plays a major role in the establishment of specific synaptic connectivity and formation of neuronal circuits. Particular attention has been directed to the Pcdh-γ family, for which experimental evidence derived from Pcdh-γ-deficient mice shows that they are involved in dendrite self-avoidance, synapse development, dendritic arborization, spine maturation, and prevention of apoptosis of some neurons. Moreover, a triple-mutant mouse deficient in the three C-type members of the Pcdh-γ family (Pcdh-γC3, Pcdh-γC4, and Pcdh-γC5) shows a phenotype similar to the mouse deficient in whole Pcdh-γ family, indicating that the latter is largely due to the absence of C-type Pcdh-γs. The role of each individual C-type Pcdh-γ is not known. We have developed a specific antibody to Pcdh-γC4 to reveal the expression of this protein in the rat brain. The results show that although Pcdh-γC4 is expressed at higher levels in the embryo and earlier postnatal weeks, it is also expressed in the adult rat brain. Pcdh-γC4 is expressed in both neurons and astrocytes. In the adult brain, the regional distribution of Pcdh-γC4 immunoreactivity is similar to that of Pcdh-γC4 mRNA, being highest in the olfactory bulb, dentate gyrus, and cerebellum. Pcdh-γC4 forms puncta that are frequently apposed to glutamatergic and GABAergic synapses. They are also frequently associated with neuron-astrocyte contacts. The results provide new insights into the cell recognition function of Pcdh-γC4 in neurons and astrocytes.     

Cloning of the PYR4 gene encoding orotidine-5′-phosphate decarboxylase in Cephalosporium acremonium

Summary We have cloned the Cephalosporium acremonium pyr4 gene by cross-hybridization with the equivalent gene from Neurospora crassa, the closest relative from which this gene is available. The C. acremonium pyr4 gene complements an E. coli pyrF mutant lacking orotidine-5-phosphate decarboxylase (OMPdecase), and most probably does not contain introns. Maxicell analysis in E. coli shows that it encodes a 46 kDa polypeptide. The C. acremonium OMPdecase contains a highly conserved pentadecapeptide characteristic for this category of enzyme. Extensive sequence comparison suggests an important role of this region in enzymatic activity.