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To assess the efficacy of sodium-glucose cotransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptors agonist (GLP-1RA) therapy on liver steatosis measured by fatty liver index (FLI) and hepatic steatosis index (HSI) at 26 weeks in outpatients with diabetes and obesity.Observational, prospective, multicenter study. Patients with steatosis determined by FLI (values30 rule out and60 indicate steatosis) and HIS (values30 rule out and36 indicate steatosis) who received combination therapy were included. Patients were stratified into three groups according to the sequential order of treatment. We used robust statistical methods.In our final report we included 174 patients (58.6% males), mean age 61.9 (10) years. Baseline body mass index, waist circumference and weight were 36.5 (6.8) kg/mOur results show a beneficial effect of the combination of GLP-1RAs plus SGLT2is on liver steatosis that goes beyond glucose control, and it is related mainly to weight loss, a decline in biomarkers and reductions in abdominal circumference. For many patients, early detection is essential to improving outcomes in NAFLD and could allow us to select the most efficient treatment options.

Cerenkov Emission (CE) during external beam radiation therapy (EBRT) from a linear accelerator (Linac) has been demonstrated as a useful tool for radiotherapy quality assurance and potentially other applications for online tracking of tumors during treatment delivery. However, some of the current challenges that are impacting the potential of CE are related to the limited detection sensitivity and the lack of flexible tools to fit into an already complex treatment delivery environment. Silicon photomultiplier (SiPM) solid-state devices are new promising tools for low light detection due to their extreme sensitivity that mirrors photomultiplier tubes and yet have a form factor that is similar to silicon photodiodes, allowing for improved flexibility in device design that may help in the process of wider clinical applicability. In this paper, we assess the feasibility of using SiPMs to detect CE during EBRT from a Linac and contrast their performance with commercially available silicon photodiodes (PDs). We demonstrate the feasibility of the SiPM-based probes for standard dosimetry measurements. We also demonstrate that CE optical signals can be detected from tissue depths about five times greater than that for standard probes based on PDs, making our SiPM probe an enabling technology of CE measurements, particularly for deep tissue applications.

Aim: To analyze changes on UACR in T2DM patients according to treatment schedule groups (GLP-1RA or SGLT2i). Methods: Observational, prospective, multicenter study. Patients were stratified according to predetermined treatment schedule groups (successively vs.simultaneously). Results: 178 patients (58.6% males, age 61.9+/-10.0 years). Table 1 shows baseline findings by groups. Initial UACR was 19.6+/-52.5 mg/g and initial UACR >30 mg/g (n=68) was 95.1+/-222 mg/g. At 26 weeks significant % change in UACR and UACR>30mg/g was found (4.35+/-30** and 48.8+/105.5**), greater when SGLT2i is added (90.5+/-276.5 *) (Table 2). Discussion: Our results shows that the combination GLP-1ra-SGLT2i reduces UACR, especially if macroalbuminuria is present and is correlated to improvement in either HbA1c, weight and SBP. Disclosure J. Carretero Gomez: None. J. Ena: None. J. Segui-Ripoll: None. F. Carrasco-Sánchez: None. J. Arevalo Lorido: None. M. Suarez Tembra: None. J. Varela: None. R. Gomez-Huelgas: None.

Aim: To analyze changes in Fatty Liver Index (FLI) in obese and T2DM patients under treatment with GLP-1RA - SGLT2i combination. Methods: Observational, prospective, multicenter study. Patients were stratified according to predetermined treatment schedule groups (successively vs. simultaneously). Results: We included 142 patients (59.1% men, mean age 60.8±8.9 years). 76.7% had hypertension and 81.7% dyslipidemia. The BMI was 36.9 ±.7.1 kg/m2, FLI was 97±11, A1C was 8.0% ±1.5%, Triglyceride (Tg) was 158±102 mg/dl, Waist circumference (WC) 120.3 cm and gamma-glutamyl-transferase (GGT) was 43±45 UI/L. At 26 weeks follow-up we found a significant reduction in FLI (-5 points; p Discussion: Nonalcoholic fatty liver disease (NAFLD) is characterized by the accumulation of fat in the absence of other causes of steatosis. FLI is an accurate algorithm which can be used as a surrogate marker of steatosis; it combines measures of Tg, GGT, WC and BMI. GLP-1RA have direct effects on hepatocytes improving liver histology and reducing GGT levels. However, data on SGLT2i over the liver fat are scarce. Our study demonstrated that the combination of GLP-1RAs-SGLT2i reduces liver fat in patients with T2DM being positively correlated with improvement in A1C, BMI, WC and GGT. Disclosure J. Carretero Gómez: None. J. Arevalo Lorido: None. R. Gómez-Huelgas: None. J. Seguí-Ripoll: None. M. Suarez Tembra: None. J. Casas: None. J. Carrasco: None.

Chronic obstructive pulmonary disease (COPD) is a prevalent and disabling disorder in the United States, especially affecting older individuals, women, and those with a history of smoking. Studies show that COPD may be underrepresented, underdiagnosed, and undertreated in elderly patients residing in long-term care (LTC) facilities. The quality of care for LTC residents with COPD is heterogeneous in regard to both the facility and the patient. For LTC facilities, care should be driven by staff education, interstaff communication, and interfacility communication. From the perspective of the LTC patient, choice of medication and device should be based on appropriate diagnosis, comorbidities, ability to perform treatment, and patient preferences. Nebulization is currently underutilized in LTC settings, although it would benefit older patients with low peak inspiratory flow, cognitive impairment, and/or physical impairment, which may preclude them from using other inhalation devices. Authors developed a COPD treatment algorithm that focuses on three primary patient aspects to consider when deciding on respiratory device in patients in LTC facilities: inspiratory flow, hand dexterity and coordination, and cognitive capacity.

In the reinforced concrete (RC) precast industry there is great concern about the seismic behavior of connections that emulate monolithic ones. Therefore, an experimental program was developed to examine the seismic performance of a particular RC precast connection type frequently used in industrial applications in comparison to monolithic connections. Tests were conducted on full scale. This paper presents and discusses the main results. Comparisons of a benchmark monolithic connection and six precast beam-column joints are presented. Precast connections were fabricated using different detailing, various levels of joint confinement, and post-tensioning. Test results are compared in terms of strength and deformation capacity, energy dissipation, and stiffness degradation. A relation between effective beam stiffness and inter-storey drift is found and compared to cracked stiffness modification factors recommended by design codes. Two effective stiffness models for reinforced concrete beams are proposed. Conclusions relevant to the precast construction industry have been formulated. Results show an acceptable performance of the tested precast system for seismic applications.

New techniques for emissions reduction and energy efficiency are important challenges of the steel industry. Although great advantages have been reached in these fields, there are still new opportunities. One of them is the possible development of systems to recover energy from slags. The recent policies that encourage the use of renewable and alternative energies determine a favorable scenario for the development of new techniques of heat recovering. In this context, this article presents a new heat recuperation system for the slags produced in the factories of Arcelor–Mittal in Asturias (Spain) and study in detail the design of an innovative slags heat exchanger. To adjust its performance and to determine the influence of the geometric and flow design parameters, the heat exchanger has been simulated using numerical analysis software (CFD).

Slag accounts for most of the residuals or by-products of the steel manufacturing process and represents a not inconsiderable amount of energy waste and CO2 emissions. Energy recovery from steel mill slags is not actually performed because of the difficulty of the industrial implementation, but the actual demand and the incentives for new electricity generation plants based on renewable energies and on industrial waste heat recovery offer a new opportunity to evaluate the feasibility of this process. This article presents a review of the slag energy potential on a global scale, and a proposal for a recovery plant in the factories of Arcelor-Mittal in Asturias (Spain), based on a steam Rankine cycle for electricity production in a turbine. The plant production and viability have been analyzed using the typical technical and economic values for this kind of plant. Also, a parametric study has been performed on the heat recuperator efficiency and investment rate.

Resumen Fundamento y objetivo Describir las caracteristicas clinicas de sujetos con hipertrigliceridemia remitidos a Unidades de Lipidos asociadas a la Sociedad Espanola de Arteriosclerosis (ULSEA). Pacientes y metodo Se trata de un estudio multicentrico, prospectivo y observacional, de pacientes con valores de trigliceridos sericos > 200 mg/dl, reclutados desde enero 2007 a diciembre de 2008. Se recogieron variables demograficas, antecedentes, consumo de medicamentos, antropometria, diagnostico y variables analiticas de la visita de inclusion. Resultados Se incluyeron 1.033 varones y 361 mujeres con edad media (DE) de 50 (12) anos. La enfermedad vascular previa, el tabaquismo, el consumo de alcohol y la esteatosis hepatica fueron mayores en los varones que en las mujeres; en ellas fueron mas prevalentes la hipertension, la diabetes y la obesidad abdominal. La actividad fisica habitual y la dieta cardiosaludable fue seguida escasamente en ambos sexos. La mayor parte de los pacientes tenian una hipertrigliceridemia primaria (54%), especialmente una hiperlipemia familiar combinada o una hipertrigliceridemia familiar. La obesidad, el alcohol y la diabetes fueron las causas mas comunes de hipertrigliceridemia secundaria. Un 27% de los pacientes se trataban con dieta, un 44% con farmacos en monoterapia y el resto (24%) con diversas combinaciones. Conclusiones Aunque predominan las causas primarias, se constata una elevada frecuencia de etiologias secundarias y de trastornos que agravan la hipertrigliceridemia, predominando el tabaquismo y el consumo de alcohol en los varones y la obesidad abdominal y la diabetes en las mujeres. Aunque muchos pacientes reciben terapia farmacologica, se evidencia un amplio margen para mejorar la dieta y reducir el sedentarismo.

Background The situation of abdominal sepsis secondary to colonic perforation sometimes forces treat the patient with multiple interventions in the open abdomen (OA) context. Correct management of OA is important to restore the patient’s clinical situation and to avoid further complications of the abdominal wall. Delayed primary closure of the abdomen using a dynamic and progressive traction is a relatively new technique for treating the OA. Case presentation We report the case of a 50 year old woman with history of malnutrition and chronic obstructive pulmonary disease, affects for an OA after several surgical interventions. Two previous interventions (right colectomy, ileostomy and laparotomy with Bogotá bag) for disseminated peritonitis and abdominal compartment syndrome were performed. Six days after the Bogota bag the of the dynamic closure system ABRA® system was placed to delayed primary closure of the abdomen with excellent result results of the contingency of the abdominal wall. Discussion The most common technique in the current management of OA is the placement of vacuum-assisted closure or the use of a mesh. These systems generally require several operations to restore the integrity of the abdominal wall. However, the dynamic closure of the abdominal wall makes it possible to restore it into the same process. Conclusions ABRA system allows delayed primary closure of the abdominal wall in an OA by sepsis secondary to colonic perforation. The stoma was not a problem with this technique. The final closure of the abdomen was at 16 days after the ABRA placement. The abdominal wall has not alterations in the follow up after 3 years.

The extirpation of Meckel's diverticulum (MD) via conventional or laparoscopic surgery is the definitive treatment. However, certain circumstances may modify or alter this situation and require the application of exceptional measures. We report a case under our observation who previously had an exploratory abdominal laparotomy for a suspected MD; however, the findings were negative. At that time, the diagnosis was established based on low-level gastrointestinal bleeding and isotopic tests that confirmed the existence of the diverticulum. Given the findings of gamma-graphic exploration and the previous negative surgical exploration, a decision was made to remove the lesion by laparoscopic radioguided surgery. The patient underwent bilateral laparoscopic radioguided surgery using a gamma radiation detection probe. The exploration of the abdominal cavity noted the existence of the diverticulum about 60 to 70 cm from the ileocecal valve. In this way, it was possible to proceed with the resection of the bowel loop and perform an intracorporeal anastomosis termino lateral. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. We believe that the combination of radioguided surgery and single photon emission computed tomography/computed tomography could be useful for treating lesions in locations that are surgically difficult because of the characteristics of the lesion itself or the peculiarities of an individual patient.

The future of research in the treatment of hernia is directed mainly in two ways. The first is in genetic research, focusing on the goal of preventing the occurrence of hernia. The second (and more realistic), addresses the introduction of a new generation of biomaterials and surgical techniques that minimize aggression hernia repair, reduce surgical time and facilitate post-operative recovery of these patients. In this second line of action appear the most important advances in the field of minimally invasive techniques and materials used to repair the hernia pathology. The development of materials currently employed in hernia surgery has focused almost entirely on improvements on the screens, coatings and methods of fixation. The point has been reached of trying to unite these concepts, creating new self-adhesive mesh, coated meshes of various substances that incorporate improvements in both fields of research.

Introduction The burden of chronic obstructive pulmonary disease (COPD) in post-acute/long-term care (PA/LTC) settings is high, and many patients do not receive guideline-recommended care. Methods An interprofessional expert panel of PA/LTC professionals convened to discuss the unmet medical needs in patients with COPD in PA/LTC settings, and to make recommendations for the assessment of COPD patients to individualize the selection of maintenance treatment. Results Unmet needs observed in patients with COPD are described in addition to new tools for assessing individual patient abilities and appropriate device selection for maintenance treatment. Conclusion COPD management in PA/LTC settings needs to be reevaluated and updated to help reduce exacerbations, hospitalizations, and readmissions.

Lymphomatoid Papulosis (LyP) is a rare disorder characterized by a self-healing eruption of papules and small nodules with histopathologic features mimicking a cutaneous T-cell lymphoma CD 30+. We report a 15-year-old girl with CD8+ T-cells, an unusual phenotype in this disease. The clinical and pathological differential diagnoses are discussed.

La educación médica ha incorporado un componente psiquiátrico, o de salud mental, de manera más consistente en el curso de las últimas décadas, merced a factores tan variados como los avances de la investigación neurobiológica, la creciente prevalencia de trastornos mentales en el escenario de la salud global, la cada vez más estrecha relación entre salud mental y salud pública, comorbilidades con cuadros médicos e impacto de fenómenos socioculturales en expresiones clínicas, diagnóstico, tratamiento, pronóstico y prevención. Basado en la adquisición de competencias nucleares y principios éticos de aceptación universal, el proceso docente examinado en este artículo postula una enseñanza sustentada en la provisión de experiencias clínicas integradas a través del acopio de información adecuada, el desarrollo de capacidades diagnósticas y sujeción a una amplia variedad de modalidades de evaluación académica de estudiantes y residentes en entrenamiento. Los componentes culturales de la educación psiquiátrica reciben mención especial, proveyéndose ejemplos de su sistemática integración con la adquisición de competencias generales. Las herramientas didácticas incluyen actividades teóricas, prácticas y de supervisión. Se presta particular atención a cómo los postulados de la moderna educación médico psiquiátrica, incluidos sus aspectos culturales y la práctica de una atención médica integral como objetivos, pueden y deben tener vigencia en los países latinoamericanos., Medical education has incorporated psychiatric or mental health components more consistently during the last decades thanks to various factors such as: advances in neurobiological research; the increasing prevalence of mental disorders in global health; the increasingly close relationship between mental health and public health; comorbidities with medical conditions and the impact of sociocultural phenomena in clinical manifestations, diagnosis, treatment, prognosis and prevention. Based on acquisition of core competencies and ethical principles of universal acceptance, the teaching process examined in this article proposes an education based on the provision of clinical experiences integrated throughout the collection of adequate information, the development of diagnostic capabilities, and exposure to a wide variety of forms of academic assessment of students and residents in training. The cultural components of psychiatric education receive special mention; we provide examples of their systematic integration with the acquisition of general skills. The teaching tools include theoretical and applied activities and supervision. Particular attention is paid to how the principles of modern psychiatric medical education, including cultural aspects and practice of holistic health care objectives, can and should be in effect in Latin American countries., Facultad de Ciencias Médicas

This study investigated whether a child's first infection with Cryptosporidium parvum had an acute effect on weight gain. Specifically, the authors compared monthly rates of weight gain between C. parvum-infected and noninfected children. Over a 2-year period (1989-1991), a cohort of Peruvian children aged 0-3 months at recruitment were followed twice weekly for assessment of daily diarrheal status, weekly for C. parvum stool examinations, and monthly for anthropometric measurements. Data on 207 children permitted the authors to examine the effect of C. parvum infection on weight gain. During the 2-year study period, 45% (94/207) of the children became infected with C. parvum for the first time. Weight gain intervals in 57 of the 94 infected children met criteria for analysis. Of these, 63 percent (36/57) were asymptomatic (i.e., had no diarrhea). On average, children with symptomatic cryptosporidiosis gained (i.e., grew) 342 g less (95% confidence interval 167-517) during the first month of infection than did children without diarrhea who were not yet infected. The effect of asymptomatic cryptosporidiosis was less severe: On average, children with asymptomatic infection gained 162 g less (95% confidence interval 27-297) during the first month of infection than did children without diarrhea who were not yet infected. Symptomatic cryptosporidiosis retarded weight gain more than did asymptomatic cryptosporidiosis, but the latter was twice as common. Since asymptomatic cryptosporidiosis is more prevalent, it may have more of an overall adverse effect on child growth in the community than symptomatic cryptosporidiosis.During September 1989-November 1991 in Peru, 207 infants, 0-3 months old at enrollment and living in a periurban shanty town in Lima, were followed to determine whether a child's first infection with Cryptosporidium parvum had an adverse effect on weight gain during the first month of infection and whether poor nutritional status was a risk factor for C. parvum. Infection with C. parvum occurred at least once in 45% (97) of the infants. Median age at onset of a first C. parvum infection was 16 months. The growth interval of only 57 (61%) of C. parvum infected children was evaluated. 36 (63%) children were asymptomatic. The remaining 21 infected children had diarrhea. Children with cryptosporidiosis, whether symptomatic or asymptomatic, gained less weight during the first month of infection than children without cryptosporidiosis. Children with symptomatic cryptosporidiosis gained 184 g less weight during the first month of infection than did children with asymptomatic cryptosporidiosis. Children with symptomatic cryptosporidiosis gained 342 g less during the first month of infection than did children who were not infected with C. parvum and did not have diarrhea. Children with asymptomatic cryptosporidiosis gained 162 g less during the first month of infection than did children who were not infected with C. parvum and did not have diarrhea. The adverse effect of C. parvum on weight gain was strongest in children younger than 12 months. Neither wasting nor underweight was a significant risk factor for C. parvum infection. Stunting tended to increase the risk of C. parvum infection but the effect was not statistically significant. These findings show that C. parvum infection has an adverse effect on growth. Asymptomatic cryptosporidiosis is of special concern, since it was more prevalent and thus probably would have more of an overall adverse effect on child growth in the community.

BACKGROUND Adenoma of the nipple is rare in men. It must be distinguished from a breast carcinoma and from Paget disease. In this sense, immunohistochemistry can be of some help. In women, for instance, immunoexpression of c-erbB-2 favors a diagnosis of Paget disease, according to some studies. Nevertheless, we have not found any studies on HER2/neu status, estrogen receptors, or progesterone receptors in nipple adenoma of male patients. METHODS We present a case of an adenoma of the nipple in a 21-year-old man in which we carried out a wide immunohistochemical study. RESULTS The lesion did not express estrogen receptors, progesterone receptors, or androgen receptors. The HercepTest was negative. Smooth muscle Actin and p63 were remarked in the basal layer of the tumoral tubules, supporting the benignancy of the lesion. CONCLUSIONS This case of adenoma of the nipple in a male shows an immunophenotype that is similar to the ones reported in female patients.

The recent information regarding the healthy properties of virgin olive oil phenols and the interest in increasing the value of byproducts from the oil extraction processs support the standardized development of phenol-enriched olive oil. Accordingly, the aim of this research work was to evaluate strategies for the development of a virgin olive oil enriched with phenolic compounds obtained from olive cake to increase phenolic ingestion without the drawback of a higher calorie intake. For this proposal, different combinations of phenolic extracts were evaluated at a range of concentrations to obtain the best prototype of enriched olive oil. To study the functionality of the phenol enrichments, the total phenolic content and the oxidative stability were determined by the Folin-Ciocalteu and Rancimat tests, respectively. In addition, the phenolic composition and antioxidant capacity (ORAC assay) of the oils were studied. Finally, the stability and potential bioaccesibility of the phenolic fraction of the enriched oils were tested by an in vitro gastrointestinal digestion model. Results of the study showed different strategies to select the best prototype of enriched olive oil, taking into consideration not only their phenolic content but also other important factors such as the feasibility of implementing the preparation process in the food industry.

A case of pancreatic mucinous cystadenocarcinoma (PMC) with two pseudosarcomatous mural nodules (PMN) is described. These nodules have not been previously described in this type of tumor. In ovarian mucinous tumors (OMT), similar nodules have been reported, the nature of which has been discussed in detail. Here the similarity between the tumor described here and ovarian tumors is stressed. The immunohistochemical study carried out disclosed in the nodules strong positive staining for vimentin and moderate positivity for keratin and epithelial membrane antigen. These findings, along with histologic details, favor the epithelial nature of the nodules. It was concluded that the nodules are foci of anaplastic carcinoma with high proliferative cell rate, which could explain the coexpression of vimentin and keratin.

The laparoscopic adrenalectomy is considered as the procedure of choice for the treatment of adrenal hyperplasia and tumor lesions. However, some special situations may limit the use of this method due to the difficulty to locate the gland and perform the lesion excision. We analyze 2 patients of a left adrenal tumor, explaining how they have overcome the difficulties in both situations. The first case was a patient with a history of intra-Abdominal surgery and the other patient suffered from severe obesity. We performed with the use of the gamma probe, and the 2 cases, was of great help to access and glandular localization. The help of gamma probe test was achieved in the surgical bed, that removal was complete. The use of the portable gamma probe facilitated the access to the left adrenal gland as well as conducting the glandular excision without delay, despite the difficulties due to the intra abdominal surgery caused by the previous surgery, and in the case of severe obesity.

Previous studies have shown an increased effect of proton pump inhibitors on intragastric pH in Helicobacter pylori (HP)-infected patients suffering from gastroesophageal reflux disease (GERD). We evaluated the effect of HP infection on healing and symptom relief in GERD patients with erosive esophagitis treated with pantoprazole. Two hundred twenty-seven patients with endoscopically proven reflux esophagitis were treated for 8 weeks with pantoprazole, 40 mg daily. Patients achieving endoscopic healing at that time were treated for 16 weeks more with pantoprazole, 20 mg daily. Healing and symptom relief rates for HP infection were compared. We found complete relief of heartburn in 72.3% of the HP-positive versus 58.8% of the HP-negative group (P < 0.05). Overall prevalence of heartburn at 8 weeks was higher in the HP-negative group (40.3 vs. 25.8%; P < 0.05), with no significant differences in endoscopic healing (overall 80.4%). At 24 weeks of treatment, the symptomatic relapse rate was higher in the HP-negative group (25.9 vs. 10.2%; P < 0.020). At 8 weeks, patients with erosive esophagitis and HP infection exhibited a significantly better response to pantoprazole through complete heartburn relief, with no differences in endoscopic healing rates between the groups. After 24 weeks, the relapse rate was significantly higher in the HP-negative group.

We measured cerebral vasomotor reactivity during normoventilation, hyperventilation (hypocapnia), and breathing of 6% CO2 (hypercapnia) in 20 normal subjects during the hours of 6 to 8 AM, 1 to 3 PM, and 7 to 9 PM. Cerebral vasomotor reactivity was calculated, using transcranial Doppler, as percent change in the mean blood flow velocity of the middle cerebral artery per mm Hg change in end-tidal CO2 during hypocapnia and hypercapnia. Vasomotor reactivity during hypercapnia was lower in the morning (1.72 +/- 0.66 %/mm Hg) than in the afternoon (2.34 +/- 0.74 %/mm Hg, p < 0.01) and evening (2.31 +/- 0.56 %/mm Hg, p < 0.001). Vasomotor reactivity during hypocapnia did not vary significantly during the three periods (2.34 +/- 0.59 %/mm Hg in the morning, 2.43 +/- 0.51 %/mm Hg in the afternoon, and 2.26 +/- 0.52 %/mm Hg in the evening). This reduced morning response to hypercapnia suggests diminished vasodilator reserve during this period, and may be related to the increased stroke risk during the morning hours.

The incidence of tuberculosis has recently risen in Southeast Florida. In order to determine the number and proportion of tuberculosis cases and the characteristics of tuberculosis that might be related to human T-cell lymphotrophic virus-III (HTLV-III) infection, all patients seen by the Dade County Florida Public Health Department-Tuberculosis Clinic during a 6-month period were medically evaluated and screened for HTLV-III antibody by an enzyme-linked immunosorbent assay. Of 71 consecutive patients confirmed to have tuberculosis (70 by culture) during the study period, 22 (31%) were seropositive and 49 (69%) were seronegative for HTLV-III antibody. The seropositive group had a significantly higher proportion of patients who were black, Haitian, and within the age group of 25 to 44 yr. The seropositive group also had a significantly higher rate of mild-to-moderate serum aspartate transaminase elevations (⩽ 5 times normal), tuberculin skin test false negativity, extrapulmonary tuberculosis (especially ly...

Among 150 cases of microscopically proved Pneumocystis carinii pneumonia secondary to the acquired immunodeficiency syndrome (AIDS) seen by our pulmonary service from January 1982 to January 1986, P. carinii presented roentgenographically as a solitary pulmonary nodule in 2 patients (1.3%). It was the sole cause of the nodules as determined by clinical and roentgenographic response to specific drug therapy, examination of specimens obtained at fiberoptic bronchoscopy, and examination of lung specimens obtained at autopsy. In one of the patients, the nodule appeared to develop a large central cavity, which was confirmed at autopsy. In patients with AIDS, a solitary pulmonary nodule with or without cavitation may rarely represent P. carinii pneumonia.

It has been recently established that ictus emeticus originates from mesial temporal lobe structures. We herein report a patient with generalized epilepsy who exhibited ictus emeticus reflexly triggered by intermittent photic stimulation accompanied by generalized photoparoxysmal responses on the electroencephalogram. All seizures and EEG abnormalities ceased after treatment with valproic acid. The occurrence of ictus emeticus in generalized epilepsy is an apparent paradox, better explained by the theory of "secondary temporalization" implying the selective engagement of temporal lobe structures during generalized seizures.

Background As the population ages, bioprosthesis are increasingly being used in cardiac valve replacement. Pericardial bioprosthesis combine an excellent hemodynamic performance with low thrombogenicity, but valve failure associated with calcification remains a concern with these valves. We describe distortion of the bioprosthesis ring as a risk factor for early calcification. Methods A total of 510 patients over the age of 70 years underwent isolated aortic valve replacement with the Mitroflow (A12) pericardial bioprosthesis. Thirty two patients (6,2%) have undergone a second aortic valve replacement due to structural valve dysfunction resulting from valve calcification. In all patients a chest radiography and coronary angiography was performed before reoperation. A 64 Multidetector Computed Tomography (MDCT) with retrospective ECG gating study was performed in four patients to evaluate the aortic bioprosthesis. Results Chest radiography showed in all patients an irregular bioprosthesis ring. At preoperative coronary angiography a distorted bioprosthesis ring was detected in all patients. Macroscopic findings of the explanted bioprostheses included extensive calcification in all specimens. Conclusion There was a possible relationship between early bioprosthetic calcification and radiologic distortion of the bioprosthesis ring.

Aspirin has been reported to induce the adult respiratory distress syndrome (ARDS) in humans. The mechanism of injury appears to be similar to other forms of experimentally induced high-permeability edema in which leukocytes play an important role. In a patient who suffered two episodes of aspirin-related ARDS, bronchoalveolar lavage showed a significant influx of leukocytes. This represents the first reported bronchoalveolar lavage in aspirin-related ARDS, as well as the first documentation of the nonhydrostatic nature of the edema in a patient with recurrence of this entity.