Biomedical subjects
C Domingo
Publications and source records attributed to C Domingo.
[Bronchiolitis obliterans organizing pneumonia: the usefulness of the transbronchial biopsy as a diagnostic technic].
Bronchiolitis obliterans organizing pneumonia (BOOP) is a recently described entity characterized by cough, fever and dyspnea. To date, only a few cases have been published in the literature. Currently, the diagnosis is established by open lung biopsy. We hereby present a case of BOOP diagnosed through transbronchial biopsy (TBB); we discuss the potential benefits of the thoracic radiography and computerized tomography scan (CT scan). Finally, we underline that in our patient, the bronchoalveolar lavage fluid (BAL) restored to normal before the resolution of the radiological images.
[A "ground-glass" computerized tomography image in an HIV-positive patient with a febrile syndrome].
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Evaluation of laboratory assays for screening antibody to hepatitis C virus.
An evaluation study, involving 11 screening methods for the detection of antibody to hepatitis C virus (anti-HCV) and a panel of 500 serum samples, was performed. Samples were tested by all 11 methods, and those showing reactivity in at least one method were studied by a combination of supplemental assays (recombinant immunoblot assays, first and second generation; neutralization test for anti-c100; synthetic peptide immunoblot assay; recombinant multi-dot immunoassay) and classified as positive (110 samples), indeterminate (4 samples), or negative (386 samples) on the basis of the results obtained. Second-generation recombinant methods performed better on positive samples than first-generation assays or synthetic peptide-based methods (99.1-100% correlation vs. 64.5-85.5% and 93.6-99.1%, respectively), whereas the latter showed higher correlations on negative samples than recombinant assays (97.4-99.7% vs. 82.4-93%). Further investigations, using broad panels of indeterminate samples from blood donors, should be done, however, before synthetic peptide-based methods are recommended for blood bank screening. Reactivity of samples must be confirmed by one supplemental test in all cases before the donor is informed. In some cases, it may require the use of two or more different tests to obtain definite conclusions.
Pulmonary parenchymal perforation as a complication of placement of a nasoenteric tube.
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Treatment of Legionnaires' disease. Current recommendations.
Legionnaires' disease is a relatively common cause of community-acquired pneumonia and of some outbreaks of hospital-acquired pneumonia. Moreover, Legionella pneumophila is frequently involved in the aetiology of the subset of pneumonias that is characterised by severe clinical course and high mortality. No sure clinical, radiographical or analytical features are useful in differentiating Legionella infection from other aetiologies of pneumonia. On the basis of these data, a rational initial therapeutic approach to community-acquired pneumonia, as well as to nosocomial pneumonia in certain circumstances, has to include an antimicrobial agent that is clinically effective against Legionella spp. Clinical studies have provided evidence that erythromycin is the first-line treatment. An intravenous dosage of 1g every 6 hours as initial therapy will be effective in most cases. Parenteral treatment may be switched to oral administration only after clinical response is observed. In vitro susceptibilities and preliminary experimental and clinical results suggest that clarithromycin will most likely become the preferred treatment once an intravenous preparation is available worldwide. However, orally administered clarithromycin at the dosage of 500 mg every 12 hours may be recommended in those developing countries in which health systems cannot afford the costs of intravenous therapy. In the case of clinically severe illness or in seriously immunosuppressed hosts with confirmed legionellosis, a combined therapeutic approach is warranted. Rifampicin 600 mg every 12 hours intravenously or orally has to be added to the usual dosage of erythromycin. Other alternative therapies, but with less distinct clinical efficacy, that can be combined with erythromycin are doxycycline 100 mg every 12 hours intravenously or orally, and intravenous ciprofloxacin 200 mg every 6 hours.
Myocarditis: a rare complication during Legionella infection.
Legionella often causes systemic manifestations. The clinical spectrum now includes cardiac legionellosis. The first case of myocarditis was reported by Gross in 1981. To date few additional cases have been described. Myocardial involvement might be more frequent than supposed in legionnaires' disease.
Pulmonary capillary hemangiomatosis: report of a case and review of the literature.
We describe a case of pulmonary capillary hemangiomatosis in a 60-year-old woman with a 1-year history of progressive exertional dyspnea. Four years before admission a diagnosis of breast cancer was made, and she underwent mastectomy plus radiation therapy and treatment with oral antiestrogens. The chest X-ray showed bilateral interstitial infiltrates. Pulmonary function studies revealed a severe restrictive pattern. Abundant red blood cells were found in the bronchoalveolar lavage fluid. On the basis of open lung biopsy, interstitial fibrosis was diagnosed. Cardiac catheterization revealed pulmonary hypertension. Steroids were prescribed, but the patient's condition continued to deteriorate and she died approximately 3 years after presentation. The identification of proliferating and invasive capillaries, which are unique to pulmonary capillary hemangiomatosis, led to the correct diagnosis at autopsy.
Acute eosinophilic pneumonia due to toxocariasis with bronchoalveolar lavage findings.
A previously healthy young man presented with breathlessness, diffuse pulmonary infiltrates on the chest x-ray film, and a high degree of peripheral blood eosinophilia. Analysis of bronchoalveolar lavage (BAL) fluid showed 64 percent eosinophils. A diagnosis of toxocariasis was eventually reached on the basis of a positive enzyme-linked immunosorbent assay (ELISA) for Toxocara canis. The routine performance of the ELISA test for Toxocara in the diagnostic approach to pulmonary infiltration with eosinophilia could reveal an undetermined, sometimes unsuspected, number of cases of adult toxocariasis with pulmonary involvement. A high degree of eosinophilia in the differential cell count of BAL fluid may eventually prove to be a useful clue in favor of such a diagnosis.
The patterning and functioning of protrusive activity during convergence and extension of the Xenopus organiser.
We discuss the cellular basis and tissue interactions regulating convergence and extension of the vertebrate body axis in early embryogenesis of Xenopus. Convergence and extension occur in the dorsal mesoderm (prospective notochord and somite) and in the posterior nervous system (prospective hindbrain and spinal cord) by sequential cell intercalations. Several layers of cells intercalate to form a thinner, longer array (radial intercalation) and then cells intercalate in the mediolateral orientation to form a longer, narrower array (mediolateral intercalation). Fluorescence microscopy of labeled mesodermal cells in explants shows that protrusive activity is rapid and randomly directed until the midgastrula stage, when it slows and is restricted to the medial and lateral ends of the cells. This bipolar protrusive activity results in elongation, alignment and mediolateral intercalation of the cells. Mediolateral intercalation behavior (MIB) is expressed in an anterior-posterior and lateral-medial progression in the mesoderm. MIB is first expressed laterally in both somitic and notochordal mesoderm. From its lateral origins in each tissue, MIB progresses medially. If convergence does not bring the lateral boundaries of the tissues closer to the medial cells in the notochordal and somitic territories, these cells do not express MIB. Expression of tissue-specific markers follows and parallels the expression of MIB. These facts argue that MIB and some aspects of tissue differentiation are induced by signals emanating from the lateral boundaries of the tissue territories and that convergence must bring medial cells and boundaries closer together for these signals to be effective. Grafts of dorsal marginal zone epithelium to the ventral sides of other embryos, to ventral explants and to UV-ventralized embryos show that it has a role in organising convergence and extension, and dorsal tissue differentiation among deep mesodermal cells. Grafts of involuting marginal zone to animal cap tissue of the early gastrula shows that convergence and extension of the hindbrain-spinal cord are induced by planar signals from the involuting marginal zone.
Effect of oxygen therapy on increasing PaO2 in hypoxemic patients with stable COPD while breathing ambient air.
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Radiographic appearance of nosocomial legionnaires' disease after erythromycin treatment.
Radiographic features of 71 patients (48 men, 23 women) with nosocomial Legionella pneumophila pneumonia were assessed and compared with those of other nosocomial series of L pneumophila pneumonia. Sixteen patients were assessed retrospectively and 55 prospectively. Chest radiographs were assessed at the onset of the illness, 10 days later, and at 3 months. Erythromycin was given to 67 patients at the time of the diagnosis and to the remaining four at a later stage. Forty eight patients were over the age of 60. On the initial chest radiograph 53 of the 71 patients had unilateral shadowing (23 of them in the right lung); 35 had unilobar shadowing and the remaining 36 had more than one affected lobe. Pleural effusion was present in 24 cases and cavitation in 2. One patient had evidence of a pericardial effusion. At 10 days 21 patients had evidence of radiographic progression (14 ipsilateral), but 28 had improved. At 3 months 36 patients had an abnormal radiograph, 30 showing residual scarring, 15 loss of volume, six pleural shadows and two cavitation. Our series shows a lesser incidence of unilateral shadowing and pleural effusion than other nosocomial series and a lesser tendency to progression, but more patients had radiographic abnormalities at long term follow up.
Spatial and temporal changes in the distribution of proteoglycans during avian neural crest development.
In this study, we describe the distribution of various classes of proteoglycans and their potential matrix ligand, hyaluronan, during neural crest development in the trunk region of the chicken embryo. Different types of chondroitin and keratan sulfate proteoglycans were recognized using a panel of monoclonal antibodies produced against specific epitopes on their glycosaminoglycan chains. A heparan sulfate proteoglycan was identified by an antibody against its core protein. The distribution of hyaluronan was mapped using a biotinylated fragment that corresponds to the hyaluronan-binding region of cartilage proteoglycans. Four major patterns of proteoglycan immunoreactivity were observed. (1) Chondroitin-6-sulfate-rich proteoglycans and certain keratin sulfate proteoglycans were absent from regions containing migrating neural crest cells, but were present in interstitial matrices and basement membranes along prospective migratory pathways such as the ventral portion of the sclerotome. Although initially distributed uniformly along the rostrocaudal extent of the sclerotome, these proteoglycans became rearranged to the caudal portion of the sclerotome with progressive migration of neural crest cells through the rostral sclerotome and their aggregation into peripheral ganglia. (2) A subset of chondroitin/keratan sulfate proteoglycans bearing primarily unsulfated chondroitin chains was observed exclusively in regions where neural crest cells were absent or delayed from entering, such as the perinotochordal and subepidermal spaces. (3) A subset of chondroitin/keratan sulfate proteoglycans was restricted to the perinotochordal region and, following gangliogenesis, was arranged in a metameric pattern corresponding to the sites where presumptive vertebral arches form. (4) Certain keratan sulfate proteoglycans and a heparan sulfate proteoglycan were observed in basement membranes and in an interstitial matrix uniformly distributed along the rostrocaudal extent of the sclerotome. After gangliogenesis, the neural crest-derived dorsal root and sympathetic ganglia contained both these proteoglycan types, but were essentially free of other chondroitin/keratan-proteoglycan subsets. Hyaluronan generally colocalized with the first set of proteoglycans, but also was concentrated around migrating neural crest cells and was reduced in neural crest-derived ganglia. These observations demonstrate that proteoglycans have diverse and dynamic distributions during times of neural crest development and chondrogenesis of the presumptive vertebrae. In general, chondroitin/keratan sulfate proteoglycans are abundant in regions where neural crest cells are absent, and their segmental distribution inversely correlates with that of neural crest-derived ganglia.
Pulmonary mass and air meniscus sign in a 19-year-old man.
Sacrococcygeal teratoma is rarely diagnosed in adults. Pulmonary mass as the presenting clinical form of the malignant variety of this germ-cell tumor is exceptional. We report herein such a case with the noticeable peculiarity of showing the air meniscus sign on chest roentgenographic examination.
Comparative study of Legionella pneumophila and other nosocomial-acquired pneumonias.
We studied, in a prospective way, the characteristics of definitively diagnosed nosocomially acquired pneumonias in our hospital over 36 months. Out of 55 cases, 27 were due to Legionella pneumophila and 28 to other, non-Legionella bacteria. The cases of legionellosis concentrated in July, August, and December. The only risk factors that showed significant differences (p less than 0.05) were general anesthesia and surgery and immunosuppressive disease, which were more frequent in the non-Legionella group, as were chronic liver disease and lowering of consciousness level. The absence of severe underlying disease, chronic or not, was uncommon in both groups, but more frequent in the Legionella group. We observed no differences in the clinical features of the two groups. Mean values of gamma-glutamyltranspeptidase and total bilirubin were higher (p less than 0.05) in the non-Legionella group. The only x-ray data that showed significant difference were pleural effusion, more frequent in the non-Legionella group (p less than 0.02). The mortality rate of legionellosis was 14.6 percent compared to 35.7 percent for the non-Legionella group (p less than 0.05). We conclude that a sure differential diagnosis based on clinical, roentgenographic and analytical features of both groups is not possible. The relatively low mortality rate of the Legionella group, when compared to other series of nosocomial legionellosis, could be due to the standard use of erythromycin in the therapeutic approach to nosocomial-acquired pneumonia in our hospital.
[The transtracheal catheter: an open door to modern continuous oxygen therapy at home].
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Tuberculosis of the breast: a rare modern disease.
A case of mammary tuberculosis is reported. A communication between the axillary glands and the breast emphasises Cooper's theory that the breast becomes secondarily involved by lymphatic extension. Involvement of other organs by acid-fast bacilli could not be demonstrated. A relapse occurred sixteen months after a 6-month course of treatment with rifampicin, isoniazid, ethambutol and pyrazinamide.
Pericardial effusion as a clinical sign of Legionnaires' disease.
Legionnella often causes systemic manifestations. The clinical spectrum now includes cardiac legionnellosis. The first case of pericardial effusion was reported in September, 1981. To date, few additional cases have been reported. We hereby report a case of asymptomatic pericardial effusion with simultaneous pulmonary involvement. Pericardial involvement, if sought, would probably be more frequent than supposed in Legionnaires' disease.