Biomedical subjects
Publications and source records attributed to J M Angulo.
A high index of clinical suspicion; careful culturing of samples from blood, endocervix, urethra, pharynx, skin, synovial fluid and tissue, and rectum; and appropriate antibiotic therapy will rapidly control and prevent more serious complications of disseminated gonococcal infection.
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OBJECTIVES: This study was performed to raise awareness among rheumatologists about two autoimmune disorders associated with long-term minocycline therapy that can coexist in the same patient. We provide an update on the occurrence of these disorders, their main characteristics, and the current knowledge of potential pathogenic mechanisms. METHODS: We searched the medical literature in English indexed in MEDLINE from 1966 through April 1998 for the term minocycline combined with each of the following: autoimmune hepatitis (AIH), chronic hepatitis, lupus, systemic lupus erythematosus (SLE), anti-myeloperoxidase (anti-MPO), arthritis, vasculitis, and toxicity. We also reviewed relevant references cited in the articles our search uncovered. RESULTS: We identified over 60 minocycline-induced cases of SLE and 24 cases of minocycline-induced AIH. Both autoimmune disorders coexisted in the same patient in 12 cases reported in the literature and in one case seen at our clinic. These 13 patients were characterized by symmetrical polyarthralgias/polyarthritis, elevated liver enzymes, and positive antinuclear antibodies (ANA); they also were generally anti-histone-negative, and only two patients had perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA). After withdrawal of minocycline, their symptoms resolved, and abnormal laboratory results normalized or markedly improved. CONCLUSIONS: Although data on the actual prevalence of autoimmune disorders induced by minocycline are not available, numerous case reports or small series deal with such disorders. Probable pathogenic mechanisms for each of these conditions are discussed.
UNLABELLED: The purpose of this project is to determine the role of the retrogade endoscopic dilatation with balloon and derivation using double pig-tail catheter, as inicial treatment for the vesicoureteral junction stenosis in children. As there are no previous paediatric publications, we present the technical details and early results. From August 1994 to December 1995, we have treated 11 children (8 boys and three girls), whose ages were between 4 months and eleven years, with objectivated vesicoureteral stenosis. Six of which were primary obstructive megaureters, and the other five were secondary obstructive megaureters (two were secondary to posterior urethral valves, one to neurogenic bladder, another one to ectopic ureter, and the last one was secondary to previous antirreflux surgery). We have used rigid dilatators and 7 Fr balloons over guide. All the patients have improved from their obstruction (proved by renogram). In six of the cases only one dilatation was needed, and in the other five only two dilatations. Only two patients presented reflux (grade I and IV). CONCLUSIONS: The endoscopic dilatation of the obstructive megaureter in children is possible, and reflux is rare.
We report our experience with the endoscopic treatment of vesicoureteral reflux by submucosal injection of Teflon (STING) in children. Since December of 1992, 45 children and a total of 67 ureters were treated. The overall success rate was 90% after one injection and 95% after two injections. The success rate was better in primary reflux with 95%, 87.5% in duplicated ureters and 75% in secondary reflux after one injection. Actually we treat the reflux grade II and III with STING when it doesn't improve after one year with medical treatment.
We had reviewed our series of 59 patients with intrarenal reflux selected out of 596 diagnosed of vesicoureteral reflux. The number of renal units affected of intrarenal reflux was 74. We divided our patients into two groups, in an attempt to clarify the relationship between renal damage and urinary infection; a group include there was prenatal diagnosis of urinary tract dilatation and another group diagnosed for bacterial infection of urine after birth. Reflux nephropathy were present in 27 renal units; 9 from 30 units (30%) in the prenatally diagnosed group, and 18 from 44 units (41%) in the other group. Reflux nephropathy was diagnosed by intravenous pyelogram and/or radionuclide renogram. We concluded that intrarenal reflux (IRR) is relatively frequent in our population and that 30% of patients prenatally diagnosed had renal damage without urinary infection, landing support to the previously published existence of a prenatal origin for some newborn.
We have studied and measured the duodenogastric reflux in 11 children with chronic abdominal pain and Helicobacter pylori (HP) through 24-hours gastric pH-metric studies. All parameters evaluated: Number of reflux episodes (NR 92.87 +/- 27.66), number of reflux episodes longer than 5.0 minutes (NR > 5M 11.45 +/- 4.68), longest reflux episode (LR 67.37 +/- 45.57) and alkaline reflux area (AA 604.89 +/- 443.54) had significative differences against a normal group (40 children). We concluded that duodenogastric reflux and HP are frequent together.
Twenty-four-hour pH-monitoring of the lower oesophagus is the best test for diagnosis of gastro-oesophageal reflux (GER) because it is the only one allowing its quantification. Unfortunately, it is limited by the fact that acid exposure is not the only mechanism by which GER harms the oesophagus. In the last 12 months we have introduced in our Institution simultaneous oeso-gastric pH-metering using a double-channel recorder and gastric and oesophageal electrodes. This procedure enables us to know when gastric pH turns alkaline because od diet, mucus, hypoacidity or duodeno-gastric reflux (DGR) to the point of making oesophageal pH-metering useless. We report 7 illustrative cases of GER with prolonged episodes of gastric alkalinization leading to oesophageal pH-metering false negatives. In the near future, double pH-metering will very probably modify our current interpretation of conventional tracings.
We have retrospectively studied 163 newborns referred to us between 1986 and 1990 for sonographic diagnosis of intra-uterine upper urinary tract enlargement. All were studied by paediatric radiologists on days 5th or 6th after birth by means of sonography and voiding cystourethrogram (VCU). Fifty percent had also IVP. No urinary tract disease could be found in 44 children, obstructive uropathy or cystic disease were diagnosed in 58 children and 61 patients had vesico-ureteric-reflux (VUR). They form the basis of the present report. There was a male-to-female ratio of 3.3 to 1. Neonatal ultrasonography was normal in 11 cases, 42 had pyelectasia (bilateral in eight cases) and eight had ureterohydronephrosis (bilateral in seven). VUR was bilateral in 28 cases, right in 16 and left in 17. Out of the 89 refluxing units, VUR grade was I in 11, II in 16, III in 24, IV in 14 and V in 23. There was intra-renal reflux in 17 units. Some other form of urinary tract disease was detected in 29 babies (47.5 per 100). Twenty-eight patients were operated upon and the remaining are under long-term urinary antisepsis with only five episodes of infection. The considerable proportion of false negatives for VUR in neonatal ultrasonography (30 per 100) and the high grade of some of these cases lead us to strongly advise routine VCU for patients with intra-uterine urinary tract dilatation.
Extended esophageal pH-metering is the best method for GER diagnosis, but it has a certain number of false negatives. In a attempt to judge in which extent we can indicate surgery with a "normal" pH-metering study, we have reviewed our 110 operated children since 1982, and selected 12 in whom pH studies were normal. There where five females and seven males with ages ranging between 18 and 90 months. The clinical course until the diagnosis was accepted was long. Nine patients had vomiting, five respiratory disease, six dysphagia, four anemia and three torticollis. Only two were malnourished. There was radiologic GER in all children (with only one hiatal hernia). In spite of "normal" pH-metering, eight had decreased lower esophageal sphincter, and 11 disturbed motility. Nine had endoscopic esophagitis and eight histologic esophagitis. After operation, indicated only after long periods of medical treatment, vomiting disappeared in all, and so did respiratory disease and torticollis. Five families were very satisfied, six rather satisfied (gas bloat syndrome) and one frankly dissatisfied (dysphagia with severe immotility). Based on this evidence, we believe that some limited indications for surgery in GER are acceptable even in the presence of "normal" pH-studies.
We report on seven simple, orthotopic, adult-type ureteroceles (UTC) treated in five children (four boys). Urologic work-up was indicated for either prenatal diagnosis of urinary dilatation (three children) or urinary infection (two children). all patients had ureterohydronephrosis with acceptable renal function. There was VUR in one instance. Five ITC in three patients were treated by endoscopic meatotomy or surgical incision with diathermy electrode. In two other instances (two UTC) ureterocelectomy and ureteroneocystostomy were performed. The results were good: all patients treated endoscopically had their excretory system dilatation improved and are asymptomatic. One child has well-tolerated grade III VUR. The two reimplanted children are cured. UTC treatment should be individualized. Meatotomy (or endoscopic incision) can cure UTC and is a good approach in the newborn, when bladder size makes ureteroneocystostomy delicate. When VUR ensues it can be corrected later on in a conventional way.
In the last nine years we have operated upon six children (eight males and two females) with primary omental pathology. The age of our patients ranged from five to eleven years with the exception of a newborn prenatally diagnosed of lymphangioma. All the remaining children had abdominal pain and right iliac tenderness for an average of two days. All had leukocytosis and left shift. Vomiting and fever were present only in one instance. In no case the mass was palpated preoperatively. The initial diagnosis was acute appendicitis in all cases. A patient suffered, one year after operation, a second acute clinical picture and the omental mass could be revealed [correction of decealed] preoperatively. At operation there was free intraperitoneal fluid in six instances (three times bloody, two times clear and one purulent). Surgical findings (nine operations) were: three omental segmental infarctions (primary in two cases and secondary to torsion in one), three segmental epiploitis in two patients (one acute, one chronic, one secondary to foreign body), two cystic lesions (one lymphangioma, one hydatic cyst) and one benign tumor (fibromatosis).
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A group of 23 patients with Fasciola hepatica have been studied in the province of Biscay. The diagnosis was reached after finding parasite eggs in the faeces or duodenal juice. The liver lesion was confirmed by means of macro and microscopic studies. Radiocolloid demonstrated the presence of cold areas in 18 patients; in 13 of them the uptake with 67Ga was positive. These isotopic findings identified Fasciola hepatica as one of the causes of 'cold areas' in traditional liver scans and positive 67Ga uptake.
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