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ABSTRACT: We present a case of giant cavernous hemangioma in renal graft tumor; we have not found any cases described in literature.
Patient transplanted from a deceased donor, 8 years previous to her admission due to deterioration in renal function, observing a 12-cm renal mass in the front face of the renal graft, which displaces it, provoking obstructive uropathy. On ultrasonography and computed tomography, it is seen as a complicated, cystic lesion. Tumorectomy with a good functional recovery of the graft was carried out. A histopathologic study showed a mass with extensive adherences to the perirenal adipose tissue and a cross section showed a spongy appearance with blood clots in the centre, microscopically formed by vascular channels, lined by a layer of endothelial cells, and filled with blood.
Giant cavernous hemangioma in renal graft tumor has not been previously described. Given its benign condition, nephron-sparing surgery should be carried out if possible.
Transplantation Proceedings 06/2012; 44(5):1453-6. · 1.00 Impact Factor
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Journal of the International AIDS Society 05/2012; 13:1-1. · 3.26 Impact Factor
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ABSTRACT: Purpose: HIV-infected patients treated for syphilis may be at increased risk for serological failure and serofast state. Our aim was to analyse serological response to treatment in HIV-infected patients diagnosed with syphilis, and factors associated with serological cure and serofast state. Methods: Open-label, no controlled study of a series of HIV-patients diagnosed with syphilis during 2004-2011. Patients were categorized by rapid plasma reagin titer (RPR) into success (4-fold decrease in RPR by 12 or 24 months after treatment of early or late syphilis), serofast (success with persistently stable reactive RPR), and failure/re-infection (failure to decrease 4-fold in RPR by 12 or 24 months after treatment or sustained 4-fold increase in RPR after treatment response). Results: 141 HIV-patients were diagnosed with syphilis during the study period (104 early syphilis, 36 late or indeterminate latent syphilis). The mean age was 36.3 years, 98.5% were male, and 87.2% homosexual men. In 46 (32.6%) cases, HIV and syphilis infection diagnosis were coincident (mean CD4 457/mm3 and HIV-VL 4.72 log10). Among patients with prior known HIV infection, 65 were on antiretroviral therapy (ART) at syphilis diagnosis (mean CD4 469/mm3, 76.9% undetectable HIV-VL). 116 patients satisfied criteria for serological response analysis (89 early, 24 late/indeterminate). At 12 months of early syphilis treatment (89.2% penicillin) there were 16 (18%) failures, and at 24 months of late/indeterminate syphilis (91.7% penicillin) there were 5 (18.5%) failures. Overall, 36 (31.0%) patients presented serofast state. Treatment failure was related with lower CD4 count (295 vs 510/mL; p=0.045) only in patients with coincident diagnosis. Serofast state was related with older age (41 vs 36 years; p=0.024), and lower CD4 count (391 vs 513/mm3; p=0.026). Conclusions: In this series of HIV-infected patients, with many patients on ART and with good immunological and virological parameters, serological failure and serofast state were frequent. Immunological status, and age could influence on serological response to syphilis treatment in HIV-infected patients.
Journal of the International AIDS Society 01/2012; 15(6):18106. · 3.26 Impact Factor
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ABSTRACT: Purpose: Iron overload (IO) has been associated with increased cardiovascular risk (CVR) and metabolic syndrome (MS) in the general population; both elevated CVR and MS are frequent in HIV-patients. Our aim was to analyze the prevalence of IO in a cohort of asymptomatic patients with HIV infection, and related factors. Methods: Cross-sectional study of a cohort of HIV outpatients in regular follow-up. Demographic, epidemiological, clinical, analytical and therapeutic data were collected. Patients completed a questionnaire about CVR factors and 10-year CV disease risk estimation (Framingham score), underwent a physical exam, and a fasting blood analysis. IO was defined as a plasma ferritin level higher than 200 μ/L in women and 300 μ/L in men. Results: 571 patients (446 men, 125 women), with a mean age of 43.2 years, sexual transmission of HIV in 68.5%, median CD4 count 474 cell/μL (IQR: 308-666), and 36.3% Aids cases. 86.2% were on antiretroviral therapy (ART), and 74.8% of them had undetectable HIV viral load. 14.6% met MS criteria, and mean CVR at 10 years was 6.67%. IO was detected in 11% of cases. Patients with IO were more immunosuppressed (CD4 count 369 vs 483/μL, p<0.0001), presented a higher prevalence of detectable HIV viral load (17.6% vs 8.9%; p<0.005), and of Aids cases (14.9% vs 8.7%; p<0.023), and lower plasma levels of cholesterol, HDLc and LDLc (154 vs 183, 34 vs 43, 93 vs 110 mg/dL, respectively; p<0.0001. In the multivariate analysis, the only related factor was CD4 count <350 cell/μL (OR 2.86, 95% CI 1.6-4.9; p<0.0001). IO was not associated with CVR nor with MS. Conclusions: IO is not uncommon in HIV patients, and it is only related with immunosuppression defined as CD4 count <350 cell/μL, and in contrast to general population, it is not related with increased CVR nor with MS.
Journal of the International AIDS Society 01/2012; 15(6):18304. · 3.26 Impact Factor
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ABSTRACT: Among 200 isolates of Shigella from patients with travellers' diarrhoea, 12 isolates (four isolated in 1995-2000 and eight in 2001-2004) exhibited quinolone resistance. Nine of these isolates originated from India. These resistant isolates had at least one amino-acid substitution in GyrA. Quinolone resistance is increasing in Shigella spp. causing travellers' diarrhoea, and particularly among isolates causing diarrhoea in travellers returning from India.
Clinical Microbiology and Infection 04/2008; 14(3):279-81. · 4.54 Impact Factor
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ABSTRACT: Amikacin-resistant Escherichia coli strains are isolated rarely from clinical samples. In the present study, investigation of an amikacin-resistant clinical isolate of E. coli demonstrated the presence of two class 1 integrons carrying the aacA4 gene plus the aacA7 gene, and the dfrA17 gene plus the aadA5 gene, respectively. Resistance to amikacin in this E. coli isolate was related to the presence of both aacA4 and aacA7.
Clinical Microbiology and Infection 02/2005; 11(1):71-3. · 4.54 Impact Factor
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ABSTRACT: The aim of this study was to determine the roles of mutations in the gyrA and parC genes and the overexpression of efflux pump(s) as mechanisms of resistance to quinolones. Forty-five Yersinia enterocolitica O:3 clinical isolates (41 nalidixic acid-resistant, three nalidixic acid-susceptible and one nalidixic acid-resistant strain obtained in vitro) were analysed.
All the nalidixic acid-resistant strains showed mutations in the gyrA gene and none in the parC gene. The presence of the inhibitor produced decreases in the MIC values of nalidixic acid by two to six serial dilution steps in 37 of the 41 nalidixic acid-resistant strains. Meanwhile, the MIC value of ciprofloxacin was affected in two strains whose values diminished three serial dilution steps. The nalidixic acid-resistant mutant obtained in vitro was also affected by the inhibitor decreasing the MIC value of nalidixic acid three serial dilutions steps whereas the MICs for the nalidixic acid-susceptible strains were not affected.
Our results show that the high level of resistance to nalidixic acid is likely due to an overexpression of an efflux pump plus a mutation in the gyrA gene, whereas decreased susceptibility to ciprofloxacin is only associated with the presence of a mutation in the gyrA gene.
Journal of Antimicrobial Chemotherapy 07/2004; 53(6):1068-71. · 5.07 Impact Factor
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ABSTRACT: Mastitis is a serious problem for sheep and rabbit farms, Staphylococcus aureus being the main causal agent. Fifty strains of S. aureus isolated from sheep and rabbits from farms located in diverse geographical regions of Spain were studied. Their resistance pattern and plasmid profile was related to the pulsotypes obtained by pulsed-field gel electrophoresis (PFGE). The results showed great heterogeneity in staphylococci isolated from sheep, both in pulse-type and plasmid profile. We found in addition, antibiotic-resistant strains and aminoglycoside-modifying enzyme (AGMEs) producer strains. The genotypes corresponding to staphylococci isolated from rabbits were less heterogeneous, although they also could be subdivided by plasmid profile and resistance patterns. Resistance to antibiotics such as methicillin or AGMEs production could indicate possible human origin of the strains or a possible source of resistant strains for human beings.
International Journal of Antimicrobial Agents 04/2004; 23(3):268-72. · 4.13 Impact Factor
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ABSTRACT: The prevalence and characterization of Class 1 integrons has been performed in eighty three strains of Shigella spp., isolated between 1995 and 2000 from patients with traveler's diarrhea. A low prevalence (13.25%) was recorded. Nine different integrons were found among 11 multiresistant strains, with a total of 10 different gene cassettes encoding for resistance to trimethoprim (dfrA1, dfrA5, dfrA7, dfrA12, and dfrA15), aminoglycosides (aadA1a and aadA2), beta-lactam antibiotics (oxa2) or ORF with unknown function (orfD and orfF). A high prevalence of dfr and aad gene cassettes was observed. The low incidence of Class 1 integrons observed in this study is in contrast with the known facility that the Shigella genus has to gain and transfer plasmids.
Diagnostic Microbiology and Infectious Disease 04/2004; 48(3):175-9. · 2.53 Impact Factor
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ABSTRACT: Antibiotic resistance in clinical isolates of Salmonella typhimurium has steadily risen in recent years. Some of the resistance genes may be carried into integrons. In this study, integrons, both from 10 epidemiologically related and unrelated S. typhimurium clinical isolates, were characterized, showing that epidemiologically different strains can carry the same integron, and that epidemiologically related strain can carry different integrons. Among the resistance genes detected in this study were genes encoding b-lactamases (bla(oxa-30) in two strains, and bla(pse-1) in five strains, one of which was carrying this cassette in two different integrons); aminoglycoside-modifying enzymes (aadA2 in four strains, one of which was carrying this cassette in two different integrons, and aadA1 in six strains); as well dihydrofolate reductases (dfrAI in three strains).
Revista espanola de quimioterapia: publicacion oficial de la Sociedad Espanola de Quimioterapia 01/2004; 16(4):398-402. · 0.81 Impact Factor
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ABSTRACT: To determine whether non-epidemiologically related, antibiotic-resistant isolates of Acinetobacter baumannii from different geographical origins possess common type 1 integrons.
The epidemiologic relationships between seven A. baumannii strains recovered from different Spanish hospitals were established by pulsed-field gel electrophoresis, the presence of integrons being determined by PCR and DNA sequencing.
Integron analysis showed the presence of four different integrons, containing six different known genes (aacC1, aacA4, aadA1, aadB, oxa21 and oxa37) plus an ORF. It was found that the same integron was present in different unrelated strains and that related strains could have different integrons.
These results show the potential risk of integron dissemination among different strains of A. baumannii.
Clinical Microbiology and Infection 10/2003; 9(9):907-11. · 4.54 Impact Factor
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ABSTRACT: To study the activity of five different fluoroquinolones against 22 epidemiologically related and unrelated strains of Staphylococcus aureus (13 methicillin-resistant (MRSA) strains and nine methicillin-susceptible (MSSA) strains) in which the mechanisms of quinolone resistance are also investigated.
The MICs of the different fluoroquinolones were determined by the microdilution method, in the presence and absence of reserpine. The quinolone resistance-determining regions of the gyrA, gyrB, grlA and grlB genes were amplified and sequenced to establish the presence of mutations. The molecular epidemiology of the 22 strains was performed by low-frequency restriction analysis of chromosomal DNA with SmaI.
MSSA strains showed lower homology than MRSA strains, in which only two clones were seen. Trovafloxacin showed the best activity against these clinical isolates of S. aureus, since strains carrying one amino acid change in both GyrA and GrlA subunits remained susceptible to this antimicrobial agent. Furthermore, trovafloxacin did not seem to be a substrate for NorA.
Trovafloxacin was the most active quinolone tested against S. aureus strains, followed by levofloxacin and sparfloxacin, whereas ciprofloxacin and norfloxacin were the least active quinolones, in both the presence and absence of reserpine. Epidemiologically related S. aureus strains presented different mechanisms of quinolone resistance, suggesting a divergent evolution of the same clone. Finally, 16 S. aureus strains with a ciprofloxacin plus reserpine MIC > or = 1 mg/L already showed a mutation in the grlA gene. This MIC may be useful as a marker of mutation in this gene, contraindicating the use of this quinolone, since a second mutation may develop during treatment.
Clinical Microbiology and Infection 12/2002; 8(12):781-90. · 4.54 Impact Factor
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ABSTRACT: Neutron strain scanning has been performed on a neutectoid steel rod at a reactor-based source (REST diffractometer, at NFL) and at a pulsed source (ENGIN diffractometer, at ISIS). The rod is primarily obtained from a drawing process and has been subject to bending and straightening procedures, which induce residual stress. The material exhibits a pearlitic microstructure, with alternating ferrite (90 vol %) and cementite (10 vol %) layers. Strain profiles for the ferritic phase were measured on REST. Both phases were measured on ENGIN and analysed by single-peak (ferrite) and Rietveld refinement (ferrite and cementite) methods. The agreement between REST and ENGIN data is excellent for the three measured directions in the ferritic phase. Total stress profiles have been evaluated by combining phase stresses using the rule of mixtures. The experimental results compare well with analytical models for a two-phase material subject to bending and straightening operations under pure bending and unbending moments with perfect elastic behaviour up to the yield point and plastic Voce behaviour above.
Applied Physics A 01/2002; 74:s1679-s1682. · 1.63 Impact Factor
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ABSTRACT: Enteroaggregative Escherichia coli (EAggEC) isolates were identified as a cause of traveller's diarrhoea in 50 (9%) of 517 patients and their antimicrobial susceptibility was determined. Molecular epidemiological characterisation and investigation of the mechanisms of acquisition of quinolone resistance among nalidixic acid-resistant EAggEC strains was performed. Seventeen (34%) of 50 patients needed antimicrobial therapy, because of persistence of symptoms in nine cases and the severity of symptoms in eight cases. Ampicillin and tetracycline resistance was high, whereas chloramphenicol and co-trimoxazole showed moderate activity and amoxicillin plus clavulanic acid, nalidixic acid and ciprofloxacin showed very good activity. Resistance to nalidixic acid was demonstrated in three isolates, two from patients who had travelled to India. In all three strains the resistance was linked to mutations in the gyrA gene alone or in both gyrA and parC genes. Although ciprofloxacin shows excellent in-vitro activity and could be useful in the treatment of traveller's diarrhoea in patients travelling abroad, it may not be useful in patients who have journeyed to India or to Mexico.
Journal of Medical Microbiology 12/2001; 50(11):996-1000. · 2.50 Impact Factor
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ABSTRACT: Quinolone-resistant (QR) Escherichia coli may have lower invasive capacity than does quinolone-susceptible E. coli. To evaluate this, we prospectively collected data regarding all cases of E. coli invasive urinary tract infections (IUTI) in 669 adults admitted to the Infectious Diseases Unit of our hospital during a 3-year period, as well as 10,950 patients with cystitis or asymptomatic bacteriuria who presented to the outpatient clinic during a 1-year period. QR E. coli was isolated in 20% of patients with cystitis, compared with 8% of those with IUTI (P<.05). The proportion of E. coli isolates that were quinolone resistant was similar in patients with bacteremic and nonbacteremic IUTI. The factors of urinary manipulation and structural abnormalities were independently associated with the presence of quinolone resistance. Old age was the only variable independently associated with blood invasion. QR E. coli is less likely to produce invasive disease (pyelonephritis and prostatitis) than is quinolone-susceptible E. coli. However, once pyelonephritis or prostatitis have developed, there is no difference in the incidence of bacteremia.
Clinical Infectious Diseases 11/2001; 33(10):1682-6. · 9.15 Impact Factor
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ABSTRACT: We studied the frequency of mutation of clinical isolates of Neisseria gonorrhoeae (two nalidixic acid susceptible and two nalidixic acid resistant), and the stability of the mutants obtained, in the presence of three different concentrations of five fluoroquinolones. The frequency of mutation was low for all the quinolones. Only one N. gonorrhoeae mutant, obtained with trovafloxacin at 4 x MIC presented a stable increase in the MIC of this quinolone, not attributable to novel mutation(s), both in the gyrA and parC genes, although not showing any increase in the MIC of the other quinolones tested. In summary, gemifloxacin was the only quinolone tested for which resistant mutants were not obtained.
Journal of Antimicrobial Chemotherapy 11/2001; 48(4):545-8. · 5.07 Impact Factor
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ABSTRACT: A sparfloxacin-susceptible clinical isolate of Staphylococcus aureus was grown in increased concentrations of sparfoxacin. The presence of mutations in gyrA, gyrB, grlA and grlB genes was analyzed. The primary point mutation was located in the gyrA gene (Glu-88 to Lys). Two further mutation steps appeared in the amino acid change Ser-80 to Tyr in GrlA. No mutations occurred in the gyrB or grlB genes. Efflux pumps involved in the increase of resistance were also found to affect norfloxacin and ciprofloxacin. This effect may be related to NorA. An overexpression of NorA, may be associated with the increase of the MIC of norfloxacin from 32 mg/l to >200 mg/l in the final mutant. The MICs levels of sparfloxacin were affected by unknown mechanism.
International Journal of Antimicrobial Agents 08/2001; 18(2):107-12. · 4.13 Impact Factor
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Journal of Antimicrobial Chemotherapy 07/2001; 47(6):904-5. · 5.07 Impact Factor
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Antimicrobial Agents and Chemotherapy 03/2001; 45(2):643--4. · 4.84 Impact Factor
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ABSTRACT: Four Salmonella enterica serovar Virchow strains resistant to broad-spectrum cephalosporins were isolated from patients with gastroenteritis in 1997 and 1998 in Murcia and Barcelona, Spain. The isolates expressed a beta-lactamase with a pI of about 8 and a positive PCR when specific primers for CTX-M-9 were used. These results suggest the presence of a CTX-M-9 beta-lactamase in these strains.
Journal of Clinical Microbiology 01/2001; 38(12):4676-8. · 4.15 Impact Factor
