Herpes esophagitis (HE) is common in immunosuppressed patients, but has rarely been reported in immunocompetent individuals, in whom it appears to be a self-limited illness. We describe 3 new cases of HE in otherwise healthy patients seen in our hospital within the last 5 years. We performed a comprehensive review of the previously reported cases of HE in immunocompetent adults and adolescents in the English and Spanish literature. We analyzed the clinical features, treatment, and outcome of this entity. A total of 56 patients were included (39 men and 17 women), with a mean age of 35 years. The most common clinical manifestations were odynophagia (60.7%), fever (51.8%), and retrosternal chest pain (46.4%). A prodrome of upper respiratory symptoms and concurrent orolabial herpetic lesions were present in 26.8% and 25% of cases, respectively. Gastrointestinal bleeding was a rare complication (5.3%). Endoscopy revealed multiple ulcers in most cases (58.9%), typically involving the distal or mid-esophagus (83%). The diagnosis was confirmed by histopathologic examination in 40 cases (71.4%), by tissue viral culture in 21 (37.5%), and by detection of viral genome in esophageal samples in 4 cases (7.1%). Herpes simplex virus type 1 (HSV-1) was identified in 27 cases and herpes simplex virus type 2 (HSV-2) only in 1 case. Serology was consistent with a primary infection in 11 of the 25 evaluable cases (44%). Acyclovir therapy was used in 45.4% of patients. The outcome was favorable in all cases, although an esophageal perforation occurred in 1 patient. HE is a rare but well-defined entity in healthy adults and adolescents, and is probably underdiagnosed. A high degree of suspicion and a prompt endoscopic examination are required for the diagnosis. It is usually a self-limited infection, but early treatment with acyclovir may hasten the resolution of symptoms. Nevertheless, the benefit of antiviral therapy remains unknown.
PTA may be a reasonable treatment for symptomatic atherosclerotic stenosis, at least in patients at high risk for carotid endarterectomy.
Pulmonary complications after orthotopic liver transplant (OLT) are frequent, involving high morbidity and mortality. We have determined the pulmonary complication incidence in 187 patients submitted to OLT at the General University Hospital "Gregorio Maraiion" in the last 4 years, analyzing the type of infection, evolution, diagnostic and therapeutic measures and their influence on OLT niortality. A total of 120 patients had pulmonary complications, the most frequent being pleural effusion (61.94 YO), pneumonia (43.36 YO), and pneumothorax (11.5 YO). Serious pulmonary hypertension was diagnosed by invasive methods in two patients at the time of surgery (unidentified before OLT); both died at early post postoperative times. Pleural effusion was noted in 70 patients. 31.42% of them requiring thoracic tube drainage, complications developing in 22.72 %. Thirteen patients were diagnosed of pneumothorax, the most frequent etiologies being percutaneous liver biopsy, thoracic tube drainage for pleural effusion. and postoperative complications in 41.6, 33.3, and 23.3 YO, respectively. Pneumonia was diagnosed in the 1st month after OLT in 45 patients. Tests to diagnose and identify the etiological agent were made in 71.1 % of diagnosed pneumonia patients, identification being obtained in 62.5 YO. Telescope catheter culture identified the agent in 48 Yo, fiber optic bronchoscopy in 50 Yo, and lung or pleural biopsy in 100 YO. Respiratory insufficiency was noted in 64 patients (34.22 YO of transplanted patients). Factors involved in their development were pneumonia (42.1 8 YO), graft dysfunction (39.06 %, pleura1 effusion (34.37 %), sepsis (28.18 Y ) , and poor nutritional status (7.81 "/o). Fifty patients (41.66 %) died, pulmonary pathology being the determinant factor in 28.8 Yo. Patient mortality with respiratory insufficiency was greater, especially in those with three factors involved the development of respiratory insufficiency.
Global warming can significantly affect many aspects of the biology of animal species, including their thermal physiology and physiological performance. Thermal performance curves provide a heuristic model to evaluate the impacts of temperature on the ecophysiology of ectotherms. When integrated with other thermal biology parameters, they can be used to predict the impacts of climate change on individual fitness and population viability. In this study, we combine holistic measures of thermal physiology and the thermal sensitivity of locomotor performance with environmental temperatures measured at fine scale to estimate the vulnerability to global warming of the endangered Patagonian lizard Phymaturus tenebrosus. Our results indicate that this lizard exhibits its preferred temperatures and maximum locomotor performance at higher temperatures than the mean temperature it currently experiences in its habitat. In addition, it exhibits a low effectiveness of thermoregulation, being a poor thermoregulator. In view of the results obtained, we suggest that the climatic conditions of Patagonia may be advantageous for P. tenebrosus to survive future global warming, since its thermal physiology and locomotor performance may improve under increasing in environmental temperatures in its habitat.
The thermal physiology determines the whole biology of ectotherm organisms, by limiting their acquisition and allocation of resources. Herein, we aim to add knowledge on how different species use the thermal resources when they coexist in a habitat, studying the thermal physiology of three sympatric and syntopic liolaemid lizards, Phymaturus querque, Phymaturus zapalensis, and Liolaemus elongatus during the summer season. We measured the body temperatures at capture places, the operative microenvironmental temperatures in the field, and the preferred body temperature in an experimental thermal gradient in the laboratory. We found that the three species are thermoregulators, selecting cooler thermal microenvironments than the ones expected by chance, and even cooler than the temperatures they selected in a laboratory environment. Liolaemus elongatus is a more efficient thermoregulator (E = 0.671) than the two Phymaturus species, P. querque (E = 0.441) and P. zapalensis (E = 0.471), which are moderate thermoregulators and, apparently, specialists in finding specific types of shelters, since they seem to select certain types of rock crevices. Herein, we found that during the summer season, although individuals have access to warm microenvironments, they spend time on cool refuges, probably to prevent overheating. This highlights the importance of an adequate spatial distribution of operative temperatures (T ), more than just a mere availability of appropriate temperatures.
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