Green hair

Green hair is an unusual dermatologic condition usually due to the deposition of copper from exogenous sources. We report the cases of two patients who presented to our clinic with green discoloration of their hair. This pigmentation of hair has generally been reported in patients with blond hair as a consequence of increased concentrations of copper in domestic or swimming pool water. Although an increased copper content of the affected hair seems to be a prerequisite, other predisposing factors have to be present for this situation to occur. These include previous hair damage (mechanical, sun exposure, bleaching, dyeing, waving), frequent contact with chlorinated water, or use of alkaline shampoos. Several options for treatment have been described for this problem, including application of hot vegetable oil, hydrogen peroxide, edetic acid- or D-penicillamine-containing shampoos, or hydroxyethyl diphosphonic acid.

Cloning and sequencing of the URA5 gene from the yeast Yarrowia lipolytica

The URA5 gene of Yarrowia lipolytica encoding the orotate phosphoribosyl transferase (OPRTase, EC2.4.2.10) was isolated by target integration in a mutant strain originally named ura2.21. The nucleotide sequence of the gene predicts a protein with high similarities with the OPRTases from Saccharomyces cerevisiae, Podospora anserina and Escherichia coli and to a lesser extent with that of Dictyostelium discoideum. The transcription start point has been mapped by primer extension analysis and indicates the existence of a long leader sequence in the corresponding mRNA. Northern-blot hybridization revealed the URA5 transcript to be approximately 0.94 kb. Deletion of the URA5 gene in Y. lipolytica produced a leaky phenotype similar to the one described for the ura5 mutation in S. cerevisiae. The URA5 gene of Y. lipolytica was able to complement functionally the ura5 mutation of S. cerevisiae.

Selective inhibition of cytosine-DNA methylases by polyamines

We have advanced the hypothesis that polyamines affect DNA methylation and thus promote the expression of developmentally controlled genes. We demonstrate that the activity of cytosine-DNA methyltransferases HpaII, HhaI, HaeIII and SssI is inhibited by physiological concentrations of polyamines. On the other hand, activity of the adenine-DNA methyltransferase EcoRI, and restriction enzymes HpaII, HhaI, HaeIII and EcoRI, is insensitive to polyamine concentrations up to 40 mM. Our results indicate that the effect of polyamines on cytosine-DNA methyltransferases is rather selective and suggest a possible mode of action in vivo.

Epidemiologic study of an outbreak of clenbuterol poisoning in Catalonia, Spain

In an investigation of 113 cases of clenbuterol poisoning in Catalonia, Spain, in 1992, more than 50 percent of those affected were found to have had symptoms of nervousness, tachycardia, muscle tremors, myalgia, and headache. There was no significant difference in the distribution of symptoms according to sex (P = 0.97). The period of incubation varied between 15 minutes and 6 hours and the duration of symptoms between 90 minutes and 6 days. Clenbuterol was detected in 47 urine samples in amounts ranging from 11 to 486 parts per billion. No traces of clenbuterol were found in serum samples. Intoxication occurred in association with the ingestion of veal liver, irrespective of the way in which the liver had been cooked. The association between consuming liver and falling ill was statistically significant (P < 0.0001). In one family, the suspected source of intoxication was meat (veal tongue) and in another canneloni. None of the patients died as a result of the intoxication. The findings reinforce the need to uphold the prohibition of the use of clenbuterol in cattle farming in those countries and communities where it already exists and to contemplate a stricter regulation of its therapeutic use.

[Seroepidemiology of hepatitis C virus infection in pregnant women in Catalonia]

BACKGROUND

The aim of this study was to investigate the prevalence of hepatitis C virus (HCV) infection in a population of pregnant women in Catalonia and the sociodemographic variables and risk factors associated to this prevalence.

METHODS

A representative sample of the pregnant women in Catalonia (n = 4,551) randomly selected by clusters (hospitals with maternity clinics) was studied. Detection of antiHCV antibodies was performed by the third generation ELISA test. Reactive cases were confirmed with RIBA 3 and MATRIX.

RESULTS

The prevalence of antiHCV was found to be 1% and was not significantly associated with any of the sociodemographic variables studied (age, social and cultural level, origin and residence). A history of blood transfusion, intravenous drug consumption and hepatitis in the sexual partner were the only risk factors associated with the prevalence of infection found on univariate analysis although these were only present in 47% of the antiHCV positive cases detected. The association between the positivity of antiHCV and the history of hepatitis in the partner was lost on stratification of the cases according to the possible existence of history of drug addiction.

CONCLUSIONS

A high proportion of young asymptomatic people (1%) were found to have hepatitis C virus infection with the possible mode of infection not being detected in approximately half of these subjects. In the other half of these cases the infection was found to have been acquired by an intravenous mechanism: blood transfusion or drug use.

Pathophysiology of HIV related thrombocytopenia: an analysis of 41 patients

AIM

To analyse the pathogenic mechanism of HIV related thrombocytopenia.

METHODS

Forty one patients with thrombocytopenia and HIV-1 infection were investigated over two years. Anticardiolipin antibodies were measured using an enzyme linked immunosorbent assay and antiplatelet antibodies were measured using an immunocapture technique. Tests for VDRL, C3 and C4, antinuclear antibodies and rheumatoid factor were also carried out in all patients and 80 control subjects (HIV-1 positive but non-thrombocytopenic). Indiumoxine labelled platelets were transfused in 13 patients. P24 antigen were also measured in 12 bone marrow aspirates.

RESULTS

Antiplatelet antibodies and circulating immune complexes were found exclusively in the thrombocytopenic group; values for antiplatelet antibodies and circulating immune complexes were both higher in homosexual and bisexual patients. Three kinds of pattern were observed using 111 In-labelled platelets: splenic (n = 10); hepatic (n = 2); and destruction of bone marrow in just one case. The two most influential factors in the sequestration pattern were antiplatelet antibodies in the splenic uptake and circulating immune complexes in the hepatic and marrow sequestration. All patients, except three, had decreased platelet recovery. In those patients with a CD4 lymphocyte count of less than 200 x 10(6) cells/l the recovery was clearly greater (53%) than in patients who had more than 200 x 10(6) /l (28%). Finally, in seven of the 12 patients who were chosen for immunohistochemical study, p24 antigen was detected in the megakaryocytes, verifying that HIV-1 infects such cells.

CONCLUSIONS

The pathogenic mechanism of HIV related thrombocytopenia is probably multifaceted. Antiplatelet antibodies and circulating immune complexes would cause peripheral destruction in the spleen, liver, and bone marrow, in that order; and, on the other hand, there would be an ineffective immune thrombopoiesis and direct infection of the megakaryocytes which could cause a change in the function and maturity of these cells.

[Chronic eosinophilic pneumonia. An analysis of 4 cases]

Chronic eosinophilic pneumonia (CEP) is characterized by non-specific clinical presentation, interstitial radiological signs, peripheral acini and pulmonary infiltration by eosinophils, accompanied or not by peripheral eosinophilia. Response to treatment with steroids is spectacular. We describe 4 patients with CEP, one diagnosed by response to treatment and the others by bronchoalveolar lavage (BAL). No patient had asthma; 1 also had peripheral eosinophilia. All received long-term treatment with steroids, and there were no relapses. Response to treatment was slow in 2 patients, but obliterans bronchiolitis with or without organizing pneumonia could not be demonstrated. We emphasize the safety and efficiency of BAL for diagnosis of CEP.

[S. pneumoniae sternoclavicular arthritis in a patient with HIV infection]

HIV infection is a predisposing factor for pneumococcic infection. While pneumonia is the most frequent location, other locations (articular, meningeal, endocardiac, etc) have been less frequently described. Among the articular infections described in patients with HIV infection, the sternoclavicular affection is extremely rare and it usually develops in association with parenterally drug addiction, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequently germs involved. We describe the first case of sternoclavicular arthritis by Streptococcus pneumoniae in a patient with HIV infection. In our case, the chronic hepatopathy associated to alcohol consumption is a predisposing factor related to the pneumococcic infection. Our case suggests the need to formally investigate the HIV infection in young patients with invasive pneumococcic infection.

Inversion polymorphism and accumulation of lethals in selected lines of Drosophila melanogaster

Five long-term selected lines of Drosophila melanogaster were monitored for the presence of lethals and inversions on the third chromosome for a period of nearly 100 generations after the cessation of selection. The results provide an example of the action of inversions as a trap for genes with homozygous detrimental effects in small populations. Lines polymorphic for cosmopolitan inversions In(3R)C and In(3L)P maintain linked lethal and detrimental genes in a near-balanced system. Consideration of the high selection response attained despite inversion polymorphism leads to the conclusion that extreme responses to selection can be obtained without exploiting the potential from large genomic regions.

[The medical world of Juan Gil de Zamora's Historia Naturalis (ca. 1275-1296)]

The article describes the authors and works which were quoted by the Franciscan Juan Gil de Zamora in his Historia naturalis, a scientific encyclopaedia written between c. 1275 and before 1296, probably in the Franciscan monastery of Zamora (Kingdom of Castille). Juan Gil made wide use of the Avicenna's Canon, Gilbertus de Aquila (Anglicus)'s Compendium medicine, and Salernitan medical literature. His work contributed to the diffusion of these medical authors and works throughout the Christian intellectual milieu of late medieval Castille. This diffusion was not without problems.

Dielectric energy of orientation in dead and living cells of Schizosaccharomyces pombe. Fitting of experimental results to a theoretical model

Using the experimental data obtained with killed cells of Schizosaccharomyces pombe (1), we have formulated a theoretical model that is able to predict cell orientation for microorganisms with ellipsoidal or cylindrical shapes as a function of the frequency of the electric field and of the conductivity of the external medium. In this model, comparison of the difference in potential energy for both orientations parallel-perpendicular with the thermal agitation energy allows one to interpret the intervals where these orientations occur. The model implies that the conductivity of the cytoplasm is slightly higher than that of the external medium. This assumption is easy to understand taking into account that not all the intracytoplasmic material is released to the exterior during cell death.

[Metaplastic carcinoma of the breast as a second neoplasm. Report of a case]

A patient with a metaplastic breast carcinoma as a second primary carcinoma after a renal pelvis neoplasm, an association not described before, is reported. Her first admission in October 1983 was due to a silent hematuria secondary to a mass in the right kidney. The histopathologic diagnosis was a grade II transitional cell carcinoma of the renal pelvis without distant or regional lymph nodes metastasis. Four years later, a right upper and outer quadrant breast mass was detected. Malignant disease was diagnosed by needle biopsy, and a simple mastectomy (Madden type) was performed. The histologic evaluation showed a metaplastic carcinoma with a pseudosarcomatous appearance: fifteen axillary lymph nodes showed only lymphoreticular hyperplasia. After surgery, the patient received locoregional radiotherapy. At present, eight years and five months after the first malignant neoplasia and four years and four months after the second malignancy, the patient is asymptomatic and free of disease. We comment the prevalence of multiple primary malignant neoplasms, the risk of developing a second tumor after a renal pelvis carcinoma, and the histologic findings and prognostic factors in metaplastic breast carcinoma.

Chromosomal analysis of D. melanogaster long-term selected lines

Crosses and chromosomal substitutions among five selected lines of Drosophila melanogaster were carried out. These lines came from the same natural population after long-term selection for increasing dorsocentral bristle number. Two of them (Ac-27S and Ac-27P) show a bristle number around 16, and the other three (S-27S, S-27P, and N-21) present very extreme phenotypes, between 35 and 40 bristles. Selected genes were located on the three major chromosomes. Recessivity and synergistic interactions among the selected chromosomes account for the existence of hidden genetic variability, which can be released by selection, for a trait that scarcely shows phenotypic variability in populations. Genes responsible for selection response in lines Ac-27S and Ac-27P are present in all the selected lines, while lines S-27S, S-27P, and N-21 have accumulated additional increasing alleles common to the three of them. Long-term response and the extreme phenotypes achieved by these three lines point to variation that arose de novo during the selection process. However, this idea disagrees with the low genetic variability found between them. All these facts are consistent with the idea that variability originated in the course of selection by a low-probability nonrandom mechanism such as the occurrence of rare recombination events.

The distribution of spontaneous mutations on quantitative traits and fitness in Drosophila melanogaster

Starting from a completely homozygous population of Drosophila melanogaster, two groups of 100 inbred lines each were established and maintained for 46 generations, by a single brother-sister mating and two double first cousin matings, respectively. Sternopleural bristle number, wing length and wing width were simultaneously scored in all lines every 4-5 generations. The means of four lines in each group departed significantly from the overall mean and, in each case, this was attributed to a single mutation of relatively large effect on at least one trait (0.3-1.4 environmental standard deviations in absolute value). Further analyses revealed widespread pleiotropy, similar gene action of a given mutation for all traits affected, and predominant additive action. No apparent association was found between the magnitudes of mutational effects on the traits and fitness. However, all recessive mutations were deleterious. The distribution of mutant effects was asymmetrical (positive for bristles and negative for wing measurements). Moreover, these distributions had a high variance and may be leptokurtic, due to the presence of major genes. Estimates of the ratio of new mutational variance to environmental variance ranged within (0.7-3.4) x 10(-3), those for wing measurements being generally larger. In agreement with theory, the rate of between-line differentiation was independent of population size.

Use of a commercial double-test tablet (Rosco PGUA/indole) for screening of Escherichia coli

A commercial double-test tablet (Rosco PGUA/indole) for detection of beta-glucuronidase (beta-GUR) activity and indole production was evaluated on a collection of 393 isolates of Enterobacteria. Both beta-GUR and indole were positive on 96.6% of Escherichia coli strains. beta-GUR, only, was also detected in 25 Shigella spp., four Enterobacter cloacae, eight Citrobacter freundii, and five Salmonella enteritidis strains, none of which were indole producers. An additional 261 consecutive clinical isolates of oxidase-negative nonswarming Gram-negative bacilli were studied in a parallel comparative field trial against conventional identification methods. For 200 strains, the standard method and PGUA/indole test were performed from the primary culture plate. The remaining 61 (23.4%) required subculture before testing. Sensitivity, specificity, positive predictive value, and negative predictive value of PGUA/indole test in the screening for E. coli were, respectively, 94.1%, 100%, 100%, and 87.1%. In our experience, PGUA/indole test is a rapid, precise, simple-to-perform, and economical method for screening E. coli. However, the need for a large inoculum may limit its application on primary cultures.

Bronchial asthma due to sensitization to chloramine T

Chloramine T, an organic, highly reactive derivative of chlorine with potent bactericidal properties, is used as a disinfectant in the food industry. Described as an occupational sensitizer in 1945 for the first time, it produces late or dual asthma, occasionally accompanied by fever and leukocytosis, which is mediated by IgE. We present the case of a male dairy worker who, after 4 years of exposure to the product, developed rhinitis and asthma. Skin tests with chloramine T were positive at a concentration of 10 mg/ml, while all other allergens tested negative. RAST detected specific IgE at 12 PRU and bronchial provocation induced immediate and late bronchoconstriction.

[Adjuvant chemotherapy in gastric cancer. Experience at the National Institute of Nutrition]

The cases of gastric carcinoma treated with surgery plus chemotherapy (FAM) at the Instituto Nacional de la Nutricion (INNSZ) in Mexico City from January 1979 to December 1988 were reviewed. In 322 patients seen in this period, only in 12.4% (40 patients) it was possible to undertake curative resection; of these, twenty two received adjuvant FAM (fluorouracil, 600 mg/m2 IV days 1,2,3; doxorubicin, 30-35 mg/m2 day 1; and mitomycin-C, 10 mg/m2 in three days). Twenty patients were in stage III and two in stage II. At a median follow-up of five years, ten patients have relapsed; of these, eight died from progressive neoplasia; one is alive with no evidence of disease 24 months after receiving combined chemotherapy with 5-fluorouracil, cisplatinum and adriamycin, and one is alive with the disease. Nine patients (40.5%) are alive with no evidence of relapse 30 to 114 months after initial surgery. One patient died from unrelated causes with no evidence of relapse. Two individuals were lost to follow up at 9 months and 28 months, without evident malignant disease at the time of last consultation. The median survival was 61 months with a 51% estimated overall survival at five years. None of the prognostic factors analyzed were significantly associated with recurrence: number of metastatic lymph nodes; number of cycles of chemotherapy; interval between surgery and chemotherapy; and intraoperative blood transfusions requirements, although there was a tendency to relapse in the majority of the patients who received intraoperative blood transfusions as compared with the untransfused (five years disease free survival of 18% vs 64% respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Timeliness of notification in infectious disease cases

Records of notification in cases of eight infectious diseases in the "Servei Territorial de Salut Publica" of the Province of Barcelona, Spain, between 1982 and 1986 were reviewed. Time from onset of symptoms to notification, time from notification to completion of data collection, and time from onset to completion of the case investigation were analyzed. For the period from onset to notification, the shortest mean was registered for meningococcal infection (6.31 days) and the longest was for pulmonary tuberculosis (54.79 days). For time from notification to complete investigation, the shortest value was for pulmonary tuberculosis (12.20 days) and the longest for rickettsioses (35.79 days). Time from onset to completion of data collection was 22.87 days for meningococcal infection and 72.34 days for tuberculosis of other organs (probably because of the long period of time that elapses between the onset of the first symptoms and notification). It would appear that both physicians and the general population must be educated so that lay-men can identify early signs and symptoms of disease and physicians can realize that statutory notification of infectious diseases is strongly linked to community health care.

[A method to quantify diazepam with high resolution liquid chromatography in patients undergoing multiple therapy]

A rapid, sensitive and specific method useful in monitoring diazepam in patients receiving multiple therapy is presented. Plasma was extracted in the presence of borate buffer with hexane and the drug was quantified by HPLC in a Novapak C 18 column. The limit of detection in plasma was about 30 ng/mL. Analytical recovery of the drug added to plasma was about 70%. Within-day variation and between-day variation ranged from 5.9 to 8.3 and 5.9 to 10.7%, respectively. The method was applied in the determination of diazepam levels in patients treated with this drug in combination with other drugs commonly used in our hospital. The concentrations found in most of the patients were in the therapeutic range. It was not possible to detect the drug in one patient with concomitant administration of magnesium hydroxide, which can be attributed to a reduced absorption of diazepam in presence of the antiacid. Average steady-state concentrations of diazepam in psychiatric patients, submitted to 5 mg doses t.i.d. during four weeks, were in the range of 200 to 450 ng/mL.