[Mallory-Weiss syndrome. Surgical treatment after sclerotherapy. Presentation of a case and review of the literature]

We herein report a case of a male patient aged 23, with acute upper gastrointestinal hemorrhage, secondary to ingestion of acetyl salicylic acid. Endoscopy showed a linear laceration in the esophagus-gastric union. Based on endoscopic findings the diagnosis of Mallory-Weiss Syndrome was established. Surgical treatment was required, after sclerotherapy; we reviewed the literature for presenting a general panorama of this pathology.

Two regression models and a scoring system for predicting survival and planning treatment in myelodysplastic syndromes: a multivariate analysis of prognostic factors in 370 patients

Therapy planning in patients with myelodysplastic syndromes (MDSs) is complicated by its high prognostic heterogeneity. Forty-one patient and disease characteristics at onset of 370 patients with MDS were analyzed to identify significant prognostic factors for survival and transformation to acute myeloblastic leukemia (AML), and to develop and validate a regression model for predicting survival. Multivariate regression analysis showed that the total bone marrow percentage of blast cells, age, platelet count, WBC count, and hemoglobin level were the characteristics more significantly associated with survival in the overall series. The bone marrow percentage of type I blast cells was the most important factor predicting transformation into AML. Proportional hazards regression analysis in a randomly selected training sample of 240 patients demonstrated that the combination of total bone marrow percentage of blast cells, platelet count, and age had the strongest predictive relation to survival length. The resulting regression models, continuous and categorized, were validated in the remaining test sample of 130 patients by demonstrating its capability of segregating patients into low-, intermediate-, and high-risk groups, with distinctively different survival curves (P less than .0001). A scoring system derived from the categorized model also had a great prognostic value (P less than .0001). These regression models and the simpler scoring system may be accurately used for decision-making regarding therapy in MDS patients.

[Heterosexual transmission of HIV infection, Madrid 1987]

Seven males of 132 (5%) and 9 females of 85 (10%) out of 217 heterosexual individuals without addiction to drugs or previous blood transfusion who attended a STD clinic in Madrid because they had high risk sexual partners were found to have antiHIV antibodies by ELISA and immunofluorescence (CNMVIS). However, when variables such as sex, promiscuity and sexual habits were correlated with HIV infection, significant differences were not found between seropositive and seronegative individuals (kappa 2, p greater than 0.05). Among the factors statistically linked with the infection (kappa 2, p less than 0.05) there were the previous STD and the sustained sexual intercourse with proven HIV seropositive individuals: there 8 infected individuals out of 40 with such type of partners (relative risk 4.4). On the other hand, the partners of individuals with unknown serological findings had the following results: 4 seropositive individuals out of 71 partners of parenteral drug abusers, 3 of 82 users of prostitutes, and 1 infected individual out of the 24 remaining ones (partners of bisexual individuals or combinations) (relative risk of each of them less than 1). These results show the importance of heterosexual, not mediated by blood, HIV transmission in couples of high risk persons, and they suggest that the infection is highly likely if sexual intercourse is maintained with infected individuals irrespective of their sex.

[Prediction of survival in myelodysplastic syndrome. Analysis of 2 scoring systems with prognostic value]

The wide prognostic variability of myelodysplastic syndromes (MDS) complicates decision-making regarding the choice and evaluation of alternative treatments to transfusional and antiinfectious supportive measures. Due to its simplicity the Bournemouth scoring system seems to have achieved wide acceptance for establishing the prognosis in MDS patients. The aims of this study were to examine the Bournemouth system in a series of 370 patients with MDS and to evaluate the capability of the prognostic index recently proposed by our group to better define the outcome predicted by the former. The Bournemouth scoring system identified 3 risk groups, A (0-1 points), B (2-3 points) and C (4 points), in the whole series (p less than 0.0001) and it allowed us to stratify refractory anemia (RA), RA with excess of blasts (RAEB) and RAEB in transformation (RAEB-t) patients into two distinct prognostic groups (p = 0.03 and p = 0.01, respectively). This scoring system did not show a significant value in RA with ringed sideroblasts (RARS) and chronic myelomonocytic leukemia (CMML) patients (p greater than 0.05). Our prognostic index clearly segregated patients in the whole series into low- (0-1 points), intermediate- (2-3 points) and high-risk (4-5 points) groups (p less than 0.00001) as well as stratifying ARSA (p = 0.0005), CMML (p less than 0.0001) and RAEB and RAEB-t patients (p less than 0.00001) into different prognostic subset, although it failed to demonstrate a significant predictive value in RA patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Production of toxins by Escherichia coli strains isolated from calves with diarrhoea in galicia (north-western Spain)

A total of 289 Escherichia coli colonies isolated from 78 diarrhoeic calves were studied for production of heat-labile (LT) and heat-stable (STa) enterotoxins, verotoxin (VT), cytotoxic necrotizing factor (CNF) and K99 antigen, and they were serotyped. Production of STa was detected in a single strain possessing both K99 and F41 antigens; the serotype was 09:K (A) 35. LT-producing strains were not detected. From 16 (20.5%) calves, 51 VT-producing colonies of E. coli were isolated. Production of the necrotic factor was detected in 33 E. coli colonies isolated from 14 (17.9%) calves. Serotype was a useful marker for production of VT and CNF. Among the 51 VT-producing colonies, 24 were untypable and the remainder belonged to serotypes O2:K?, O103:K--, O104:K?, O128:K?, O153:K-- and O157:K--:H7. Four of the 33 CNF-producing colonies were untypable and the majority of the remaining colonies belonged to serotypes O15:K14, O78:(K80), O123:K-- and O139:K--. Both VT and CNF were lethal for mice, but only CNF showed necrotizing reaction in rabbit skin. Our results indicate that VT-producing and CNF-producing E. coli strains are frequently isolated from diarrhoeic calves and that according to the serotypes exhibited, some of them might be considered potential pathogens for humans. The role of VT-producing and CNF-producing strains in calf diarhoea remains to be established.

Prognostic factors in chronic myelodysplastic syndromes: a multivariate analysis in 107 cases

A retrospective multivariate analysis of 37 clinical, biochemical, and hematological data was performed in 107 cases of primary myelodysplastic syndromes (MDS) in order to recognize their prognostic significance. The most important individual variables, isolated in a previous univariate analysis, were placed in a multiple regression modeling procedure to identify major significant prognostic factors. Multivariate analysis tends to identify prognostic variables containing significant independent predictive information. Characteristics were examined on both continuous and binary bases. The FAB classification was the first parameter entered in regression equations on both models, followed by platelet count, hemoglobin level, and circulating erythroblasts in the binary model, and by hemoglobin level, systemic symptoms, platelet count, age, and dyserythropoiesis in the continuous model. Our analysis confirms FAB classification as the main prognostic factor in MDS, supports the previously noted predictive value of platelet count, hemoglobin level, and age, and recognises the importance of circulating erythroblasts, systemic symptoms, and dyserythropoiesis as prognostic characteristics in MDS.

Lisuride infusion pump in Parkinson's disease. A report of two cases

Two patients, ages 66 and 72, with complications of chronic levodopa therapy (random fluctuations, end of dose deterioration and dyskinesias) who were treated with Lisuride by means of a portable subcutaneous infusion pump are reported. Results obtained show significant improvement in disability through a net increase in the number of hours spent "on". Dyskinesias remained unmodified. Limiting psychiatric side effects were observed in one of the patients. Practical and technical aspects of the management of this therapeutic method are discussed.

On the binding of cinmetacin and indomethacin to human serum albumin

The binding of two non-steroidal anti-inflammatory drugs, indomethacin and cinmetacin, to human serum albumin was studied by dynamic dialysis at 37 degrees C and pH 7.4. Cinmetacin is bound more than indomethacin. The affinity constant for the primary binding site is 4.28 X 10(6) M-1 for cinmetacin and 1.4 X 10(6) M-1 for indomethacin. The protein binding of indomethacin is decreased in the presence of cinmetacin.

Placement of biliary endoprosthesis through T-tube tract--case report

We report a case of obstructive jaundice in which the tract of a surgically placed T-tube was used as a route for easy access to stent a neoplastic stenosis of the common bile duct.