Influence of administration of long-chain polyunsaturated fatty acids on process of histological recovery in liver cirrhosis produced by oral intake of thioacetamide

Patients with liver cirrhosis frequently show some degree of protein-energy malnutrition and obviously require nutritional support. In this study, the treatment of rats consisted of the ad libitum oral intake of a 300 mg/liter thioacetamide solution, used as drinking water for four months. Thioacetamide treatment produced a severe alteration in the plasma fatty acid profile with significant decreases of these, which mimicked changes described in human cirrhosis. This hepatotoxic agent causes nodular cirrhosis, with loss of the normal architecture of the liver and disruption of the vascular pattern. The goal of the study was to evaluate the influence of n-3 and n-6 series long-chain polyunsaturated fatty acid dietary supplementation in experimental animals and to assess the effects of those dietary components on structural recovery in the liver. Significant increases of saturated and monounsaturated fatty acids as well as n-6 polyunsaturated fatty acids were seen only in the animals given the n-6 polyunsaturated fatty acid supplemented diet. However, only rats given the standard diet exhibited some degree of histological regeneration.

[Prevalence of hepatitis B and risk factors as motivation for vaccination campaign among adolescents]

OBJECTIVES

To study the prevalence of viral Hepatitis B infection (VHB) among eighth-year EGB (basic) students; associated risk factors; and the prevalence of Hepatitis C (HC).

DESIGN

A descriptive crossover study.

SETTING

Eighth-year EGB students from 8 schools in Villaverde-Usera (Madrid).

PARTICIPANTS

A sample of 262 individuals was used to calculate the prevalence of VHB infection (prevalence defined at 1.5%, precision = 0.015, confidence at 95% and 5% loss).

MEASUREMENTS AND MAIN RESULTS

Variables were age, gender, alcohol, tattoos, drugs, family history of drugs, Hepatitis, exchanging syringes, razors, syringes, sexual relations, history of transfusions or surgery. These were obtained from a questionnaire filled in by the students themselves. The definitions were: chronic HB carrier: AgHBS+ in the blood; VHB infection: anti-HBc and/or anti-HBs positives; VHC infection: presence of anti-HC. 402 children answered the questionnaire. Serology was tested in 263 before the vaccination. Average age was 13.3 +/- 0.69. There were 52.8% males and 47.2% females. Prevalence of VHB infection was 2.28% (CI = 0.93-5.14), 6 cases. Prevalence of carriers was 0.38% (CI = 0.02-2.43; one case). There were no VHC positives. No links between VHB and risk practices could be demonstrated.

CONCLUSIONS

1) Low prevalence of VHB infection 2) The zero prevalence of VHC infection is lower than that in healthy donors.

Dietary long-chain polyunsaturated fatty acids influence the recovery of thioacetamide-induced liver cirrhosis in rats

BACKGROUND

The aim of this study was to evaluate the dietary supplementation with omega-3 and omega-6 long-chain polyunsaturated fatty acids on the fatty acid composition of plasma and red blood cell membranes in rats with thioacetamide-induced liver cirrhosis.

METHODS

Thirty-eight female Wistar rats were given 300 mg thioacetamide/L in drinking water for 4 months to induce the experimental liver cirrhosis. Sixteen rats were used as controls. After treatment with thioacetamide, nine rats of each group were killed. Then, thioacetamide-treated rats were divided into three new groups, each receiving a different diet for 2 weeks: a semipurified diet (n = 9), the same diet supplemented with omega-3 long-chain polyunsaturated fatty acids (n = 10), or the same semipurified diet supplemented with omega-3 and omega-6 long-chain polyunsaturated fatty acids simultaneously (n = 10). The remaining control rats were fed the semipurified diet. Liver histology and plasma and erythrocyte fatty acid composition were assessed.

RESULTS

An apparent improvement of the histological damage took place in the rats fed the omega-3+ omega-6-supplemented diet. The diet supplemented with polyunsaturated fatty acids of the omega-3 series induced increases in the omega-3 long-chain polyunsaturated fatty acid levels in total plasma lipids, plasma lipid fractions and in erythrocyte phospholipids, and decreases in omega-6 long-chain polyunsaturated fatty acids in erythrocyte phospholipids during the recovery of rats with thioacetamide-induced liver cirrhosis. The administration of the diet supplemented with both omega-3 and omega-6 long-chain polyunsaturated fatty acids contributed to increase the levels of total plasma saturated, monounsaturated, and omega-6 long-chain polyunsaturated fatty acids from cirrhotic rats.

CONCLUSION

We conclude that the simultaneous supply of long-chain fatty acids of the omega-3 and the omega-6 series can be beneficial to improve the fatty acid status of this experimental model of liver cirrhosis.

[A comparative study of 2 technics of percutaneous endoscopic gastrostomy]

OBJECTIVE

To compare the two most frequently used methods of percutaneous endoscopic gastrostomy: Pull-string Ponsky-Gauderer type and Push-over-wire Sachs-Vine gastrostomy.

PATIENTS AND METHODS

Forty-four patients with oral feeding incapacity were prospectively randomized to one of the two methods of percutaneous endoscopic gastrostomy. In 22 patients the Ponsky-Gauderer type were used and in the other 22 the Sachs-Vine gastrostomy were employed. In every case the gastrostomy tube was replaced 4-5 months after its placement by a Flexiflo tube. The mean follow-up of the patients was 7.3 months (range: 4-18).

RESULTS

Gastrostomy was successful in every case. No differences were found between the two procedures in technical difficulties or complications during gastrostomy placement. Wound infection occurred in 6 patients (13%), 3 in each group, and in all cases it was cured with topic antibiotic treatment administered through the gastrostomy. Tube dislodgement was observed in 3 patients in the Ponsky-Gauderer group (soft internal with-holder). The only significant difference between the two procedures was found at the removal of the gastrostomy tube. In the Sachs-Vine type the removal of the tube was always endoscopically performed (due to the presence of a rigid internal with-holder), while the Ponsky-Gauderer type was always done by traction (soft internal with-holder). No related procedure mortality was found with any of the two techniques.

CONCLUSION

Both percutaneous endoscopic gastrotomy techniques are similar in efficacy, safety and morbidity and they prove to be a valid alternative to surgical gastrostomy in patients with oral feeding incapacity.

Involvement of calcium in phosphoinositide metabolism in the blood-brain barrier

The Ca2+ effect on phosphoinositide metabolism in the blood-brain barrier was studied by using rat cerebral microvessels prelabelled with either [32P]orthophosphate or myo-[3H]inositol and stimulated with Ca2+ ionophore A23187. In radioactivity steady-state conditions, addition of ionophore caused a rapid and marked loss of labelling in both phosphatidylinositol-4-phosphate (PIP) and phosphatidylinositol-4,5-bisphosphate (PIP2), without significant alterations in phosphatidylinositol (PI) and phosphatidic acid (PA) labelling. These facts were accompanied by a rise in labelling of both inositol 1-monophosphate (IP) and inositol 1,4-bisphosphate (IP2), but not in inositol 1,4,5-trisphosphate (IP3). In addition, a Ca(2+)-dependent inhibition of phosphoinositide kinase activities from isolated membranes was also found. These data suggest that elevated intracellular Ca2+ level evokes a PIP and PIP2 hydrolysis by phosphodiesterasic and phosphomonoesterasic activities respectively, and also partially inhibits the synthesis of these phosphoinositides. Our results constitute evidence that a reciprocal control mechanism between polyphosphoinositide metabolism and mobilization of Ca2+ exists in the blood-brain barrier.

[A comparative randomized controlled study of the efficacy of interferon alfa-2b and interferon alfa-2a in the treatment of chronic hepatitis C]

Interferon (INF) is the treatment of choice in active chronic hepatitis C although the optimum therapeutic schedule remains undefined to date. One forty-eight patients with active chronic hepatitis C were included in a randomized controlled study to compare the therapeutic efficacy of 2 types of recombinant alpha IFN: alpha-2b IFN and alpha-2a IFN. Twelve patients were excluded from the study for different reasons. The groups were made up of 34 untreated patients (group I), 68 patients treated with 5 MU of alpha-2b IFN three times per week for 12 months (group II) and 32 patients with 6 MU of alpha-2a IFN three times per week for one year (group III). On finalization of the treatment 39 patients from group II (57%) and 20 (63%) from group III showed normal transaminases (p > 0.05) while this was not so in any patient from group I (p < 0.001). HCV infection of less than 5 years was significantly associated with complete biochemical response. During the post treatment follow up (16.2 +/- 11.1 months; range: 6-45 months) the transaminase levels reelevated in 26 (67%) responding patients from group II and in 12 (60%) patients from group III (p > 0.05). Therefore complete biochemical response was maintained in only 12 (19%) of the patients from group II and in 8 (25%) of the patients from group III (p > 0.05). Liver biopsy was carried out in the 3 post treatment months in 15 patients from group I, 29 from group II and 18 patients from group III with all the rebiopsied patients from groups II and III having demonstrated complete or partial response to IFN.(ABSTRACT TRUNCATED AT 250 WORDS)

Kaliotoxin (1-37) shows structural differences with related potassium channel blockers

The three-dimensional structure of kaliotoxin (1-37), KTX(1-37), a toxin from the scorpion Androctonus mauretanicus mauretanicus that blocks calcium-dependent potassium channels, has been determined by NMR. This toxin is homologous with other scorpion toxins such as charybdotoxin (ChTX) or iberiotoxin (IbTX) for which the structures are already known, but the presence of prolines in the expected alpha-helical region suggested that there may be some major difference in the structure of KTX that could be related to its different selectivity. Proline residues are also found in the homologous region of other scorpion toxins such as noxiustoxin or margatoxin. Our results indicate that KTX(1-37) contains the same sequence of secondary structure elements as ChTX but that the helical region is shorter and distorted due to the presence of two prolines. The distortion consists of a bending in the alpha-helix and in the presence of a 3(10) helix turn in the last three residues. Furthermore, the increased length of the extended structure preceding the helix favors a different packing of this part of the molecule with respect to the secondary structure elements. This change in folding modifies the accessibility of the conserved 27Lys which is known, from mutation studies, to be involved in channel blocking by ChTX.

[Tumors of the female urethra: difficulties in the early diagnosis]

There is no widespread agreement on the treatment of tumors of the female urethra due to their scant incidence. These are generally slowly growing tumors with no salient or specific symptoms and signs. They manifest late and can be misdiagnosed as urethral lesions mimicking a tumor, therefore a biopsy is warranted. For all the foregoing reasons, these tumors are diagnosed in the advanced stages, with a worse prognosis despite very aggressive therapies. Two such cases are described: one was a Grabstald stage C3 epidermoid carcinoma that was submitted to anterior pelvic exenteration and died at 6 months, and the other was a Grabstald stage D4 papillary adenocarcinoma that died a few days after a resection biopsy. Due to the lower incidence of urethral adenocarcinoma, we review the literature on this tumor type and highlight its greater predisposition to progression which carries a worse prognosis.

Effect of succinylation on the membrane activity and conformation of a short cecropin A-melittin hybrid peptide

A 15-residue hybrid peptide (KWKLFKKIGAVLKVL-amide) incorporating partial sequences of cecropin A and melittin causes the release of carboxyfluoresceine encapsulated in phosphatidylcholine liposomes. Succinylation of the amino groups in the N-terminus and lysine side chains inhibits the effect of this peptide on liposome permeability. Conformational analysis of the parent peptide and its succinyl derivative by CD and nmr indicates that both peptides form amphipathic alpha-helices in the presence of hexafluoro-2-propanol, but only the unmodified peptide acquires a relevant level of alpha-helical conformation in the presence of liposomes.

[Cicatrization effect of Jatropha curcas latex (Angiospermae: Euforbiaceae)]

The wound healing effects of Jathopha curcas latex upon surgical wound produced in Balb/c mice skin, were studied with a modification of the Hoowes-Sooy-Harvey method. The effects of topical treatment using single 50 ul doses of latex at different dilutions (10% to 100%) was compared with a multiple dose treatment (four 25 ul/dose q12h, latex 5% to 100%). The single dose treatment with 10%, 50% or 100% latex and the multiple dose treatment with dilutions between 5% and 10%, have a healing effect but only on males. The multiple dose treatment with 50% or pure undiluted latex produced caustic lesions to treated skin.

Platelet-activating factor inhibits (Na+,K+) ATPase activity in rat brain

In the present study, experiments were conducted to determine the effect of platelet-activating factor (PAF) on (Na+,K+)-ATPase in rat cerebral cortex. PAF, but not lysoPAF, inhibited (Na+,K+)ATPase activity, in a dose- and time-dependent manner, 10(-7) to 10(6) M being the most effective dose. These effects were abolished in the presence of PCA-4248, a PAF antagonist, indicating that the PAF effect may be mediated by its specific membrane receptors. Omission of external calcium caused an increase in the basal activity and abolished the PAF effect on (Na+,K+)ATPase. The present study demonstrates that PAF inhibits (Na+,K+)ATPase activity in the cerebral cortex and suggests that PAF released during certain pathological conditions, such as ischemia, may act on ATPase. This could be one possible mechanism of PAF action that needs further attention.

[Diagnostic value of the hepatic echo-histogram in chronic hepatopathy]

The aim of this study was to determine the histogram patterns and the diagnostic efficacy of liver echohistogram in chronic diffuse liver diseases. Abdominal ultrasound and liver echo-histogram were prospectively and blindly performed on 21 healthy controls, 24 patients with chronic hepatitis, 26 patients with liver cirrhosis, and 22 patients with fatty liver disease. Maximum liver echo intensity and echogenicity were decreased in chronic hepatitis. Increased anterior maximum liver echo intensity and echogenicity, decreased posterior maximum liver echo intensity and echogenicity, and reduced posterior/anterior maximum liver echogenicity ratio were found in fatty liver disease. The diagnostic efficacy indexes of abdominal ultrasound were enhanced by some echo-histogram data: anterior maximum echo intensity of the liver less than 20.52 decibels for chronic hepatitis and posterior/anterior maximum liver echogenicity ratio less than 0.231 for fatty liver disease. In liver cirrhosis, echohistogram showed a high dispersion of values and not enhanced the abdominal ultrasound diagnostic efficacy. In fatty liver disease, a positive correlation was found between percentage of hepatocytes with fatty change and anterior maximum echo intensity of the liver (rs = 0.47, p < 0.05), as well as between percentage of hepatocytes with fatty change and anterior maximum echogenicity of the liver (rs = 0.68, p < 0.01). These findings indicate that the liver echo-histogram improves the diagnostic efficacy of abdominal ultrasound in chronic hepatitis and fatty liver disease. We suggest that combined abdominal ultrasound and liver echo-histogram should be performed in the investigation of chronic diffuse liver diseases.

Ultrastructure of the lophophoral tentacles in the genus Phoronis (Phoronida, Lophophorata)

The lophophoral tentacles of two phoronids, Phoronis psammophila and Phoronis hippocrepia, are described from an ultrastructural point of view. The tentacles are hollow structures, with an epidermis exhibiting supporting cells, sensory cells, and four types of gland cells, A, B1, B2, B3. The epidermis rests on a connective tissue layer, tubular in shape, enclosing a coelomic space lined by myoepithelial mesothelium (peritoneum). There is a single blood capillary in the tentacular coelomic cavity, attached to the frontal face of the tentacle, with contractile walls derived from the peritoneum. Both erythrocytes and amoebocyte-like cells occur inside the capillary. Differences between the tentacles of these two species and those of Phoronis australis, whose structure is already known, mainly concern the abundance and distribution of the epidermal gland cell types and are related to the burrowing and tube-building activities of these animals in different substrata.

[Comparative study of 1st generation versus 2d generation (CAVPE) combinations in intermediate and high-grade lymphomas]

PURPOSE

To compare four first generation chemotherapy regimes (FGR) used by GATLA in low and intermediate grade lymphomas. Versus a second generation regimen called CAVPE.

PATIENTS AND METHODS

A group of 205 patients treated with FGR (79 with BACOP, 89 with COPP, 19 with CHOP, and 18 with CNOP), and 244 others treated with the combination of cyclophosphamide, doxorubicin, vincristine, prednisone and etoposide (CAVPE) were included. Two randomized phase III multicentric studies, COPP vs BACOPP and CHOP vs CNOP, as a whole group, were compared with the second generation scheme, CAVPE. All the patients with FGR received 6 monthly treatment courses, and the CAVPE patients were given 8 monthly courses.

RESULTS

The median age was 55 years (18-85) for the FGR group and 51 years (15-79) for the CAVPE group. The stage distribution for both FGR and CAVPE groups was, respectively, as follows: II: 38 and 55 cases; III 80 and 84 cases; IV: 87 and 105 cases. No significant differences were found between both groups when comparing other characteristics of the patients, namely, sex, symptoms, mediastinal, abdominal or extranodal involvement, liver, spleen or bone-marrow infiltration, and bulky tumoural mass. The percentage of complete remission (CR) was 52% (107/205) in the patients treated with FGR, and 67% (163/244) in the CAVPE group (p < 0.001). The estimated probability of sustained first CR at 72 months was 38% for the FGR group and 54% for the CAVPE group (p = 0.0167), whereas 17% and 36%, respectively, of the evaluable patients were alive and well, with no signs of disease progression (p = 0.000). The 72-month survival was estimated in 32% and 51%, respectively, for each group (p = 0.0004).

CONCLUSIONS

1. CAVPE seems to offer better responses and disease-free survival in this non-selected group of low and intermediate lymphoma patients. 2. The better results in terms of CR and lower incidence of relapses attained with CAVPE with regard to FGR are probably related with a number of facts, such as the use of more aggressive drugs, higher doses, a better drug combination rationale, the inclusion of new drugs, such as etoposide, or a selection of the patients.

[Endourologic treatment of calyceal diverticulum complicated with lithiasis]

Presentation of 9 cases of calyceal diverticulum symptomatic lithiasis, 6 of which have been treated up to the present time. Of the remaining 3, one patients, in spite of its evolutive character (increased cavity) and moderate pain, prefers to abstain from therapeutic therapy, but undergoes follow-up controls every 6 months; the other 2 cases are waiting endourological treatment. Out of 6 patients who underwent surgery, two cases, who had previously experienced shockwave extracorporeal lithotripsy (SWEL), were advised to have endourological procedures due to persistence of pain and gallstones debris.

Randomized trial of chemotherapy versus chemotherapy plus radiotherapy for stage III-IV A & B Hodgkin's disease

A total of 151 patients with previously untreated Hodgkin's disease, clinical stages III-IV A & B, were randomized to receive CVPP for 6 cycles, or CVPP plus RT 3000 cGy to previously involved areas between the 3rd and 4th cycles. CVPP consists of cyclophosphamide 600 mg/m2/i.v., vinblastine 6 mg/m2/i.v. on day 1, procarbazine 100 mg/m2/p.o. and prednisone 40 mg/m2/p.o. on days 1 to 14. Both groups displayed similar clinical characteristics at diagnosis. Sixty-six were treated with CVPP + RT (52 St III and 14 St IV) and 85 with CVPP alone (68 St III and 17 St IV). Complete remission was obtained in 57 (86%) of 66 patients who received CVPP plus RT, and in 62 (73%) of 85 patients treated with CVPP. Five and sixteen patients, respectively, achieved partial responses, while 2 in each group died during treatment. At 7 years, duration of complete remission and failure-free survival were: 51% and 45% for those treated with CVPP plus RT, and 23% and 21% with CVPP alone (p = 0.0150 and P = 0.0016, respectively). Overall survival at 7 years was 71% and 58%, respectively (p = 0.1488). A dose analysis performed in 84 pts showed that 91% and 88% received full protocol doses of CPM and PCZ, respectively, in the CVPP + RT group, and 95% and 94% for CVPP. The WBC nadir was 3.5 and 3.7 x mm3, respectively. Of 25 pts on CVPP + RT who relapsed, 9 are now disease-free, 5 are alive with disease and 11 have died, and with CVPP, of 37 relapsing pts, 18 are disease-free, 5 are alive with disease and 14 are dead.(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibitory effect of insulin and cytoplasmic factor(s) on brain (Na(+) + K+) ATPase

(Na+ + K+)ATPase activity in cerebral cortex was modulated by insulin action depending on the Mg2+ concentration. Thus, in homogenates in the presence of 1-3 mM Mg2+, insulin stimulated the enzyme, whereas in the presence of 4-6 mM Mg2+ inhibition was observed. Exposure of synaptosomal membranes to the soluble fraction resulted in inhibition of ATPase activity in a dose-dependent manner. The inhibitory effect of insulin was regulated by a cytoplasmic factor in a dose-dependent manner. Similar variations to those obtained with a crude synaptosomal fraction were obtained by using a partially purified ATPase. These results indicated the importance of soluble factors in the modulation of ATPase by insulin and add more evidence in support for a role of insulin as a neuromodulator.

PAF-induced activation of polyphosphoinositide-hydrolyzing phospholipase C in cerebral cortex

The action of platelet-activating factor (PAF) on phosphoinositide hydrolysis was studied in rat brain slices. PAF produced a significant increase of 32P incorporation into phosphoinositides and phosphatidic acid (PA), in a dose- and time-dependent manner. Concomitantly, an increase of inositol phosphates and diacylglycerol (DAG) production was observed. Both inositol bisphosphate (IP2) and inositol trisphosphate (IP3) were detected as early as 5 s and they returned immediately to basal levels; concomitantly, formation of inositol monophosphate (IP) was detected. These findings demonstrated that PAF causes a rapid hydrolysis of polyphosphoinositides in cerebral cortex by a phospholipase C-dependent mechanism followed by subsequent resynthesis.

[Infiltrating transitional carcinoma of the bladder. 3. Effect of regional lymph node dissemination on the prognosis]

The evolution of 168 patients, 136 of which underwent bilateral lymphadenectomy is analyzed in this paper. In 126 cases it was possible to obtain all the data in order to define N within the T.N.M. rating. With regard to the remaining patients 10, of which we lack the anatomopathological report, and 32 which did not undergo lymphadenectomy, are included under item Nx. During follow-up, metastasis was diagnosed in 60% node-positive patients. We believe it to have been already present at the time of undergoing surgery. Survival was significantly higher in the group without node dissemination than in both negative-nodes and Nx groups. When assessing the nodular dissemination group, patients treated with 2000 rad prior to cystectomy showed higher survival rates: 36% vs 22% and 11% for groups treated with 4500 rad and no radiotherapy. respectively. Metastatic percentage, however, was lower for the group managed with surgery alone (50%) than those treated with pre-operative radiotherapy (73% and 67% with 2000 and 4500 rad, respectively), on the other side, it would seem a contradiction that a 2000 rad dosage should be more effective than a 4500 rad dosage for this group of patients, since theoretically, the latter is closer to the ideal dosage to eradicate the nodular disease. Since 3 of 5 patients have micrometastasis, which we are yet unprepared to detect, all positive-node patients should receive chemotherapy immediately after recovery from surgery.

Combination of rubidazone and cytosine arabinoside in the treatment of first relapse in acute myelocytic leukemia

This study tested the efficacy of rubidazone and cytosine arabinoside in 35 patients (13 children and 22 adults) with acute myelocytic leukemia in first relapse. Induction consisted of 1-2 courses of rubidazone 200 mg/m2 days x 4 days plus cytosine arabinoside 100 mg/m2 x 7 days in CI followed by 2 consolidation courses of 3 days and 5 days. Nineteen patients (54%) achieved complete remission, 8 failed to respond, and 8 died. Twelve patients relapsed after 1 to 9 months, at a median of 4 months, 1 patient died of cardiac failure and 1 remains in complete remission at 12 months. Five patients underwent bone marrow transplantation, 3 of them autologous, 1 was still in complete remission at 29 months, 1 relapsed, and 1 died of sepsis. Two received allogeneic marrow transplants and died at 3 and 4 months afterwards of VOD and graft failure. The main toxicity was severe and prolonged myelosuppression.

[Unilateral essential hematuria: diagnostic and therapeutic attitude in 2 cases]

Unilateral essential haematuria is an unusual clinical entity where diagnosis is achieved by exclusion of other urological and nephrological conditions. The paper reports two female patients with unilateral anaemic macroscopic haematuria which were evaluated using flexible ureteropyeloscopy, and one also underwent percutaneous pyeloscopy. In one of the patients a renal papilla haemangioma was found which was fulgurated, while the lesion was not identified in the other patient, although neither of them has shown haematuria recurrence during the follow-up period. The authors believe that uretororrenoscopy and percutaneous nephroscopy should be considered in selected patients with unilateral essential haematuria due to its diagnostic and therapeutic possibilities.

Urinary schistosomiasis with cutaneous lesions

We report a case of urinary schistosomiasis with simultaneous presence of cutaneous lesions in a white male. The literature is reviewed, and the frequency, characteristics and physiopathology are discussed.