[Deletion of ABH antigens in urine sediment cells from patients with prostatic adenoma]

OBJECTIVE

This study was conducted to analyze ABH antigenic expression in urinary sediment of patients with benign prostatic hyperplasia (BPH) before and after deobstructive surgery.

METHODS/RESULTS

The agglutination inhibition technique was utilized to determine the ABH antigenic expression in urinary sediments of 30 healthy subjects and 34 patients with BPH. The presence of neoplastic cells was also determined in urinary sediments of the patients by Papanicolaou's stain. These studies were performed before and 12 months after surgery. Membrane antigen expression was found in 100% of the healthy subjects and in only 50% of the patients with BPH before surgery. Only 25 patients returned for control evaluation after surgery. Of these, 17 were positive and of the remaining 8 patients who were negative preoperatively, only one continued to be negative. Urine cytology demonstrated progression to malignancy in this patient.

CONCLUSIONS

Determination of ABH antigenic expression appears to be able to identify premalignant conditions and could be a useful complementary diagnostic method to cytology.

Pyarthrosis in patients with rheumatoid arthritis: a detailed analysis of 10 cases and literature review

OBJECTIVES

1) To analyze the clinical features and outcome of patients with rheumatoid arthritis and pyarthrosis seen in a rheumatology department during a 9-year period; 2) To review the available literature about this association in the last decade.

METHODS

From the database of our department, we collected all hospitalized cases of infectious arthritis in native joints between January 1990 and December 1998. In 10 cases (27%), pyarthrosis occurred in patients with rheumatoid arthritis. A detailed analysis of each patient was performed. The literature was reviewed by using MEDLINE from 1990 to 1999.

RESULTS

The mean age of patients was 63.2 years; six were female. Most patients had long-standing disease and poor functional class, and all received glucocorticoid treatment. Mean diagnostic delay was 7.3 days. Causative organisms were Staphylococcus aureus (4 cases), gram-negative bacilli (3 cases), anaerobic bacteria (2 cases), and Streptococcus pneumoniae (n = 1). Two patients died. In all but two patients who survived, joint function worsened.

CONCLUSIONS

Rheumatoid arthritis is a relevant host-related risk factor for septic arthritis. Pyarthrosis in these patients is associated with considerable morbidity and mortality.

[Abnormal glycosylation of soluble ABH antigens in tumors of the urinary tract]

OBJECTIVE

To determine the secretor expression in patients with bladder cancer, adenoma of the prostate and normal subjects.

METHODS

The secretor character was determined in saliva of normal subjects (n = 40), patients with bladder cancer (n = 61) and adenoma of the prostate (n = 44) by the technique of hemoagglutination inhibition.

RESULTS

80% of the normal subjects were found to be secretors, which is in agreement with the data reported in the literature. Only 23 (37.71%) of the patients with bladder cancer were secretors and 24 (54.54%) of the patients with prostate adenoma expressed the secretor gene.

CONCLUSIONS

The expression of soluble antigens decreased in patients with bladder cancer or prostate adenoma in comparison to the normal subjects. Deletion of ABH antigens in the membrane of tumor cells has been reported in other studies. This lack of expression results from a genetic alteration in the clones involved in tumor pathology. The decrease in soluble antigens in the patient groups analyzed might be due to the same mechanism of genetic alteration that could involve non tumor tissues. Most of the cancers in humans originate in epithelial cells and the changes in blood group antigens constitute an important aspect in tumor immunology.

[Study of bone mineral density in postmenopausal women with rheumatoid arthritis treated with low dose glucocorticoids]

BACKGROUND

To study bone mineral density (BMD) in a group of postmenopausal women with rheumatoid arthritis (RA) treated with low doses of corticosteroids.

PATIENTS AND METHODS

One hundred and eleven patients were included. Mean age (SD) was 63.8 (8.8) years, mean duration of postmenopausal period was 16.4 (10.1) years and the mean disease duration was 12.5 (8.2) years.

RESULTS

A significant reduction of lumbar BMD (p < 0.05) and femoral BMD (p < 0.0001) was observed. The prevalence of osteoporosis was of 47%.

CONCLUSIONS

The study supports, in the Spanish population, that postmenopausal women with RA treated with low doses of corticosteroids, have low BMD. We consider that the prevalence of osteoporosis in these patients is high.

Löfgren's syndrome revisited: a study of 186 patients

PURPOSE

To evaluate the clinical features, the results of noninvasive tests and biopsies, and the outcome of patients with Löfgren's syndrome.

SUBJECTS AND METHODS

Patients diagnosed as having Löfgren's syndrome at a university hospital in Barcelona, Spain, from 1974 to 1996, were prospectively followed. Löfgren's syndrome was defined as the association of erythema nodosum or periarticular ankle inflammation with unilateral or bilateral hilar or right paratracheal lymphadenopathy.

RESULTS

Löfgren's syndrome was diagnosed in 186 patients. The mean age was 37 +/- 11 years, and 157 (85%) were women. In 91 patients (49%), symptoms started during the spring (P < 0.0001). Erythema nodosum, periarticular ankle inflammation, or both were present at onset in 173 patients (93%). At the time of diagnosis, 161 patients (87%) had no respiratory symptoms; 151 (81%) had stage I abnormalities on chest radiograph, 29 (16%) stage II, and 6 (3%) stage 0. Five percent of patients had decreased forced vital capacity, and 15% had decreased carbon monoxide diffusing capacity. Extrathoracic involvement was infrequent. Serum angiotensin-converting enzyme levels were increased in 50% of patients. Gallium-67 scans showed hilar uptake in all the studied patients, but it yielded useful additional diagnostic information only in those with normal chest radiographs or with unilateral hilar lymphadenopathy. The diagnosis was proven with biopsy results in 63% of patients. None of the patients without histologic confirmation were subsequently found to have a diagnosis other than sarcoidosis. In the 133 patients who were followed for a mean of almost 5 years, 11 (8%) continued to have active disease, and 8 (6%) had several recurrences between 18 months and 20 years after a complete resolution. A normal serum angiotensin-converting enzyme level at diagnosis was associated with disease resolution without recurrence.

CONCLUSION

Löfgren's syndrome is usually a self-limiting form of sarcoidosis. Histologic confirmation is not necessary in typical cases. In a small number of patients, the disease may remain active or recur long after its onset, although usually with mild organ dysfunction.

Senescent erythrocytes: modification of rheologic properties, antigenic expression and interaction with monocytes

Human erythrocytes have a well-defined lifespan of 120 days. Their eventual removal from circulation is a complex process affected by many cellular parameters, making them susceptible to sequestration in the spleen and other organs. The purpose of this study was to investigate putative changes in rheologic properties, antigenic expression and interaction with monocytes of senescent erythrocytes (SE). SE and young erythrocyte (YE) fractions were obtained by differential centrifugation from 20 healthy donor blood samples. Membrane rheomechanic properties (by diffractometric method), ABO and MN antigens reactivity and erythrophagocytosis by peripheral monocytes were investigated in each fractions. SE showed a little decrease in the deformability index and an increase of both membrane elastic modulus and surface viscosity. The studies performed indicate a decreased expression in the antigens of both blood group systems studied (p < 0.01) and an increased rate of erythrophagocytosis by monocytes in SE compared to YE (p < 0.01). The significant modifications in the biomechanic properties of senescent red blood cell membrane and the loss of antigenic expression could lead to physiological phagocytosis.

[Diarrhea associated with Clostridium difficile. One-year retrospective study at a tertiary hospital]

BACKGROUND

Diarrhea associated with Clostridium difficile is a health care problem of growing importance in the last few years specially in the hospital environment. The epidemiologic data and factors associated with this disease have not, to date, been sufficiently studied in Spain.

METHODS

The cases of diarrhea associated with C. difficile reported in 1996 in a tertiary hospital of 1,500 beds were retrospectively reviewed, collecting clinical and epidemiologic data. The technique used for the detection of the C. difficile toxin was EIA Premier.

RESULTS

One hundred thirty-two patients were included in the study, 83.3% of whom were over the age of 65 years, who had had 148 episodes of diarrhea associated with C. difficile. Most had been admitted into internal medicine (36%) or in the geriatric department (25%) and the remaining in the surgical departments (16.4%) or others (22.6%). The most frequently prescribed antibiotics were third generation cephalosporins (28.6%), clindamycin (17%), quinolones (11.1%) and macrolides (9.1%). Most of the patients received from 2 to 4 antibiotics prior to presenting diarrhea. Thirteen percent of the episodes of diarrhea associated with C. difficile were exclusively treated with withdrawal of the prescribed antibiotic, while the remaining cases were also given specific treatment which in 68.6% of the cases was with metronidazole and 31.4% with vancomycin. No significant difference was observed in the evolution of the patients according to the antibiotic prescribed.

CONCLUSIONS

Diarrhea associated with C. difficile should be taken into account as a frequent complication of wide spectrum antibiotic treatment, specially in the elderly, immunosuppressed or in patients with pluripathology. With this study the authors wish to underline the need for the judicious use of antibiotics in the hospital environment and aid in the rapid diagnosis of this entity.

Effect of complement on the rheological properties of the erythrocyte membrane

The effect of complement (C) on the erythrocyte deformability was investigated. Sheep erythrocytes (E) were sensitized with specific antibodies (A) and treated with various doses of human C. Gravity filtration of unlysed EAC showed a C dose-dependent decrease in whole cell deformability, which was shown to be due to an impairment of the membrane rheological properties. As the fluidity of the lipid bilayer, sensed by a spin label, was not modified, the observed effects should be related to an interaction between C and the cytoskeleton. The influence of C3b and C3d in these processes seems unlikely, as similar hemagglutination titers were found, respectively, for anti-C3c and anti-C3d antisera against the varying EAC. The study of the degree of spontaneous hemolysis of EAC in buffers with solutes of different Stokes radii showed that differing-sized functional C lesions were produced, and that the formation of larger-sized lesions was favored by incubation with higher C doses. These results suggest that the insertion of proteins from the membrane attack complex, C5b-9 (MAC), into the erythrocyte membrane may be responsible for the effect of C on the rheological properties of the erythrocyte membrane.

Complex viscoelasticity of normal and lectin treated erythrocytes using laser diffractometry

A new method to find directly complex viscoelastic parameters (CVP) of red blood cells (RBC) is presented in this paper. Experimental determinations were carried out in an Erythrodeformeter (Rasia et al., 1986) operating in oscillating mode (0.5 to 3.5 Hz). The Erythrodeformeter performs direct determination of CVP of erythrocytes undergoing sinusoidal shear stresses by laser diffractometry. The measurements lead to the determination of mean values of the four components of erythrocyte complex viscoelasticity. The influence of the alterations induced on erythrocyte membrane by vegetable lactins (Ulex europaeus, wheat germ agglutinin and Enterolobium contorticilicum seeds) was analyzed to verify the sensitivity of this method. Differences observed between the CVP parameters of treated cells and the ones corresponding to control samples (non treated cells) are analyzed. Results obtained from cells treated with wheat germ agglutinin agree with observations published by Smith and Hochmuth (1982). Determinations of RBC complex viscoelasticity carried out by laser diffractometry could become an important tool to understand the influence of the factors associated with alterations of the rheologic properties of RBC membrane, which can affect the in vivo blood flow.

[Blood preservation. Bacteriological, immunohematological, hematological and hemorrheological studies]

The knowledge of erythrocyte viability during blood bank storage period has been a major problem for transfusional practice. This problem must be considered by taking into account blood flowing properties which are directly related to the rheological properties of erythrocytes. The aim of this work was to perform an interdisciplinary study of the modifications induced in erythrocyte properties during 29 days storage of whole blood in a blood bank. Three samples of venous blood collected from healthy adults in plastic bags, anticoagulated with ACD (citric acid, citrate, dextrose) and stored at 4 degrees C were studied. Rheological properties (deformability, membrane elasticity and surface viscosity), immunohematological conditions (antigenicity) of erythrocytes, haematological index variation and bacteriological cultures of blood were weekly analysed. Rheological studies were performed using the Erythrodeformeter, a polymicroviscosimeter (paper filter) and erythrocyte filtration through polycarbonate membranes of 5 microns pore diameter. Impairment of membrane rheological properties, loss of antigenicity and decreases of Ht, Hb, MCHC and MHC were observed. Bacteriological cultures gave always negative results. The studies performed showed significant alterations of erythrocyte rheological parameters. It becomes evident that such modifications would influence the erythrocyte mechanical behavior in microcirculation and impair the in vivo viability of the transfused red cells.

Treatment of chronic hepatitis C with interferon-alpha. Clinical histological and virological implications

OBJECTIVE

to identify pretreatment predictive factors of long-term biochemical and virological response to interferon-alpha in chronic hepatitis C and to determine the effects of a second course of interferon-alpha in patients who responded but relapsed after interferon withdrawal.

DESIGN

retrospective analysis.

SETTING

outpatient liver clinic of a tertiary hospital in Spain.

PATIENTS

112 patients with chronic hepatitis C were treated with recombinant interferon-alpha (3 MU three times a week for 6 months). Twenty-four patients who responded but relapsed after interferon withdrawal were treated with a second course of interferon (3 MU three times a week for 12 months).

RESULTS

seventy-two patients were non-responders (64%), 11 patients had a sustained response (10%) and 29 patients responded but relapsed after interferon withdrawal (26%). Five (25%) of the 24 patients who relapsed and were treated with a second course of interferon experienced a sustained response (mean follow-up: 10 months). By multivariate analysis, four pretreatment variables were found to be predictive of a complete response: age < 40 years (p = 0.0004), history of IVDA (p = 0.001), low serum levels (p = 0.013), and genotype 3 (p = 0.01). Two variables were found to be predictive of a sustained response: short duration of HCV infection (p = 0.09) and genotype 3 (p = 0.01). Sustained responders appeared to have lower HCV-RNA levels than those with complete response who relapsed and non-responders. HCV viremia levels were not associated with the severity of liver histology, duration of disease or the source of hepatitis.

CONCLUSIONS

in the present study a low sustained response rate was observed using a standard interferon-alpha regimen (3 MU three times a week for 6 months). The sustained response rate increased slightly with a second course of interferon-alpha (3 MU three times a week for 12 months) in patients with a complete response who relapsed after interferon withdrawal. Sustained response is related to viral genotype and duration of HCV infection.

[Osteonecrosis in systemic lupus erythematosus. Report of 3 cases]

We present three cases of patients with systemic lupus erythematosus (SLE) and osteonecrosis or avascular necrosis (AV). Although, the pathogenesis of osteonecrosis is controversial and multifactorial, the glucocorticoids therapy is the most important factor contributing to the lesion. We report the clinical presentation of the three patients. We comment the characteristics of AV, the diagnosis and the treatment of this uncommon complication in SLE patients.

Periarticular ankle sarcoidosis: a variant of Löfgren's syndrome

OBJECTIVE

To focus more attention on the syndrome characterized by periarticular ankle inflammation associated with bilateral hilar adenopathy--some authors regard it as a variant of the Löfgren syndrome, while other suggest it is a distinct clinical entity-- we present a series of 33 cases of periarticular ankle sarcoidosis.

METHODS

Sarcoidosis was diagnosed in 330 patients at Bellvitge Hospital over a 20 year period. The medical charts of patients who presented with periarticular ankle inflammation (swelling of both ankles with acute inflammatory signs and preserved articular motion) were reviewed.

RESULTS

33 patients (10%) were identified. Periarticular ankle inflammation began during the spring in more than one-half (54.5%). The mean age was 33 years and patients were predominantly women (66.6%). Most cases (78.8%) were stage I on chest radiograph. All patients had thoracic gallium scans showing increased hilar/mediastinal uptake. Increased characteristic parotid, lacrimal, and/or submandibular uptake was found in 11 of 13 patients who had head scans. Four of 6 whose scans included the legs had bilateral ankle uptake. Erythema nodosum was present concomitantly in 36.3% of patients. No granulomas were found in 4 biopsies of periarticular ankle tissue. All 24 patients who were followed had inactive disease one year after diagnosis.

CONCLUSION

The association of periarticular ankle inflammation with bilateral hilar adenopathy is an acute form of sarcoidosis that follows a benign course to total remission. It should be regarded as a variant of the Löfgren syndrome.

Achalasia-like syndrome as the first manifestation in a patient with CREST syndrome

We report a case of oesophageal disease as the first manifestation in a patient with CREST syndrome. A 46-year-old man with achalasia-like syndrome developed CREST syndrome 4 years later. A pneumatic dilatation of the cardia was performed. After pneumatic dilatation the dysphagia and regurgitation disappeared but the patient developed reflux oesophagitis. Four years after diagnosis of oesophageal disease he presented with a clinical picture of CREST syndrome. An acute ileus and constipation developed later. After receiving medical therapy with omeprazole and cisapride the patient is free of oesophageal symptoms and bowel movements are normal. Oesophageal disease is common in patients with limited and diffuse scleroderma, but to our knowledge achalasia-like syndrome has not been previously described as the first manifestation of the systemic disease.

GDNF induces a dystonia-like state in neonatal rats and stimulates dopamine and serotonin synthesis

To test whether glial cell line-derived neurotrophic factor (GDNF) regulates the development of nigral dopaminergic neurons in vivo, neonatal rats received bilateral injections of GDNF into the striatum. Injections at postnatal day 2 induced a unique transient behavioral pattern characterized by forelimb hyperflexure, clawed toes of all limbs, and a kinked tail. Parallel to the behavioral changes, the levels of striatal and ventral mesencephalic dopamine and serotonin were increased from 60% to 100% with a proportional increase of principal metabolite levels. GDNF increased tyrosine hydroxylase activity in the ventral mesencephalon, but did not affect striatal activity of choline acetyltransferase and GABA uptake. GDNF failed to induce sprouting of dopaminergic neurites. Our findings suggest that during development striatal GDNF regulates the capacity of dopaminergic and of serotonergic neurons for neurotransmitter production and release.

Regulated release and polarized localization of brain-derived neurotrophic factor in hippocampal neurons

The site and regulation of neurotrophic factor release from neurons is poorly understood. We used a combination of model cell lines and primary culture systems to study the polarity of BDNF sorting and the regulation of its release from hippocampal neurons. Transfection and expression of a human BDNF cDNA in a mouse pituitary cell line, AtT20, resulted in the colocalization of BDNF with the secretory granule marker, chromogranin A. Furthermore, stimulation of these cells with 56 mM KCl or with 5 mM 8-bromo-cAMP increased the release of BDNF approximately 10-to 15-fold within 30 min. To study BDNF release from primary cultures of hippocampal neurons, cells were infected with a defective Herpes Simplex Viral (HSV) vector expressing human BDNF. Depolarizing conditions increased the release of BDNF 5-fold from these cells, further verifying that secretion is regulated. Immunocytochemical analysis using highly specific antibodies determined that endogenous BDNF was predominantly localized to the somatodentritic domain of hippocampal neurons. These findings support the view that BDNF functions as a target-derived signal for afferents to hippocampal pyramidal cells and that it may serve as a regulator of hippocampal plasticity.

Emetic control in breast cancer patients receiving iv CMF

Two consecutive antiemetic studies were performed in a homogeneous population of female breast cancer patients receiving i.v. CMF chemotherapy for six courses. Survival analyses (failure-free survival and emesis-free survival) were used as method of assessment of efficacy in these studies. The first of the two studies was a randomized, single-blind, placebo-controlled trial comparing three different dose levels of i.v. methylprednisolone (80 mg i.v., 250 mg i.v. and 500 mg i.v.) and placebo. 104 consecutive female breast cancer patients entered the study. There were no statistically significant differences in failure-free survival or emesis-free survival among the three methylprednisolone dose levels. Both failure-free survival and emesis-free survival were significantly superior in the three methylprednisolone arms than in the placebo group (p<0.05 to p<0.01). Since the results obtained with methylprednisolone alone in the first study were not completely satisfactory, the second study analyzed the interest of adding oral thyethylperazine (6 mg p.o. every 8 h) to i.v. methylprednisolone (80 mg) in 31 consecutive female patients scheduled to receive 6 courses of i.v. CMF. Sixty-eight percent of patients were free of emesis during the 6 courses of i.v. CMF chemotherapy with i.v. methylprednisolone plus oral thyethylperazine. This figure was significantly better than the emesis-free survival observed in methylprednisnolone-treated patients in the first study (p<0.05). Patients who did not achieve a complete response with methylprednisolone plus thyethylperazine in study 2 were treated with methyl-prednisolone (80 mg i.v.) and ondansetron (8 mg i.v. before chemotherapy and 8 mg per os every 8 h for 3 days) in subsequent courses of chemotherapy. Nearly 3/4 of such patient were rendered emesis-free with subsequent ondansetron treatment. Overall, 90% of patients obtained an excellent control of emesis with first-line methylprednisolone plus thyethylperazine or methylprednisolone-ondansetron rescue. The cost per patient of this antiemetic approach compares favorably with that of ondansetron as primary antiemetic therapy.

[Methotrexate treatment of amyloidosis secondary to rheumatoid arthritis]

Amyloidosis secondary to rheumatoid arthritis is a complication with a poor prognosis and as yet an undefined medical therapy. In the last decades the use of different cytostatics has been advocated to avoid renal function deterioration. The clinical characteristics and course in eight patients with amyloidosis secondary to rheumatoid arthritis are here reported after therapy with low dosage methotrexate. In twelve patients who followed a 12-month therapy a clinical improvement was observed, with a marked decrease in proteinuria; in one of them proteinuria disappeared. These results suggest that methotrexate at low doses might be an alternative in the early treatment of amyloidosis secondary to rheumatoid arthritis in patients with preserved renal function.