Differences in airway responsiveness to acetaldehyde and methacholine in asthma and chronic bronchitis

Inhaled acetaldehyde may induce bronchoconstriction in asthmatic subjects and provides a new method to investigate airway responsiveness. The objective of the study was to determine whether acetaldehyde was a more specific stimulus than methacholine in differentiating asthma from chronic bronchitis with or without airflow limitation. Bronchial provocation challenges with methacholine and acetaldehyde were performed in 62 asthmatics and in 59 smokers with chronic bronchitis (32 with chronic bronchitis alone and 27 with chronic bronchitis and coexisting chronic obstructive pulmonary disease (COPD)). The response to both bronchoconstrictor agents was measured by the provocative concentration required to produce a 20% fall in forced expiratory volume in one second (FEV1; PC20). The two types of challenge yielded a similarly high level of sensitivity (100% for methacholine and 92% for acetaldehyde) in revealing airway hyperresponsiveness in asthma. However, bronchoprovocation with acetaldehyde yielded considerably greater specificity (95%) than bronchoprovocation with methacholine (24%) in separating asthma from chronic bronchitis. In subjects with asthma, methacholine and acetaldehyde responsiveness were weakly but significantly correlated (r=0.42, p=0.001) but no correlation was found between airway responsiveness to acetaldehyde and baseline FEV1 (r=0.13, p=0.33). These findings suggest that the demonstration of bronchoconstriction in response to acetaldehyde may be a more specific test than methacholine in the differentiation of asthma from chronic bronchitis. Furthermore, methacholine and acetaldehyde hyperresponsiveness are not reflecting the same pathophysiological process in the airways.

[Psychotic symptoms and Alzheimer's disease]

BACKGROUND

Psychotic symptoms appear during the course of Alzheimer's disease, but their frequency and intensity vary according to different studies and their nature remains unsettled.

OBJECTIVES

To study the frequency and intensity of psychotic symptoms in two transversal series of patients with Alzheimer's disease and analyze its relationship with the duration of the disease and severity of cognitive impairment.

PATIENTS AND METHODS

This study has been carried out in patients suffering from probable Alzheimer's disease (NINDS-ADRDA criteria). The stage of the disease was determined according to FAST, and the intensity of cognitive impairment in Mini Mental State Examination was classified as mild, moderate or severe. Frequency and intensity of psychotic symptoms (delusions, hallucinations and misidentifications) were determined by means of semistructured interviews (BEHAVE-AD 78 patients and CUSPAD 69 patients). The results obtained in these three groups of patients were compared through ANOVA variance analysis and mean contrast. Variance and covariance analysis were done to determine the relationship between psychotic symptoms and other variables (degree of cognitive impairment, length of evolution and stage of the disease). For this purpose, the patients with Alzheimer's disease but without psychotic symptoms were considered as control and compared to patients with psychotic symptoms.

RESULTS

Nearly half the patients had psychotic symptoms. Delusions appeared earlier and were more frequent than hallucinations and misinterpretations. The more severe was the cognitive impairment, the more frequent and intense were psychotic symptoms, but the difference was significant only in cases with severe cognitive impairment. Hallucinations appeared mainly in patients with advanced dementia and were related firstly with the intensity of functional and cognitive impairment and secondly with the duration of the disease.

CONCLUSIONS

Mild psychotic symptoms, especially delusions, appear early during the course of Alzheimer's disease. The frequency and intensity of these symptoms increase in parallel with the functional and cognitive impairments caused by the disease. Hallucinations, which appear mainly when the dementia is severe, can be considered as an evolutive marker of the process. Psychotic symptoms differ from those occurring in other disorders, either neurologic or psychiatric in nature.

Expanding informativeness of microsatellite motifs through the analysis of heteroduplexes: a case applied to Solanum tuberosum

The incorporation of heteroduplex analysis into conventional strategies for the study of polymorphisms at microsatellite loci has allowed us to obtain information useful in determining genetic diversity and relationships among organisms. We have chosen, as a model for the testing of this strategy, several Solanum tuberosum varieties cultivated on Tenerife Island (Canary Archipelago) and a (TCT)(n) microsatellite located in intron I from the gene for granule-bound starch synthase. The data obtained confirm the high degree of agreement between molecular and farmer taxonomy.

Validation of a rapid method for extraction of total RNA applied to Leishmania promastigotes

This report explains a rapid procedure (approximately 50 min) for the isolation of highly purified total RNA from Leishmania promastigotes based on extraction with acidic phenol. The simplicity of the manipulations required make this method ideal for processing multiple samples; the quality of the RNA obtained is suitable for reverse transcription polymerase chain reaction analysis.

Conformational behavior of the HAV-VP3(110-121) peptidic sequence and synthetic analogs in membrane environments studied by CD and computational methods

The present study was undertaken to examine the structural features that may be important to explain the immunogenicity of the (110-121) peptide sequence (FWRGDLVFDFQV) of VP3 capsid protein of hepatitis A virus. A conformational analysis of the preferred conformations by CD and molecular mechanics was carried out. Present results suggest that the interaction with liposomes as biomembrane model induces and stabilizes the amphipathic beta-structure of the peptide. To study the contribution of amino acid replacements at the RGD tripeptide as well as the influence of the peptide chain length on peptide conformation, solid-phase peptide synthesis of several peptide analogs was carried out and the peptide conformation was studied using CD spectroscopy. The results show that the RGD sequence is necessary to induce the beta-structure in the presence of liposomes.

A new continuous epitope of hepatitis A virus

A new continuous epitope of hepatitis A virus (HAV) was defined in the VP3 protein. Convalescent sera recognised the synthetic peptide 3110-3121 (FWRGDLVFDFQV). The replacement of the arginine, glycine, or aspartic acid at positions 112, 113, or 114, respectively by other amino acids induced the loss of synthetic peptide recognition by human convalescent sera, thereby confirming the presence of an epitope in the original VP3(110-121) sequence. Shorter VP3 peptides such as VP3(110-119). VP3(110-117), and VP3(110-116) and a tandem repeat of VP3(111-116) failed to react with convalescent sera, indicating the importance of the entire peptide in the epitope structure. The maximum inhibition of human convalescent binding to HAV by the VP3(110-121) peptide was around 60%, and 50% inhibition was achieved at a peptide concentration of 2.3-2.4 micrograms/ml. Antibodies generated by this peptide bound to intact HAV and neutralised its infectivity. Antipeptide antibodies inhibited convalescent serum binding to HAV. Monoclonal antibodies H7C27 and MAK-4E7 inhibited completely binding of the antipeptide antibodies to HAV.

Solid phase synthesis and immunogenicity of a VP3 peptide from hepatitis A virus

The synthesis of a peptide belonging to the VP3 capsid protein of Hepatitis A virus has been accomplished by the continuous flow Fmoc-polyamide solid phase method. The use of methoxytrimethylbenzenesulphonyl (Mtr) and pentamethylchromansulphonyl (Pmc) as arginine side-chain protecting groups in the presence of tryptophan without lateral protection or protected with t-Boc is discussed. The synthetic VP3 peptide has been administered to mice in different forms: (i) free, (ii) coupled to keyhole limpet hemocyanin, (iii) encapsulated in multilamellar (MLV) liposomes, and (iv) incorporated to a tetrameric branched lysine core. The immune response induced by these preparation is reported.

N-aralkyl substitution of 2-aminoindans. Synthesis and their inotropic and chronotropic activity in isolated guinea pig atria

Amino substitution of rigid forms of dopamine 4,5-dihydroxy-2-aminoindan and 5,6-dihydroxy-2-aminoindan with aralkyl functionalities were carried out to investigate the role of such structural modifications upon cardiac inotropic-chronotropic activity. Compounds synthesized demonstrated a modest inotropic selectivity, while one of them, described as 5,6-dihydroxy-N-[2-(4-hydroxyphenyl)-1-methylethyl]-2-aminoindan hydrobromide 17, showed a marked inotropic action on isolated heart tissue.

Direct determination of prolintane and its metabolite oxoprolintane in human urine by capillary zone electrophoresis and beta-cyclodextrin-modified micellar electrokinetic chromatography

This paper describes a fast and simple method for the direct determination of the stimulant prolintane and its principal urinary metabolite, oxoprolintane, in human urine by capillary zone electrophoresis and beta-cyclodextrin-modified micellar electrokinetic chromatography. The determination was performed in phosphate buffer, pH 8.5, with UV detection at 211 nm. The effect of the ionic strength ratio between sample and running electrolyte, pH, sodium dodecyl sulphate and beta-cyclodextrin concentrations, and other factors, on the electrophoretic signals of these drugs was examined. This method can be applied for doping control. The determination limits are 1.0 microgram ml-1 for prolintane and 0.7 microgram ml-1 for oxoprolintane.

[Deafness secondary to lumbar puncture]

INTRODUCTION AND OBJECTIVE

Disorders of hearing have been described in patients who have undergone lumbar puncture. The lower frequencies are most affected, temporarily and with spontaneous recovery in most cases. It would seem that the cochlea aqueduct (AC) (an anatomical structure found in the internal ear) is the part involved in the pathogenesis of this infrequent complication. The object of this paper is to review the different hypothesis put forward by various authors on the subject, emphasizing the one which seems most probable. At the same time, we offer a new vision of this little known and often forgotten anatomical structure of the internal ear. The anatomy and physiology of the AC is considered, studying the part played by the labyrinth fluid when the patient undergoes an operation involving the cerebro-spinal fluid (CSF) or the subarachnoid space.

CONCLUSIONS

Whenever this technique is to be used, it is essential to obtain a clinical history to find out whether the patient has, or has had, any problems of hearing, and if so of what type. All patients should be warned of the possibility of deafness, in most cases temporary, and if the patient has hydrops endolymphaticus (syndrome of Ménière) of the high risk of worsening his hearing threshold. We therefore recommend precise evaluation of the use of this technique.

Clinical pharmacokinetics and tolerability of dotarizine in healthy subjects after single and multiple oral administration

Dotarizine is a new diphenylmethylpiperazine derivative with Ca2+ channel blocking properties and inhibitory effects on 5-HT2A and 5-HT2C receptors. Previous pilot studies in healthy volunteers demonstrated a good tolerability after single and multiple dosing. Dotarizine appeared to be rapidly and extensively metabolized to an active compound (FI-6020). We aimed to study the physiologic, subjective and psychomotor acute effects of oral dotarizine after single dose administration, to evaluate the tolerability and safety after multiple dosing over 2 weeks, and to study the pharmacokinetic parameters and linearity after single and multiple administration. Two different studies were carried out in 2 groups of 8 healthy male volunteers. Oral single doses of dotarizine 50, 100 and 200 mg were administered in a randomized, double-blind, crossover, placebo-controlled trial. Oral doses of 50 mg twice daily were administered in an open trial over 14 days. Drug effect assessments included vital signs, collection of adverse events, ECG and blood and urine safety evaluations, subjective effects, psychomotor performance tasks and blood sampling. Dotarizine and its metabolite were determined by gas chromatography with N-P detector. The results showed a good tolerability of dotarizine after single oral doses as well as multiple oral doses over 14 days. No clinically relevant adverse events were reported during the study. The highest single dose (200 mg) produced a slight increase in sedation-related symptoms as well as a slight impairment in psychomotor performance tasks. Dotarizine and its major metabolite proved linear kinetics at single doses. The administration of oral doses of dotarizine 50 mg b.i.d. reached the steady state after the 7th day of treatment. The pharmacokinetic parameters remained similar from day 7 to day 14. The terminal elimination half-life of dotarizine and its metabolite appeared to be between 7 and 12 h.

Pharmacokinetics of ebrotidine in rats and dogs

The pharmacokinetics of ebrotidine (N-[(E)-[[[2-[(diaminomethylene)amino] -4-thiazolyl]methyl]thio]ethyl] amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) was studied in the rat and dog. After oral (agar suspension) and intravenous administration at 10 mg/kg to rats, ebrotidine was rapidly absorbed. Cmax values averaged 0.498 microgram/ml attained at tmax = 30 min. Distribution was fitted to a two-compartmental model with t1/2 beta = 1 h (i.v.). Clearance (Cl) was 29 ml/min.kg and volume of distribution (Vdss) was 1852 ml/kg. Absolute bioavailability was 22% of the dose administered. After oral (the same tablet formulation as that used for clinical trials) and intravenous administration at 150 mg and 25 mg, respectively, to dogs, absorption of ebrotidine was relatively rapid. Cmax values averaged 2,170 micrograms/ml attained at tmax = 2 h. Distribution was fitted to a two-compartmental model with t1/2 beta = 2.8 h (i.v.). Clearance (Cl) was 600 ml/h.kg and volume of distribution (Vdss) was 1000 ml/kg. Absolute bioavailability, which is variable in this type of drugs, ranges from 29% to 64% of the dose administered.

Pharmacokinetics of ebrotidine in healthy volunteers. A summary

Several clinical pharmacokinetic studies of ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]-4-thiazolyl] methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfonamide, CAS 100981-43-9, FI-3542) administered by oral route in single and multiple doses to healthy volunteers have been performed. Dosage levels were 150, 300, 400, 500, 600 and 800 mg. Plasma concentrations of unchanged ebrotidine and its major metabolite, ebrotidine sulfoxide, excreted in the urine were determined. The main pharmacokinetic parameters were calculated from the experimental data. Absorption was relatively rapid (Imax = 2 h) and unrelated to dose. Drug behavior was considered as reasonably linear: Cmax = 364-1168 ng/ml and AUC0-12 h = 1427-5997 ng.h/ml (doses from 150 mg to 800 mg). The mean values of terminal elimination half-life (t1/2 beta) ranged from 13.9 to 20.3 h (doses of 400, 600 and 800 mg). After multiple dosing there was no drug accumulation, and no significant changes in the mean values of the main pharmacokinetic parameters were observed. The steady state was reached from the second day of administration, 10-24% of the ebrotidine administered dose was excreted in urine mainly as its major metabolite, ebrotidine sulfoxide, as well as unchanged drug and other minor metabolites. These percentages were constant and independent of the dose administered.

[Surgical treatment of diffuse hyperthyroid goiter. Experience at a hospital in Valdivia, Chile]

BACKGROUND

The choice of medical, radiation or surgical therapy for hyperthyroid diffuse goiter is still empirical.

AIM

To report a retrospective analysis of the surgical treatment of hyperthyroid goiter in a Regional Hospital in Chile.

PATIENTS AND METHODS

The charts of 64 patients, 54 female, aged between 15 and 57 years old, operated between 1985 and 1995 were analyzed.

RESULTS

The indication for surgical treatment was failure of medical treatment in 59 patients and a big goiter causing mechanical compression in 3 patients. A subtotal thyroidectomy was done after an abbreviated surgical preparation. The mean weight of the resected glands was 65.9 g. Four patients had transient hypocalcemia and 4 had surgical wound seromas. After a mean follow up of 31 months, 77% of patients remain euthyroid, hyperthyroidism relapsed in 13.1% and 10% became hypothyroid.

CONCLUSIONS

Surgical treatment of hyperthyroid goiter is safe but the percentage of hyperfunction relapse is high.

[Breast hydatid cyst. A case report]

We report the case of a 63 years old woman with a left mammary hydatid cyst. The patient presented with a left painless mammary mass of four months evolution. Mammography showed a dense image of 9 cm phi in the left breast. Ultrasound showed a solid and heterogeneous lesion. The tumor was excised under general anesthesia. The initial macroscopic inspection showed a tumor with a well defined fibrous capsule filled with a grayish material that contained membrane debris. The pathological study confirmed the diagnosis of a hydatid cyst.

[Medullary cancer of the thyroid. Experience at the Hospital de Valdivia]

BACKGROUND

Medullary carcinoma of the thyroid is an infrequent type of thyroid tumor.

AIM

To retrospectively study all cases of medullary carcinoma of the thyroid diagnosed at a regional hospital.

PATIENTS AND METHODS

The charts and pathological studies of eight patients with medullary carcinoma of the thyroid, among 75 with thyroidal cancer, were reviewed.

RESULTS

Solitary nodules were the presenting sign in seven patients and cachexia in one. Five patients were subjected to total thyroidectomy, five to cervical lymph node dissection and four to complementary radiotherapy. Pathological diagnosis was made with the surgical piece in seven patients and by aspiration cytology in one. Five of the eight patients are alive after 50 months of follow up as a mean, one patient with bone metastasis.

CONCLUSIONS

The small sample size precludes conclusions on the prognosis and treatment of the disease.

Cloning and sequence analysis of the invertase gene INV 1 from the yeast Pichia anomala

A genomic library from the yeast Pichia anomala has been constructed and employed to clone the gene encoding the sucrose-hydrolysing enzyme invertase by complementation of a sucrose non-fermenting mutant of Saccharomyces cerevisiae. The cloned gene, INV1, was sequenced and found to encode a polypeptide of 550 amino acids which contained a 22 amino-acid signal sequence and ten potential glycosylation sites. The amino-acid sequence shows significant identity with other yeast invertases and also with Kluyveromyces marxianus inulinase, a yeast beta-fructofuranosidase which has a different substrate specificity. The nucleotide sequences of the 5' and 3' non-coding regions were found to contain several consensus motifs probably involved in the initiation and termination of gene transcription.

Fluconazole therapy in coccidioidal meningitis maintained with intrathecal amphotericin B

BACKGROUND

Meningitis follows approximately 0.15% to 0.75% of cases of extrapulmonary coccidioidomycosis. Successful treatment of coccidioidal meningitis (CM) has generally required intrathecal therapy with amphotericin B, which often causes significant toxic effects and discomfort to the patient. Prior to fluconazole, azoles had not been efficacious in CM either because of toxicity at elevated doses or because of poor cerebrospinal fluid distribution. Fluconazole however, has been found to have both good cerebrospinal fluid penetration and a favorable side effect profile.

METHODS

We studied 11 patients with CM who were maintained with amphotericin B and were then switched to oral fluconazole therapy alone at a dosage of 400 mg/d for a period of up to 19 months. The patients were evaluated clinically for evidence of deterioration measured by need for hospitalization, development of extrameningeal disease during the study period, need to reinstitute intrathecal amphotericin B therapy because of worsening disease, cerebrospinal fluid leukocyte count, protein level, and serologic tests for complement-fixing antibody.

RESULTS

Three patients required hospitalization during the study, two patients for reasons unrelated to CM. No patient developed extrameningeal disease or required discontinuation of fluconazole therapy because of deteriorating disease. Patients at exit reported no symptoms related to meningitis or adverse effects related to fluconazole therapy. There was no deterioration in general health or neurologic status.

CONCLUSIONS

Our study demonstrates that conversion from amphotericin B to fluconazole was associated with a stable disease course of CM for up to 19 months. Further studies delineating both optimal dosage and characteristics of patients likely to respond to fluconazole therapy alone are needed.

[Intestinal obstruction caused by peritoneal carcinomatosis due to signet ring cell carcinoma of the breast]

The signet ring variant of lobular mammary carcinoma is aggressive and metastasis to serosal surfaces. We report a 46 years old woman presenting with an intestinal obstruction due to a peritoneal carcinomatosis secondary to a signet ring cell carcinoma of the breast. After surgery, the patient received chemotherapy (5-fluorouracil, adriamycin, cyclophosphamide and tamoxifen). A satisfactory response, with regression of peritoneal carcinomatosis and a good quality of life, was achieved. The patient is alive after 2 years of diagnosis.

Lignan models as inhibitors of Phanerochaete chrysosporium lignin peroxidase

The lignan 8,8'-bis-(methylenedioxy)cinnamic acid (BMDCA) is a powerful competitive inhibitor (K1 = 2.0 microM) of the lignin peroxidase (LiP) from Phanerochaete chrysosporium and of the extracellular peroxidase of Phlebia radiata (I0.5 = 10 microM). BMDCA derivatives with the same double bond system also inhibited these enzymes to some extent. If the double bonds were hydrogenated, the inhibitory effect was lost. HRP-VIII and HRP-XI were slightly inhibited by BMDCA (I0.5 > 50 microM) and two plant peroxidases described as efficient lignan synthesizers were unaffected. Liquid cultures of P chrysosporium did not discolour the dve Poly R478 when 250 microM of BMDCA was present.

[Cysts of second branchial cleft: review of 32 operated cases]

The aim of this work was to analyze retrospectively the clinical features of 32 patients aged 23.9 years (21 female) with the histological diagnosis of second branchial cleft cyst. In 28 patients, the cyst was localized below the mandibular angle. The presenting symptom was a cervical tumor in 30 patients and pain in eight. Fourteen aspiration punctures was performed obtaining 8 purulent and 6 straw colored aspirates. The preoperative diagnosis was correctly made in only 19 patients; the principal confounding diagnosis was tuberculous adenitis. All patients were operated performing a complete cystectomy in 30 and partial cystectomy in two. Three patients had a surgical wound infection and the cysts recurred 5 months and 4 years after operation in the two patients subjected to partial cystectomy. The histological study revealed squamous epithelial with underlying lymphoid tissue. It is concluded that aspiration puncture is useful for the correct diagnosis and that the cyst must be completely eradicated to avoid recurrences.

[The prevalence of chronic obstructive pulmonary disease and asthma. A cross-sectional study]

Four hundred sixty-seven patients between 35 and 65 years of age were studied, all taken from a random sample of the population of Health Area 5 of the Valencian Community. Figures for respiratory symptoms, smoking, previous lung disease, professional activity and lung function were obtained through questionnaires and spirometry. The prevalence of asthma found was 2.78% (C.I. 2.76-2.79); chronic bronchitis was 4.07% (C.I. 2.37-5.77) and airflow limitation was 6.4% (C.I. 4.5-8.3). Smokers represented 33.2% of the sample. A significant association was found between the level of intensity of symptoms and lung function. There were no differences between smokers and non smokers with respect to FEV1%. An association between workplace exposure and spirometry was found only for FEV1/FVC%.

[Diffuse hyperthyroid goiter associated with occult papillary carcinoma of the thyroid. Report of 2 cases]

The association of diffuse hyperthyroid goiter and thyroid cancer is rare and interesting, considering that both diseases affect the same organ but have different pathogenesis and prognosis. We report two patients that consulted for diffuse hyperthyroid goiter and were subjected to a subtotal bilateral thyroidectomy due to antithyroid drug failure. Pathological study revealed the coexistence of diffuse gland hyperplasia and a papillary thyroid carcinoma of less than 7 mm phi. In both cases, the thyroid remanent was ablated with radioactive iodine during the postoperative period and thyroid substitution was started.