Verapamil Reverts Acute Renal Functional Impairment Induced by Angiotensin II Converting Enzyme Inhibitors

Angiotensin converting enzyme inhibitors (ACEI) reduce blood pressure (BP) and provide end-organ protection, but may induce renal function deterioration. In these cases, serum creatinine (SCr) can be normalized by ACEI withdrawn. In some patients, it could be desirable to maintain the ACEI for the protection of the kidney and heart. The objective of the study was to evaluate the effect of Verapamil (V) on renal function added to patients with elevated SCr due to ACEI treatment. In 46 hypertensive patients without previous renal failure, in which ACEI treatment induced an acute increase in SCr (> or = 20% or 0.5 mg/dL), ACEI treatment was maintained and 180 mg/day of V was added for 12 weeks. Those patients showing further SCr increase or no BP control at four weeks were withdrawn. Patients under BP control were moved on the combination V 180 + Trandolapril 2 mg/day for eight weeks more. SCr decreased from 136 +/- 49 micromol/L at baseline to 126 +/- 49 at 12 weeks after adding V (p < 0.001) and to 111 +/- 31 micromol/L at 20 weeks (p < 0.01). Creatinine clearance increased from 62 +/- 22 mL/min at baseline to 68 +/- 28 after 12 weeks of V (p < 0.001). This article demonstrates than in patients with acute renal function impairment secondary to ACEI treatment, the addition of 180 mg/day of verapamil to ACEI reverses SCr towards previous values.

Characterization of a new monoclonal antibody to human IL-17A (96.14)

Although IL-17A is made by CD4+ TH17 cells and there is an ever-increasing body of literature on these cells, other cells make IL-17A, including CD8+ (Tc17) and gamma-delta T cells, NK cells, and neutrophils. There are many factors that contribute to published findings of the percentage of cells producing IL-17A, including the activation or differentiation conditions, time course of activation, and antibody used for detection. It has been published that high levels of IL-17A are secreted by human PBMCs after anti-CD3/CD28-treatment alone for only 24 hrs. We have developed a new monoclonal Ab (clone 41802) that is specific for human IL-17A. The specificity of this Ab has been rigorously tested. Clone 41802 detects an increase in IL-17A in PMA/ionomycin-treated human PBMCs over resting cells by intracellular flow cytometry. This finding correlated with real-time PCR data in activated vs resting CD4+ PBMCs. This clone also detects IL-17A in a population of activated CD3+ PBMCs that is also positive for IL-22 and IL-23R by flow cytometry. Importantly, clone 41802 detects IL-17A in transfectant cells overexpressing human IL-17A, but not in cells overexpressing human IL-17F. The specificity of clone 41802 was further confirmed by western blot. In conclusion, clone 41802 is specific for human IL-17A. Although a larger percentage of IL-17A+ cells are detected in activated PBMCs than with other commercially available clones, this indicates an interesting biological finding, not a lack of antibody specificity.

Enhanced 40 and 80 Gb/s wavelength conversion using a rectangular shaped optical filter for both red and blue spectral slicing

By using a tunable filter with tunability of both bandwidth and wavelength and a very sharp filter roll-off, considerable improvement of all optical Wavelength Conversion, based on Cross Gain and Phase Modulation effects in a Semiconductor Optical Amplifier and spectral slicing, is shown. At 40 Gb/s slicing of blue spectral components is shown to result in a small penalty of 0.7 dB, with a minimal eye broadening, and at 80 Gb/s the low demonstrated 0.5 dB penalty is a dramatic improvement over previously reported wavelength converters using the same principal. Additionally, we give for the first time quantitative results for the case of red spectral slicing at 40 Gb/s which we found to have only 0.5 dB penalty and a narrower time response, as anticipated by previously published theoretical papers. Numerical simulations for the dependence of the eye opening on the filter characteristics highlight the importance of the combination of a sharp filter roll-off and a broad passband.

Perianth organization and intra-specific floral variability

Floral symmetry and fusion of perianth parts are factors that contribute to fine-tune the match between flowers and their animal pollination vectors. In the present study, we investigated whether the possession of a sympetalous (fused) corolla and bilateral symmetry of flowers translate into decreased intra-specific variability as a result of natural stabilizing selection exerted by pollinators. Average size of the corolla and intra-specific variability were determined in two sets of southern Spanish entomophilous plant species. In the first set, taxa were paired by family to control for the effect of phylogeny (phylogenetically independent contrasts), whereas in the second set species were selected at random. Flower size data from a previous study (with different species) were also used to test the hypothesis that petal fusion contributes to decrease intra-specific variability. In the phylogenetically independent contrasts, floral symmetry was a significant correlate of intra-specific variation, with bilaterally symmetrical flowers showing more constancy than radially symmetrical flowers (i.e. unsophisticated from a functional perspective). As regards petal fusion, species with fused petals were on average more constant than choripetalous species, but the difference was not statistically significant. The reanalysis of data from a previous study yielded largely similar results, with a distinct effect of symmetry on variability, but no effect of petal fusion. The randomly-chosen species sample, on the other hand, failed to reveal any significant effect of either symmetry or petal fusion on intra-specific variation. The problem of low-statistical power in this kind of analysis, and the difficulty of testing an evolutionary hypothesis that involves phenotypic traits with a high degree of morphological correlation is discussed.

Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer

OBJECTIVE

The reduction in tumour stage induced by full course radiotherapy plus chemotherapy is apparent from histological changes. The purpose of this study was to determine the rate of complete pathological response and to evaluate the prognostic value for disease free survival (DFS) and disease specific survival (DSS) of the response. The relation between pretreatment variables (age, gender, stage, tumour height and [carcinoembryogenic antigen (CEA)] and postsurgical variables was compared to the pathological response.

METHOD

A total of 119 patients with stage II or III rectal cancer underwent surgery 6 weeks after neoadjuvant treatment. Group A included patients with a complete or good pathological response (Mandard grade I-II) and group B patients with a poor response (Mandard grade III-IV-V). The pretreatment endo-rectal ultrasound scan stage was compared with histopathology stage of the resected specimen. DFS and DSS were compared using the log-rank test.

RESULTS

All 119 patients (mean age 67.9 years, 83 males) underwent resection. The tumour was located in the upper, middle and lower third of the rectum in 11, 51 and 57 patients. 88 patients had a low anterior resection, 28 patients abdomino-perineal resection and three a Hartmann's operation. There was no postoperative death. The circumferential margin (CM) was involved in 10%. A complete pathological response was observed in 17 (14.2%) patients. Thirty-six (30.2%) patients had a group A and 83 a group B response. Group A showed DFS to be significantly higher than group B (log rank: P = 0.007). The DSS rate was not significantly different between the two groups (log rank P = 0.113). Down-staging was not related with DFS. No relation was found between pretreatment variables and response. A good pathological response was related to a lower rate of permanent colostomy but not with CM involvement or the number of lymph nodes.

CONCLUSION

Tumour regression of grades I or II was a good indicator of DFS in locally advanced rectal cancer, treated by neoadjuvant chemotherapy and radiotherapy. Patients with a high regression grade were associated with a lower incidence of definitive stoma formation. The regression grade was shown to be a better prognostic factor than down-staging.

Sedative and anxiolytic efficacy of Tilia americana var. mexicana inflorescences used traditionally by communities of State of Michoacan, Mexico

AIM OF THE STUDY

Increasing demand of herbal products acquired in stores and markets, as well as medicinal plants collected for personal consume are a known modern tendency. In this study, the ethnomedicinal use of Tilia americana var. mexicana inflorescences as sedative and anxiolytic is reinforced by examinating inflorescences used by communities of the State of Michoacan, Mexico.

MATERIALS AND METHODS

Experimental mouse models were used to evaluate the sodium pentobarbital (SP)-induced hypnosis potentiation, ambulatory activity, as well as sedative and anti-anxiety responses via oral administration of the aqueous extracts (10, 30 and/or 100 and 300mg/kg).

RESULTS

All samples tested produced a lengthening in the time of SP. Moreover, a significant attenuation in the anxiety-response in the plus-maze test and a diminution in both the head dipping response and ambulatory activity were observed resembling the response to diazepam (0.3mg/kg, i.p.). TLC profiles of the samples showed similar pattern of flavonoids; HPLC-DAD exhibited peaks identified as derived of quercetin and kaempferol that may be responsible for the plant activity.

CONCLUSIONS

Our results demonstrate that inflorescences of stored specimens obtained from popular local markets show the same effectiveness with regard to sedative and anxiolytic-like actions than freshly collected samples. Since no toxicity was observed through this route of administration (up to 5000mg/kg); therefore, it suggests that this plant is secure when used as tranquilizer in folk medicine.

The effect of furanoheliangolides from Tithonia diversifolia on superoxide anion generation in human neutrophils

Four known lactones were isolated from Tithonia diversifolia: furanoheliangolides 1,3-dihydroxy-3,10-epoxy-8-(-2-methylpropanoyloxy)-germacra-11(13)-ene-6,12-olide (1), 1,3-dihydroxy-3,10-epoxy-8-(2-methylpropanoyloxy)-germacra-4,11(13)-diene-6,12-olide (2), 1,3-dimethoxy-3,10-epoxy-8-(2-methylpropanoyloxy)-germacra-4,11(13)-diene-6,12-olide (3) and, observed in natural source for the first time, furanoheliangolide 1-hydroxy-3-methoxy-3,10-epoxy-8-(2-methylpropanoyloxy)-germacra-4,11(13)-diene-6,12-olide (4). The activity of sesquiterpene lactones on superoxide anion (O(2)(o)(-)) generation from PMA-activated neutrophils was evaluated. Compound 1 did not show a full dose dependent behavior. The IC(100) was 8+/-1, 12+/-1, and 17+/-3 microM for 2 to 4, respectively.

[Effects of mycophenolate mofetil in ischemic acute renal failure in rats]

Mycophenolate mofetil (MMF) is a purine synthesis inhibitor commonly used as immunosupresive agent in transplantation. Kidney grafts undergo more or less prolonged cold ischemia after harvesting which results in variable degrees of ischemia reperfusion injury. To determine whether the inhibition of early events of cellular infiltration may influence the severity of damage induced by ischemic acute renal failure, 45 Sprague Dawley rats were given MMF at a dose of 20mg/kg/day (MMF-rats) by gavage 2 days before (pre-MMF group, n=15) or after (post-MMF group, n=15) clamping the left renal artery for 40 minutes followed by rigt-sided nephrectomy. (control group, n=15) received vehicle. Serum Creatinine (Screat) was measured daily in all groups. On the 2nd post-ischemic day Screat was significantly lower (p=0.001) in pre-MMF group compared with post-MMF group and control group (4 +/- 2mg/dl post-MMF group vs 1.7 +/- 1.2 mg/dl pre-MMF group, control group 5+/-2, p< 0.05). Kidney biopsies shown that the histologic damage was 54 +/- 28% in post-MMF group vs 34+/- 22% in pre-MMF group and 61 +/- 25% in control group (pre-MMF vs post-MMF, p NS). On the 5th day post-ischemic, MMF-rats showed more severe tubulointerstitial necrosis (pre-MMF group: 17 +/- 20 %, post-MMF group: 33 +/- 27%) than controls (4 +/- 5%). The severity of ATN was significantly higher in post-MMF group compared with controls (p=0.01). Tubulointersticial T-lymphocyte (T CD 5) and monocyte (ED 1) infiltration evaluated on the 2nd post-ischemic day was less intense in group I (T CD5: 3 +/- 3, ED 1: 10 +/- 9, cel/mm2) compared to post-MMF group (T CD 5: 10 +/- 4, ED 1: 55 +/- 40) and to control group (T CD 5: 10+/- 4, ED 1: 64 +/- 46). However, on the 5th post-ischemia day, ED 1 infiltration was significantly higher in post-MMF group (24 +/- 18%) compared to pre-MMF group (5 +/- 5, p NS) and also in pre-MMF group vs control group (31 +/- 33, p< 0.05). Our results suggest that MMF given before a renal ischemic insult may reduce the severity of histologic damage resulting from ischemia reperfusion injury.

[Factors associated with strongyloides stercoralis infection in an endemic area in Peru]

In order to determine the epidemiological factors and clinical symptoms associated with Strongyloides stercoralis infection, we carried out a descriptive study with a control group in the District of Chanchamayo, Province of Chanchamayo, Junin, Peru. Group I (n = 50) represented those individuals with strongyloidosis and group II (n = 50) were those who tested negative for S. stercoralis by parasitological methods. Epidemiological variables significantly associated with group I were: bathing in the river 3-4 times per week, consuming non-drinking water, defecating in the field; and with group II: drinking boiled water, wearing sneakers and living in houses with cement floor. The clinical symptoms of epigastric pain, daily abdominal pain, semi liquid feces, liquid feces, daily defecation frequency, urticaria and nausea were significantly associated with group 1; whereas more solid feces and defecating every other day were significantly associated with group II. Among individuals under the age of 20 there was a higher percentage of malnutrition according to the weight-age index in group I (p = 0.045). We conclude that infection by S. stercoralis should be suspected in persons from tropical areas who are in frequent contact with rivers or streams or live close to watercourses, who have gastroenterological or dermatological symptoms or who are malnourished, especially if they are children or adolescents.

232 EFFECT OF DIETARY FAT SUPPLEMENTATION ON OOCYTE AND EMBRYO QUALITY AND ON EARLY EMBRYONIC DEVELOPMENT OF SHEEP

The objective was to evaluate the effect of fat supplementation on oocyte quality and in vitro embryonic development (48 h). A total of 18 ewes, with a body condition score of 2.5 to 3 points out of 5, having had three to four lamb births, and at three to four months post-lamb birth, were distributed between an experimental oil group (OG; n = 9) that received corn oil (4% of the MS/diet) and a control group (CG; n = 9) that didn't receive oil. The two groups were maintained in confinement for 21 days (the duration of the experiment) and fed first with a concentrate diet followed by forage. The animals had access to minerals and water ad libitum. The diets were similar in energy (10.3 ± 0.05 MJ/s/d) and protein (141.75 ± 5.7 gPC/s/d) for both groups. The estrous cycle was synchronized (14 days) with intravaginal sponges (40 mg of fluorogestone acetate), inserted 7 days after the beginning of the diets. The end of the diet coincided with the retirement of the sponges. One day before sponge retirement, 75 mg prostaglandin F2α per sheep was administered, followed by ovarian stimulation with 1000 IU of pregnant mare serum gonadotropin (PMSG). Follicular diameter was determined by ventral laparotomy with the aid of a micrometer. Follicles were classified as small (2 to 2.9 mm), medium (3 to 4.9 mm), and large (>5 mm); oocytes were collected in TCM-199 medium. Oocytes were classified as excellent, good, fair, or low quality and transferred to Petri dishes in drops (50 mL) of TCM-199. Oocytes were matured and fertilized in vitro and cultured for 48 h. Oocyte quality as well as maturation, fertilization, and cleavage rates were compared by ANOVA. Ewes from the OG group presented a statistically higher proportion of oocytes with excellent quality (42%; P < 0.05) than GT ewes (26%). The proportion of good quality and fair quality oocytes was similar among groups (P > 0.05). A higher proportion of oocytes of low quality was found in the control group than in the OG group (40% vs. 18%); however, there was no significant difference (P > 0.05). Higher rates of maturation, fertilization, and early development were found in the OG compared with the CG (81.8, 60.6, and 36.4 vs. 68.6, 42.9, and 17.1, respectively); however, the differences were not significant (P > 0.05). In conclusion, the addition of 4% corn oil in the diet improved the quality of the oocytes; however, it had no significant effect on early embryonic development.

Resultados iniciales del Registro Nacional de Cirugía Hepática por Laparoscopia

INTRODUCTION

Experience in laparoscopic liver surgery is limited, and multicenter studies with large series are required for a critical evaluation of this type of surgery.

OBJECTIVE

To analyze the results of the National Registry of Laparoscopic Liver Surgery. Indications, technical features, conversion rates, morbidity, and mortality were analyzed.

PATIENTS AND METHOD

Seventy-four patients from 10 centers who underwent surgery between February 2000 and April 2005 were included. There were 58 women and 16 men, with a mean age of 55 years. More than one lesion was present in 16 patients. Consequently, 74 patients with 156 lesions were treated.

RESULTS

Forty-six patients had cystic lesions (26 simple cysts, 13 polycystic disease, five hydatid cysts and two cystic adenomas). Surgical treatment consisted of 37 fenestrations, five cystopericystectomies, two atypical resections, one segmentectomy and one bisegmentectomy of segments II-III. In 28 patients the lesions were solid (four adenomas, six focal nodular hyperplasias, three hemangiomas, four hepatocarcinomas, five colorectal metastases, two lung metastases, one breast metastasis, one malignant melanoma metastasis, one pancreatic vipoma metastasis, and one lymphoma). Ten bisegmentectomies of segments II-III, 17 atypical resections and one segmentectomy of segment III were performed. Other surgery was associated in 23 patients. The mean operating time was 160.5 minutes and the conversion rate was 8%. The mean length of hospital stay was 5.6 days and was less than 5 days in 78% of the patients. Analgesia was administered for less than 48 hours in 55%. Morbidity was observed in eight patients (10.8%). Reoperations were performed in three patients. There was no mortality in this series.

CONCLUSIONS

Laparoscopic hepatic resection is safe and feasible in selected patients. Large, controlled series are required to determine long-term outcomes. The national registry provides a good basis for evaluating laparoscopic liver surgery in Spain.

Inhibition of functionalized 1,3-dienes against Trypanosoma cruzi

Six functionalized 1,3-dienes were synthesized using cross-coupling reactions, catalyzed by palladium complexes, between alkenylboronic acids and alpha-bromo-alpha,beta-unsaturated carbonylic compounds. Their cytotoxicity against epimastigotes of Trypanosoma cruzi and fibroblastic Vero cells was evaluated, using concentrations ranging from 100 microM to 2.5 mM in experiments with three incubation times (4, 8 and 16 h). These tests were performed using MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] colorimetric bioassays and its further reduction to formazan, according to the viability of the parasites and cells. With the exception of (5E,6E)-5-benzylidene-2-methylundec-6-en-4-one, all compounds were cytotoxic to both Trypanosoma cruzi and Vero cells, however differential values of IC50 were observed for two of these compounds. A possible structure-activity relationship is discussed.

[Laparoscopic surgery in colorectal diseases]

The present state of laparoscopic surgery in colorectal diseases is presented, showing results that are superior to open surgery during the hospital stay, infection of the wound and quality of life in the first postoperative month. It is technically possible to carry out all of the techniques of colorectal resection with assisted laparoscopic surgery. The counter-indications depend above all on the state of the patient and his disease: emergency laparoscopy of the colon and rectum barely have a place in the therapeutic arsenal. However, elective surgery contributes a great number of cases, as well as colon cancer, whose laparoscopic approach is only contraindicated if the neighbouring organs are affected or if surgery by laparoscopy is not radical and oncological, due to the case itself or if the surgical team lacks the technique, given that the results for curing cancer are identical to open surgery, with level I scientific evidence. The results of cure and survival from laparoscopic surgery of cancer of the rectum are being studied. A description is given of the details of the surgical technique of right and left colectomies, laparoscopic resections of the rectum and of total colectomy.

[Doxazosine associated to renin-angiotensin blockers and calcioantagonists in chronic renal failure patients]

OBJECTIVE

To evaluate the safety and effectiveness of the alfa-blocker doxazosin GITS in CRF patients.

DESIGN AND METHODS

The study recruited 203 CRF patients (creatinine > 1,4 mg/dl for males, creatinine > 1,2 mg/dl for females, or creatinine clearance < 80 ml/min). All patients were receiving ACE inhibitores (63.4%) or angiotensin II antagonist (36.6%) therapy but they had higher blood pressure than recommended for CRF (130/85 mmHg). Patients were clinically evaluated 1, 3 and 6 moths after starting treatment with lercanidipine (10 mg once daily). Patients with high blood pressure in spite of combined therapy with two drugs added doxazosin GITS 4-8 mg once daily to treatment.

RESULT

57 patients rendered evaluable for the study (age 64.8 +/- 12.7 years, 47.4% males and 52.6 females). BP significantly decrease from 164 +/- 17/92 +/- 9 mmHg to 135 +/- 13/78 +/- 8 mmHg. 67.6% patients showed a significant BP reduction and 32.4% gets optimal BP control (< 130/85 mmHg). Two patients (3.6%) showed untoward effects. No biochemical changes were detected.

CONCLUSIONS

Doxazosin showed a good antihypertensive effect in CRF patients when used as third drug in resistant severe hypertension. It has a good tolerability profile and showed a neutral profile on biochemical parameters.

Effect of a Simple Dose-Escalation Schedule on Tramadol Tolerability

OBJECTIVE

To assess the effect of a very simple dose-escalation schedule on tramadol tolerability in clinical practice. This schedule consists of starting treatment with sustained-release tramadol 50mg twice daily, and escalating the dose around 7 days later to 100mg twice daily.

METHODS

Data from 1925 outpatients with non-malignant chronic pain were collected in this multicentre, prospective, comparative, non-randomised, open, observational study.

RESULTS

A total of 1071 patients (55.6%) were included in the dose-escalation group (50mg group) and 854 patients (44.4%) in the control group (sustained-release tramadol 100mg twice daily; 100mg group). The proportion of patients who interrupted tramadol treatment due to the occurrence of adverse reactions was significantly lower in the 50mg group (5.6%) than in the 100mg group (12.6%) [p = 0.001]. In line with this, the proportion of patients who experienced at least one adverse reaction was significantly lower in the 50mg group (18.4%) than in the 100mg group (30.4%) [p = 0.001] and, interestingly, the two most frequently reported adverse reactions, nausea and dizziness, were found with a significantly lower frequency in the 50mg group (p < 0.001). Multivariate analysis showed that the risk of safety-related treatment cessations was 2.3 times higher in the 100mg group than in the 50mg group, and 2.2 times higher in females than in males. The two treatments were equally effective in reducing pain intensity (p = 0.121), measured as a reduction in pain score obtained by means of a visual analogue scale.

CONCLUSION

The instauration of tramadol treatment, starting with sustained-release 50mg capsules twice daily and escalating the dose some days later to 100mg twice daily, was shown to be an effective and easy way to improve tramadol tolerability in clinical practice, whilst maintaining its analgesic efficacy.

Lercanidipine in patients with chronic renal failure: the ZAFRA study

OBJECTIVE

The objective was primary to evaluate the safe use of a new calcium channel blocker, lercanidipine, in patients with chronic renal failure (CRF). The secondary objective was to study the protective effect of calcium channel blocker on renal function in CRF patients previously treated with ACE inhibitors or angiotensin receptor blockers.

DESIGN AND METHODS

The study recruited 203 CRF patients (creatinine >1.4 mg/dL for males, creatinine > 1.2 mg/dL for females, or creatinine clearance <70 mL/min). All patients were receiving ACE inhibitors (63.4%) or angiotensin II antagonist (36.6%) therapy, but they had higher blood pressure than recommended for CRF (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3, and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to the treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection.

RESULTS

175 patients rendered valuable for the study (age 63.9+/-11.9 years, 52.9% males and 47.1% females). Blood pressure (BP) significantly decreased from 162+/-17/93+/-8.3 mmHg to 132+/-12/78+/-6 mmHg. 89.2% of patients showed a significant BP reduction, and 58.1% achieved optimal BP control (<130/85 mmHg). Seven patients (3.4%) showed untoward effects. Not one case of edema was detected, and the prevalence of adverse effects related to vasodilatation was extremely low (three patients, 1.48%). Plasmatic creatinine did not change (1.9+/-0.5 baseline versus 1.9+/-0.6 mg/dL), but creatinine clearance increased at the end visit (41.8+/-16.0 baseline versus 45.8+/-18.0 mL/min, p=0.019). Plasmatic cholesterol also decreased from 221+/-46 to 211+/-35 mg/dL (p=0.001).

CONCLUSIONS

Lercanidipine showed a high antihypertensive effect in CRF patients. It has a good tolerability profile and showed an interesting effect on plasmatic lipids. An improvement in renal function, measured through creatine clearance, was detected.

[The role of laparoscopy in emergency abdominal surgery]

Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

Evolution of endogenous hormone concentration in embryogenic cultures of carrot during early expression of somatic embryogenesis

Embryogenic callus and suspension cultures of carrot (Daucus carota L., cv. Nantaise), growing on/in medium including 1 mg/l 2,4-dichlorophenoxy acetic acid (2,4-D), were transferred to medium with or without this plant growth regulator, to impair or induce, respectively, further development of somatic embryos. The endogenous hormone levels of the cultures were determined over 7 days by means of radio-immunoassay, to characterize their evolution in the initial stages of embryo development. In general, levels of indoleacetic acid (IAA) and abscisic acid (ABA) showed only short-lived differences among treatments during this time in both types of tissue analyzed (i.e., a peak of IAA in callus cultures in the absence of 2,4-D, 48 h after medium change, and higher ABA contents 144 h after subculture of suspension cultures in the presence of 2,4-D). Gibberellins (1, 3 and 20) were detected only in suspension cultures devoid of 2,4-D, starting 24 h after subculture. Concerning the evaluated cytokinins-zeatin/zeatin riboside and N6(Delta2-isopentenyl) adenine/N6(Delta2-isopentenyl) adenosine-the most remarkable observation is that high levels of the former generally coincided with low concentrations of the latter, indicating a shift from precursor to the active form, and vice versa.

[Comments on Cogan's syndrome (congenital oculomotor apraxia) based on a case]

CASE

A 4-month-old girl was seen by a paediatrician for psychomotor delay and defective visual fixation. In order to shift gaze direction, she had to jerk her head in order to drag her eyes in the direction she wanted to look. She also showed non-specific pyramidal impairment. Herpes human virus type 6 (HHV-6) was amplified by PCR. No other findings could explain her troubles with fixation. She was diagnosed with congenital ocular motor apraxia (C.O.M.A.).

DISCUSSION

When C.O.M.A. is suspected, other causes of defective fixation and abnormal cephalic movements must be ruled out through the use of physical examination, electrophysiology and neuroimaging: troubles with ocular motility, poor vision or neurological processes. There have been cases associated with neurological misdevelopment, systemic diseases, metabolic deficits and chromosomic abnormalities.

[Lercanidipine in diabetic patients with renal failure]

OBJECTIVE

To evaluate the safe use of a new calcium channel blocker, lercanidipine, in diabetic chronic renal failure (CRF) patients.

DESIGN AND METHODS

The study recruited 42 diabetic CRF patients (creatinine > 1.4 mg/dl for males, creatinine > 1.2 mg/dl for females, or creatinine clearance < 70 ml/min). Mean age was 68.2 +/- 9.1 years. 53.8% were males and 46.2% females. Three patients were type 1 diabetics and 39 ones were type II. All patients were receiving ACE inhibitors (67.4%) or angiotensin II antagonist (32.6%) therapy but they had higher blood pressure than recommended for CRF patients (130/85 mmHg). No patients were under diuretic treatment. Patients were clinically evaluated 1, 3 and 6 months after starting treatment with lercanidipine. Samples for urine and blood examination were taken during the examination. When needed, a third drug was added to treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection.

RESULTS

BP significantly decrease from 163 +/- 18/90 +/- 8 mmHg to 134 +/- 12/77 +/- 9 mmHg. One half of patients showed significant reduction of blood pressure, 26.7% reached the target blood pressure (< 130/85 mmHg) and 20.0% gets optimal BP control (< 130/85 mmHg). No one patient showed untoward effects. No edema was detected nor adverse effects related to vasodilatation were found. Plasmatic creatinine did not change (1.9 +/- 0.5 baseline vs 1.8 +/- 0.5 mg/dl) and creatinine clearance increased at the end visit (40.1 +/- 14.5 baseline vs 45.4 +/- 18.2 ml/min) but the difference was not significant. Proteinuria was unchanged.

CONCLUSIONS

Lercanidipine showed a good antihypertensive effect in diabetics CRF patients. It has a good tolerability profile and showed neutral effect on plasmatic lipids. Neither impairment of renal function nor increment in proteinuria were detected.

[Present state of the surgical treatment of hepatic metastasis of colorectal origin: a practical view]

Hepatic resection is the only real possibility of cure for a selected group of patients with hepatic metastasis of colorectal cancer. Survival obtained in these patients is of some 30-40% after 5 years and some 20-25% after ten years following surgery; no other treatment approaches these results. The key for obtaining these results is the treatment of these patients by a multidisciplinary team, a team that must include the participation of surgeons specially trained in the techniques of hepatic resection. The present review describes: the pre-operational staging of hepatic metastasis of colorectal origin by diagnostic imaging techniques, the selection criteria for surgery, the standards of the surgical technique and the adjuvant treatment that forms part of the Protocol of the Hepatobiliary Surgery Section of the Hospital of Navarra, based on our experience in 150 hepatectomies and on the best scientifically available evidence.

Expression of lectin receptors on the membrane surface of sperm of fertile and subfertile boars by flow cytometry

Studies suggest that carbohydrates are important in different stages of fertilization. Plasma membrane changes accompanying in vitro capacitation and acrosome reaction (AR), such as removal or appearance of specific glycoproteins, have been studied using lectins that bind specifically to carbohydrate residues. In specialized artificial insemination farms and semen production centers, identification of boars with decreased fertilization ability (subfertility) is a newborn necessity. This investigation is a sequential study to determine the kinetics of surface carbohydrates turnover during in vitro capacitation and AR in fertile and subfertile boar sperm. Flow cytometry determinations of the binding of three FITC-labeled lectins were assessed. WGA binding was significantly lower in fresh, capacitated, and acrosome-reacted sperm of subfertile boars than in fertile boars. Con-A binding was not significantly different in fresh sperm of fertile and subfertile boars. However. Con-A labeling in capacitated, and acrosome-reacted sperm differed significantly in both groups. UEA binding increased only in capacitated sperm of subfertile boars. These findings could be used as indicators of capacitation and AR and may also be a good indicator of sperm fertilizing ability in boars.

Acrosome reaction in fertile and subfertile boar sperm

The main purpose of sperm evaluation is to predict its fertilizing ability. However, basic sperm test results show a low correlation with fertilizing ability. The purpose of this study was to determine whether there is an association between acrosome reaction (AR) and the incidence of subfertility of normal sperm boar. The production records of 22 farms were analyzed to identify boars with low fertility and/or prolificity, classified as subfertile. Twenty-two subfertile boar semen samples were analyzed and compared with 51 samples of fertile boars. Sperm were capacitated during 4 h at 39 degrees C. viability was determined by bisbenzimide (Hoechst-33258) staining. Acrosome reaction was assessed with fluorescein isothiocyanate conjugated Pisum sativum agglutinin. The percentage of spontaneous acrosome reaction (SAR) was not significantly different in fertile (4.5%) and subfertile boars (4.75%) (p > .05). Nevertheless, the percentage of progesterone-induced acrosome reaction (IAR) was significantly lower in subfertile boars (5.75%) as compared with fertile boars (10%) (p < .01). These results suggest that assessment of IAR in vitro may be a useful parameter to identify subfertility in boars.

Physical activity in first-degree relatives of breast cancer patients

This study sought to evaluate physical activity in women at moderate risk for breast cancer, the correlates of engaging in regular physical activity, and whether physical activity relates to psychological well-being. The results revealed that 55% of women were regularly active. Logistic regression models indicated that positive affect was associated with increased and negative affect was associated with decreased overall and leisure activity. Older, married, and employed women were more likely to engage in household/occupational activity, whereas women who perceived their risk for breast cancer as high were less likely. More educated women and those with higher perceived risk were more likely to engage in leisure activity, and married women were less likely. These results suggest a need to increase activity levels in women at moderate risk for breast cancer, provide variables upon which interventions can be tailored to promote activity, and point to psychological benefits of activity in this population.

Changes in symptoms, lipid and hormone levels after the administration of a cream with phytoestrogens in the Climacteric--preliminary report

OBJECTIVE

To establish the changes in lipid and hormone levels, as well as in symptoms, after topical application of a cream with phytoestrogens in postmenopausal women.

METHODS

30 postmenopausal women were studied. At baseline and 1 month after the beginning of treatment, levels of FSH, estradiol, estrone, testosterone, androstenedione, dehydroepiandrosterone, total cholesterol, HDL-C, LDL-C, and triglycerides were measured. Climacteric symptoms were evaluated with a modified Kupperman's index (KI). The subjects received a cream with phytoestrogens (n = 15) or placebo (cold cream) (n = 15) in a randomized, double-blind manner. Statistically significant differences were determined by Student's t test.

RESULTS

No differences were found in hormones, lipids, or in KI between the groups. When comparing each group separately, only a significant decrease in KI was found, in both groups, at the end of the treatment.

CONCLUSIONS

This cream with phytoestrogens had an effect only in climacteric symptoms, but similar to the placebo. The lack of effect in the other variables was probably due to the administration route, or to a lack of effect of this product.

Trypanosoma cruzi: data supporting clonality in Mexican stocks

To further study genetic heterogeneity of Mexican stocks of Trypanosoma cruzi, genomic Southern analyses from 54 Mexican isolates and 5 South American reference stocks were carried out. The membranes were hybridized with a homologous cDNA clone from the ribosomal protein S4 that identifies allelic bands from a single gene type locus. These allelic bands were sequentially numbered depending on their relative size. Mexican T. cruzi stocks were quite homogeneous: 31 cases (57%) showed a homozygous genotype 3/3, and 21 isolates (38%) exhibited the heterozygote genotype 2/3. Just 2 Mexican stocks (3%) showed a different genotype 2/5, but the potential parental homozygous 2/2 was never observed. Being that T. cruzi is a diploid organism, the apparent absence of the presumptive parental homozygous genotype 2/2 argues against sexual reproduction within the population, at least as a common event. Therefore, these data support a clonal population structure of T. cruzi in Mexico.

Embryonic-derived glial-restricted precursor cells (GRP cells) can differentiate into astrocytes and oligodendrocytes in vivo

We have isolated and characterized a unique glial-restricted precursor cell (GRP) from the embryonic spinal cord. Clonal analysis demonstrated that these cells are able to generate oligodendrocytes and two distinct type of astrocytes (type 1 and type 2) when exposed to appropriate signals in vitro. We now show that many aspects of these cells are retained in vivo. GRP cells are restricted to the glial lineage in vivo as they seem to be unable to generate neuronal phenotypes in an in vivo neurogenic environment. GRP cells survive and migrate in the neonatal and adult brain. Transplanted GRP cells differentiate into myelin-forming oligodendrocytes in a myelin-deficient background and also generate immature oligodendrocytes in the normal neonatal brain. In addition, GRP cells also consistently generated glial fibrillary protein-expressing cells in the neonatal and adult brain, a property not consistently expressed by other glial precursor cells like the O-2A/OPC cells. We suggest that the lineage restriction of GRP cells and their ability to generate both oligodendrocytes and astrocytes in vivo together with their embryonic character that allows for extensive in vitro expansion of the population makes the cell useful for clinical application.