[Toxic hepatitis caused by nimesulide, presentation of a new case and review of the literature]

Nimesulide is a potent non-steroidal anti-inflammatory drug. It is a new, selective cyclooxygenase-2 inhibitor with few adverse effects on the gastrointestinal system. We present a case of hepatotoxicity in which other possible causes of liver damage were excluded. A biochemical pattern of cholestasis was predominant. Evolution was favorable after the drug was stopped and enzymatic alterations progressively returned to normal. The cases reported to date are reviewed. The precise mechanism by which nimesulide produces liver damage is not known but it is probably caused by an idiosyncratic reaction. Because of the severity of the hepatitis described in some cases, treatment should be stopped when liver dysfunction is detected and the patients should be closely monitored.

Determinants of smoking behaviour in outpatients with schizophrenia

The present study is an assessment of the rate and severity of tobacco consumption in outpatients with schizophrenia, and the determinants of smoking behaviour. Sixty-four patients, assessed by the Item Group Checklist section of the SCAN interview and fitting DSM-IV criteria, were evaluated with CGI and the PANSS scales. In addition, they completed STAI (Spielberger), EPQ (Eysenck), and TPQ (Cloninger) questionnaires. Tobacco dependence was assessed by the Fagerström test. One hundred and thirty-seven consecutive outpatients were psychiatric controls. Forty-one out of 64 patients with schizophrenia (64.1%) were current smokers, this rate being significantly higher than in other psychiatric patients and general population. The severity of cigarette consumption in smokers was greater (mean of 22.4 cigarettes/day) than in the general population, but it was not different from that of other psychiatric patients. For patients with schizophrenia, no one variable (except male sex) was different between smokers and non-smokers, but the number of cigarettes/day correlated with state anxiety, trait anxiety, and neuroticism. In the multivariate analysis, the only variable that remained significant was neuroticism. The relationship between clinical features and severity of smoking behaviour may be linked to non-specific variables such as neuroticism and anxiety, but not to psychotic symptoms.

Characterization of two glycosyltransferases involved in early glycosylation steps during biosynthesis of the antitumor polyketide mithramycin by Streptomyces argillaceus

A 2,580-bp region of the chromosome of Streptomyces argillaceus, the producer of the antitumor polyketide mithramycin, was sequenced. Analysis of the nucleotide sequence revealed the presence of two genes (mtmGIII and mtmGIV) encoding proteins that showed a high degree of similarity to glycosyltransferases involved in the biosynthesis of various antibiotics and antitumor drugs. Independent insertional inactivation of both genes produced mutants that did not synthesize mithramycin but accumulated several mithramycin intermediates. Both mutants accumulated premithramycinone, a non-glycosylated intermediate in mithramycin biosynthesis. The mutant affected in the mtmGIII gene also accumulated premithramycin A1, which contains premithramycinone as the aglycon unit and a D-olivose attached at C-12a-O. These experiments demonstrate that the glycosyltransferases MtmGIV and MtmGIII catalyze the first two glycosylation steps in mithramycin biosynthesis. A model is proposed for the glycosylation steps in mithramycin biosynthesis.

Stimulatory effect of growth in the presence of alcohols on biotransformation of penicillin G into cephalosporin-type antibiotics by resting cells of Streptomyces clavuligerus NP1

Growth of Streptomyces clavuligerus NP1 in the presence of methanol or ethanol resulted in a marked increase in production of cephalosporin(s) from penicillin G by resting cells. The mycelium produced in alcohol-supplemented medium was fragmented and dispersed as compared with growth in control medium. HPLC analysis showed that at least two products were present in the biotransformation supernatant fluid after 1 h incubation. One of them has been identified as deacetoxycephalosporin G (DAOG).

Prognosis of medically stabilized unstable angina pectoris with a negative exercise test

Three hundred twenty seven patients with medically stabilized unstable angina and a negative exercise test were followed-up during a mean of 39 months. Male gender, diabetes mellitus, and previous myocardial infarction, but not exercise parameters, were predictors of death or acute myocardial infarction.

[Seroprevalence versus Parvovirus B19 in blood donors]

BACKGROUND

The aim of the study was to describe the seroprevalence against Parvovirus B19 in a random sample of blood donors in the Hospital Universitario de Salamanca.

METHODS

We studied the presence of IgG and IgM antibodies against Parvovirus B19 in 136 sera from asymptomatic blood donors by enzyme immunoassay methods.

RESULTS

From 136 samples tested, 88 (64.7%) had positive absorbance values for IgG. Forty eight samples (35.5%) were negative. IgM was negative in all cases. We did not find indeterminate results.

DISCUSSION

Parvovirus primoinfection usually happens in the childhood. Thus, we can expect a high percentage of general population to have antibodies against Parvovirus B19. Anti-Parvovirus B19 antibodies prevalence in blood donors was 64.7%. This failure is similar to data reported before (65%). Clinical importance of these viruses in currently related with hemathopoyesis diseases and with the possible role in theratogenesis. The presence of IgG seems to give protection except in some chronic infections recently described.

Cholecystectomy and fistula closure versus enterolithotomy alone in gallstone ileus

BACKGROUND

The management of gallstone ileus is controversial. This study compared the results of simple enterolithotomy with those of enterolithotomy, cholecystectomy and fistula closure.

METHODS

A retrospective analysis was made of 25 patients with a mean age of 75 (range 55-84) years. Enterolithotomy was performed in 16 patients (group 1) and cholecystectomy and fistula closure were added in nine patients (group 2).

RESULTS

The diagnosis was made before operation in 12 patients, and was associated with previous biliary disorder (P = 0.03) and pneumobilia (P < 0.001). Postoperative morbidity occurred in eight patients in group 1 and in six in group 2. Three patients died in each group; all but one of the deaths were unrelated to the surgical procedure. There was no relationship between age and mortality, and patients in American Society of Anesthesiologists (ASA) classes III and IV did not have higher rates of morbidity or mortality than those in ASA classes I and II.

CONCLUSION

Evidence from this study does not support one-stage enterolithotomy, cholecystectomy and fistula closure as the procedure of choice; simple enterolithotomy is appropriate in most patients. However, the one-stage procedure may be acceptable in patients at low risk.

Detection of enterohaemorrhagic Escherichia coli O157:H7 in minced beef using immunomagnetic separation

Enterohaemorrhagic Escherichia coli (EHEC) O157:H7 has been recently recognized as a human pathogen associated with haemorrhagic colitis and haemolytic uraemic syndrome. Most outbreaks of haemorrhagic colitis resulted from the consumption of undercooked minced beef or raw milk. Dairy cattle have been identified as a reservoir of EHEC O157: H7. In this study E. coli O157 specific antibody, coated on magnetic beads, was used to concentrate and release EHEC O157:H7 from meat samples. A survey of retail fresh minced beef and hamburger samples using this procedure revealed that 3 (5%) of 58 beef samples were positive for EHEC O157:H7. Two of the strains produced both VT1 and VT2 verotoxins, and one produced only VT2. Immunomagnetic separation is a sensitive and simple technique for the isolation of E. coli O157 from food, and could be useful for a further elucidation of the epidemiology of this organism. The relatively high prevalence of EHEC O157:H7 in beef samples may constitute a risk for public health. Thus, a suitable epidemiologic control and effective methods of prevention should be applied.

[Left ventricular hypertrophy in a general hypertensive population in Barcelona]

BACKGROUND

Left ventricular hypertrophy (LVH) is a well known cardiac risk factor. There are no data available as to the epidemiology of this disease in the general hypertensive population in Spain.

METHODS

A randomized sample (n = 267) of a general hypertensive population under the age of 80 years was followed in a Basic Health Care Area located in the center of Barcelona, Spain. A Doppler-echocardiographic study of the patients was carried out. The patients were considered to have LVH when they demonstrated an index > 134 g/m2 of left ventricular mass in males and > 110 g/m2 in females. The odds ratio (OR) was estimated on presentation of LVH associated with exposure to different factors.

RESULTS

A prevalence of LVH diagnosed by echocardiogram was observed in 64% (confidence interval 95% from 58.3 to 69.8%). The independent risk factors associated with the presence of LVH were female sex, age and systolic blood pressure.

CONCLUSIONS

Left ventricular hypertrophy is a frequent cardiovascular risk factor in the general hypertensive population in Spain. A systematic search by echocardiography cannot be recommended in primary health care until cost-effectiveness studies have been performed.

[Anesthetic management of labor in a pregnant woman with myocardial infarction]

Given the rarity of acute myocardial infarction (AMI) in parturients, we report the case of a 29-years-old woman who suffered 2 AMIs related to her 2 pregnancies. In our patient, the anesthetic technique chosen for the second birth, which was vaginal, was epidural analgesia with invasive hemodynamic monitoring. No complications occurred during the birth or the perinatal period.

[Reflex sympathetic dystrophy]

OBJECTIVE

The description of three cases of reflex sympathetic dystrophy.

DESIGN

Retrospective clinical observations.

SETTING

Gòtic basic Health Area, Barcelona.

PATIENTS AND OTHER PARTICIPANTS

Two women and a man (aged 75, 65 and 56) with mechanical pain and inflammation in the extremities. Two of the cases had a case history of trauma. Radiological signs of mottled osteoporosis were observed in the affected extremities of all the patients. In one there was gammagraphic pick-up. They were diagnosed as suffering reflex sympathetic dystrophy.

INTERVENTIONS

Rehabilitation, non-steroid anti-inflammatories and treatment with Calcitonin.

MEASUREMENTS AND MAIN RESULTS

Clinical and complementary diagnostic trials.

CONCLUSIONS

Describing the clinical presentation and the necessary complementary trials to be able to reach an early diagnosis of this illness, which provides a better prognosis.

Acetylator polymorphism in human colorectal carcinoma

Acetylator phenotype has been determined using sulfamethazine in 109 patients histologically diagnosed with colorectal carcinoma (resected in 74 patients by the time of the study) and in 96 age-matched controls. Fifty-five % of patients and 58.3% of controls were classified as slow acetylators (chi 2 = 0.11, not significant). No differences were observed in the distribution of acetylator phenotype when analyzing separately male and female, surgically treated and untreated, and colonic and rectal carcinoma patients. We conclude that acetylator polymorphism is not a genetic trait related to the risk of developing colorectal carcinoma in human beings.

[Epidemiologic study of cancer of the colon and rectum in the health area of the Nalón valley (Asturias, 1978-1986)]

An epidemiological study was made of malignant tumors of the colon and rectum in the Nalon valley health district (Asturias, Spain). The study period comprehend from 1978 to 1986, inclusive. The population studied, 103,000 hab., has been stable over the last 10 years, and is grouped into well defined sectors: industrial-mining activities and agricultural-livestock raising. The total number of cases was 275 patients, for a mean annual incidence (IMA) of 29.7/10(5) hab., making this a zone of high risk of the disease. Also analyzed are the clinical characteristics, diagnostic methods ant therapeutic measures, as well as the epidemiological distribution, a higher incidence being found in the industrialized zone than in the agricultural zone (p less than 0.05).

[Induction of cellulases and xylanases in Aureobasidium pullulans]

The specificity or induction of wood-degrading enzymes using series of mono, di or polysaccharides as carbon source for the yeasts Geotrichum candidum and Trychosporon penicillatum and the yeast-like organism Aureobadidium pullulans were studied. The strain A. pullulans was the only one that when xylan or "steam exploded wood" were used as carbon source all the enzymes tested were found. This strain was unable to grow on carboxymethyl or Avicel cellulose. D-xylose was the nutritional inducer of beta-xylosidase and beta-xylanase but D-glucuronic acid induced CMCase activity and beta-glucosidase was produced with every carbon source. The 1,4 beta-xylobiose was not an inducer of beta-xylanase but with the structural 1,2-beta- and 1,3-beta-xylobiose isomers high levels of this enzyme were obtained.

Acetylator polymorphism in discoid lupus erythematosus

Acetylator phenotype was determined, using sulphamethazine, in 37 patients with histologically confirmed discoid lupus erythematosus, who were free from visceral damage, and in 157 normal control subjects. Twenty patients (54%) and 90 control subjects (57.4%) were slow acetylators (p not significant). Acetylator polymorphism appears not to be related to the risk of developing pure cutaneous discoid lupus erythematosus.

Hepatic acetylator polymorphism in breast cancer patients

Hepatic acetylator phenotype has been determined, using sulfamethazine, in 81 white Spanish women with histologically proven breast cancer and in 75 adequate female controls. No differences were detected in the distribution of acetylator phenotype between the two groups of slow acetylators, 49 patients (60.5%) and 45 controls (60%). The percentage of acetylated sulfamethazine in plasma for each phenotype was not different either. Our results suggest that there is no relationship between the hepatic acetylator polymorphism and the risk of developing breast cancer in women.

[Treatment of acute promyelocytic leukemias in children]

Acute promyelocytic leukemia (APL), besides distinctive cytological characteristics has a high incidence of haemorrhagic complications due to disseminated intravascular coagulation (DIC). Nine patients with APL, between a day and 12 years old, were studied. Diagnosis was based on cytomorphological classification FAB. Eight presented with haemorrhages and DIC were found. Five received Daunorubicin and 4 DATOP. Patients with DIC also were given substitution therapy with platelets and heparin.

RESULTS

two died during the first two weeks, of intracranial haemorrhage (ICH) and sepsis respectively. Three in initial remission relapsed after 3 to 21 months and two died of ICH; the third one attained a new remission but presented a new relapse and finally died 61 months after onset. The other 4 patients are at present in their first remission of 1 to 12 months.

IN CONCLUSION

APL must receive, besides specific chemotherapy, early DIC therapy; with present polychemotherapy a high remission rate and prolonged disease-free survivals can be obtained.

[Ventricular tachycardia in a healthy child. Electrophysiological study and review of the literature]

Report of a healthy child with ventricular tachycardia is the reason for a review on the literature on this subject. Diagnosis can be made with usual electrocardiographic criteria and surely by electrophysiologic studies. Latter technique allows to study the origin, mechanism, efficiency of drugs and the type of pace-maker in case of drug treatment failure. Case report exemplifies all these aspects, and the essentials about etiology, symptoms, diagnosis and treatment are mentioned in the literature review.