Nutritional status of the Andean population of Puna and Quebrada of Humahuaca, Jujuy, Argentina

OBJECTIVE

To assess the nutritional status of the Andean population of Puna and Quebrada of Humahuaca, Jujuy, using anthropometric measurements.

DESIGN AND SUBJECTS

A cross-sectional nutritional survey was carried out in a representative sample (n = 1236) of individuals from these regions. Children aged 2-9 years, adolescents (10-17 years) and adults (>or=18 years; pregnant and lactating women excluded) were considered. Height-for-age, weight-for-height and body mass index (BMI) were calculated in children and adolescents and compared with World Health Organization/National Center for Health Statistics/Centers for Disease Control and Prevention reference standards using Z-scores or percentiles, in order to assess the prevalence of stunting, wasting/thinness and excess weight. In adults, BMI, waist circumference (WC) and waist-to-hip (WHR) ratio were used to identify obesity and central adiposity.

RESULTS

Stunting (height-for-age Z-score <-2 standard deviations) and obesity (BMI >or= 95th percentile) were found to be major nutritional problems in children and adolescents. Stunting was prevalent in 10.7% of children and 12.4% of adolescents; 8.2% of children and 3.5% of adolescents were obese. Adults were short (mean: 155.8 cm) and values of overweight (32.3%), obesity (18.3%) and central adiposity (mean WC: 86.5 cm) were high. Older adults and those with higher economic development showed higher prevalence of obesity and central adiposity.

CONCLUSIONS

The present population may be at the early stages of nutritional transition as symptoms of undernutrition and overnutrition coexist at the population level. These results suggest that rates of growth retardation may be decreasing owing to improved nutritional conditions; however, this could be accompanied by a sharp increase in the prevalence of other diet-related chronic diseases.

Interaction of omapatrilat with FD&C Blue No. 2 lake during dissolution of modified release tablets

The purpose of this study was to identify the mechanism(s) of omapatrilat degradation observed during dissolution from modified release (MR) tablet formulations containing colorants. The tablets were manufactured by a dry granulation process employing roller compaction. The colorants were added intragranularly and included red and yellow iron oxides and FD&C Blue No. 2 lake and dye. Dissolution studies in pH 6 or 6.8 media do not indicate any omapatrilat degradation in the absence of colorants. In the presence of colorants the degradation rate of omapatrilat in pH 6.8 media was in the following order: blue lake>blue lake+yellow iron oxide>yellow and red iron oxides. Higher degradation was observed with MR tablets formulated with indigo carmine (dye) as opposed to tablets formulated with aluminum oxide or aluminum hydroxide (dye substrate portion of lake). The inclusion of tartaric acid and the photostabilizer, uric acid, in omapatrilat MR tablets containing the blue lake reduced the degradation significantly. The dissolution instability observed at pH 6.8 in the MR tablet formulated with FD&C Blue No. 2 Lake was attributed to the dye component of the lake. The instability was more pronounced at higher pH and in the absence of a photostabilizer.

Safety and efficacy of once daily intranasal zanamivir in preventing experimental human influenza A infection

Zanamivir, a potent inhibitor of influenza A and B virus neuraminidases, is protective against experimental human influenza when given intranasally twice daily. We conducted two studies to assess the pharmacokinetics and protective efficacy of a reduced frequency dosing regimen of topical zanamivir. In the first study, 36 uninfected volunteers received a single dose of zanamivir by intranasal spray (6.4 mg), intranasal drops (16 mg) or dry powder oral inhalation (10 mg). At 4 h, median nasal wash concentrations were 50-fold higher after intranasal dosing than after inhalation. Substantial levels (spray group, median 4,596 ng/ml; drop group, 1,239 ng/ml) were detected in nasal wash 48 h after intranasal dosing. In the double-blinded efficacy study, 47 sero-susceptible volunteers were randomized to receive either placebo or zanamivir intranasal spray (6.4 mg). Among the 43 subjects evaluated, decreases in viral shedding occurred in the group receiving one dose of zanamivir 4 h prior to inoculation, whereas no significant benefit was observed in those receiving a single dose 48 h prior to challenge. In the group given three daily doses, reductions were seen in viral shedding and infection. In the two regimens providing zanamivir 4 h prior to inoculation, significant reductions in nasal mucus weight were observed. Decreases in total symptom scores and the incidence of upper respiratory illness also occurred, but they did not reach statistical significance. The efficacy of a single dose of zanamivir given 4 h prior to inoculation supports the hypothesis that influenza virus neuraminidase is essential for initial virus spread through respiratory secretions. These findings indicate that once daily dosing of zanamivir is protective against experimental influenza A infection.

Src mediates stimulation by vascular endothelial growth factor of the phosphorylation of focal adhesion kinase at tyrosine 861, and migration and anti-apoptosis in endothelial cells

Vascular endothelial growth factor (VEGF) stimulates the tyrosine phosphorylation of focal adhesion kinase (FAK), increases focal adhesion formation and is chemotactic for human umbilical-vein endothelial cells (HUVECs). In the present study we identified the major sites of VEGF-induced FAK tyrosine phosphorylation and investigated the mechanism mediating this pathway in the action of VEGF. VEGF increased the focal adhesion localization of FAK phosphorylated at Tyr-397 (Y397) and Y861 but stimulated a marked increase in phosphorylation at Y861 without significantly affecting the total level of phospho-Y397 FAK. Inhibition of Src with the specific inhibitor 4-amino-5-(4-chlorophenyl)-7-(t-butyl)pyrazolo[3,4-d]pyrimidine (PP2) completely blocked VEGF-induced Y861 phosphorylation without decreasing the level of phospho-Y397 FAK. We also examined the role of Src in mediating endothelial functions of VEGF in which FAK has been implicated as having a role. PP2 markedly inhibited VEGF-induced chemotaxis and wound-healing cell migration. The Src inhibitor also decreased the anti-apoptotic effect of VEGF determined by surface staining of annexin V but did not increase FAK proteolysis or prevent the VEGF-dependent inhibition of FAK proteolysis. In contrast, the specific PtdIns 3-kinase inhibitor LY294002 induced apoptosis and markedly decreased p125(FAK) expression and increased FAK proteolysis but had little effect on Y861 phosphorylation. These findings identify Src-dependent FAK phosphorylation at Y861 as a novel VEGF-induced signalling pathway in endothelial cells and suggest that this pathway might be involved in the mechanisms mediating VEGF-induced endothelial cell migration and anti-apoptosis.

[Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries]

Arterial steal syndrome in patients after liver transplantation: transarterial embolization of the splenic and gastroduodenal arteries.

PURPOSE

To evaluate transarterial embolization of splenohepatic and gastroduodenal steal syndrome in patients with impaired liver function tests after liver transplantation.

METHODS AND MATERIAL

In a prospective study 22 patients (10 male, 12 female; mean age 49.5 years) with unexplained elevation of hepatic enzymes after liver transplantation underwent transcatheter arterial embolization of splenohepatic (n = 18) and gastroduodenal (n = 4) steal syndrome with use of Gianturco coils or microcoils. Liver and spleen parenchyma were surveyed and evaluated before and after embolization with plain helical CT, including volumetry of liver and spleen.

RESULTS

DSA examinations revealed a dilated splenic artery (n = 18) or gastroduodenal artery (n = 4) combined with a slightly decreased perfusion of the hepatic arteries, while immediately after successful embolization a normal perfusion of the hepatic arteries could be noted. Volumetric measurements before and after embolization showed no significant changes in liver parenchyma (x = + 7 % +/- 2), and variable changes in splenic volume of -5 % to + 28 % (mean, + 11 %), with initial measurements. Clinical follow-up examinations revealed a normalization of the previously elevated hepatic enzymes and a normalization of liver function tests after successful embolization. Complications were observed in 4 patients (infarction of the spleen).

CONCLUSIONS

The preliminary results reveal that in liver transplant candidates with splenohepatic and gastroduodenal steal syndrome successful embolization results in an improvement of organ perfusion with normalization of function tests.

Nuclear localization and apoptotic regulation of an amino-terminal domain focal adhesion kinase fragment in endothelial cells

This study investigated the subcellular compartmentalization of focal adhesion kinase (FAK) fragments and their regulation during apoptosis of human umbilical vein endothelial cells. A 50 kDa NH(2)-terminal FAK fragment and a 120 kDa FAK variant were constitutively expressed and specifically found in the nuclear fraction of cells, while a 55 kDa COOH-terminal FAK fragment was only in the cytosolic fraction. FAK cleavage fragments generated during apoptosisremained in the cytosol, while p120FAK and p50 NH(2)-terminal FAK remained in the nuclear compartment. The caspase inhibitor, ZVAD-fmk, prevented the apoptosis-induced proteolysis of p125 and p120FAK, generation of the 80 kDa cleavage product, and increased expression of p50N-FAK. Western blot with phospho-specific FAK showed that nuclear p125(FAK) was phosphorylated at a significant level at Y861, while FAK phosphorylated at Y397 and Y407 was largely in the cytosol. These results indicate that FAK NH(2)- and COOH-terminal domain fragments are segregated between nuclear and cytosolic compartments in endothelial cells and suggest novel functions for the FAK NH(2)-terminal domain.

Use of the oral neuraminidase inhibitor oseltamivir in experimental human influenza: randomized controlled trials for prevention and treatment

CONTEXT

Influenza virus neuraminidase is thought to be essential for virus replication in humans; however, to date, available neuraminidase inhibitors are limited to zanamivir, which is topically administered.

OBJECTIVE

To determine the safety, tolerability, and antiviral activity of oral neuraminidase inhibitor oseltamivir (GS4104/Ro64-0796) for prevention and the early treatment of influenza in experimentally infected humans.

DESIGN

Two randomized, double-blind, placebo-controlled trials conducted between June and July 1997.

SETTING

Individual hotel rooms; 2 large US university medical schools.

PARTICIPANTS

A total of 117 healthy adult volunteers (aged 18-40 years; median age, 21 years) who were susceptible (hemagglutination-inhibition antibody titer < or =1:8).

INTERVENTIONS

All subjects were inoculated intranasally with influenza A/Texas/36/91 (H1N1) virus. For the prophylaxis study, oral oseltamivir (100 mg once daily [n = 12], 100 mg twice daily [n = 12], or matching placebo [n = 13], starting 26 hours before virus inoculation) was administered. For the treatment study, the same drug was given (20 mg, 100 mg, or 200 mg twice daily, 200 mg once daily, or matching placebo [n = 16], in each group starting 28 hours after inoculation). All regimens were continued for 5 days.

MAIN OUTCOME MEASURES

Comparing placebo groups with pooled treatment groups, for prophylaxis, outcomes included frequency of infection and viral shedding; for treatment, viral shedding in titers.

RESULTS

In the prophylaxis study, 8 (67%) of 12 placebo and 8 (38%) of 21 oseltamivir recipients became infected (P = .16; efficacy, 61%); 6 (50%) placebo compared with 0 oseltamivir recipients shed virus (P<.001; efficacy, 100%), and 33% of placebo but no oseltamivir recipient had infection-related respiratory illness (P<.01). Among infected subjects in the treatment study (n = 69), the viral titer area under the curve of the combined oseltamivir groups (n = 56) was lower (median [interquartile range [IQR]], 80 [23-151] vs 273 [79-306] log10 tissue culture-infective doses50 per milliliter x hour; P = .02) than the placebo group (n = 13), and the median (IQR) duration of viral shedding with therapy was reduced from 107 (83-131) to 58 (35-59) hours (P = .003). Oseltamivir treatment also reduced symptom scores (median [IQR] score-hours, 225 [97-349] vs 400 [189-645]; P = .05), and nasal proinflammatory cytokine levels. Transient mild to moderate nausea after dosing was observed in 15 (17%) of 88 oseltamivir and 2 (7%) of 29 placebo recipients (95% confidence interval for difference, -11% to 68%), which was largely prevented by ingestion with food.

CONCLUSIONS

In these trials, prophylaxis and early treatment with oral oseltamivir were both associated with significant antiviral and clinical effects in experimental human influenza.

Differential regulation of extracellular signal-regulated protein kinases (ERKs) 1 and 2 by cAMP and dissociation of ERK inhibition from anti-mitogenic effects in rabbit vascular smooth muscle cells

The inhibition of extracellular signal-regulated protein kinases (ERKs) is implicated in the negative regulation of vascular smooth muscle cell (VSMC) mitogenesis by cAMP-elevating agents and transforming growth factor beta(1) (TGF-beta(1)). These factors inhibited rabbit aortic VSMC mitogenesis induced by platelet-derived growth factor (PDGF)-BB by preventing the entry of cells into S-phase. cAMP-elevating agents partly inhibited the late phase (1-4 h) of activation of ERKs 1 and 2 induced by PDGF-BB without inhibiting the early phase of activity (5-15 min) and had no effect on activity induced by basic fibroblast growth factor (bFGF). In contrast, cAMP elevation caused a marked inhibition of early ERK activation induced by angiotensin II and thrombin. TGF-beta(1) had no inhibitory effect on ERK activation induced by PDGF-BB or bFGF. The inhibition of PDGF-BB-stimulated DNA synthesis by either forskolin/3-isobutyl-1-methylxanthine (IBMX) or TGF-beta(1) was not decreased when the agents were added up to 8 h after growth factor. In contrast, the selective ERK kinase inhibitor PD98059 was a weak inhibitor of DNA synthesis; a combination of PD98059 and forskolin/IBMX had an additive inhibitory effect on DNA synthesis. Forskolin/IBMX inhibited the growth factor-induced expression of c-myc mRNA and cyclin D(1) protein, and enhanced the protein expression of p27(kip1). TGF-beta(1) had no effect on the expression of c-myc or p27(kip1) and weakly attenuated the expression of cyclin D(1). These findings support the conclusion that the suppression of VSMC mitogenesis by cAMP and TGF-beta(1) is independent of ERK inhibition. Anti-mitogenic effects of cAMP might be primarily mediated by events in late G(1).

Safety and efficacy of intravenous zanamivir in preventing experimental human influenza A virus infection

Zanamivir is a potent inhibitor of influenza A and B virus neuraminidases and is active topically in experimental and natural human influenza. We conducted this double-blinded, placebo-controlled study to evaluate the safety and efficacy of intravenously administered zanamivir. Susceptible volunteers were randomized to receive either saline or zanamivir (600 mg) intravenously twice daily for 5 days beginning 4 h prior to intranasal inoculation with approximately 10(5) 50% tissue culture infectious doses (TCID50) of influenza A/Texas/36/91 (H1N1) virus. Reductions in the frequency of viral shedding (0% versus 100% in placebo, P < 0.005) and seroconversion (14% versus 100% in placebo, P < 0.005) and decreases in viral titer areas under the curve (0 versus 11.6 [median] log10 TCID50. day/ml in placebo, P < 0.005) were observed in the zanamivir group, as were reductions in fever (14% versus 88% in placebo, P < 0.05), upper respiratory tract illness (0% versus 100% in placebo, P < 0.005), total symptom scores (1 versus 44 [median] in placebo, P < 0.005), and nasal-discharge weight (3.9 g versus 17.5 g [median] in placebo, P < 0.005). Zanamivir was detectable in nasal lavage samples collected on days 2 and 4 (unadjusted median concentrations, 10.5 and 12.0 ng/ml of nasal wash, respectively). This study demonstrates that intravenously administered zanamivir is distributed to the respiratory mucosa and is protective against infection and illness following experimental human influenza A virus inoculation.

Prognostic value of immunohistochemical expression of beta-1 integrin in pancreatic carcinoma

BACKGROUND

Prognostically relevant factors based on the histological assessment of the resected pancreas are known. However, the knowledge of additional factors associated with the prognosis is helpful in planning the therapy for an individual patient. beta1 Integrin expression is known to have a prognostic influence in some malignant tumors. No data are, however, available on the prognostic value of beta1 integrins in pancreatic carcinoma.

METHOD

We investigated paraffin-embedded specimens of 19 patients undergoing surgical treatment for periampullary carcinoma and of 42 patients for ductal pancreatic carcinoma by immunohistochemistry to assess the expression pattern and the prognostic impact of beta1 integrins. Neither histomorphological parameters nor the survival time of the patients were known at the time of the investigation.

RESULTS

No correlation was established between histomorphological parameters and beta1 integrin expression in periampullary or ductal pancreatic carcinoma, respectively. Patients with periampullary carcinoma and beta1 integrin overexpression had a significantly poorer prognosis than patients without overexpression of beta1 integrins (median survival: 18.3 vs. 58.4 months). In ductal pancreatic carcinoma beta1 integrin expression had no influence on prognosis.

CONCLUSION

beta1 Integrins exert an influence on prognosis in periampullary carcinoma but not in ductal pancreatic carcinoma. However, further investigations in larger patient samples are required to confirm these results.

[Expression of CD44 and isoforms v4, v5, v6, v7, v10--new prognostic parameters in ductal pancreatic carcinoma?]

Prognostically relevant factors based on the histological assessment of the resected pancreas are known. However, additional parameters, such as biological staging of the intrinsic malignant potentiality of the tumor, would be useful. There has been no uniform finding of a relationship between CD44 variant expression and tumor progression.

METHOD

We assessed the expression pattern and prognostic impact of CD44 standard and CD44 isoforms v4, v5, v6, v7 and v10 in 40 ductal pancreatic carcinomas by immunochemistry on paraffin-embedded tumor material in patients after tumor resection. At the time of the investigation neither histomorphological parameters nor the survival time were known.

RESULTS

There was no correlation between the histomorphological parameter and the expression of CD44 splice variants. CD44 splice variants v4-v10 were almost only expressed in tumor tissue. In ductal pancreatic carcinoma, patients with an overexpression of CD44 splice variants had a worse prognosis. However, because of the small number of cases this was statistically not significant.

CONCLUSION

CD44 splice variants may have an influence on prognosis in ductal pancreatic carcinoma. However, further investigation on a larger number of patients is necessary to confirm these results.

Respiratory nitric oxide levels in experimental human influenza

BACKGROUND

Exhaled oral nitric oxide (NO), a reported marker of inflammation in the respiratory tract, can be elevated by "upper respiratory tract infections." However, the responsible viruses and the time course of this rise in NO are not clear.

OBJECTIVE

To determine the expired nasal and oral NO levels during experimentally induced influenza A infection in 14 healthy volunteers without a history of asthma, rhinitis, or sinusitis.

METHODS

After being housed in individual rooms, susceptible volunteers were inoculated with 10(6) 50% tissue culture infective dose of influenza A/Texas/36/91/(H1N1) virus on a single occasion by intranasal drops. Volunteers remained in the isolation unit for 8 days and returned for follow-up 21 days after inoculation. Symptom scores and nasal washing for viral culture were obtained daily. NO samples from the mouth and nose were obtained on days 0 through 4, 8, and 21 by having the patient perform a slow vital capacity maneuver through a plastic tube into a Mylar balloon.

RESULTS

All patients had influenza virus cultured from nasal washings (12 of 14 on day 1, 14 of 14 by day 5). Patient symptom scores peaked on day 3 (mean+/-SE; 15.4+/-3.2) and returned to baseline by day 8. Preinfection exhaled nasal NO (right, 28.4+/-3.7 parts per billion [ppb]; left, 27.7+/-4.6 ppb) was significantly higher than oral NO (5.8 ppb; p<0.001). Exhaled oral NO was significantly elevated on day 8 postinoculation (12.9+/-0.8 ppb; p<0.01 Bonferroni) and returned to baseline at follow-up. Nasal NO levels showed a slight decrease on days 2 to 4 but returned to baseline by day 8.

CONCLUSION

Experimental influenza virus infection can increase oral but not nasal exhaled NO levels. The timing of exhaled NO changes suggests that NO does not contribute to illness manifestations directly.

Low plasma levels of adrenocorticotropic hormone in patients with acute influenza

Plasma levels of adrenocorticotropic hormone (ACTH) and cortisol were measured in young adults with influenza virus type A (H3N2) infection for whom cultures were positive and in comparable controls without symptoms or other evidence of illness. The mean plasma ACTH level +/- SE in 19 patients with acute influenza was 13.5 +/- 2.1 pg/mL compared with 23 +/- 3.2 pg/mL in 11 controls (P = .02). Mean plasma ACTH levels +/- SE had risen to 21 +/- 4.1 pg/mL in specimens obtained from patients during convalescence. The mean plasma cortisol level +/- SE in patients with acute influenza was 13.7 +/- 1.4 micrograms/dL compared with 10.8 +/- 1.0 micrograms/dL in controls (P = not significant). ACTH levels in individual controls were relatively higher than their cortisol levels, but ACTH levels in patients tended to be lower than cortisol levels in paired specimens. These findings suggest that influenza virus type A infection may have an inhibitory effect on the production or release of ACTH.

Safety and efficacy of the neuraminidase inhibitor GG167 in experimental human influenza

OBJECTIVE

The current study evaluated whether intranasal administration of the sialic acid analog 4-guanidino-Neu5Ac2en (GG167), an inhibitor of influenza virus neuraminidase, was effective and safe in either preventing or treating experimental human influenza.

METHODS

Four randomized, double-blind, placebo-controlled trials involving three prophylaxis limbs, two early treatment limbs, and one delayed treatment limb were conducted.

SETTING

Isolation in individual rooms.

PARTICIPANTS

Susceptible (serum hemagglutination-inhibition antibody titer < or = 1:8) adult volunteers (n = 166) were inoculated intranasally with 10(5) TCID50 influenza A/Texas/91 (H1N1) virus.

INTERVENTION

GG167, 3.6 to 16 mg, was administered intranasally two or six times daily beginning 4 hours before inoculation (prophylaxis) or 1 or 2 days afterward (early or delayed treatment).

MAIN OUTCOMES

Virological measures were frequency of infection based on viral shedding and/or seroconversion (prophylaxis) or quantitative viral shedding based on titers and duration of virus recovery (treatment). Clinical measures were the frequency of febrile illness and symptom severity scores.

RESULTS

Intranasal GG167 was well tolerated for both prophylaxis and therapy. For all dose groups combined, GG167 prophylaxis was 82% effective in preventing laboratory evidence of infection and 95% effective in preventing febrile illness (P < .01 vs placebo). Early treatment with GG167 reduced peak viral titers by 2.0 log10, the median duration of viral shedding by 3 days, and the frequency of febrile illness by 85% (P < .05 for each comparison). Other measures of illness were reduced by approximately 50% to 70% in the GG167 dosing groups. Twice daily dosing was as effective as six times daily.

CONCLUSIONS

Direct respiratory administration of the selective neuraminidase inhibitor GG167 appears safe and effective for both prevention and early treatment of experimental influenza. Influenza virus neuraminidase is important for viral replication in humans.

[Solid and papillary epithelial neoplasm of the pancreas. Report of 2 cases]

Solid and papillary epithelial tumor of the pancreas occurs mainly in young women and its main characteristic is the appearance of an abdominal mass which progressively increases in size. The radiologic, surgical and pathological correlation shows that it is a tumor of low grade malignancy with a favorable prognosis, after therapy and according to the location of the tumor. The authors report the clinical history of the first two confirmed cases of this entity in Panama, which occurred in 1985 and 1992, respectively, in women less than 25 years of age.

Psychiatric morbidity: prevalence, associated factors and significance

A cross-sectional observational systematic study was carried out on ambulatory patients at a tertiary care hospital to determine the probable prevalence, associated factors and significance of psychiatric morbidity by using an Urdu translation of the hospital anxiety and depression (HAD) scale over a period of 6 days in a week. Results showed a prevalence of 38.4% which is slightly higher than what has been generally reported (30%). Two variables, i.e., female sex and being a housewife were significantly related with the outcome. An attempt has been made to identify the probable reasons for this and some suggestions laid down for further work.

[Inhalation anesthesia in porphyria variegata]

We report the anesthetic technique performed in a 38 year old woman with variegate porphyria who underwent a partial right mastectomy. The patient was diagnosed in 1984 on the basis of the biochemical profile and enzymatic deficit. She presented marked photosensitivity without neurological or systemic symptoms. Among their personal antecedents an uneventful general anesthesia in 1982 was recorded. The patient was premedicated one hour before surgery with 0.25 mg of scopolamine, 5 mg of dihydrobenzperidol (DHB), and 100 micrograms of fentanyl, all of them given by the intramuscular route. At the operating theater the patient received 5 mg of diazepam, 2.5 mg of DHB, and 200 micrograms of fentanyl. Anesthetic induction was done with a bolus of 20 mg of etomidate, 1 mg of atropine, and 60 mg of suxamethonium. Maintenance of the anesthetic level was achieved with 0(2), N2(0) with 0.5 of 1% isoflurane, and 40 mg of atracurium in two doses. Surgery lasted 50 min and pharmacologic reversion of the anesthesia was not required. Urine was collected in a dark recipient 24 hours after surgery in order to measure the following parameters: porphobilinogen, aminolevulinic acid, coproporphyrins and uroporphyrins. We found a significant increase of uroporphyrins at the three sampling times, although this increase was less marked during surgery, probably due to hemodilution. We stress the advantages of inhalation anesthesia in these patients.