Effects of perinatal asphyxia on cell proliferation and neuronal phenotype evaluated with organotypic hippocampal cultures

The present report summarizes studies combining an in vivo and in vitro approach, where asphyxia is induced in vivo at delivery time of Wistar rats, and the long term effects on hippocampus neurocircuitry are investigated in vitro with organotypic cultures plated at postnatal day seven. The cultures preserved hippocampus layering and regional subdivisions shown in vivo, and only few dying cells were observed when assayed with a viability test at day in vitro 27. When properly fixed, cultures from asphyxia-exposed animals showed a decreased amount of microtubule-associated protein-2 immunocytochemically positive cells (approximately 30%), as compared with that from controls. The decrease in microtubule-associated protein-2 immunocytochemistry was particularly prominent in Ammon's horn 1 and dentate gyrus regions (approximately 40%). 5-Bromo-2'deoxyuridine labeling revealed a two-fold increase in cellular proliferation in cultures from asphyxia-exposed, compared with that from control animals. Furthermore, confocal microscopy and quantification using the optical disector technique demonstrated that in cultures from asphyxia-exposed animals approximately 30% of 5-bromo-2'deoxyuridine-positive cells were also positive to microtubule-associated protein-2, a marker for neuronal phenotype. That proportion was approximately 20% in cultures from control animals. Glial fibrillary acidic protein-immunocytochemistry and Fast Red nuclear staining revealed that the core of the hippocampus culture was surrounded by a well-developed network of glial fibrillary acidic protein-positive cells and glial fibrillary acidic protein-processes providing an apparent protective shield around the hippocampus. That shield was less developed in cultures from asphyxia-exposed animals. The increased mitotic activity observed in this study suggests a compensatory mechanism for the long-term impairment induced by perinatal asphyxia, although it is not clear yet if that mechanism leads to neurogenesis, astrogliogenesis, or to further apoptosis.

[All-trans retinoic acid induces apoptosis in human mesangial cells: involvement of stress activated p38 kinase]

All-trans retinoic acid (AR-t) is used for treating acute promyelocytic leukemia and renal cell carcinoma and it also has therapeutic value in several animal models of renal disease. Among its renal targets, mesangial cells have been widely studied: they have both retinoic acid receptors (RAR) and retinoid X receptors (RXR) and the cell growth is inhibited when human mesangial cells are incubated with 1-10 microM AR-t. Although his effect has been related with the antiproliferative action of AR-t, there are no studies on the involvement of apoptosis in AR-t induced cell growth when higher concentrations of retinoid are used. Our studies show that 25 microM AR-t triggers mesangial cell apoptosis assessed by light and fluorescence microscopy (Giemsa stain and acridine orange stain, respectively), DNA electrophoresis, flow cytometry (annexin-V) and immunocytochemistry (TUNEL). AR-t induced apoptosis was not inhibited by preincubation with the RXR pan-antagonist HX531 nor with the RAR pan-antagonist AGN 193109, this suggesting RAR and RXIR are not involved in AR-t induced cell death. Previous results of our group showed that ERK (extracellular regulated kinase) and INK (c-Jun kinase), two members of the MAP (mitogen activated protein) kinase family, are involved in non apoptotic effects of AR-t on mesangial cells. Therefore we focussed on the stress activated p38 kinase, the third member of the MAPK family, to investigate its involvement in AR-t induced apoptosis. The results confirmed a role of p38 since: 1) preincubation with B5203589, a p38 inhibitor, inhibited ARA induced apoptosis; 2) incubation with AR-t induced p38 phosphorilation after few minutes and p38 remained phosphorilated for at least 8 hours and 3) AR-t induced p38 phosphorilation was inhibited by SB203589. These data suggest that AR-t might have toxic side effects on the kidney but also suggest that AR-t could be an useful inhibitor of pathological mesangial cell expansion.

Reduction of group delay ripple of multi-channel chirped fiber gratings using adiabatic UV correction

We demonstrate reduction of group delay ripple (GDR) from 24 ps to 9 ps peak to peak in a four channel 43 Gb/s dispersion compensating chirped fiber grating by adiabatic UV post processing. The eye opening penalty due to the grating GDR was improved from ~2dB to <1dB for all of the channels over a range of carrier frequencies of 15GHz. Our results demonstrate that at 43 Gb/s, the adiabatic UV correction technique is sufficient to substantially improve multi-channel fiber grating performance. We also discuss three limitations of the correction technique which cause GDR to vary from channel to channel: Noise in the sampling function, cladding mode loss, and varying channel reflectivity. While these limitations are visible in our results they do not reduce the effectiveness of the adiabatic correction for our gratings.

In vitro effect of melatonin on oxygen consumption in liver mitochondria of rats

OBJECTIVE

To examine the in vitro effect of melatonin on rat mitochondrial liver respiration.

METHODS

Oxygen consumption by liver mitochondria was measured polarographically in the presence of one of the following Krebs' cycle substrates: Lsuccinate, DL-3- beta-hydroxybutyrate or L-malate. Respiratory velocities at rest (state 4) and during rapid respiration in the presence of substrate and adenosine diphosphate (state 3) were measured in the presence of 10 (-9)-10(-3) M concentrations of melatonin.

RESULTS

In vitro melatonin (10(-7)-10(-3) M) reduced state 3 mitochondrial respiration. Basal, state 4 respiration was not affected by melatonin. Consequently, control respiratory index (i.e., the ratio of state 3 to state 4 respiration) was inhibited by melatonin with a threshold at 10(-7) M concentration.

CONCLUSION

The ability of melatonin to curtail acutely the stimulation of oxygen consumption in liver mitochondria may protect the mitochondria from excessive oxidative damage.

Retinoids as a potential treatment for experimental puromycin-induced nephrosis

1 Puromycin aminonucleoside (PAN)-induced nephrosis is a model of human minimal change disease. In rats, PAN induces nephrotic-range proteinuria, renal epithelial cell (podocyte) damage, infiltration of mononuclear leukocytes, and apoptosis of several renal cell types. 2 Retinoic acid (RA) modulates a wide range of biological processes, such as inflammation and apoptosis. Since renal damage by PAN is characterized by inflammatory infiltration and epithelial cell death, the effect of treatment with all-trans RA (tRA) was examined in the PAN nephrosis model and in the cultured differentiated podocyte. 3 Treatment with tRA 4 days after PAN injection did not inhibit the proteinuria peak but reversed it significantly. However, treatment with tRA both before and 2 days after the injection of PAN protected the glomerular epithelial cells, diminishing the cellular edema and diffuseness of the foot process effacement. Preservation of the podocyte architecture correlated with the inhibition of proteinuria. The anti-inflammatory effect of tRA was evidenced by the inhibition of PAN-induced interstitial mononuclear cell infiltration and the decreased renal expression of two molecules involved in monocyte infiltration: fibronectin and monocyte chemoattractant protein-1. TUNEL assays showed that tRA inhibited the PAN-induced apoptosis of cultured differentiated mouse podocytes. 4 We conclude that tRA treatment may prevent proteinuria by protecting the podocytes from injury and diminishing the interstitial mononuclear infiltrate in the model of PAN nephrosis. Retinoids are a potential new treatment for kidney diseases characterized by proteinuria and mononuclear cell infiltration.

Richter's syndrome after allogeneic stem cell transplantation for chronic lymphocytic leukaemia successfully treated by withdrawal of immunosuppression, and donor lymphocyte infusion

Development of high-grade non-Hodgkin's lymphoma is a possible complication of chronic lymphocytic leukaemia/small lymphocytic lymphoma, known as Richter's syndrome (RS). Treatment for RS includes systemic chemotherapy and, recently, allogeneic stem cell transplantation (SCT). We describe a patient with B-chronic lymphocytic leukaemia who developed RS 4 months after allogeneic SCT from an HLA-identical sibling. The RS presented with systemic symptoms, lymphadenopathy, pancytopenia and serum lactate dehydrogenase elevation. The patient was treated with immunosuppressive drug withdrawal and a donor lymphocyte infusion (DLI) of 1 x 10(7) CD3/kg, leading to the disappearance of all symptoms and the attainment of complete donor chimerism. After 18 months of the therapeutic DLI, the patient continues in complete remission.

[Frequency of E. vermicularis in a rural school population of Quipile, Colombia, 2001]

OBJECTIVES

To study the prevalence of Enterobius vermicularis infection in children aged 3 to 14 years in a rural zone of the town of Quipile, Colombia.

METHODS

159 children from 14 villages, with a homogeneous distribution according to their degree of scholarity, were studied. The detection of Enterobius vermicularis eggs was done by the Graham method. The design was a cross-sectional descriptive study, for which a convenience non-probabilistic sampling was carried out. Fisher's exact test and chi 2 were performed for data analysis. Multivariate analysis by multiple correspondence was also carried out.

RESULTS

2.5% of the children were found to be infected with E. vermicularis and 5% with Ascaris lumbricoides. This frequency is low when compared to reports from other authors; one of the possible causes is the sampling method used.

CONCLUSIONS

Deficient sanitation conditions of the population studied as well as the low frequency of anal hygiene practices may represent behavioural risk factors which favour the transmission of this helminth.

Highly tunable birefringent microstructured optical fiber

We demonstrate a method for introducing and dynamically tuning birefringence in a microstructured optical fiber. Waveguide asymmetry in the fiber is obtained by selective filling of air holes with polymer, and tunability is achieved by temperature tuning of the polymer's index. The fiber is tapered such that the mode field expands into the cladding and efficiently overlaps the polymer that has been infused into the air holes, ensuring enhanced tunability and low splice loss. Experimental results are compared with numerical simulations made with the beam propagation method and confirm birefringence tuning that corresponds to a phase change of 6pi for a 1-cm length of fiber.

Ultraviolet photosensitive response in an antimony-doped optical fiber

A silica optical fiber doped with Sb is fabricated with a refractive-index profile that is comparable with standard single-mode fiber. In D(2)-loaded samples, we observe UV photosensitivity with an initial refractive-index-modulation growth rate six times higher than that of the equivalent Ge-doped standard fibers. Enhanced temperature stability of the Bragg grating strength up to 200 degrees C is also observed. Grating growth kinetics in the Sb-doped fiber is compared with those of other Ge-doped photosensitive fibers.

[Pain in children: a pediatrician's point of view]

The interest in the topic of pain in children is increasing within the paediatric community after a long period of misrecognition, often under-valuation, sometimes negligent or even denial. A lack of knowledge concerning pharmacology and toxicity of antalgic drugs and poorly adapted galenic presentations induced delay and complications in their use in children. The recent progress is supported by a better semiology, development of adequate pain scales, availability of adapted drugs, an effort at education of caregivers and public sensitization. In primary care the objective is to lead the practitioner to identify and consider pain in his/her preventive and curative strategies. In hospitals efforts are needed to improve the use of protocols and evaluations, the systematic practice of preventive analgesia and the quality of interprofessional cooperation within care teams. Managed care organizations are today an effective system to promote these practices.

Low flow veno-venous ECMO via subclavian dialysis catheter for severe respiratory failure

BACKGROUND

We present the case of a 12-year-old female with severe postoperative bacterial pneumonia unresponsive to conventional treatment following a failed renal transplant.

CASE REPORT

The patient was placed on low flow veno-venous extracorporeal membrane oxygenation (ECMO) as an adjuvant treatment to antibiotic therapy and maximal ventilatory support. Venous ECMO resulted in rapid improvement and the patient was successfully weaned after 48 hours of circulatory assistance. Two days later, the patient was extubated and safely discharged from the intensive care unit. Eighteen months later, she remains stable on peritoneal dialysis and is awaiting a new donor kidney.

CONCLUSIONS

Low flow veno-venous ECMO represents a new therapeutic alternative for critically ill patients whose condition does not meet the conventional ECMO criteria. Further clinical experience is still needed.

Photocatalytic degradation of pentachlorophenol on TiO2 sol-gel catalysts

The photocatalytic degradation of pentachlorophenol (PCP) in aqueous solution was investigated using TiO2 catalysts. The samples were prepared by the sol-gel method using different gelation pH and different calcination temperatures. The solids were characterized by specific surface area, X-ray diffraction, UV-Vis absorbance, FTIR and pentachlorophenol adsorption. The catalytic activity of the solids was evaluated in a conventional photoreactor at 298 K using 30 ppm of pentachlorophenol. It was found that the reaction follows a first-order reaction and the kinetic constant values change slightly with the pH of gelation and more significantly with the calcination temperature.

Gastroparesia diabética: Comparación del vaciamiento gástrico de pacientes tratados con eritromicina o cisaprida

En 1958 aparece el término gastroparesis diabeticorum para describir el proceso de atonía y alteración del vaciamiento gástrico, encontrados en algunos pacientes diabéticos. La prevalencia varía de 10 a 76 %, variación ocasionada por la poca especificidad de los síntomas. Se ha encontrado relación entre el adecuado control de glucemia y la absorción de medicamentos y el vaciamiento gástrico, por lo que es importante el tratamiento. Con este estudio se pretende comparar la eficacia clínica y paraclínica entre la eritromicina y el cisapride, utilizados aisladamente en gastroparesía. Se tomaron 18 pacientes diabéticos tipo 1 y 2, con un año de evolución de la diabetes, edad media de 57.82 años, excluyendo pacientes con patología y medicamentos que alteraran el vaciamiento gástrico. Se elaboró un cuestionario sobre resultados antes y después del tratamiento y respecto al vaciamiento antes y después de quince días de tratamiento. Los síntomas más frecuentes fueron llenura posprandial, pérdida de peso, dispepsia y distensión abdominal. Nueve pacientes recibieron cisapride, ocho presentaron mejoría subjetiva, 55% mejoría del vaciamiento yen uno no cambió. Diez pacientes recibieron eritromicina, un diabético se retiró por intolerancia, siete presentaron mejoría subjetiva y 45% mejoría en los vaciamientos; (X2=1). No hubo diferencia significativa entre cisapride y eritromicina en la respuesta del vaciamiento gástrico

[Validity of clinical tests to confirm or to exclude the diagnosis of acute appendicitis]

AIMS

The clinical usefulness of the diagnostic tests (usually employed to diagnose an acute appendicitis in a group of patients in which this diagnosis is clinically highly suspected).

PATIENTS AND METHODS

A cross sectional study was designed. The sample (n = 116) was randomly selected by term and specific days from the patients attending the Emergency Service at Elda General Hospital in a year period. The method used was is a validity study making 2 x 2 tables. We have cross matched the habitual routine tests with: a) the clinical outcome if the patient was not surgically treated, or b) the result of the biopsy for those operated. Being these the gold standard. The validity indexes studied were sensibility (S), specificity (E). The 95% confidence index of the CF were calculated.

RESULTS

Acute appendicitis clinical suspicion was confirmed in 29.4% (IC 95%: 20.8-38). The best validity indexes were: a) kind of pain (S = 81.3; E = 33.8); b) peritoneal inflammatory signs (S = 78.5%, E = 45.9%); c) presence of leucocytosis in blood exam (S = 100%, E = 54.5%), and d) a greater difference in axillary-rectum temperature (S = 13.6%, E = 96.6%). Only leucocytosis reached 0 for PP- and CP-; the blood leucocytosis (PP+ = 47.8%, CP+ = 2.20) and the axillary-rectum temperature (PP+ = 60%, CP+ = 4.0) dissociation were the test with most valuable indexes.

CONCLUSIONS

Clinical suspicion of acute appendicitis in a group of patients having a great probability of suffering it over estimates this diagnosis. The symptoms or signs routinely used in the diagnosis did not reach high validity indexes in these patients. They are a poor help to stress or reject the diagnosis of acute appendicitis. To be careful is the main tool the doctors have. Blood leucocytosis is the test that has the best agreement indexes of clinical usefulness and it has the best countence with the gold standard.

Mesenchymal stem cells from osteoporotic patients produce a type I collagen-deficient extracellular matrix favoring adipogenic differentiation

Mesenchymal stem cells (MSCs), precursor cells resident in the bone marrow, have the capacity to differentiate into bone, cartilage, fat, and connective tissue. We have recently reported that MSCs from "healthy" donors differ from cells obtained from osteoporotic postmenopausal women in their proliferation rate, mitogenic response to osteogenic growth factors, and potential to mineralize. The purpose of this study was to examine the factors that explain the differential capacity of MSCs derived from "healthy" control and osteoporotic postmenopausal women to support mineralization. In addition, we examined the factors that regulate the differentiation of osteoporotic cells into adipocytes. For this purpose, we isolated MSCs from bone marrow of donors and analyzed the synthesis and deposition of type I collagen, the main component of bone extracellular matrix, the time course of gelatinolytic activity expression, the deposition of transforming growth factor beta (TGF-beta), and the ability of cells to differentiate into adipocytes. Our results indicate that cells derived from osteoporotic donors synthesized 50% less type I collagen than normal cells and maintained higher levels of gelatinolytic activity under differentiation conditions (70% versus 15% after 14 days in culture). MSCs derived from osteoporotic women produced 60-65% less TGF-beta and expressed higher adipogenic capacity. We conclude that the capacity of MSCs derived from osteoporotic postmenopausal women to generate and maintain type I collagen-rich extracellular matrix is decreased, favoring their adipogenic differentiation. These observations may explain the decreased mineralization previously observed in these types of cells.

DNA sequencing of HLA-B alleles in Mexican patients with Takayasu arteritis

Takayasu arteritis (TA) is characterized by a 'pulseless' condition and occurs frequently in young females from Asian and South American countries. It has been associated with Mayor Histocompatibility Complex (MHC) genes in different populations. Recent data indicate direct participation of HLA-B alleles in the susceptibility to the disease. This fact was explored in an associative study with TA to establish if some region in the exon 2, intron 2 or in the exon 3 of HLA-B alleles is common in the alleles associated with TA and at the same time to know if a specific sequence or an epitope, more than an allele, would be responsible for the susceptibility to this vasculitis. We studied HLA-B alleles of 12 Mexican patients with TA using PCR-SSP and sequencing. The analysis by PCR-SSP in 12 patients showed that five of them showed the B*15 allele, three the B*40 allele and two the B*39 allele, the remaining two presented the B*44 allele. Sequence analysis enabled us to define that the B*39 subtypes are B*3908; B*15 subtypes are B*1510, B*1515, B*1522 and B*1531; and the B*40 subtypes are B*4005 and B*4008. An individual with B*51 (B*5107) and another with B*52 (B*5201) alleles were also identified. The sequences of the intron 2 seem be heterogeneous. Analysis at the 63 and 67 positions of HLA-B alleles showed that 9 of them have similarity in some of these positions with the residues detected in the B*5201 and B*3902 alleles associated with TA in Asian populations. The results indicate that there is heterogeneity in the alleles associated with TA in Mexicans but, in spite of that heterogeneity, the alleles associates can be separated into three groups: B*39, B*15 and B*40, whose subtypes are rare and apparently of recent generation in Mexico, probably by recombination events at intron 2 level. The sequences analysis also shows that most of the alleles detected in the Mexican patients share two epitopes described in the susceptibility alleles in Asian populations, suggesting that these epitopes could be responsible for the susceptibility to develop the disease in spite of the allele in which are found.

Prevalence of Trypanosoma cruzi and Leishmania chagasi infection and risk factors in a Colombian indigenous population

This study was carried out in order to obtain base-line data concerning the epidemiology of American Visceral Leishmaniasis and Chagas' Disease in an indigenous population with whom the government is starting a dwelling improvement programme. Information was collected from 242 dwellings (1,440 people), by means of house to house interviews about socio-economic and environmental factors associated with Leishmania chagasi and Trypanosoma cruzi transmission risk. A leishmanin skin test was applied to 385 people and 454 blood samples were collected on filter paper in order to detect L. chagasi antibodies by ELISA and IFAT and T. cruzi antibodies by ELISA. T. cruzi seroprevalence was 8.7% by ELISA, L. chagasi was 4.6% and 5.1% by IFAT and ELISA, respectively. ELISA sensitivity and specificity for L. chagasi antibodies were 57% and 97.5% respectively, as compared to the IFAT. Leishmanin skin test positivity was 19%. L. chagasi infection prevalence, being defined as a positive result in the three-immunodiagnostic tests, was 17.1%. Additionally, 2.7% of the population studied was positive to both L. chagasi and T. cruzi, showing a possible cross-reaction. L. chagasi and T. cruzi seropositivity increased with age, while no association with gender was observed. Age (p<0.007), number of inhabitants (p<0. 05), floor material (p<0.03) and recognition of vector (p<0.01) were associated with T. cruzi infection, whilst age ( p<0.007) and dwelling improvement (p<0.02) were associated with L. chagasi infection. It is necessary to evaluate the long-term impact of the dwelling improvement programme on these parasitic infections in this community.

At the crossroads: options for financing college health services in the 21st century

At a time when increasing numbers of uninsured and underinsured students are attending college, many college health programs face formidable challenges in their efforts to sustain services. As financial pressures increase, college health programs must revisit their funding options, including (1) maintaining the current level and source of funding but requiring additional out-of-pocket fees for certain services from students, (2) establishing their own insurance plans, (3) qualifying as a preferred provider organization, or (4) some combination of the above. Whatever strategies are selected and pursued, college health programs must continue to try to provide quality services at a reasonable cost while maintaining an emphasis on prevention, health education, and the provision of services most needed by the college population, including mental health and substance abuse services.

Major histocompatibility complex genes in a Mexican family with deficiency of the second component of the complement system

Hereditary deficiency of the second component of the complement system is an uncommon condition that has been reported so far mostly in Caucasians. We describe a Mexican patient with undetectable C2 levels and absence of complement hemolytic activity. Major histocompatibility complex (MHC) genes in his family showed that the proband had the MHC haplotypes HLA-A25, B18, DR2, DQ1, SQ042/HLA-A24, B18, DR2, DQ1, SQ042. A strong genetic linkage of the deficiency of the second component of the complement gene and the HLA antigens A25, B18, and DR2, is well established in Caucasian populations. This suggests that the probable origin of the deficiency in our patient was admixture with Caucasian ancestors.

HLA-DR6 (possibly DRB1*1301) is associated with susceptibility to Takayasu arteritis in Mexicans

Takayasu arteritis is characterized by a "pulseless" condition and occurs frequently in young females from Asian and South American countries. This disease has been found to be linked with major histocompatibility complex (MHC) antigens in Japanese individuals. In the present study we compared gene frequencies of class I, class II, and class III MHC genotypes in patients with Takayasu arteritis and ethnically matched healthy controls. Serological typing was confirmed by molecular typing at the DNA level. We found significant increases in the frequencies of human leucocyte antigen (HLA)-DR6 and HLA-B62 in patients compared to the healthy controls (P corrected [C] = 0.0007, relative risk [RR] = 5.08; PC = 0.05, RR = 3.13 respectively). However, since the number of patients was considerably lower than the number of controls this can be considered as a tendency and not a true association. On the other hand, we found a significantly decreased frequency of HLA-DR4 in patients compared to healthy controls (PC = 0.04, RR = 0.34). At the DNA level, all DR6-positive individuals were HLA-DRB1*1301 whereas controls were HLA-DRB1*1301 (4.2%). Takayasu arteritis in Mexicans is probably associated with the HLA-DR6 (DRB1*1301) gene.

Refractory hemolytic anemia secondary to perivalvular leak diagnosed by transesophageal echocardiography

Transesophageal echocardiography (TEE) has become increasingly important in the assessment of mitral valve prosthetic dysfunction. We report on three patients who developed medically refractory hemolytic anemia after St. Jude mitral valve replacement secondary to perivalvular mitral prosthetic regurgitation. Two of the three cases had corrective surgical intervention that resolved the hemolytic process. Careful transesophageal echocardiographic evaluations of the perivalvular area proved diagnostic and resulted in appropriate management decisions.

Inhibitory action of hydrogen peroxide on a high-resistance epithelium

The present study describes the action of H2O2 on active transporting epithelium, and the partial blockade of this action by antioxidants. The addition of increasing concentrations of H2O2 (0.80; 8.0 and 24.0 mmol/l) to the mucosal surface of isolated toad skin causes an irreversible and dose-dependent inhibition of the short circuit current (SCC) and potential difference (PD). Quantitative determination of the parameters of the electrical equivalent circuit of the skin, by means of Isaacson's amiloride test, shows that the most affected parameters were the SCC, PD and shunt conductance. When the skins were preincubated with mannitol and vitamin E, the inhibition elicited by H2O2 was partially blocked; on the other hand, when the skins were preincubated with superoxide dismutase or allopurinol, this inhibition remains unchanged. The thiobarbituric acid method was used as an indirect quantification of lipid peroxidation. The inhibitory action of H2O2 in terms of the equivalent electrical circuit and the parallel production of lipid peroxidation points to free-radical formation. Furthermore, the significant blockade of this action by some enzymatic antioxidants is in agreement with this hypothesis.

[Geriatric evaluation of elderly patients at a university hospital]

The aim of this work was to evaluate general aspects, medical diagnoses, degree of disability, mental status and social support of hospitalized elders using a Geriatric Assessment Scale, devised at the Catholic University. Ninety eight hospitalized subjects (58 female, aged 60 to 74 years old) were surveyed before discharge. Results showed that 34% had serious handicaps in their daily living and required third party help, 14% had a moderate cognitive impairment and that 12% lacked social or family support. We conclude that the scale is useful, easy to use and allows to obtain a thorough diagnosis of hospitalized elders.

Raised agalactosyl IgG and antimycobacterial humoral immunity in Takayasu's arteritis

OBJECTIVE

Takayasu's arteritis is an inflammatory occlusive disease of the aorta and its main branches of unknown etiology. Some suggested causes include inapparent infection with Mycobacterium tuberculosis, or autoimmunity evoked by this organism. We have therefore sought links with mycobacterial disease.

METHODS

We assayed the % agalactosyl IgG, antibody to a tuberculosis-specific 38 kDa protein, and antibody to the mycobacterial 65 kDa heat shock protein (HSP), in patients with active or inactive Takayasu's arteritis, in whom the diagnosis of tuberculosis was excluded. The results were compared with findings in tuberculosis (positive controls), normal donors and patients with Wegener's granulomatosis.

RESULTS

The % agalactosyl IgG in patients with active arteritis was in the range previously seen only in rheumatoid arthritis, Crohn's disease, and the mycobacterioses. Similarly, significantly raised antibody to the purified 38-kDa protein of M. tuberculosis, and to the 65-kDa HSP of M. leprae, was found in 78% of patients with Takayasu's arteritis, and the levels were higher in those with active disease.

CONCLUSION

These results suggest that Takayasu's arteritis particularly clearly illustrates the occasional relationship between mycobacteria and diseases of superficially autoimmune pathogenesis.

Recurrent renal thrombotic angiopathy after kidney transplantation in two patients with primary antiphospholipid syndrome (PAPS)

Renal artery and venous thrombosis and thrombotic microangiopathy have been related to PAPS. This condition may lead to end-stage renal disease (ESRD). We present 2 patients with PAPS and ESRD who received a living unrelated kidney transplant. Despite intensive anticoagulant therapy, the disease recurred in the grafts.

The attenuation effect in brain SPECT

False perfusion defects simulating Alzheimer's disease can be attributed to skull thickness and head holders of a SPECT scan table. Brain phantom SPECT was performed using a different type of head holder in order to evaluate the effect of attenuation due to head holders and skull thickness on brain SPECT. Skull thickness was measured in 10 normal or non-Alzheimer's patients and 10 patients with suspected Alzheimer's disease. Visual and quantitative analysis of regional perfusion showed a 19% count loss due to attenuation by commercially available head holders and average skull thickness, less than 18% count difference between frontal-temporal and parietal-occipital skull in non-Alzheimer's disease patients, and more than 22% count difference observed in suspected Alzheimer's patients.