[Coagulation and total parenteral nutrition: the effect of 2 lipid emulsions]

Among the general complications caused by total parenteral nutrition (TPN), the hematological alterations play an important role, and they have been related to the lipid emulsions. With the objective of studying the influence of two lipid emulsions on the hemocoagulation of patients with TPN, we have done a prospective and double blind study in which 21 patients were randomized into two groups to receive TPN which included lipid emulsions and other components, Group I (n = 10) received a 20% LCT lipid emulsion with the TPN, and group II (n = 11) received a 20% MCT-LCT (50-50) lipid emulsion with the TPN. The following were then studied: activated cephalin time, prothrombin time, percentage of prothrombin time, thrombin and fibrinogen time, hemogram, and proteinogram. The basal values of both groups were similar and after eight days there were no differences in any of the variables when comparing the two groups. We came to the conclusion that both lipid emulsions behaved in a similar fashion, both were clinically well tolerated and neither produced by alteration in hemocoagulation.

Anisaldehyde production and aryl-alcohol oxidase and dehydrogenase activities in ligninolytic fungi of the genus Pleurotus

A variety of simple aromatic compounds were identified in liquid cultures of the basidiomycetes Pleurotus cornucopiae, P. eryngii, P. floridanus, P. pulmonarius, P. ostreatus, and P. sajor-caju by using gas chromatography-mass spectrometry. Such compounds were detected in fungal cultures on lignin- and straw-containing media, but it was found that they were also produced in the absence of aromatic precursors. Anisylic and hydroxybenzylic compounds (such as alcohols, aldehydes, and acids) were identified, p-anisaldehyde being the most characteristic extracellular metabolite synthesized by these ligninolytic fungi. Small amounts of 3-chloro-p-anisaldehyde were also detected in several species. It is postulated that the balance between the more-or-less-oxidized aromatic compounds can be explained in terms of the activity of fungal enzymes, including aryl-alcohol oxidase and dehydrogenase. The former enzyme shows high affinity for p-anisyl alcohol, which is oxidized to p-anisaldehyde with production of H2O2. The aryl-alcohol dehydrogenase was detected only in the mycelium, where it reduces aromatic aldehydes in the presence of NADPH. Both enzymes could be involved in the redox cycling of these aromatic compounds, providing H2O2 to ligninolytic peroxidases.

Purification and characterization of an extracellular endo-1,4-beta-xylanase from Fusarium oxysporum f. sp. melonis

Fusarium oxysporum f. sp. melonis produces extracellular endo-1,4-beta-xylanase and beta-xylosidase when grown in shaken culture at 26 degrees C in a mineral salts medium containing oat spelt xylan and glucose as carbon sources. Endo-1,4-beta-xylanase was purified 251 times from 5-day-old culture filtrates, by Sephacryl S-200, ion exchange and gel filtration HPLC. The purified sample yielded a single band in SDS polyacrylamide gels with a molecular mass of 80 kDa on electrophoretic mobility and 83 kDa by gel filtration behavior. High activity of the endo-1,4-beta-xylanase against xylan was observed between 5 and 8 pH, and between 40 and 60 degrees C, the optimum pH and temperature being 5.0 and 50 degrees C, respectively. Kinetic properties of the enzyme are similar to those of other fungal xylanases, showing high affinity towards oat spelt xylan with a Km of 1 mM expressed as xylose equivalent.

Regulation of rat liver microsomal cholesterol ester hydrolase by reversible phosphorylation

The regulation of neutral cholesterol ester hydrolase activity by changes in its phosphorylation state was studied in rat liver microsomes. Treatment with cAMP-dependent protein kinase resulted in increased enzyme activity, which was further enhanced by the addition of cAMP and MgATP. Consistent activations were also achieved with MgCl2 and MgATP, the magnesium effect being abolished by ethylenediaminetetraacetic acid and adenosine triphosphate. Cholesterol ester hydrolase was activated twofold by free calcium and Ca2+/calmodulin; this latter effect was blocked by the chelator ethylene-glycol-bis(beta-aminoethyl ether)N,N,N',N'-tetraacetic acid and the calmodulin antagonist trifluoperazine. The phosphatase inhibitors pyrophosphate and glycerophosphate led to marked and dose-dependent increases in esterase activity, whereas okadaic acid elicited no effect. Furthermore, pyrophosphate and okadaic acid did not change the increases in enzyme activity promoted by Ca2+, Ca2+/calmodulin, Mg2+ and MgATP. Cholesterol ester hydrolase was inactivated in a concentration-dependent manner by nonspecific alkaline phosphatases. In cAMP-dependent protein kinase/cAMP- or Ca2+/calmodulin-activated microsomes, a time-dependent loss of activation in cholesteryl oleate hydrolysis was caused by alkaline phosphatase. These findings suggest that microsomal cholesterol ester hydrolase is activated through cAMP and Ca2+/calmodulin phosphorylation, whereas enzyme deactivation is dependent on phosphatase action.

Cholesteryl ester synthesis and hydrolysis in the rat mammary gland during pregnancy and lactation

The activities of a lysosomal acid and two neutral cholesteryl ester hydrolases (microsomal and cytosolic) found in the mammary gland were studied in subcellular fractions prepared from tissue from rats at various stages of pregnancy, lactation, and after weaning the pups. The relationship between the activities of these enzymes and that of acyl coenzyme A: cholesterol acyl transferase (ACAT) was also investigated. Acid cholesteryl ester hydrolase activity was increased considerably in glands from lactating as compared to pregnant animals, and was sharply decreased 2 days after weaning. The microsomal neutral cholesteryl ester hydrolase activity followed a similar pattern, but took longer to return to pre-lactating values on weaning. In contrast, the activity of the cytosolic neutral cholesteryl ester hydrolase increased throughout pregnancy, then remained relatively constant in lactation and for 2 days after weaning. At 8 days post-weaning, however, activity was markedly decreased. No correlation between the changes in the activities of any the cholesteryl ester hydrolases and ACAT during mammary gland development was detected. The microsomal neutral cholesteryl ester hydrolase activity showed a strong positive linear correlation with the unesterified and esterified cholesterol content of the microsomal fraction. No relationship, however, was found between the cytosolic neutral cholesteryl ester hydrolase and the level of either form of cholesterol in the cytosol. In addition, there was no correlation between ACAT activity and microsomal cholesterol concentrations. These results provide evidence for an important role for the enzymes responsible for cholesteryl ester synthesis and hydrolysis in the mammary gland in the regulation of cholesterol metabolism and the provision of cholesterol for secretion into milk.

Divalent metal ions as modulators of rat liver microsomal cholesterol esterase

The regulatory properties of the divalent metal ions Mg2+, Ca2+ and Mn2+ on the activity and kinetic behaviour of rat liver microsomal cholesterol esterase were studied in vitro. Mg2+ and Ca2+ exhibited similar concentration and preincubation time-dependent increases in esterase activity, with maximal stimulation at a concentration of 2 mM. However, Mn2+ had no effect at this concentration but displayed a potent inhibitory effect at concentrations above 20 mM. Activation of cholesterol esterase by Mg2+ and Ca2+ was selective in relation to i) the changes that cations produced in the enzyme kinetic constants, and ii) the chelating agents that reversed the metal ion-induced activation. Hence, the maximum rate of cholesterol ester hydrolysis doubled in the presence of Mg2+ and activation was reversed by EDTA, whereas a significant decrease in the apparent Km for cholesterol oleate was found when Ca2+ was added and this effect was blocked by ATP and EGTA. Both cations were able to reactivate cholesterol ester hydrolase activity in metal-depleted microsomes.

[The effect of the administration of an amino acid solution enriched with branched-chain amino acids on the nutritional assessment of patients with stress who require total parenteral nutrition]

The effects of two solutions of amino acids (AA) were compared in the nutritional assessment of stressed patients requiring total parenteral nutrition (TPN) by finding anthropometric, biochemical and immune parameters on day 0 and day 8. In addition, calculations were made to find the nutritional prognosis index, stress index nitrogenated balance (NB) and net protein use (NPU). A double-blind prospective study was run in which 35 patients with moderate to high stress were divided at random into two groups to receive, for seven days, TPN that was both isonitrogenated (1.56 g/Kg/day of AA) and isocaloric (115.6 +/- 13.6 non-protein Kcal/g. nitrogen), 37% as lipids (LCT), differing only in the AA solution used, one being 15.6% and the other, 45% BCAA. Twenty-eight patients finished the study, 14 in each group. No significant differences were found between the groups in the parameters under study; however, the patients who received the 45% BCAA solution obtained superior development of the parameters evaluating nutritional status and an increase in their NB (p = 0.0213) and NPU (p = 0.0497). Total lymphocytes increased significantly in both groups. Disturbances in hepatic enzymes and alkaline phosphatase (AF) were higher than in the standard group. Gamma glutamyl transferase (GGT) increased in group I (p = 0.0168), while in group II there were increases of GGT (p < or = 0.05), glutamic pyruvic transaminase (GPT) (p < or = 0.025) and AF (p = 0.0213). In the standard group, plasma urea increased (p = 0.0117), and the creatine/size ratio decreased (p = 0.0094). Anthropometric measurements were not valid in this study. The results do not allow the conclusion to be drawn that the 45% BCAA solution is the most effective, but it does make clear that its use is suitable in patients with moderate and high levels of stress, changing to standard AA solutions when the patients improve.

[Plasma aminogram in critical patients]

This study of the plasma aminogram was done on 35 patients with a moderate to high level of stress and/or sepsis. For the criteria of illness, the SAPS (Simplified Acute Physiological Score) was used on their admission to the intensive Care Unit, and the diagnosis of sepsis was established according to the criteria of Jacobs and Boone. The stress level was calculated according to Bistrian. The plasma aminogram was determined with High Resolution Liquid Chromatography. The plasma samples were taken while nutrient units containing what is considered a standard solution of amino acids were infused. The eight essential amino acids (EAA) and 10 non-essential were quantified. The ratio of ramified to aromatic amino acids (RAA/AAA) was calculated by Fisher's criteria. An increase in AAA (phenylalanine, p < 0.001, and tyrosine, NS) and sulphur containing amino acids (methionine, p < 0.001) was found. The RAA were within normal ranges (valine) or increased (leucine, p < 0.001 and isoleucine, p < 0.001). The RAA/AAA ratio was reduced, p < 0.0001. Glycine was increased, p < 0.0001 and alanine reduced, p < 0.05. Glutamine and glutamic acid were reduced, p < 0.0001 and p < 0.01 as was arginine, p < 0.001. No difference was found in the total concentration of AA. The results confirm the standard plasma aminogram described in situations of metabolic stress and/or sepsis.

[Topical treatment with oxybutynin chloride in neurogenic incontinence]

Intravesical oxybutynin chloride was administered to 12 children with neurogenic bladder and incontinence who had unacceptable side effects. Urodynamic studies showed hyperreflexia was eliminated or improvement in 100% of them and low compliance was improved (88%), with a mean increase in bladder volume to 123% and a mean decrease of filling pressure to 24 cm H2O. Six patients became completely dry (50%), 4 continent period was increased and 2 did not improve. No systemic effects were observed.

Substrate specificity and properties of the aryl-alcohol oxidase from the ligninolytic fungus Pleurotus eryngii

The production in a 5-1 fermenter of the extracellular enzymes laccase and aryl-alcohol oxidase by the fungus Pleurotus eryngii was studied. The latter enzyme has been purified 50-fold by Sephacryl S-200 and Mono Q chromatography. Purified aryl-alcohol oxidase is a unique flavoprotein with 15% carbohydrate content, a molecular mass of 72.6 kDa (SDS/PAGE) and a pI of 3.9. The enzyme presents wide specificity, showing activity on benzyl, cinnamyl, naphthyl and aliphatic unsaturated alcohols. Neither activity nor inhibition of veratryl alcohol oxidation was found with saturated alcohols, but competitive inhibition was produced by aromatic compounds which were not aryl-alcohol oxidase substrates, such as phenol or 3-phenyl-1-propanol. From these results, it was apparent that a double bond conjugated with a primary alcohol is necessary for substrate recognition by aryl-alcohol oxidase, and that activity is increased by the presence of additional conjugated double bonds and electron donor groups. Both affinity and maximal velocity during enzymic oxidation of methoxybenzyl alcohols were affected in a similar way by ring substituents, increasing from benzyl alcohol (Km = 0.84 mM, Vmax = 52 U/mg) to 4-methoxybenzyl alcohol (Km = 0.04 mM, Vmax = 208 U/mg). Aryl-alcohol oxidase presents also a low oxidase activity with aromatic aldehydes, but the highest activity was found in the presence of electron-withdrawing groups.

An immunoblotting study of serologic response in patients with acute brucellosis

Immunoblotting was used to study the evolution of serologic response in 35 patients with acute uncomplicated brucellosis. Although no definite pattern was seen in serologic response, patients whose disease had existed for longer periods before being diagnosed had antibodies against the different bands more frequently than did patients with a shorter first-symptom-diagnosis interval.

[Effect of the extraction of LPS (R) on the demonstration of the serological response in acute brucellosis by immunoblotting]

In order to establish the possible influence of Brucella melitensis rough strains protein extracts contamination using LPS (R) in the immunoblotting evaluation of serologic response, we have studied sera samples from 41 patients with acute brucellosis before treatment was started and also from 62 healthy individuals (control group). A whole-cell B. melitensis 115 strain extract with an without LPS (R) was used. Extraction was carried using ether-chloroform of oil-phenol. Overall, more than 50% of patients showed an antibody response (protein bands 85, 53, 50, 47, 41, 38 and 28 kD) to both antigenic products. Less than 6.4% of the control group sera showed response to any of these protein bands. There were no significant differences in the frequency of response development against these proteins using the two antigen types. However, there was some disagreement when each individual band response was compared to its homologous band.

Beta-N-acetylglucosaminidase from Aspergillus nidulans which degrades chitin oligomers during autolysis

A hexosaminidase from autolyzed cultures of Aspergillus nidulans was purified 196 fold and characterized as a beta-N-acetylglucosaminidase (EC 3.2.1.30). The enzyme has a MW of 190000, a pI of 4.3, and optimum pH of 5.0 and is unstable at temperatures above 50 degrees C. The enzyme is a glycoprotein with 19.5% sugars, mannose being the principal component. It binds strongly to chitin. The enzyme hydrolyzes different substrates. The Ki with the competitive inhibitor 2-acetamido-2-deoxy-D-gluconolactone was independent of the substrate used. The enzyme was inhibited by Hg2+, Ag+, acetate and other organic anions. The kinetics of hydrolysis of chitin oligosaccharides from 2 to 6 units was studied by HPLC. This enzyme is an exoenzyme which degraded chitin oligomers gradually with the production of N-acetylglucosamine. The hydrolysis of N-N'-diacetylchitobiose was inhibited non-competitively by glucosamine and N-acetylglucosamine. In mixtures of chitin oligosaccharides, the hydrolysis of chitobiose was competitively inhibited by each of the other oligomers.

[Levels of blood theophylline in patients with acute bronchospasm]

Plasma theophylline levels (mcg/ml) of 93 patients with a bronchopulmonary disease (asthma and chronic obstructive lung disease) who were on theophylline (normal or retarded) treatment, were determined on admission at the emergency ward because of acute bronchospasm. Our results show that theophylline blood levels were subtherapeutical in patients treated either with normal (2.1 +/- 0.8 mcg/ml) or retarded theophylline (9.6 +/- 1.3 mcg/ml). This was probably due to insufficient dosing and/or poor patient compliance. The necessity of monitoring this type of treatment is once again evident.

ACTH and prolactin deficiency

A 35 year old woman suffering from ACTH and prolactin (Prl) deficiency is described. Her symptoms of adrenal insufficiency appeared gradually after her first pregnancy in 1970; however, she conceived twice more and delivered healthy babies in 1972 and 1974, which she could not breast feed due to lack of milk. During an episode of pneumonia in 1977 she suffered acute adrenal insufficiency, after which she began treatment with hydrocortisone. Her pituitary reserve for TSH, GH, LH and FSH was normal, but her ACTH and Prl levels were undectable and did not respond to acute iv challenges of corticotrophin-releasing factor (CRF) and TRH, respectively. Autoantibodies, including antilactotroph titres, were negative, except for a positive pituitary immunofluorescence to ACTH. There was also no ACTH stimulation to a prolonged infusion of CRF followed by an acute iv bolus. These results, together with the gradual onset of symptoms which worsened after each pregnancy, suggest a possible autoimmune aetiology of her pituitary ACTH and Prl deficiencies.

Studies on the mechanisms of somatostatin release after insulin induced hypoglycaemia in man

Insulin-induced hypoglycaemia, which stimulates gastric acid secretion, is associated with an increase in circulating somatostatin levels in man. In order to assess the mechanisms involved in this rise, six normal volunteers connected to a Biostator for continuous glucose monitoring were studied, on three separate occasions. On each occasion after basal blood sampling, 0.15 i.u./kg body weight of insulin was administered i.v. and further samples were obtained intermittently over 150 min. On one occasion, dextrose was infused by the Biostator to prevent hypoglycaemia, while on the other two, a constant infusion of either normal saline or the specific H2 antagonist cimetidine was administered. Insulin plus dextrose caused no significant changes in circulating somatostatin levels, whereas insulin plus saline was associated with a marked, sustained and significant rise in all subjects; insulin plus cimetidine also produced a rise but it was delayed; the area under the curve was significantly (P less than 0.05) greater with insulin plus saline than with insulin plus cimetidine. These results show that in man insulin itself does not stimulate somatostatin secretion directly, but indirectly via hypoglycaemia. Further, the inhibition of gastric acid secretion with cimetidine reduces somatostatin release during insulin-induced hypoglycaemia. This suggests that gastric acid may mediate somatostatin secretion associated with insulin-induced hypoglycaemia.

[Coronary fistula of the left ventricle. Report of a case treated surgically]

A case of a left coronary artery fistula to the left ventricle successfully by surgery treated is reported. The medical literature was reviewed, and it is concluded that because of the surgical low mortality rate, all cases of coronary fistula, diagnosed by angiography and cardiac catheterization, ought to be submitted to surgical treatment.