Mucocutaneous leishmaniasis in a patient with the human immunodeficiency virus

We report a case of mucocutaneous leishmaniasis (MCL) in a patient with the human immunodeficiency virus (HIV), Centers for Disease Control (CDC) Stage A2, with no previous history of cutaneous or systemic leishmaniasis. The patient had not travelled outside the province of Málaga, on the Mediterranean coast of southern Spain, so that it concerns an indigenous case, extremely unusual in this area. The HIV infection may well have influenced the defence against leishmania, but the exact mechanism by which this occurred is unknown.

Differential staining of DNA strand breaks in dried comet assay slides

The comet assay involves embedding cells in agarose on microscope slides. After lysis and electrophoresis, staining is usually performed with a fluorescent DNA-binding dye and observation is carried out on fresh wet slides through an epifluorescence microscope. We present here a simple alternative for preservation of the agarose comet slides and a fluorescent staining that allows fine differential analysis of DNA strand breaks under confocal microscopy. Lymphocytes were processed according to previous published methods. Slides were quickly dehydrated in a hot oven at 50C for 20 min. Once the agarose layer was dried and reduced to a thin film, slides were treated with RNase. Image analysis showed higher tail length, total area, and tail moment. Using confocal microscopic optical sectioning, a thickness of approximately 180 microm for wet slides and 12 microm for dehydrated gels was calculated. Acridine orange, used for DNA differential staining, allowed quantitation of metachromasia and orthochromasia with confocal scanning microscopy. Differences between alkaline and neutral comet assay with AO were clear-cut and, in principle, a metachromatic index can be calculated. (J Histochem Cytochem 49:921-922, 2001)

Accidental aluminum intoxication in patients undergoing acetate-free biofiltration

Eight patients undergoing acetate-free biofiltration (AFB) suffered aluminum intoxication. The source of this outbreak was parenteral exposition to high concentrations of aluminum in sodium bicarbonate solutions. The manufacturer of bicarbonate solutions used in AFB was substituted in May 1994 and the solutions were stored in glass containers. At the peak of intoxication (July 1994) serum aluminum determination revealed an average value of 147.3 +/- 21 microg/l. Aluminum levels in bicarbonate solutions were 400 microg/l. Serum ferritin rose from 307.4 +/- 161 to 735.6 +/- 206 ng/ml, whereas MCV decreased significantly from 98.4 +/- 9 to 90.1 +/- 10 fl. No significant changes were found in hemoglobin, neither in plasma iron, nor in iron transferrin saturation. The doses of recombinant human erythropoietin showed a considerable increase. The replacement solutions were changed and a new solution, stored in plastic containers and with aluminum levels lower than 10 microg/l, was used. The biochemical parameters were normalized. This outbreak demonstrates the need for a stringent control of aluminum-containing replacement fluids.

Cutaneous cryptococcosis in two patients with acquired immunodeficiency syndrome

We present 2 cases of systemic cryptococcosis with cutaneous involvement in patients with acquired immunodeficiency syndrome (AIDS). Both patients were male, intravenous drug abusers, 31 and 35 years old, with severe immunodepression and a CD4+ lymphocyte count of 10/ml and 1/ml, respectively. They both had papular lesions reminiscent of molluscum contagiosum and in one patient with concomitant systemic leishmaniasis, there were spores of Cryptococcus neoformans coexisting with the leishmanias in the cutaneous lesions, constituting the first reported case of this particular association. Both patients responded well to amphotericin B followed by fluconazole.

[Accumulation and efflux of quinolones by clinical isolates of Stenotrophomonas maltophilia]

The presence of quinolone efflux pumps was analyzed in clinical isolates of Stenotrophomonas maltophilia. The presence of the protein Omp54, which is associated with the expression of multidrug resistant systems, was also tested. Western blot analysis of outer membrane proteins demonstrated that Omp54 was expressed in strains with high-level resistance to quinolones, whereas those strains with low MIC values did not express this protein. This result shows that Omp54 has an important role in the phenotype of quinolone resistance in clinical S. maltophilia isolates. Biochemical analyses have shown that clinical S. maltophilia strains are capable of quinolone efflux (namely norfloxacin, ofloxacin and ciprofloxacin). Quinolone efflux is dependent on the integrity of membrane potential. These data indicate the presence of active quinolone efflux pump systems in clinical S. maltophilia isolates.

[Organic personality disorder. Conceptual and diagnostic aspects]

INTRODUCTION

Probably the commonest neuropsychiatric sequela in persons who have had some type of cerebral lesion (of whatever origin) are the complaints of changes in the personality of the patient prior to the lesion which cause problems with the family, socially and at work. These problems have been grouped together under the same diagnosis in current psychiatric nosology called 'organic personality disorder'.

DEVELOPMENT

In this article we wish to point out the disadvantages due to this diagnosis which have a double origin. Firstly, it is based on the concept of personality, which has been shown to be inconsistent throughout the history of science. Secondly, because this group contains heterogeneous phenomena and conducts which are probably based on different neurobiological processes.

CONCLUSION

The development of strategies of investigation, and of effective therapeutic techniques for these patients make it necessary to separate the different phenomena which, in the author's opinion, are erroneously included in this nosological group.

[Digestive tract hemorrhage secondary to jejunal angiodysplasia associated with jejunal diverticulosis]

The most important factor in the management of alimentary tract bleeding is the adequate localization of the lesion. Small bowel bleeding is a rare entity and determination of the specific anatomic site is difficult. Once stomach, duodenum, or colon origin has been discharged through endoscopy, methods such as angiography and Tc99m RBC scans are appropriate. We present a patient with lower gastrointestinal bleeding secondary to jejunal angiodysplasia associated with jejunal diverticular disease. In the present case, Tc99m RBC scans were used to identify the bleeding site. In cases of lower gastrointestinal bleeding of undetermined origin, we suggest the consideration of both diagnoses (angiodysplasia or diverticular disease) with exploratory celiotomy to resolve these pathologies, particularly in the elderly patient.

Rapid and cost-effective multiparameter toxicity tests for soil microorganisms

Three biochemical parameters, DNA quantification in soil samples and two enzymatic activities, beta-galactosidase and dehydrogenase have been assessed as potential end-points for the use in cost-effective toxicity tests on soil microorganisms. The assessment included the development of a classical dose-response 24-h assay and the incorporation of measurements of the effects on microbial activities in soil column leaching studies and multispecies miniaturised terrestrial systems (MTS). Four different chemicals, copper, a new herbicide, thiabendazole and fenthion were studied. A rapid fluorescence DNA quantification technique did not produce adequate responses. The efforts to quantify DNA after extraction and clean-up procedures failed due to the presence of humic acids. From the protocol of the technique one could see that the technical procedure is time-consuming and expensive and, for this reason, not suitable for use as a parameter in rapid and cost-effective tests. However, the enzymatic activities showed their potential as toxicity end-points. Copper produced a concentration/response inhibition of beta-galactosidase and dehydrogenase with EC50 values of 78.39 and 24.77 mg Cu/kg soil, respectively. In the soil column study, these endpoints allowed the measurement of the microbial activities through the column. The effects of the new herbicide on beta-galactosidase and dehydrogenase activities were statistically significant for the highest application dose (40 g/ha). Thiabendazole affected the microbial activity when mixed within the soil, but no effects were observed when this fungicide was applied on the soil surface. Fenthion produced effects when applied either in the soil or on the soil surface. These results can be explained by the low mobility of thiabendazole. The results show the capabilities of these biochemical parameters to be included as endpoints in cost-effective bioassays.

Flow cytometric detection of micronuclei and cell cycle alterations in fish-derived cells after exposure to three model genotoxic agents: mitomycin C, vincristine sulfate and benzo(a)pyrene

The measurement of cytogenetic alterations in vitro is considered an initial step in the risk assessment procedures for genotoxic agents. The concern about genotoxic pollutants in natural fish population makes the use of fish-derived cells an useful tool for these purposes. The technological improvements in well-established cytogenetic endpoints, such as micronuclei (MN) estimations by means of flow cytometry, have been proposed in the later years using mammalian cells. In this work, we test the capability of flow cytometry to evaluate MN induction and cell cycle alterations in an established fish cell line (RTG-2) using three agent-inductor models at different concentrations and exposure periods. For mitomycin C, an inverse relationship between length of exposure period and concentrations was observed. A dose-response relationship was observed after exposing RTG-2 cells to vincristine sulfate and benzo(a)pyrene. As this study shows, RTG-2 cells respond to clastogenic and aneugenic effects of the tested chemicals through the induction of MN at similar doses to mammalian cells and without the addition of exogenous metabolic activity. The possibility to check cell cycle alterations, in the same sample, gives the opportunity to evaluate early signals of cytotoxicity. The use of flow cytometry improves the assay by means of its speed and objectivity, which makes the assay very useful for genotoxicity assessment of aquatic chemicals.

[Levels of evidence in the prevention and control of nosocomial infection]

BACKGROUND

Sanitary, economic and social importance of nosocomial infections justifies the introduction and development of control and surveillance systems in hospitals. The practice of a rational medicine needs the scientific evidence evaluation of the control measures employed, in terms of efficacy, efficiency and effectivity.

METHODS

Critical appraisal of medical literature with special emphasis in recommendations provided by Centers for Disease Control and Prevention (CDC).

RESULTS

A minimum proportion of prevention and control recommendations provided by Centers for Disease Control and Prevention (CDC) are included in the Category IA (demonstrated evidence in well-designed epidemiological or experimental studies), while sanitary impact (reduction of the nosocomial infection incidence or prevalence) or economic impact (the benefit derived of this nosocomial infection frequency reduction) of numerous interventions keeps being a motive for study and discussion because its evidence level is not demonstrated due to internal or external validity problems.

CONCLUSIONS

An appropriate strategy to be adopted by sanitary professionals in charge of nosocomial infection control is the application of the evidence-based medicine methodology and principles.

Determinants of left ventricular mass in untreated mildly hypertensive subjects: hospitalet study in mild hypertension

The objectives of this cross-sectional study were to identify the determinants of left ventricular mass in untreated mildly hypertensive subjects at the Hypertension Unit, Department of Internal Medicine, Red Cross Hospital, Hospitalet de Llobregat, Barcelona, Spain. One hundred seventy-one untreated mildly hypertensive subjects, with a mean age of 41.1+/-11.8 years (from 18 to 65 years) were sequentially visited in our Unit; 54% were men. Echocardiographic measurements of good quality were obtained in 142 subjects (83%). Two-dimensional guided M-mode echocardiograms were used and left ventricular mass was estimated according to the Penn convention. Left ventricular mass (LVM) was analyzed as a continuous variable. In the bivariate analysis, the variables that significantly correlated with LVM were patient's height (r = 0.42, P<.0005), weight (r = 0.47, P< or =.0005), heart rate (r = -0.22, P = .01), HDLc (r = -0.30, P = .002), hematocrit (r = -0.28, P = .001), urinary sodium excretion (r = 0.23, P = 0.012), and different measurements from the ambulatory blood pressure profile for 24 h. By means of multiple regression analysis, a maximum of 41.2% of LVM variability could be explained from the factors registered in our study. The final model included age, gender, patient's weight, and diastolic night load from ambulatory blood pressure monitoring. When added to different models, weight and diastolic night load showed a similar strength in predicting left ventricular mass. In untreated patients with mild hypertension, traditional factors such as blood pressure levels explain a maximum of 41.2% of LVM variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients.

Allergy to the pine processionary caterpillar (Thaumetopoea pityocampa)

BACKGROUND

The contact with the pine processionary caterpillar (Thaumetopoea pityocampa) induces dermatitis and ocular lesions by a mechanic and toxic mechanism. However, IgE-mediated hypersensitivity to this caterpillar has been demonstrated in two recent studies.

OBJECTIVE

To find if an IgE-mediated mechanism was operative among patients with suspected previous reactions to processionary caterpillars, particularly exposed workers.

METHODS

Fifty-five patients were studied by skin prick test (SPT), and specific IgE detection by immunoblotting.

RESULTS

A total of 58.18% patients had a positive SPT for caterpillar extract. Positive SPT patients had more generalized cutaneous reactions (47%) and oedema (50%) as well as a shorter latency period (mean, 36 min) and duration of cutaneous lesions (mean, 26 h) than the patients with negative SPT. A total of 60% of the positive SPT patients had occupational exposure to the processionary caterpillar. The occupationally exposed workers showed significant symptoms from October to December. The anaphylactic reactions only appeared in allergic patients with occupational exposure and were also more frequent from October to December. These patients with anaphylactic reactions had a major size of SPT and the exercise was found in them to be a variable that increased the symptoms. The IgE immunoblot detected in the caterpillar extract several reactive bands with apparent molecular weights from to 35-4 kDa in 72% of the cases with positive SPT.

CONCLUSIONS

Allergic reactions to T. pityocampa urticating hairs have different clinical characteristics than those induced by a toxic-irritative mechanism and are more frequent than suspected. Allergic reactions to this caterpillar among occasional visitors to pine-wood areas, and particularly in pine-forest workers, should be taken into consideration by allergists.

[Inhibition of pump and permeability mechanisms]

The presence of multidrug efflux-pump systems in bacteria showing resistance to various drugs is increasingly reported in the literature. These systems are inducible by compounds such as salicylate and can thus be involved in situations of phenotypic resistance at the point of the infection which would otherwise be barely detectable under standard laboratory testing conditions. On the other hand, mutants which overproduce efflux-pumps and show increased levels of antibiotic resistance are easily selectable. It has been shown that inactivation of efflux-pump determinants produces an increased susceptibility to different antibiotics as well as prevents the emergence of mutants with a high-level antibiotic resistance to drugs such as quinolones. The search for efflux-pump inhibitors to be used in combination with other currently used antibiotics is therefore an important task for the renewal of the antibacterial therapeutic armamentarium. No efflux-pump inhibitors are commercially available as yet. However, several companies are in the process of working on their development. In this review, we discuss four possible targets that could be useful in the screening of inhibitors of efflux-pump systems in bacteria.

Target-organ damage and cardiovascular risk profile in resistant hypertension. Influence of the white-coat effect

BACKGROUND

It is difficult to draw definite conclusions about the prevalence and clinical characteristics of patients with resistant hypertension because of the heterogeneity of study designs described in published studies.

OBJECTIVES

To estimate the prevalence of resistant hypertension, the associated cardiovascular risk factors and the degree of target-organ damage, and to analyze the differences between true resistant hypertension (TRH) and white-coat resistant hypertension (WCRH).

DESIGN

Cross-sectional study.

METHODS

Patients who visited the Hypertension Clinic with resistant hypertension were sequentially included. Resistant hypertension was defined as an average of three measurements of systolic blood pressure, >/= 160 mmHg or a diastolic blood pressure >/= 95 mmHg, or both, in patients treated with a triple-drug regimen, over at least 2 months. Twenty-four-hour ambulatory blood pressure monitoring and M-mode bi-dimensional echocardiography were performed. WCRH was defined as a mean daytime ambulatory blood pressure </= 135/85 mmHg; patients with higher values were classified as having TRH.

RESULTS

Of 1200 hypertensive subjects who visited the clinic, 60 patients with resistant hypertension were included [mean age 59+/-8 years; 38 women (63%)]. Office blood pressure was 173+/-14/100+/- 8 mmHg. Of 36 patients with a good quality echocardiograph, 18 had left ventricular hypertrophy. Twenty cardiovascular events were recorded in 16 patients. Obesity was present in 43% of patients, diabetes in 28%, and hypercholesterolemia in 47%. Hypoalphalipoproteinemia was detected in 18%of the patients, all of whom had TRH (P = 0.01). Nineteen subjects (32%) had WCRH. The subjects with TRH had a higher office systolic blood pressure, greater frequency of hypoalphalipoproteinemia than those who had WCRH and a greater proportion of clinical target-organ damage.

CONCLUSIONS

Resistant hypertension is uncommon in clinical practice. Resistant hypertension is associated with multiple cardiovascular risk factors, including left ventricular hypertrophy. A third of patients with resistant hypertension achieve adequate control of their blood pressure outside the physician's office. The proportion of patients with clinical target-organ damage is greater in subjects with TRH than in those with WCRH.

Delayed-type hypersensitivity to subcutaneous enoxaparin

BACKGROUND

Enoxaparin and other low-molecular-weight heparins are widely used to prevent and treat thromboembolic disorders. Cutaneous reactions secondary to enoxaparin injections include delayed hypersensitivity skin reactions described as erythematous, infiltrated plaques at injection sites. We studied three cases of erythematous infiltrated plaques after enoxaparin injection in order to establish the allergenic importance of this low-molecular-weight heparin.

METHODS

Patch tests were performed with sodium heparin, calcium heparin, calcium enoxaparin, and calcium nadroparin. A subcutaneous test with calcium heparin and an intravenous challenge test with sodium heparin were done. A punch biopsy was obtained from an erythematous plaque in one patient.

RESULTS

Patch tests were negative to calcium heparin in all patients, positive to enoxaparin and nadroparin in two patients, and positive to sodium heparin in one patient. In two patients, the subcutaneous challenge test was positive, the intravenous challenge test was negative, and the histopathologic appearance of the biopsy resembled a delayed-type hypersensitivity reaction.

CONCLUSIONS

These cases provide evidence of type IV hypersensitivity and the possibility of crossed-allergenicity among unfractionated heparin and low-molecular-weight heparins. We show that the subcutaneous challenge test is the most reliable diagnostic measure.

[Soft tissue infections with S. Lugdunensis. Presentation of 2 cases and general review]

Staphylococcus lugdunensis was first described in 1988 by Freney et al. Since that moment, it has been recognised as an important cause of endocarditis that is able to involve native valves and follow an aggressive, often fatal course. By now, we know only few potential virulence factors, but its ability to produce a wide range of human infections, varying from life threatening (such us endocarditis) to more benign ones, is unquestionable. Unlike other coagulase negative Staphylococci, S. lugdunensis is frequently implicated in soft tissue infections and affects commonly persons with clinical antecedents of neoplastic diseases. We report two new cases of deep tissue abscesses in patients that had history of uterine tumours. In both occasions we isolated coagulase negative Staphylococci that were markedly susceptible to all the antimicrobial agents tested. It is relevant to perform a detailed microbiological study in order to avoid misidentification of this species, since it differs significantly from other coagulase negative ones and may lead to important morbidity--and even mortality--. There are great differences in the rates of resistant strains between countries and, up-to-date, the lack of antibiotics susceptibility seems not to be a serious problem in Europe if we compare with the 30% american strains that are resistant via production of beta-lactamase.

[The sensorineural component of hearing loss associated with cholesteatoma]

Patients with cholesteatoma often suffer neurosensorial hearing loss with variable bone conduction thresholds. Its origin is debated and has been attributed to the ototoxicity of topical drugs, immune reactions, effects of ototoxic antibiotics applied to the ear, etc. A selected series of 50 patients who underwent surgery for chronic ear disease due to cholesteatoma in our ENT department were studied to evaluate the possible origin of the bone conduction component of hearing loss. Different clinical, audiological, and surgical aspects were analyzed, including cholesteatoma site and extension, age, sex, evolution of the symptoms, pure tone audiometry data, middle ear involvement, the operation performed, and the occurrence of complications. Bone conduction thresholds were reported as pure tone differential thresholds (affected vs non-affected ear). A specific cholesteatoma-related neurosensorial hearing loss was observed that might lead to irreversible hearing loss. Neurosensorial involvement seems to be related mainly to the duration of symptoms, type of surgery, certain specific clinical aspects, and complications.

[Prognostic value of dipyridamole echocardiography in 1st acute uncomplicated myocardial infarction]

BACKGROUND

To assess the prognostic value of dipyridamole stress echocardiography in survivors of a first uncomplicated acute myocardial infarction.

PATIENTS AND METHODS

A total of 75 patients (68 men, 7 women) aged 58 years (range, 37-77) were studied 3-5 days after a first acute myocardial infarction and followed up for a mean of 10 months. Dipyridamole infusion was administered at high doses: 0.56 mg/kg, adding 0.28 mg/kg if the test was still negative. Two-dimensional echocardiography was continuously recorded during infusion and the test was considered positive if a decrease in regional contractile function appeared and negative if no assynergy was observed up to 15 min after the beginning of dipyridamole administration. A wall motion score index of regional function was derived by summation of individual segment scores divided by the number of interpreted segments. This was calculated for rest and peak dipyridamole echocardiograms. Fifty of 75 patients underwent coronary angiography based on clinical criteria.

RESULTS

There were 31 coronary events: 4 deaths, one reinfarction, 13 angina. Thirteen patients underwent coronary revascularization (9 bypass and 4 angioplasty). Dipyridamole echocardiography was positive in 29 patients (39%) and negative in 46 patients (61%). Twenty patients (69%) presented coronary events in the group of positive test versus only 11 (24%) of negatives (p = 0.0001). Four patients died in the positive group while none in the negative group. Sensitivity, specificity and accuracy for all cardiac events were 65, 80 and 73%, respectively. Significant variables from univariate analysis were dipyridamole stress echocardiography response, wall motion score index at peak dipyridamole, ischemic changes in ECG and treatment with two or more antianginal drugs. Multivariate analysis showed positive dipyridamole echocardiography as the only independent prognostic factor to predict cardiac events in postmyocardial infarction patients (RR = 2.56; 95% CI = 1.12-5.84). Four of 19 patients with one vessel disease and 17 of 22 patients with 2-3 vessel disease presented a positive dipyridamole test; whereas the test was negative in the remaining nine patients with normal coronary angiography.

CONCLUSION

Dipyridamole stress echocardiography is a safe and feasible pharmacologic stress imaging method to stratify postmyocardial infarction patients at risk of cardiovascular events.

[Improvement in diastolic function in hypertensive patients with left ventricular hypertrophy with inhibitors of the angiotensin converting enzyme]

An open and multicentric study was conducted with 66 patients with mild to severe diastolic arterial hypertension and echocardiographic left ventricular hypertrophy, the evolution of diastolic function, by means of doppler transmitral flow echocardiography, under treatment with ramipril, an angiotensin converting enzyme inhibitor, at a dose of 2.5 and 5 mg/day, or combined with a diuretic, after three and six months of treatment. Despite not obtaining the tensional control in all patients, a decrease in the mass, both in absolute values and mass index, was obtained. This decrease was observed both in male and female patients from the first three months, which went on until the sixth month, thus suggesting an independent action of the hemodynamic load decrease for the obtention of this effect. There was also a change in the ventricular geometry with a displacement of patients from concentric enlargement to normal, remodelling and eccentric enlargement. The diastolic function improved both for the early and for the late maximal filling velocity, relationship between both, and deceleration time, although the time during which this improvement occurred was different for each parameter, thus indicating the different influence of the dynamic and structural factors on these parameters. No correlation was found between the improvement in diastolic function and hypertrophy regression. We can conclude that ramipril is useful for the control of the left ventricular hypertrophy and diastolic function, irrespective of arterial tension values.

[Deafness secondary to lumbar puncture]

INTRODUCTION AND OBJECTIVE

Disorders of hearing have been described in patients who have undergone lumbar puncture. The lower frequencies are most affected, temporarily and with spontaneous recovery in most cases. It would seem that the cochlea aqueduct (AC) (an anatomical structure found in the internal ear) is the part involved in the pathogenesis of this infrequent complication. The object of this paper is to review the different hypothesis put forward by various authors on the subject, emphasizing the one which seems most probable. At the same time, we offer a new vision of this little known and often forgotten anatomical structure of the internal ear. The anatomy and physiology of the AC is considered, studying the part played by the labyrinth fluid when the patient undergoes an operation involving the cerebro-spinal fluid (CSF) or the subarachnoid space.

CONCLUSIONS

Whenever this technique is to be used, it is essential to obtain a clinical history to find out whether the patient has, or has had, any problems of hearing, and if so of what type. All patients should be warned of the possibility of deafness, in most cases temporary, and if the patient has hydrops endolymphaticus (syndrome of Ménière) of the high risk of worsening his hearing threshold. We therefore recommend precise evaluation of the use of this technique.

Analysis of xysA, a gene from Streptomyces halstedii JM8 that encodes a 45-kilodalton modular xylanase, Xys1

The gene xysA from Streptomyces halstedii JM8 encodes a protein of 461 amino acids (Xys1) which is secreted into the culture supernatant as a protein of 45 kDa (Xys1L). Later, this form is proteolytically processed after residue D-362 to produce the protein Xys1S, which conserves the same xylanolytic activity. The cleavage removes a domain of 99 amino acids that shows similarity to bacterial cellulose binding domains and that allows the protein Xys1L to bind to crystalline cellulose (Avicel). Expression of this monocistronic gene is affected by the carbon source present in the culture medium, xylan being the best inducer. By using an anti-Xys1L serum, we have been able to detect xylanases similar in size to Xys1L and Xys1S in most of the different Streptomyces species analyzed, suggesting the ubiquity of these types of xylanases and their processing mechanism.

Two genes encoding an endoglucanase and a cellulose-binding protein are clustered and co-regulated by a TTA codon in Streptomyces halstedii JM8

Streptomyces halstedii JM8 Cel2 is an endoglucanase of 28 kDa that is first produced as a protein of 42 kDa (p42) and is later processed at its C-terminus. Cel2 displays optimal activity towards CM-cellulose at pH6 and 50 degrees C and shows no activity against crystalline cellulose or xylan. The N-terminus of p42 shares similarity with cellulases included in family 12 of the beta-glycanases and the C-terminus shares similarity with bacterial cellulose-binding domains included in family II. This latter domain enables the precursor to bind so tightly to Avicel that it can only be eluted by boiling in 10% (w/v) SDS. Another open reading frame (ORF) situated 216 bp downstream from the p42 ORF encodes a protein of 40 kDa (p40) that does not have any clear hydrolytic activity against cellulosic or xylanosic compounds, but shows high affinity for Avicel (crystalline cellulose). The p40 protein is processed in old cultures to give a protein of 35 kDa that does not bind to Avicel. Translation of both ORFs is impaired in Streptomyces coelicolor bldA mutants, suggesting that a TTA codon situated at the fourth position of the first ORF is responsible for this regulation. S1 nuclease protection experiments demonstrate that both ORFs are co-transcribed.

[Sequential chemotherapy and radiotherapy in the treatment of locally advanced carcinoma of the head and neck]

In patients with non-resectable carcinoma of the head and neck, radiotherapy produces an average survival of 12 months. Neoadjuvant chemotherapy followed by radiotherapy has been shown to prolong survival and preserve organ structure and function, and to reduce systemic relapses in patients with advanced, resectable disease. An analysis was made of 35 patients treated with sequential chemotherapy and radiotherapy, 20 with non-resectable disease and 15 with resectable disease who refused surgery. Treatment consisted of 4 cycles of cisplatin + 5-fluoruracil in a 96-h continuous intravenous infusion in 16 patients, and the same treatment with leucovorin in 19 patients. After chemotherapy, the patients underwent cobalt irradiation of the primary tumor and neck. Chemotherapy produced a complete response rate of 46% and a partial response rate of 28%, yielding an overall rate of 74%. After radiotherapy, the CR increased to 63%. After 92 months of maximum follow-up, overall survival was 20% and median survival was 25 months. Locoregional relapses were the main cause of treatment failure. Our results suggest that sequential chemo-radiotherapy achieved encouraging CR rates with no significant increase in toxicity, prolonged survival in non-resectable patients, and enabled organ preservation in patients with resectable disease.

Pourfour du Petit syndrome: a case following a traffic accident with severe cranioencephalic trauma

Poufour du Petit syndrome is an extraordinarily unusual clinical condition produced by hyperactivity of the sympathetic cervical chain as a consequence of irritation of these nerves. It causes an ipsilateral mydriasis, which, in patients suffering a head injury as in the case reported here, can confuse the diagnosis and disconcert physicians.

Neoadjuvant chemotherapy with continuous infusion of cisplatin and 5-fluorouracil, with or without leucovorin, for locally advanced nasopharyngeal carcinoma

Cisplatin-based induction chemotherapy has been extensively tested in nasopharyngeal carcinoma for the improvement of local and systemic control and survival of this disease. In this study, we report the results of the treatment with induction chemotherapy in 40 patients with locally advanced carcinoma of the nasopharynx (LANPC) with four courses of cisplatin (P) 25 mg/m2 per day and 5-fluorouracil (F) 1000 mg/m2 per day both in a 4-days continuous infusion, with or without leucovorin (L) 250 mg/m2 per day in 2-hour infusion at the beginning of daily administration of PF, followed by sequential radiotherapy. All except one were in stage IV. The overall response after induction chemotherapy was 93%, with 55% CR and 38% PR. Definitive overall response after radiotherapy was 98%, with 80% CR and 18% PR. At a maximum follow up of 11 years, the overall survival rate is 55%. Induction chemotherapy with continuous infusion of PF with or without leucovorin followed by radiotherapy is a highly active regimen for the treatment of locally advanced nasopharyngeal carcinoma with response and survival rates comparable to other combinations of sequential or simultaneous chemotherapy and radiotherapy.

[Cesarean section in a patient with a congenital deficit of antithrombin III: apropos of a case]

Antithrombin III (AT III) is a physiological inhibitor of coagulation. AT III deficit, whether congenital or acquired, results in a state of hypercoagulability characterized by recurring instances of venous thrombosis in young people. Although AT III levels normally change little during pregnancy, a deficit can be associated to the appearance of recurring thromboembolism and the need to perform cesarean section increases the risk. We report a cesarean section under general anesthesia in a patient with congenital AT III, reviewing the etiology and pathophysiology of this entity as well as its treatment.

[Frequency of white coat arterial hypertension in mild hypertension. Profile of cardiovascular risk and early organic involvement]

BACKGROUND

The aim of the present was to study the frequency and characteristics of white coat hypertension (WCH) in a series of individuals with slight hypertension (SH) consecutively attended, as well as to evaluate the degree of organic involvement and the presence of other cardiovascular risk factors.

METHODS

One hundred six subjects [mean age 43 +/- 12 years, 51 males (48%)] with SH (diastolic pressure between 90-104 mmHg) who were not receiving pharmacologic treatment and did not have severe organic involvement were included in the study. Systolic/diastolic blood pressure (BP) was (x +/- SD) 150 +/- 12/96 +/- 4mmHg. The basic protocol of the Hypertension Unit was applied with out patient monitorization of BP for 24 hours with a Spacelabs 90202 monitor and a two-dimension echocardiogram with measurements according to the recommendations of the American Society of Echocardiography. WCH was defined as a mean diurnal BP (07:00-23:00 h) under 134/90 mmHg.

RESULTS

The frequency of WCH was 46%, being more frequent in those over the age of 40 years [OR: 3.08 (IC 95% 1.26-7.62) p = 0.006]. WCH was associated with total cholesterol >or= 5.2 mmol/l [OR: 2.8 (IC 95% 1.14-6.91)]. No significant associations were observed with cholesterol HDL, LDL, triglycerides, glycemia, family history of high blood pressure, body mass index and smoking. Left ventricular hypertrophy (LVH) was less frequent in WCH (6%) than in maintained hypertension (MH) (18%) (NS), while concentric remodelling was more frequent in WCH (22% and 5%, respectively [p < 0.03]). Microalbuminuria was observed in 50 individuals being >or= 30 mg/24 h in 15% of the WCH and in 30% of the MH.

CONCLUSIONS

The frequency of white coat hypertension in subjects with slight hypertension is high. The profile of cardiovascular risk among the patients with white coat hypertension and moderate hypertension is similar.

Copper-algae interactions: Inheritance or adaptation?

This study evaluated the responses of wild, adult plants of Enteromorpha compressa, and their progeny, to various copper concentrations. Experiments were designed to test the hypotheses that: 1) individuals of E. compressa from Caleta Palito, a copper-enriched coastal locality, tolerate higher copper concentrations than those from a place with no history of copper pollution and 2) such copper tolerance is under genetic control and therefore, was an inherited character. Our results indicate that algae which inhabit a copper-enriched environment tolerate higher concentrations of copper than those from waters with low copper concentrations. On the other hand, our results suggest that generalizations regarding heritability of the tolerance to copper do not apply to the Chilean E. compressa, as no differences in growth or rhizoid production were found between the progeny from Caleta Palito and Caleta Zenteno. These findings are an indication that heritability and adaptation may represent alternative strategies used by different populations of the same algal species to tolerate copper.