[Retroperitoneal germinal tumor: extragonadal or burned out phenomenon of testicular primary? Presentation of a clinical case]

Clinical record case of a retroperitoneal seminoma with "burned-out" phenomenon in the testicular primary, in a 38 year old male with no background of interest who consults for a picture of left nephritic colic. The ipsilateral testis study detects a fibrotic area with hyalinosis and hemosiderin deposits, although there are no tumoral debris, compatible with the "burned-out" phenomenon. Management is through surgery plus a chemotherapy protocol. Discussion of the diagnostic algorithm of retroperitoneal tumours and the literature on extragonadal germinal tumours.

[Percutaneous suprapubic bladder lithotripsy]

The authors present a case of multiple bladder stones in a patient with severe ankylosis of the lower extremities, treated via percutaneous suprapubic approach. The suprapubic tract was created with Teflon-coated dilators and an Amplatz tube and the stones were fragmented with the nephroscope and a pneumatic lithotriptor. The simplicity of the procedure and the ease of the manoeuvre accelerated the stone fragmentation process while avoiding unnecessary trauma of the urethra.

[Paroxysmal dyskinesias as the initial manifestation of multiple sclerosis]

We herein report two patients with paroxysmal dyskinesias (PD) as the initial manifestation of multiple sclerosis (MS). PD can occur in clinically definite MS or rarely be the presenting symptom. They are produced by demyelinating lesions at any level in the motor pathway or in the thalamus. MRI disclosed an area of demyelination in the posterior limb of the internal capsule contralateral to the PD in the patients reported herein. PD associated with MS do not adjust completely to the accepted classifications of PD, therefore they should be considered a special category of dyskinesias.

Increase in insulin secretion with age: its clinical importance in evaluating abnormal secretions focused on diabetes type II and obesity

The urinary C-peptide excretion was measured in a healthy standardized population sample of 160 subjects from 20 to 90 years of age, homogeneously distributed by age and sex. Urinary C-peptide excretion corresponded to 7% of the total amount released. The daily C-peptide excretion was 61.23 +/- 2.2 (S.E.) microg in the whole sample which corresponds to 41.9 +/- 1.5 IU of insulin secreted/day (I(CP)d), without sex differences. There is an increase of the I(CP)d value from the young to the healthy middle-aged person, but when the results were corrected for standard amounts of excreted creatinine (1 g) and urea (22 g) the age-dependent increase is to be observed during the whole adult life span. Assuming that cross-sectionally observed data are representative of the individual changes, it is concluded that age alone increases insulin secretion. The results which may be useful as reference values for clinical application were as follows: (A) in 5 diabetes type II patients in which the I(CP)d value was measured several times a week, the intraindividual variation coefficient was 10.9 +/- 7.2%;(B) in a sample of 47 type II diabetic patients of both sexes, between 51 and 70 years of age, a clear correlation was found between I(CP)d and the results of the glucagon stimulation test, mainly regarding the relationship between I(CP)d and the planimetrically measured area under the curve (r = 0.7, P < 0.0001); (C) in 7 obese non-diabetic individuals of similar ages the influence of the hypocaloric diet on the I(CP)d value was more evident than the use of C-peptide blood determinations before or after glucagon. Finally, the I(CP)d values of type II diabetes patients with insulin requirement (n = 27) were significantly lower than in the healthy control group (31.1 +/- 24.0 vs. 45.0 +/- 20.4), while diabetic patients without insulin requirement showed significantly higher values (73.0 +/- 33.0) (n = 27). These clinical studies primarily focused on the physiology of human ageing justify the measurement of C-peptide urinary excretion for evaluating daily insulin secretion in patients with type II diabetes.

Are anthropometric changes in healthy adults caused by modifications in dietary habits or by aging?

The aim of this work was to investigate to what extent age-dependent anthropometric changes are causally related to changes in dietary habits. In a randomly obtained sample of 246 healthy adults in the age range of 20-90 years from a well-defined agrarian population, the intake of proteins, fat and carbohydrates in males decreases with age (r = -0.65, p < 0.001; r = -0.65, p < 0.001; r = -0.5, p < 0.01, respectively), but in females it remains unaltered (e.g. the mean +/- SD daily protein intake in young adult females is 74 +/- 31 vs. 71 +/- 11 g in individuals over 80); in males it decreases from 140 +/- 34 to 71 +/- 13 g. On the contrary, in both sexes the muscle-mass-related measurements decrease (r = -0.45, p < 0.001; vs. r = -0.41, p < 0.001; mean values of the quotient lean body mass with body length in young adult females and males were 41.9 +/- 4.4 and 52.7 +/- 5.9 vs. 35.0 +/- 3.1 and 43.2 +/- 5.0, respectively, in individuals over 80, p < 0.001 in both sexes). From 35 onwards, the daily urea excretion-as a marker of the protein degradation rate-declines significantly with age, but without a clear correlation to the protein intake (r = 0.38), as occurs during young adulthood (r = 0.63). Furthermore, body fat content tends to increase with age, but the differences are statistically significant only in males of very advanced age (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical experience with the treatment of metastatic renal cell carcinoma with subcutaneous interleukin-2r (IL-2r) and interferon Alpha-2b (IFN Alfa-2b)]

This work presents our recent clinic experience in the treatment of advanced RCC with IL-2 in association to alpha IFN given subcutaneously. Fifteen patient with histologically confirmed advanced RCC and measurable lesions were entered in the study. Patients were treated in cycles of 7 weeks at a IL-2 dose of 4.8 million IU/m2 (induction phase)-2.4 million IU/m2 (maintenance phase) every 12h five days a week and alpha IFN: 6 million IU/m2 every 24h three days a week, and were afterwards evaluated for response. Responders with localized residual bulk underwent rescue surgery. Seven patient has objective response (3 complete, 2 partial and 2 stable responses). The complete responses were stable and lasted 36 m, 14 m and 8 m, and global survival was of 14.6 m (3-36 m). All patients had toxicity at various degrees but WHO grade II was not exceeded at any time. The association of IL-2 and alpha IFN 2b given subcutaneously, appears to have antitumoral activity against advanced RCC with durable responses and in a proportion similar to other associations in intravenous administration, but with lower systemic toxicity. Surgical resection of residual bulk can be beneficial in selected patient with partial response.

[Atherosclerosis as a physiological manifestation of aging for measuring the rate of aging]

This work studies the follow-up of vitality using parameters related to the arterial wall. This study is based on the application of several mathematical models and different calculation procedures. Humoral parameters together with measurements of the daily insulin secretion (own methodology based on the C-peptide elimination) were applied for the calculations using the exclusively healthy population. In the case of the non-selected population the percentage of disease prevalences due to vascular affections were applied for calculations.

[HTLV-II infection in parenteral drug addicts from western Andalucia]

The epidemiology of retrovirus HTLV-II is scarcely known even though it appears to be narrowly related to parenteral drug addiction. In order to find out the prevalence of HTLV-II among IVDU in our area, the sera of 137 subjects who came to our center for clinical evaluation were analyzed. The presence of HTLV-I/II antibodies were determined via ELISA and the sera that were repeatedly reactive were confirmed by the Western blot technique which reveals infection by both retroviruses. Two sera were repeatedly positive by ELISA (1.45 percent). Western blot confirmed HTLV-II positivity in both sera. Serology for HIV-1 was positive in 52 sera (37.9%). The two HTLV-II positive sera were also positive for HIV-1. These results indicate that HTLV-II infection is already present in the IVDU population in our area, where, similar to what happens in the U.S. and Europe, this retrovirus is implicated in the majority of HTLV infections in IVDU.

[Risky practices associated with HIV infection of seamen who travel in sub-Saharan West Africa]

We report the results of the epidemiological and serological studies concerning HIV-1 and HIV-2 infections carried out in a group of 203 seamen who visited the sub-Saharan area (west coast of Africa). The following risky practices were detected: history of drugs abuse 8 (3.9%), transfusion 3 (1.5%), use of parenteral medicines in Africa 80 (39.4%), surgery in Africa 41 (20%), tattoos 18 (8.9%). Sexual behavior: stable couple 180 (88.7%), number of sexual couples 4.2 +/- 6, contacts with prostitutes 108 (53%), contacts with prostitutes in Africa 83 (40.9%), others heterosexual contacts 58 (28.6%), homosexual 1 (0.5%), history of VD 34 (16.7%), 94% of the seamen never (or occasionally) used the preservative with theirs couples and 73% of them didn't use it with others contacts. Four seamen were HIV-1 (+): contacts with prostitutes in Africa 2, use of parenteral medicines in Africa 1 and drugs abuse 1. We observed a high prevalence of risky practices associated with HIV-1 infection between seamen population. It is interesting to remark the importance of heterosexual transmission and the use of parenteral medicines.

[HTLV-I infection in sailors who travel to sub-Saharan West Africa]

In order to assess if HTLV-1 retrovirus had penetrated in a group of sailors that often travel to endemic areas for HTLV-1 infection (West coast of sub-Saharan Africa) we have performed the following study. A total of 499 sera samples from sailors traveling to Africa during the last five years were studied. The presence of HTLV-1 antibodies was determined using an enzyme-linked immunosorbent assay (ELISA, Dupont HTLV-1). Positive ELISA test results were further confirmed using a Western blot technique. In all patients the presence of HIV-1 and HIV-2 antibodies was also tested using ELISA and Western blot techniques. Using ELISA we find 7 positive sera to HTLV-1 (1.4%) but only one sera sample (0.2%) was also positive by Western blot analysis. We conclude that HTLV-1 infection is entering a population group traveling to endemic areas. The possibility of heterosexual transmission of the virus in our environment has to be taken into account.

[Spread pattern of HIV-2 in patients at risk. Evaluation of serologic markers]

The aim of this paper is to ascertain the spread pattern of HIV-2 in patients at risk in an area of frequent contact with sub-Saharan Africa and evaluate the seric marker of HIV-2 infection. 606 serum samples from 524 patients were analysed. 445 patients were intravenous drug users (IDU), 17 used inhaled drugs, 26 had HIV-2 (+)partner, and others 36 high-risk practice. The ser were analysed for HIV-1 and HIV-2, using ELISA, Western blot (LAVBLOT 1, LAVBLOT 2) and specific synthetic peptides such as gp 41 and gp 36 (PEPTI-LAV 1-2). 245 out of 524 (47%) patients were HIV-1 (+). 65 out of 524 (12.4%) were Elavia-2 and HIV-1 (+). All samples tests using Western blot 1, confirmed the results of the ELISA (2 protein of the membrane). The Western blot of HIV-2 Elavia-2 (+) in 2/53 showed two proteins of the membrane and 26/53 one protein of the membrane and several of the core. The PEPTIL-LAV 1-2 was HIV-1 positive in 77/77 HIV-1 serum samples and in 10 HIV-2 positive, however, in all cases the HIV-2 reactivity was lower than HIV-1, allowing the orientation of the diagnosis towards the HIV-1 positive serum. In spite of the frequent contact with Africa, the spread of HIV-2 in the south of Spain is still quite insignificant. The Western blot of HIV-2 gives a high proportion of double reactivity, including those cases with restrictive criteria to be positive. PEPTI-LAV 1-2 has proved most useful in the diagnosis orientation in the cases of crossed reactivity between HIV-1 and HIV-2.

Disturbed hypothalamic-pituitary axis in idiopathic recurring hypersomnia syndrome

Disturbed function of the hypothalamic-pituitary axis at adrenal and thyroid levels was found during an episode of hypersomnia in the idiopathic recurring hypersomnia syndrome. These endocrinological abnormalities, abolished ACTH and cortisol responses to insulin-induced hypoglycemia and absent TSH response to TRH, normalised thereafter in the symptom-free interval. These data support the hypothesis that Kleine-Levin syndrome is related to an intermittent hypothalamic dysfunction.

[HTLV-I infection in a high-risk group]

The aim of this study is to detect the presence of HTLV-1 in a high-risk population in west Andalusia. We studied 267 samples of serum from 255 patients: 179 of these patients being intravenous drug-users, 14 had ADVP sexual partners, 16 were inhalation drug-users, 4 were hemophiliacs, 9 had other high-risk habits and 25 hematological patients afflicted with leukemia or lymphoma. All of them were tested for antibodies against HTLV-1 by means of an in vitro qualitative ELISA technique (ELISA Du Pont HTLV-1). The positive results were confirmed by the Western blot technique. Additionally, the p24 antigen and the antibodies against VIH-1 and VIH-2 (ENV/CORE) were analysed, except in the 25 hematological patients. We found 20 serum samples positive to HTLV-1 by ELISA (7.4%), but only 1 (0.3%) was confirmed by the Western blot technique. The prevalence of VIH-1 was 46%; 9% had p24 VIH antigen and 26% had false positive ELISA to VIH-2. We found a statistically significant relationship (p = 0.0005) between positive ELISA to HTLV-1 and antibodies against VIH. We conclude that HTLV-1 has penetrated into the high-risk population of west Andalusia , although not yet to a great degree, and point out the need for seric epidemiological surveillance to prevent the spread of the retrovirus in these groups.

[Prognostic value of CAT scanning in spontaneous supratentorial cerebral hemorrhage. Multivariate study in 114 patients]

Prognostic computed tomographic findings for 30-day outcome (survival or death) were retrospectively assessed in 114 patients with spontaneous supratentorial intracerebral hemorrhage. All were treated nonsurgically. CT scans were used to determine location and size of the lesion, presence or absence of intraventricular spread, degree of mass effect and presence or absence of cortical atrophy. Mortality rate was 25.6%. Size of hemorrhage, presence of intraventricular spread and cortical atrophy were multivariately associated with outcome and therefore, acting jointly, contribute substantially to the prediction of outcome. In patients with intraventricular spread who died, age and systolic blood pressure on admission were significantly higher.

Mitochondrial defects in Lowe's oculocerebrorenal syndrome

We performed biochemical studies on isolated mitochondria from a muscle biopsy specimen in a patient with Lowe's syndrome. Respiratory controls of mitochondrial preparations with substrates reducing nicotinamide adenine dinucleotide and with a flavoprotein-linked substrate were markedly diminished, but the oxygen consumption was normal with ascorbate and tetramethylphenylenediamine as substrates, which suggested a defect in electron transport prior to the cytochromes. The organelles also showed decreased adenosine diphosphate phosphorylate-oxygen ratio, indicating a partial uncoupling. These findings suggest that Lowe's syndrome could be considered a mitochondrial disease.