[Congenital sternal cleft]

INTRODUCTION

Congenital sternal cleft is a rare malformation. Little more than one hundred cases have been published, and rarely more than two cases are published in a single publication. We present five new cases that show the entire spectrum of defects.

METHODS

They were 3 males and 2 females. Age range between 1 day and 5 years of age. There were 2 supraxiphoid clefts (SC), 2 gladiolar defects and 1 xiphoid cleft. We evaluate the demographics, associated malformations, mode of treatments and results.

RESULTS

The SC were not associated to congenital herat malformations, but with a many other malformative spectrum (anterior cervical web, hemangiomatosis, CNS malformations, coloboma and pectus excavatum). The two females had SC and were operated on the 24th and 30th days of age. The first one developed a superior vena cava síndrome for a few days after surgery and a moderate pectus excavatum that did not required surgery. A midline cervical web was also surgically repaired at 10 years of age. The second patient with SC was treated with interferon alfa-2a and local infiltration of corticosteroid for treatment of hemangiomatosis. Both patients had excellent final results (follow up 11 and 5 years respectively). Gladiolar clefts were observed durign surgical repair of congenital Herat malformations (ventricular septal defect and partial anomalous of pulmonary venous draninage). They were repaired by direct closure of the defect. The patient with the xiphoid cleft had associaed a Cantrell pentalogy. He died 4 days after operation because of extreme prematurity and pulmonary vascular hypertenion.

CONCLUSIONS

1) We have observed five new cases of sternal cleft. 2) Each anatomical variety had their own mode of presentation, a different malformative spectrum and clinical evolution that are based on a distinct embryonic origin. 3) Excluding the xiphoid clefts, the long term surviving is 100%, but they are associated with a great variety of other congenital defects.

Use of sorption and extraction tests to predict the dynamics of the interaction of trace elements in agricultural soils contaminated by a mine tailing accident

Over 2000 ha of agricultural soils were contaminated by a pyritic sludge and acidic waste waters coming from a spill from a mining exploitation. The affected soils were acidic with sandy-loam texture (SL), loamy with neutral pH (L), and calcareous, saline, with clay texture (Cs). The Cs soils were contaminated only with acidic waste waters. Sorption and extraction tests were applied to examine the medium-term dynamics of the interaction of trace elements (As, Cd, Cu, Pb and Zn) in the soils. The solid-soil solution distribution coefficient (KD) was determined in soil samples taken 3 months (initial stage, 3M samples) and then nearly 2 years (final stage, 21M samples) after the accident. Distribution coefficient values ranged from the lowest values in the SL samples (from 0.2 l kg(-1) for Cd and Zn to 25 l kg(-1) for As) to higher values in the L and Cs soils. Lead and As had the highest KD in all soils (over 10(5) l kg(-1) in the L soils). No clear dynamics pattern could be derived from these data because of the low heavy metal concentrations in the soil solution. As a complementary approach, four single extractions (0.01 and 1 mol l(-1) CaCl2; 0.05 mol l(-1) EDTA; 0.43 mol l(-1) CH3COOH) were applied to soil and sludge samples. Samples derived from submitting field 3M samples to drying-wetting (DW) cycles were included to define a complete laboratory approach to predict field dynamics. Results from extraction tests indicated that changes of the trace element interaction over time depended on the soil pH and on the source of contamination. For those soils affected only by the acidic waste waters, where an increase in fixation occurred, natural processes such as diffusion controlled dynamics. For those soils contaminated by a mixed source, the dynamics of the interaction was the resultant process of the combination of the natural attenuation and the oxidation of the pyritic sludge. This latter process led to an increase in the remobilization for those elements associated with soluble secondary minerals (Cd and Zn) and to an increase in the fixation for those elements coprecipitating with insoluble secondary minerals (Pb and As). Drying-wetting cycles were useful to predict the dynamics in the field at month-year scale. The CH3COOH was recommended as the best test among those studied here to derive conclusions about dynamics pattern because it provided significant desorption yields in most scenarios. Acidic soils with sludge contamination represented the scenarios with the highest risk, while calcareous soils better attenuated contamination. In a longer time scale, the depletion of calcareous components needs to be controlled.

Study of the antibody response against Mycobacterium tuberculosis antigens in Warao Amerindian children in Venezuela

This study was aimed at investigating alternate methods for serodiagnosis of tuberculosis (TB), which are needed because bacteriologic diagnosis of childhood TB is difficult. A selection of 80 serum and saliva samples were tested from Warao indigenous children under 15 years of age; 34 high TB suspects (28 positive and 6 negative for the tuberculin skin test, TST) and 46 healthy contact children (32 positive and 14 negative for the TST). Several enzyme-linked immunosorbent assay (ELISA) serological tests were developed to test for Mycobacterium tuberculosis-specific antibodies, including serum IgA, IgG, IgE, and secretory IgA (sIgA) in saliva against 3 specific antigens (PPD, HSP60, 38 kDa). Of these, 2 antigens, PPD and 38 kDa, showed significantly higher reactivity. The sensitivity and specificity of these tests for diagnosis remained limited, between 26.5% and 38.2%, and 77.4% and 97%, respectively. Of all the samples studied and combinations realized between all isotypes and antigens combined with 3 isotypes (anti-PPD IgG, IgE, and anti-38kDa sIgA) managed to detect the largest number of patients, showing an improved sensitivity level of 64.7%, although specificity levels dropped to 81.8%. These results were compared with the Omega diagnostics commercial kit results. The commercial kits showed significantly lower reactivity (sensitivity of 20% and 13.33% to Myco G and Complex Plus, respectively) and a specificity of 100%. This study shows that in indigenous populations of Venezuela, where invasive procedures cannot be used to select samples but evaluation with a chest X-ray for radiological studies is available, the combination of 3 specific isotypes may be a useful tool to increase diagnostic accuracy with pulmonary TB in this population, when used together with clinical and epidemiological criteria.

Stable renal transplant recipients can be safely converted from MMF to enteric-coated mycophenolate sodium tablets: Interim results of a multicenter Latin American study

Enteric-coated mycophenolate sodium (EC-MPS) is designed to reduce mycophenolate acid (MPA)-related upper gastrointestinal (GI) adverse events (AEs). A multicenter, open-label, Latin American study in stable renal transplant patients is ongoing to assess the safety of the conversion from mycophenolate mofetil (MMF) to EC-MPS. An interim analysis was performed when 93 patients had completed 3 months. Prior to conversion, they had received MMF at a dose of 2 g/d, with the exception of eight adult patients who were receiving an average daily dose of 1.25 g. All adult patients were converted to EC-MPS (1.44 g/d; 0.450 g/m(2) bid for children). After conversion, the reported total incidence of AEs was 40.9%, including 28% infections, 1.1% hematologic, 19.4% GI, including 10.8% upper-GI AE (all mild) and 5.4% diarrhea. No patient discontinued the study medication due to adverse events. Only six patients (6%) required a dose adjustment. There were no episodes of acute rejection, death, or graft loss. During the period of analysis, the conversion from MMF to EC-MPS was safe, the enteric-coated tablet formulation prevented release of MPA in the upper GI tract, and only one patient had to reduce the dose due to an upper GI AE, concomitant with diarrhea. EC-MPS offers transplant physicians and their patients an alternative MPA therapy that is as effective and safe as MMF, but in a formulation that may provide GI tolerability benefits.

Zinc pretreatment prevents hepatic stellate cells from cadmium-produced oxidative damage

Pretreatment with zinc produces tolerance to several cadmium toxic effects. This study was performed to further elucidate the mechanism of zinc-induced tolerance to cadmium cytotoxicity in a rat hepatic stellate cell line (CFSC-2G). Twenty four hours after seeding, cells were treated with 60 micromol/L ZnCl2 for 24 h. Following zinc pretreatment, cells were exposed to 3 micromol/L and 5 micromol/L CdCl2 for an additional 24 h. The toxicity of cadmium was significantly reduced in the zinc-pretreated cells. Zinc pretreatment produced a decrease in lipid peroxidation damage of cadmium-treated cells. Glutathione cell content diminished 33% and 43% as a result of 3 micromol/L and 5 micromol/ L CdCl2 treatment, respectively. Cell pretreatment with zinc recovered glutathione content at control cells level. Catalase and glutathione peroxidase activities were also recovered to control values with zinc pretreatment. Cadmium (5 micromol/L) was able to induce 39% the expression of alpha1 collagen (I) gene after 1 h treatment, while zinc pretreatment prevented this cadmium profibrogenic effect. We also examined the production of heat shock protein 70 (Hsp70) as a cellular response to oxidative stress produced by cadmium. By Western blot analysis, a 1.3 and 3 times increment in Hsp70, with 3 micromol/L and 5 micromol/L CdCl2 treatment, respectively, was observed. Zinc pretreatment prevented the production of Hsp70. Metallothionein-II (MT-II) gene expression was induced by cadmium, but the induction was unaffected with zinc pretreatment. These data suggest that zinc-induced protection against the cytotoxicity of cadmium in stellate cells may be related to the maintenance of normal redox balance inside the cell.

Two-wave mixing by means of dynamic Bragg gratings recorded by saturation of absorption in erbium-doped fibers

We present experimental results of two-wave mixing in single-mode Er-doped optical fibers for which dynamic Bragg reflectance gratings are formed as a result of saturation of fiber-optic absorption (i.e., by means of the effect of spatial hole burning). The gratings are probed by the same recording waves at lambda approximately = 1549 nm and are detected as periodic changes of the intensity of light reflected from a Sagnac interferometer (with a piece of the doped fiber included) observed when periodic phase modulation is induced in one of the waves. Both rectangular and sinusoidal modulation were used, which permitted evaluation of the grating recording time (tau(g) approximately = 3 ms for OFS-Fitel EDF-HG980 fiber) and the grating amplitude, which proved to be approximately 6-7 times lower than expected from measurements of saturation of fiber-optic absorption by one wave only.

[Antiproteinuric effect of renin-angiotensin system blockade in patients with normal/lower than 115 mmHg systolic blood pressure]

The renoprotective effect of renin-angiotensin system (RAAS) blockade by ACE inhibitors (ACEI) or AT1 receptor antagonists (ARA) in chronic proteinuric nephropathies is well known. Most studies have related this beneficial effect with the antihypertensive and antiproteinuric properties of these drugs, but this aspect has not been extensively analyzed in patients with normal/low values of blood pressure. We studied nineteen patients with different chronic proteinuric nephropathies that started ACEI or ARA because of proteinuria and despite systolic blood pressure (SBP) < or = 115 mmHg. Short and long-term tolerance to treatment as well as evolution of renal function parameters were recorded.

RESULTS

At baseline, SBP was 110.2 +/- 2.6 mmHg (105-115) an diastolic blood pressure (DBP) 68.6 +/- 4.3 (60-75). Initial low doses of ACEI or ARA were well tolerated. After 6 months of treatment, proteinuria decreased by 46% of baseline, from 2.1 +/- 1.8 g/day to 1.1 +/- 0.8 g/day, without significant changes in BP or renal function. After a 48 +/- 27 months follow up, proteinuria decreased to 0.7 +/- 0.6 g/day (68% of basal values). Renal function and BP did not show significant changes during follow up.

CONCLUSIONS

RAAS blockade by ACEI/ARA induces a significant antiproteinuric and renoprotective effect in proteinuric patients with normal/low levels of BP Initial doses of ACEI/ARA were well tolerated.

[Acute hyperphosphatemia secondary to phosphate administration for bowel preparation]

We report a 75-years-old woman, stable on a three-weekly hemodialysis program over a period of 3 years, who develop acute hyperphosphatemia secondary to phosphate administration for bowel preparation. The quick clinical diagnosis and the treatment with intensive hemodialysis resulted in a correction of hyperphosphatemia, hypocalcemia, acidemia and other electrolyte abnormalities. The phosphate cathartics are contraindicated in patients with severe renal insufficient or in dialysis program. Our case shows the severe side effects secondary to injudicious use of sodium phosphate cathartics.

[Impact of formation programs in initial management of injured children]

INTRODUCTION

In 1997 we developed the "Pediatric Trauma Life Support Course"applied to every one who provide care for the pediatric trauma patient. Since November 1997 until December 2000, 14 courses were imparted inside of the "Comunidad de Madrid" with total number of 289 students. Thirty-eight students have been people who worked in the prehospital area inside of our Community. The aim of this paper is to determinate the possible impact of these Courses in the prehospital management of the pediatric trauma patient.

MATERIAL AND METHODS

We reviewed the Pediatric Trauma Registry inputs of our hospital since January 1995 until December 2000. A total number of 2166 patients required admission in our hospital after the injuries. 495 patients which moved to our Institution by medical people and a special transport (ambulance/medical van) were enrolled. The patients were classified into two groups. In the first group were included the children admitted between 1995 to 1997 (group 1, n = 232), before we had applied our Courses and in the second group, the patients admitted between 1998 to 2000 (group II, n = 263), after The Pediatric Trauma Life Support Course was conducted. Both groups seems to be equal if we compare the age, sex and severity of the injuries. We analysed the infant orotracheal intubation in a coma patient, gastric intubation in the several trauma patient, vascular access and apply a semirigid cervical collar into a head injury. If we think that the application of these manouvers will be a good quality index of the management of these patients in the prehospital area, we compare the index of application of these variables according to the years before and after the Courses were imparted. For this pourpose we used the X2 test shows significant differences within both groups if p < 0.05.

RESULTS

All paramethers analyzed were better in group II than in group I (p < 0.05).

CONCLUSIONS

The results of this paper shows that the use of this program for the management of the pediatric trauma patient is going well and the assessment is doing better than few years before.

Dopaminergic modulation of nNOS expression in the pituitary gland of male rat

Nitric oxide is an unconventional transmitter since it is not transported and released by exocytosis. In the pituitary gland, nitric oxide is locally synthesised by gonadotroph and folliculo-stellate cells. Dopamine, the principal central inhibitory signal in prolactin release, may exert its inhibitory effects by stimulation of nitric oxide production. However, the effects of dopaminergic modulation on nitric oxide-producing pituitary cells have not been analysed. Therefore, we examined the effects of intraventricular administration of the dopamine antagonist haloperidol (40 microg) on the pituitary expression of neuronal nitric oxide synthase (nNOS) in male adult rats. In untreated and control animals, nNOS-positive cells were very similar. Two types of nNOS-positive cells appeared in the pars distalis: round or polygonal cells and stellate cells. Although some isolated cells were found, the nNOS-positive cells commonly appeared grouped in clusters close to blood vessels. nNOS immunoreactivity appeared as a uniform staining throughout the cytoplasm, including cell prolongations. The number and size of nNOS-expressing cells in the pituitary gland decreased significantly after treatment with haloperidol (p<0.01). To evaluate the potential direct effect of dopamine on pituitary cells, pituitary monolayer cultures were treated with dopamine during a time-course of 12 h. Our in vitro studies revealed that dopamine increases the percentage of nNOS-positive cells and augments cellular area (p<0.05). These results demonstrate that: (1) treatment of rats in vivo with a dopamine antagonist significantly decreases expression of nNOS in the pituitary and (2) in vitro dopamine exerts a direct effect on pituitary cultures by increasing nNOS-positive cells. Thus, these findings suggest that dopamine may function as a physiological stimulator of nNOS expression in the rat pituitary gland.

Prediction of trace element mobility in contaminated soils by sequential extraction

The modified three-step sequential extraction procedure proposed by the Community Bureau of Reference (or Bureau Communautaire de Reference, BCR) was used to predict trace element mobility in soils affected by an accidental spill comprising arsenopyrite- and heavy metal-enriched sludge particles and acid waste waters. The procedure was used to obtain the distribution of both the major (Al, Ca, Fe, Mg, and Mn) and trace elements (As, Bi, Cd, Cu, Pb, Tl, and Zn) in 13 soils of contrasting properties with various levels of contamination and in the sludge itself. The distributions of the major elements enabled us to confirm the main soil fractions solubilized in each of the three steps, and, in turn, to detect the presence of pyritic sludge particles by the high Fe extractability obtained in the third step. Cadmium was identified as being the most mobile of the elements, having the highest extractability in the first step, followed by Zn and Cu, Lead, Tl, Bi, and As were shown to be poorly mobile or nonmobile. In the case of some of the trace elements, the residual fractions decreased at higher levels of contamination, which was attributed to the anthropogenic contributions to the polluted samples. Comparison with soil-plant transfer factors, calculated in plants growing in the affected area, indicated that a relative sequence of trace element mobility was well predicted from data of the first step.

Results of kidney transplantation in recipients over 70 years of age: experience at a single center

We performed 41 kidney transplants in patients >70 years (35 single and 6 dual), with a mean recipient age of 72+/-2 years, from January 1990 to December 2001. Mean age of the donors was 69+/-12 years. Immunosuppression used triple therapy with steroids, mycophenolate mofetil, and cyclosporine or tacrolimus. Cold ischemia time was 23+/-3 hours. The incidence of primary nonfunction was 4.8%, and delayed graft function 58.5%. Acute rejection incidence was 12%. The actuarial patient survival rates at 12, 24, and 36 months were 82.5%, 82.5%, and 75%, respectively. Actuarial survival rates of the grafts censuring for death of the recipient with a functioning graft were 89.5%, 86%, and 68%, respectively. Nine of the 18 graft losses were due to recipient death. Overall, renal transplant recipients >70 years showed good results. The principal cause of graft loss was recipient death.

Transvascular ethanol embolization: first option for the management of symptomatic nonfunctioning renal allografts left in situ

BACKGROUND

Transplantectomy has been the conventional therapy for symptomatic failed grafts left in situ (FGLIS). Graft intolerance syndrome (GIS) is a common complication after withdrawal of immunosuppression. Our group first reported transvascular ethanol embolization (TVEE) as an alternative for the management of GIS.

OBJECTIVE

Our goal was to evaluate the efficacy and safety of TVEE in a large series of patients with symptomatic FGLIS.

PATIENTS AND METHODS

From January 1989 to December 2001, 944 patients received cadaveric renal transplants in our center. During this period, 59 patients with FGLIS underwent TVEE (50+/-7 years, 71% men, 15% diabetics). TVEE was performed using a transfemoral approach. A balloon occlusion catheter was inflated in the renal artery before ethanol injection (10-12 cc). The position of coils completed the procedure. No systematic prophylactic antibiotic or steroid treatment was administered.

RESULTS

The main indication for TVEE was GIS (51 patients, 86%). TVEE was initially successful in 39 patients (66%). A second TVEE, which was performed in 9 of 20 unresolved cases, was successful in six. After a second TVEE, the efficacy increased to 76%. The most frequent complication was postembolization syndrome (62%), which was manifested by fever, local pain, and inflammation that generally resolved in 48-72 hours. No major complications or deaths were observed. One of four patients underwent transplantectomy. Histologic examination of the removed graft showed renal tissue necrosis (10 cases) and pyonephrosis (4 cases).

CONCLUSIONS

TVEE, a safe and effective technique, may be considered as the treatment of choice for symptomatic FGLIS.

Extreme superheating and supercooling of encapsulated metals in fullerenelike shells

Nanometer-sized tin and lead crystals exhibit drastically altered melting and solidification behavior when encapsulated in fullerenelike graphitic shells. The melting transitions of encapsulated Sn and Pb nanocrystals are shown in an in situ electron microscopy study to occur at unexpectedly high temperatures, significantly higher than the melting point of the corresponding bulk materials. Atomistic simulations are used to show that the driving force for superheating is a pressure buildup of up to 3 GPa, that prevails inside graphitic shells under electron irradiation.

Biosorption of heavy metals influenced by the chemical composition of Spirulina sp. (Arthrospira) biomass

The capacity of Spirulina sp. cells with different chemical composition for Pb (II), Cd (II) and Cr (VI) sorption, was evaluated. Four different types of Spirulina biomass with a different chemical composition were tested. Two of them contained a high percentage of protein (68.95 +/- 0.30 and 63.73 +/- 0.25%) as a result of being cultivated in Zarrouk medium and exposedat two light intensities (66 micromol photon m(-2) s(-1) and 144 micromol photon m(-2) s(-1)) in batch cultures. A third type of biomass, cultivated in a "Complex" medium and exposed at 66 micromol photon (m-2) s(-1), contained a high percentage of lipids (30.08 +/- 1.92. Finally, the fourth type of biomass was enriched in polysaccharides (25.54 +/- 0.51%) as a result of being cultivated in the "Complex" medium, but exposed at 144 micromol photon m(-2) s(-1). It was found that the chemical composition of Spirulina sp. cells did have a strong influence on their adsorption capacity. The maximum adsorption capacities (q(max)) for Pb and Cd were highest (172.41 and 54.05 mg g(-1) of cells, at pH 5.0 and 4.5 respectively) when cells exhibited the higher polysaccharide content. In the case of Cr VI, the highest q(max), was exhibited by cells cultivated in Zarrouk medium and showing the higher protein content (at pH 2.0). pH did not affect the adsorption of Pb II in the range of 3 to 5.5, nor of Cd in the range of 4 to 7. For Cr VI, adsorption was observed only at a pH equal to 2 or lower.

Pentoxifylline diminished acetaldehyde-induced collagen production in hepatic stellate cells by decreasing interleukin-6 expression

The effect of pentoxifylline (PTX), a methylxanthine derivative, on collagen induction and secretion and on the production of mRNA of two fibrogenic cytokines: interleukin-6 and transforming growth factor-beta(1) (IL-6 and TGF-beta(1)) in a rat hepatic stellate cell line (CFSC-2G) exposed to acetaldehyde was studied. CFSC-2G cells were treated with 175 microM acetaldehyde for 24h. The cells were then exposed to a medium containing 200 microM PTX. Collagen secretion, increased 2.6 times in acetaldehyde treated cells. Cells exposed to acetaldehyde and treated with PTX diminished collagen secretion to control values and decreased alpha(1)(I) collagen mRNA by 15%. Reverse transcriptase-polymerase chain reaction (RT-PCR) assays of TGF-beta(1) mRNA showed no variation in different experimental conditions. However, PTX induced a decrease of 32% in IL-6 mRNA in acetaldehyde-treated cells. CFSC-2G cells treated with anti-IL-6 monoclonal antibody, 15min before acetaldehyde was added, did not present an increase in alpha(1)(I) collagen mRNA. These results show that PTX inhibits the expression of alpha(1)(I) collagen via the inhibition of IL-6 in acetaldehyde treated cells. The effect herein reported on IL-6 and alpha(1)(I) collagen mRNA adds to the previously described effect of PTX, which could be useful in the fibrogenic process induced by acetaldehyde.

Effects of extremely hot days on people older than 65 years in Seville (Spain) from 1986 to 1997

The effects of heat waves on the population have been described by different authors and a consistent relationship between mortality and temperature has been found, especially in elderly subjects. The present paper studies this effect in Seville, a city in the south of Spain, known for its climate of mild winters and hot summers, when the temperature frequently exceeds 40 degrees C. This study focuses on the summer months (June to September) for the years from 1986 to 1997. The relationships between total daily mortality and different specific causes for persons older than 65 and 75 years, of each gender, were analysed. Maximum daily temperature and relative humidity at 7.00 a.m. were introduced as environmental variables. The possible confounding effect of different atmospheric pollutants, particularly ozone, were considered. The methodology employed was time series analysis using Box-Jenkins models with exogenous variables. On the basis of dispersion diagrams, we defined extremely hot days as those when the maximum daily temperature surpassed 41 degrees C. The ARIMA model clearly shows the relationship between temperature and mortality. Mortality for all causes increased up to 51% above the average in the group over 75 years for each degree Celsius beyond 41 degrees C. The effect is more noticeable for cardiovascular than for respiratory diseases, and more in women than in men. Among the atmospheric pollutants, a relation was found between mortality and concentrations of ozone, especially for men older than 75.

Serotonin, 5-hydroxyindoleacetic acid and serotonin transporter in blood peripheral lymphocytes of patients with generalized anxiety disorder

Several immune system modifications have been reported in pathological anxiety, such as generalized anxiety, panic and obsessive-compulsive disorders. Since serotonin transporter is a marker of peripheral blood lymphocytes and it is modified in major depression, the aim of the present work was to evaluate this transporter by the binding of [3H]paroxetine to membrane preparations of blood peripheral lymphocytes from control subjects and patients with generalized anxiety disorder. The number of transporters and the affinity for the ligand did not differ among the two groups. Serotonin and 5-hydroxyindoleacetic acid (5HIAA) were determined in platelet-rich and -poor plasma, and in lymphocytes. Nonsignificant changes were found in the patients as compared to controls. However, there was a significant positive correlation between serotonin concentration in platelet-poor plasma and in lymphocytes in the patients, but not in the controls. This finding might be an indication of a poor regulation of the transporter function by which serotonin plasma concentration might influence lymphocyte serotonin concentration. Previous results indicate that serotonin transporter is reduced in these cells in major depression disorder; however, in generalized anxiety disorder, the number of transporters was not modified, although the functional efficiency of serotonin transporter might be altered.

Diagnostic performance of arginase activity in colorectal cancer

Arginase activity was measured in serum and biopsy from healthy individuals and colorectal cancer patients. Arginase activity in tumor samples (87 +/- 7.7 U/g tissue) was significantly higher than in controls (40.7 +/- 3.3 U/g tissue). However, serum arginase activity did not show any significant change in both groups. Finally, the micromethod used to quantify arginase activity in this study is superior to other methods because it has increased sensitivity, requires less sample, and is less time-consuming. Arginase differences are significant, according to the t-test (P<0.05)

Heat waves in Madrid 1986-1997: effects on the health of the elderly

OBJECTIVE

The objective of this paper is to analyse and quantify the effects exerted on summer mortality by extremes of heat, particularly among persons aged 65-74 and 75 years and over, groups in which mortality is higher.

METHODS

The study included the period from 1 January 1986 to 31 December 1997, for all people aged over 65 years resident in Madrid, based on mortality due to all causes except accidents (ICD-9 codes 1-799), and circulatory (390-459) and respiratory (460-487) causes. Meteorological variables analysed were: daily maximum temperature, daily minimum temperature and relative humidity. To control the effect of air pollution on mortality we considered the daily mean values of sulphur dioxide (SO2), total suspended particulate (TSP), nitric oxides (NOx), nitrogen dioxide (NO2) and tropospheric ozone (O3). Univariate and multivariate ARIMA models were used. Box-Jenkins pre-whitening was performed.

RESULTS

The results yielded by this study indicate a mortality increase up to 28.4% for every degree the temperature rises above 36.5 degrees C, with particular effect in women over the age of 75 years and circulatory-cause mortality. The first heat wave that leads to the greatest effects on mortality, due to the higher number of susceptible people and the duration of the heat wave, show an exponential growth in mortality. Furthermore, low relative humidity enhances the effects of high temperature, linking dryness to air pollutants, ozone in particular.

CONCLUSIONS

Since a warmer climate is predicted in the future, the incidence of heat wave should increase, and more comprehensive measures, both medical and social, should be adopted to prevent the effects of extreme heat on the population, particularly the elderly.

Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms

The objective of this report was to analyze the current surgical results of operative treatment in patients suffering ruptured AAA (abdominal aortic aneurysms) and to define those independent predictive factors for mortality. During a period of 2 years, from January 1996 to December 1997, 144 patients operated on for ruptured AAA in 10 hospitals were included in a multicenter retrospective study. Among the collected variables concerning each patient, those with potential relation to surgical mortality were studied: gender, age, diabetes, hypertension, cardiopathy, pulmonary obstructive disease, preoperative renal dysfunction, symptomatic cerebrovascular disease, peripheral vascular disease, hematocrit on admission, preoperative hypotension < 80 mmHg, loss of consciousness, cardiac arrest, aortic aneurysm location (infrarenal versus non-infrarenal), iliac involvement, aneurysm size, type of rupture, left renal vein ligature, ligature of a patent inferior mesenteric artery, place of aortic cross-clamping, type of grafting, exclusion of both hypogastric arteries, venous technical complications, associated surgery, use of cell saver, intraoperative blood loss, and postoperative complications (renal failure, sepsis, coagulopathy, cardiac complications, pulmonary complications, colon ischemia, prosthetic graft complications, and need for reoperation). Those variables with statistical significance in the univariate analysis were introduced into a multivariate logistic regression model to determine the independent predictors of death. From our results we concluded that surgery for ruptured abdominal aortic aneurysms continues to have an excessively high mortality rate. Even though some preoperative variables could be identified as predictors of mortality, an absolute mortality risk has not yet been determined and the decision to negate surgery should be individualized rather than taken on that basis only. Early diagnosis and treatment of symptomatic aneurysms would improve mortality figures and selective screening should be contemplated.

Metadoxine prevents damage produced by ethanol and acetaldehyde in hepatocyte and hepatic stellate cells in culture

Metadoxine (pyridoxine-pyrrolidone carboxylate) has been reported to improve liver function tests in alcoholic patients. In the present work we have investigated the effect of metadoxine on some parameters of cellular damage in hepatocytes and hepatic stellate cells in culture treated with ethanol and acetaldehyde. HepG2 and CFSC-2G cells were treated with 50 mM ethanol or 175 microM acetaldehyde as initial concentration in the presence or absence of 10 microg ml(-1) of metadoxine. Twenty-four hours later reduced and oxidized glutathione content, lipid peroxidation damage, collagen secretion and IL-6, IL-8 and TNF- alpha secretion were determined. Our results suggest that metadoxine prevents glutathione depletion and the increase in lipid peroxidation damage caused by ethanol and acetaldehyde in HepG2 cells. In hepatic stellate cells, metadoxine prevents the increase in collagen and attenuated TNF- alpha secretion caused by acetaldehyde. Thus, metadoxine could be useful in preventing the damage produced in early stages of alcoholic liver disease as it prevents the redox imbalance of the hepatocytes and prevents TNF- alpha induction, one of the earliest events in hepatic damage.

Effect of endotoxin pretreatment on hepatic stellate cell response to ethanol and acetaldehyde

BACKGROUND AND AIM

The role of endotoxin in alcohol-induced liver damage is well recognized. How pre-exposure to endotoxin might affect alcohol injury is not known. We herein studied the effect of endotoxin pretreatment on hepatic stellate cell (HSC) response to ethanol and acetaldehyde.

METHODS

Rat HSC (CFSC-2G) were exposed to media supplemented with 1 microg/mL lipopolysaccharide (LPS). This was followed by a 24 h exposure to media containing LPS plus 50 mmol/L ethanol or 175 micromol/L acetaldehyde. Lipid peroxidation, collagen, and tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6 and transforming growth factor (TGF)-beta1 secretion were determined at the end of both periods of exposure.

RESULTS

Lipopolysaccharide pretreatment did not modify lipid peroxidation induced by ethanol or acetaldehyde alone. Glutathione (GSH) content decreased to 4.2 +/- 0.5 and 16.3 +/- 0.8 nmol protein after exposure to ethanol or acetaldehyde alone, and decreased further with LPS pretreatment (2.4 +/- 0.2 and 2.7 +/- 0.3 nmol/mg protein, respectively). Oxidized GSH (GSSG) content increased in ethanol and acetaldehyde LPS-pretreated cells only. Collagen secretion increased to 988 +/- 82 and 1169 +/- 91 microg/10(6) cells after exposure to acetaldehyde or LPS alone. Lipopolysaccharide pretreatment enhanced collagen secretion significantly in both ethanol- and acetaldehyde-treated cells (969 +/- 56 and 1360 +/- 72 microg/10(6) cells, respectively). Interleukin-6 production increased to 288 +/- 48, 1195 +/- 86 and 247 +/- 35 pg/mL per 10(6) cells after ethanol, acetaldehyde and LPS exposure, and increased further with LPS pretreatment in ethanol-exposed cells (680 +/- 23 pg/mL 10(6) cells).

CONCLUSION

Lipopolysaccharide pretreatment of HSC adds to the damage produced by ethanol and acetaldehyde by diminishing GSH content and increasing GSSG content, collagen and IL-6 secretion.

The evolution of the pH in Europe (1986-1997) using panel data

The temporal evolution of pH values in precipitation over Europe during the period 1986-1997 is examined using panel data. The use of panel data techniques allows us to determine the temporal evolution of groups of stations rather than analyzing the temporal behavior of each of them. The analysis reveals three different temporal patterns: Peripheral, Central and French. We find a significant increasing trend (P < 0.00001) in both Peripheral and Central patterns. The annual increases are +0.057 pH-units yr(-1) and +0.022 pH-units yr(-1) respectively. However the French pattern is characterized by a significant decreasing trend (P < 0.004) and the annual decrease is -0.022 pH-units yr(-1). The standard errors of panel data estimates are around 47% smaller than those of classical pooling and 32% smaller than aggregate time-series regression. The use of panel data produces higher R2 values than classical pooling and aggregate data. This technique takes into account the individual heterogeneity, allows a larger number of data points and improves the efficiency of the estimates. In general, the policies of governments to reduce pollutant emissions seem to be effective.

Characterization of GFAP expression and cell proliferation in the rat median eminence following hypophysectomy

To analyze whether the reorganization of the rat median eminence after hypophysectomy might be related to changes in glial fibrillary acidic protein (GFAP)- and cellular proliferation, the distribution of cells immunoreactive for GFAP and the proliferation rate of such cells were analyzed at 20, 40 and 60 days posthypophysectomy. For this study, four rostro-caudal regions of the median eminence were differentiated: the retrochiasmatic, preinfundibular, infundibular and postinfundibular regions. In each of these regions, three layers were studied: the ependymal, the internal and the external. At 20 and 40 days after hypophysectomy, significant increases in cellular proliferation affecting all three layers studied in the preinfundibular and infundibular regions were found. At the same time points, increases in GFAP expression were also observed. However, after 60 days, GFAP and proliferative cellular nuclear antigen (PCNA) expression decreased. Although variations of PCNA and GFAP levels were evident, no colocalisation of PCNA and GFAP was found in the cells of the median eminence in untreated or hypophysectomized rats when sections were analyzed by double immunohistochemical staining. Our results suggest that reorganization of median eminence involves alterations (or modulation) of GFAP-immunoreactive cells together with a proliferation of cells that are not GFAP-immunoreactive. This study also demonstrates that this reorganization is completed within the first two months after hypophysectomy.

Multivariate space analysis of the major precipitation ions over Europe, 1986-1997

The annual average concentrations (1986-1997) of the major ions SO4(2-), NO3-, Cl-, NH4+, Na+, Mg2+, Ca2+, and K+ in precipitation are analyzed for selected EMEP stations. The objective is to determine the ion patterns or typologies in precipitation by principal component analysis (PCA) combined with a cluster analysis. SO4(2-) and NO3- ions are predominant in central and eastern Europe. This area corresponds to high emissions of SO2 and NO2. Sea spray ions are predominant in coastal sites. The soil components show an important contribution in southern Europe, possibly due to the soil dust transported from northern Africa.

Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis

BACKGROUND

Several cases of obesity-associated focal segmental glomerulosclerosis (OB-FSG) have been reported but little is known about the clinico-pathological features of this entity and its long-term outcomes.

METHODS

We studied 15 obese patients (BMI 35+/-5.2 kg/m(2)) with biopsy-proven FSG. They were compared with a control group of 15 non-obese patients with idiopathic FSG (I-FSG).

RESULTS

Mean proteinuria at the time of renal biopsy was 3.1+/-2 g/24 h in OB-FSG; it reached the nephrotic range (> or =3.5 g/24 h) during follow-up in 12 patients (80%), but none of them had oedema, hypoproteinaemia, or hypoalbuminaemia. Proteinuria was more marked amongst I-FSG (6.5+/-4.2 g/24 h) and most of them developed oedema and biochemical nephrotic syndrome. Glomerulomegaly was observed in all renal biopsies from OB-FSG patients (mean glomerular diameter 256+/-24 microm in OB-FSG vs 199+/-26 microm in I-FSG, P<0.001). Twelve OB-FSG patients (80%) were treated with ACE inhibitors (ACEI) and proteinuria significantly decreased within the first 6 months of treatment but showed a later increase. None of the obese patients achieved a sustained weight loss. Seven (46%) patients with OB-FSG experienced a progressive renal insufficiency and five of them started intermittent dialysis. Kaplan-Meier estimated probabilities of renal survival after 5 and 10 years were 77 and 51%, respectively, in OB-FSG patients, and 52 and 30% in I-FSG (P<0.05). The risk of developing progressive renal failure among OB-FSG patients was statistically correlated with serum creatinine and creatinine clearance at presentation.

CONCLUSIONS

OB-FSG indicates a poor prognosis with almost one-half of patients developing advanced renal failure. Knowledge of the clinico-pathological features of this entity (obesity, FSG lesions with glomerulomegaly, absence of nephrotic syndrome despite nephrotic-range proteinuria) should be helpful in establishing an accurate and early diagnosis.

[Acute water intoxication as complication of intravenous urography]

Physiologically, two complementary mechanisms regulate plasma osmolality: antduretic hormone ADH) and thirst. ADH release s supressed, thirst s inhbted and renal water loss occurs when plasma osmolality below a threshold level. The rise in plasma osmolalty causes ADH release, stimulation of thirst and water intake. Acute water intoxication is exceptional in patients without a chronic psychiatric disease. Herein, we describe a case of acute water intoxication in a previously healthy patient, after making an intravenous urography. The excessive water intake and the impossibility of renal water loss because of streee-induced ADH release originated t. Only nine cases have been previously described; almost they all were women preparing for diagnostic procedures.

Association of angiotensinogen M235T and A(-6)G gene polymorphisms with coronary heart disease with independence of essential hypertension: the PROCAGENE study. Prospective Cardiac Gene

OBJECTIVES

We examined the relationship between the angiotensinogen (AGT) gene M235T polymorphism, the variant promoter of the AGT gene A(-6)G and the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and coronary heart disease (CHD) in native Gran Canaria Island habitants, who have the highest rates of CHD in Spain.

BACKGROUND

Some studies subject that the ACE (I/D) polymorphism could be associated with CHD, while AGT (M235T) has been related to essential hypertension.

METHODS

We studied 304 subjects with angiographic evidence of coronary artery disease and a clinical diagnosis of myocardial infarction or unstable angina and 315 age- and gender-matched controls. Blood was drawn and DNA extracted. Angiotensin-converting enzyme (I/D) gene polymorphism was analyzed by polymerase chain reaction (PCR) and AGT gene polymorphisms by restriction fragment length polymorphism-PCR and mutagenically-separated PCR.

RESULTS

The ACE (I/D) polymorphism showed no association with CHD, whereas the frequency distribution of AGT (M235T) genotypes among patients and controls (235T: 29.1% and 19.0%; M235T: 48.5% and 50.2%; M235: 22.4% and 30.8%, respectively) was statistically different (p = 0.005) and not related to the presence of essential hypertension. Similar results were observed with the AGT A(-6)G polymorphism. In multiple logistic regression analysis, CHD odds ratio associated with 235T and M235 homozygotes were 1.7 (1.1 to 2.6) and 0.54 (0.36 to 0.82), respectively.

CONCLUSIONS

This study shows that genetic variation of the AGT (M235T), but not the ACE (I/D), genotypes contributes to the presence of CHD independently of blood pressure profile in a subset of the Spanish population with a high prevalence of cardiovascular disease.

The effect of low light flux and nitrogen deficiency on the chemical composition of Spirulina sp. (Arthrospira) grown on digested pig waste

Evaluation of the effect of low light flux and nitrogen deficiency on growth and chemical composition of Spirulina sp. (straight filaments strain, SF) in batch cultures utilizing a complex medium containing sea-water supplemented with anaerobic effluents from digested pig waste, was undertaken. Cultivation was carried out either at a light flux of 66 (lower) or 144 micromol photon m(-2) s(-1) (higher), utilizing bench raceways. Biomass concentration (as dry weight) after 12 days of cultivation in the complex medium was similar (P < 0.05) to the one observed in a chemically defined medium (Zarrouk), regardless of the light intensity. Protein content of the biomass in the complex medium was significantly lower (P < 0.05), compared to the Zarrouk medium, regardless of the light flux. However, biomass from the complex medium was enriched in total lipids (28.6%), when cultures were exposed to the lower light flux. On the other hand, the palmitoleic acid percentage of total fatty acids was significantly higher (P < 0.05) at a higher light intensity and a high level of gamma linolenic acid (GLA) as a percentage of total fatty acids was observed (28.13%) in the biomass harvested from the complex medium at the lower light intensity. Finally, polysaccharide content was significantly higher (P < 0.05) at the high light intensity and a very high content of total polysaccharides (28.41%) was observed in the complex medium.

[Diagnostic and clinical course features of lupus membranous glomerulonephritis]

BACKGROUND

Lupus membranous glomerulonephritis (LMG) is sometimes difficult to distinguish from idiopathic membranous glomerulonephritis (IMG) and little is known about its natural history.

METHODS

We have performed a retrospective study of 16 patients with LMG, types Va ("pure" LMG) (8 patients) and Vb (mesangial proliferation) (8 patients). Analytical and clinical characteristics were analyzed in each case at the onset of the disease and during follow-up.

RESULTS

At the time of diagnosis, 7 patients (43%) did not present any extrarenal manifestations of systemic lupus erythematosus (SLE). Nephrotic syndrome was the most common clinical presentation (81%). 14 patients (87%) showed positive antinuclear antibodies (ANA), but at low titres (< 1/300); anti-DNA antibodies were positive only in 3 cases (18%) and hypocomplementemia was observed in 2 (12%). The most relevant histological findings were the presence of Clq deposits (83%) and subendothelial and mesangial deposits. Treatment consisted of corticosteroids, adding immunosuppression when no response was obtained in 2-3 months. In recent years, an angiotensin-converting enzyme inhibitor (ACEI) was added before immunosuppression. At the end of the study, 6 patients (42%) developed chronic renal insufficiency and 8 (58%) renainea with normal renal function. Actuarial renal survival was 100% at 5 years and 75% at 10 years. The evolution towards a non-nephrotic range proteinuria throughout the follow-up was the only parameter significantly associated with a good prognosis.

CONCLUSIONS

LMG can present without extra-renal symptoms of SLE and even with very poor expression of its serological markers. Almost half of the patients (42%) developed chronic renal insufficiency. The evolution towards a non-nephrotic range proteinuria correlated with the maintenance of a normal renal function.

Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy

BACKGROUND

Some patients develop proteinuria and progressive renal failure after unilateral nephrectomy, although the majority of patients maintain normal renal function. Reasons to explain this different evolution are not known.

METHODS

A cross-sectional study was performed in 73 patients who had undergone unilateral nephrectomy 13.6 +/- 8.6 years before. Patients with morphologic abnormalities in the remaining kidney, systemic disorders, or abnormal renal function at the time of nephrectomy were excluded. All of the 73 included patients showed normal renal function and negative proteinuria at nephrectomy. The patient's medical records were reviewed, and clinical and analytical data throughout follow-up were obtained.

RESULTS

Fifty-three out of the 73 patients (group I) showed a normal renal function and negative proteinuria at the cross-sectional study. The remaining 20 patients (group II) showed proteinuria (3.4 +/- 3.1 g/day). The time elapsed between nephrectomy and proteinuria appearance was 10.1 +/- 6.1 years. Thirteen patients of group II had developed renal insufficiency (serum creatinine at the cross-sectional study of 3.9 + 3.2 mg/dL) in addition to proteinuria. The time elapsed between proteinuria appearance and the onset of renal insufficiency was 4.1 +/- 4.3 years. Renal insufficiency showed a slowly progressive course in most of these patients. There were no significant differences between group I and group II patients in age, gender, renal function, or blood pressure at the time of nephrectomy. In contrast, group II patients showed a body mass index (BMI) that was significantly higher than group I at nephrectomy (31.6 +/- 5.6 vs. 24.3 +/- 3.7 kg/m(2), P < 0.001), at cross-sectional study (33.3 +/- 6.6 vs. 25.1 +/- 3.5 kg/m(2), P < 0.001), and throughout follow-up. Among the 14 obese (BMI > 30 kg/m(2)) patients at the time of nephrectomy, 13 (92%) developed proteinuria/renal insufficiency. In contrast, among the 59 patients with BMI < 30 kg/m(2), only 7 (12%) developed these complications (P < 0.001). Kaplan-Meier estimated probability of negative proteinuria and normal renal function 10 years after nephrectomy was 40 and 70%, respectively, in obese patients at nephrectomy. At 20 years after nephrectomy, these percentages were 8 and 35%, respectively. In contrast, in nonobese patients, the probability of negative proteinuria and normal renal function was 93 and 98%, respectively, at 10 years (P < 0.001) and 77 and 91%, respectively, at 20 years (P < 0.001). Multiple logistic regression analysis showed that the risk of developing renal disease was only statistically correlated with BMI at the time of unilateral nephrectomy (odds ratio 1.34, 1.03 to 1.76 CI).

CONCLUSIONS

Obese patients are at risk for developing proteinuria and chronic renal failure after unilateral nephrectomy. Regular and long-term follow-up are recommended in these patients.

Transcatheter occlusion of complex atrial septal defects

Percutaneous device occlusion of secundum atrial septal defects (ASDs) is becoming an accepted alternative to surgical closure. This method allows us to evaluate patients with complex conditions for treatment. From a total of 70 patients with ASD evaluated for percutaneous closure, we selected for analysis 28 who had complex conditions. The mean age was 36+/-23 yr (range, 4-72). Six had heart failure, and of these six, three had atrial fibrillation. At cardiac catheterization, the pulmonary pressure was 47+/-24 mm Hg, and the QP/QS was 1.7+/-0.4; two patients had bidirectional shunt and systemic pulmonary pressure. Two patients received a buttoned device and 26 an Amplatzer septal occluder. The groups of patients with complex conditions were separated into the following groups. Group I (n = 4) underwent combined treatment of associated anomalies. Two patients had pulmonary stenosis, one had mitral stenosis, and one had an aortic root-left atrium fistula. They were treated in or during with the same procedure by combined transcatheter techniques (balloon valvuloplasty and fistula occlusion) before ASD occlusion. Group II (n = 9) had multiple defects (cribiform or two separate holes). They were treated with a single device in five instances and with two separate devices in four cases. Group III (n = 14) had large (32+/-3 mm) single defects. Nine of them underwent successful implantation using a device 33+/-3 mm in diameter; in the remaining five patients the device was removed because of instability. Group IV (n = 3) had residual defects after previous partial device occlusion. All three defects were successfully occluded with a second device. No movement or interference with the first device was observed. Group V (n = 6) had severe pulmonary hypertension (86+/-16 mm Hg). Immediately after ASD occlusion we observed significant relief in these patients (67+/-14 mm Hg; P<0.01). There were no major complications; all 23 patients with successful implants were discharged without symptoms 2-7 days later; one patient with atrial fibrillation recovered sinus rhythm. The follow-up (8+/-5 mo) Doppler echo study showed complete ASD occlusion in 22 patients and a peak pulmonary pressure of 30+/-14 mm Hg. We conclude that transcatheter occlusion of ASDs is an effective and safe treatment for patients with complex anatomic or physiopathologic conditions, as evaluated by short-term follow-up.