[Progressive deterioration in an elderly patient]

Vasculitis is diagnosed with increasing frequency in the elderly. We hereby present the case of an 84-year-old male, who had weight loss, low-degree fever, anemia and epigastric pain. After 14 days of study with the tentative diagnosis of digestive neoplasia, a progressive renal insufficiency was detected. This clinical picture was secondary to ANCA-positive vasculitis. The case poses the differential diagnosis of non-oliguric acute renal failure (FRA) in elder people and the systematics of the study of renal insufficiency in individuals with previously unknown renal function. Also, this patient's history emphasizes the importance of acute deterioration of renal function as a guiding symptom for orienting the interpretation of clinical data. In the present case, a diagnostic hypothesis based only in the pursue of an occult digestive tumor misguided the attention from the main cause of the disease.

Amino acid nitrosation products as alkylating agents

Nitrosation reactions of alpha-, beta-, and gamma-amino acids whose reaction products can act as alkylating agents of DNA were investigated. To approach in vivo conditions for the two-step mechanism (nitrosation and alkylation), nitrosation reactions were carried out in aqueous acid conditions (mimicking the conditions of the stomach lumen) while the alkylating potential of the nitrosation products was investigated at neutral pH, as in the stomach lining cells into which such products can diffuse. These conclusions were drawn: (i) The alkylating species resulting from the nitrosation of amino acids with an -NH(2) group are the corresponding lactones; (ii) the sequence of alkylating power is: alpha-lactones > beta-lactones > gamma-lactones, coming respectively from the nitrosation of alpha-, beta-, and gamma-amino acids; and (iii) the results obtained may be useful in predicting the mutagenic effectiveness of the nitrosation products of amino acids.

[Health-related quality of life of elderly patients in primary care]

OBJECTIVES

To study the quality of life of the consultant elderly people and the associated factors to them.

DESIGN

A transversal and observational study.

SETTING

Primary care. An urban health center.

PARTICIPANTS

Patients over 64 years without any physical or psiquical limitation that disturb the communication between patient and doctor, that ask for a consultation. Election of a necessary sample trough consecutive sampling, to precision of 0,05 points and 95% CI.

OPERATIONS

The patients filled out the valid version to Spanish of the Nottinghan Health Profile. The social demographics and the morbility variables were taken through clinical histories or in other case, through the patients interviews.

MEASUREMENTS AND MAIN RESULTS

The questionnaire was answered for 386 patients with a global mid punctuation of 9166 points (25,5% of deterioration; 95% CI, 23,8-27,1%), being the deterioration in each one of following sizes: <<energy>> (22%; 95% CI, 25,3-18,7%); <<pain>> (22,5%; 95% CI, 24,9-20,1%); <<sleep>> (31,7%; 95% CI, 34,8-28,6%), <<social isolation>> (16,5%; 95% CI, 18,9-14%); <<emotional state>> (27,9%; 95% CI, 30,5-25,8%) and <<mobility>> (28,3%; 95% CI, 30,7-25,9%). It was presented with a high level of deterioration and with differences statistically significant, women (28,7% versus 19,0%; p < 0,001), except in <<energy>> sphere, patients with elevated age (23,1%, 21,1%, 24,4%, 30,5% y 35,9% in 65-69, 70-74, 75-79, 80-84 and > 84 years old respectively; p < 0,001), except in <<pain>> and <<sleep>> sphere), those who lived alone or without partner, those who were included in the house attention program 42,8% frente a 23,3%; p < 0,001), those who had a major number of chronic disease and those who took a great number of drugs.

CONCLUSION

There are an important deterioration in the quality of life of our elderly people, associated to different social demography factors and morbidity. The assessment of the quality of life should be an habitual tool in our clinical practice.

The role of system A for neutral amino acid transport in the regulation of cell volume

System A is a secondary active, sodium dependent transport system for neutral amino acids. Strictly coupled with Na,K-ATPase, its activity determines the size of the intracellular amino acid pool, through a complex network of metabolic reaction and exchange fluxes. Many hormones and drugs affect system A activity in specific cell models or tissues. In all the cell models tested thus far the activity of the system is stimulated by amino acid starvation, cell cycle progression, and the incubation under hypertonic conditions. These three conditions produce marked alterations of cell volume. The stimulation of system A activity plays an important role in cell volume restoration, through an expansion of the intracellular amino acid pool. Under normal conditions, system A substrates represent a major fraction of cell compatible osmolytes, organic compounds that exert a protein stabilizing effect. It is, therefore, likely that the activation of system A represents a portion of a more complex response triggered by exposure to stresses of various nature. Since system A transporters have been recently cloned, the molecular bases of these regulatory mechanisms will probably be elucidated in a short time.

Oxidation of nitrobenzene by O3/UV: the influence of H2O2 and Fe(ll). Experiences in a pilot plant

Abstract The degradation of nitrobenzene using some advanced oxidation processes (O3/UV, O3/UV/H2O2 and O3/UV/Fe(III)) has been investigated. In the combined O3/UV process, the effect of pH and ozone was studied. In the other combinations, the influence of the amount of hydrogen peroxide and ferric ion in the degradation rate and TOC evolution, has been studied. Under our conditions, the combination O3/UV did not improve the degradation rate obtained by ozonation. The best TOC decrease was obtained when the O3/UV process was carried out at low ferric ion concentrations.

Replacement of H2O2 by O2 in Fenton and photo-Fenton reactions

The consumption of oxygen during the degradation of aniline by Fenton and photo-Fenton reactions is studied. The effect that parameters like aniline, Fe(II) and H2O2 initial concentration, pH, temperature and O2 flow rate have on the ratio O2 consumed/H2O2 consumed is examined. The determination of those combinations of experimental conditions for which an effective partial replacement of H2O2 by O2 as electron acceptor takes place is investigated. The results show that this replacement takes place in a variable extent, but the presence of H2O2 is necessary along the reaction, and the maximum consumption of O2 only takes place when the ratio amount of aniline mineralized vs. initial aniline concentration is minimal.

Role of antiretroviral therapy in long-term survival of patients with AIDS-related pulmonary aspergillosis

The aim of the study presented here was to describe the clinical presentation and outcome of invasive pulmonary aspergillosis (IPA) in a cohort of HIV-infected patients and to assess factors associated with survival by means of a longitudinal study of all HIV-infected adults with IPA who attended the infectious diseases service of a tertiary center between January 1985 and December 1998. The outcome measure was the time to death after diagnosis of IPA. The endpoint for data collection and survival analysis was 31 December 1998. Nineteen of 1,605 HIV-infected patients were identified, resulting in an overall IPA attack rate of 1.12%. Most patients had AIDS (95%). Unilateral cavitary disease was the most frequent radiographic presentation (37%). Median survival was 148 days (95% confidence interval [95% CI], 0-402), but it exceeded 12 months in 37%. In patients in whom antiretroviral treatment (ART) was initiated or modified in relation to the IPA diagnosis, median survival increased to 906 days (95% CI, 754-1,058; 1-year survival, 83%) compared with 86 days in those who did not take any ART (95% CI, 55-117; 1-year survival, 8%; P=0.0002). Survival was even longer when ART changes included only nucleoside reverse transcriptase inhibitors, prior to the availability of protease inhibitors (833 days, 95% CI, 369-1,297; 1-year survival 75%; P=0.003). Three (16%) patients are still alive after a mean time of 36 months postdiagnosis. Although IPA is a life-threatening complication of advanced AIDS, it does not always lead to short-term death. An adequate management of HIV infection together with antifungal treatment may prolong survival and, as described for other AIDS-related disorders, a significant decrease in its occurrence can be expected.

Catheter ablation of repetitive monomorphic ventricular tachycardia from left ventricular outflow tract guided by unipolar mapping

Repetitive monomorphic ventricular tachycardia from the left ventricular outflow tract is an uncommon arrhythmia. Successful catheter ablation has been previously reported in a few cases, but a large number of applications were usually needed when an approach based on either activation mapping or pace mapping was used. In our patient, the selection of the target point for application was based exclusively on unipolar mapping criteria of the ectopic beats, resulting in a short procedure with successful outcome.