Preservation of the recipient inferior vena cava in liver transplantation

Twenty piggy-back (PB) liver transplantations (LT) were compared with 20 LT performed by the standard technique in order to evaluate whether or not the theoretical haemodynamic advantages of the preservation of the inferior vena cava (IVC) have any impact on the final results of the LT. Statistically significant differences were observed in the duration of the hepatectomy, which was longer for PB LT (192 min vs. 146 min), and in the duration of the anhepatic phase, which was shorter in that group (52 min vs. 76 min). There were no differences in the duration of the complete surgical procedure, consumption of blood products, incidence of postoperative acute renal failure, number of reoperations or survival.

Melatonin prevents oxidative stress resulting from iron and erythropoietin administration

Intravenous iron (Fe) and recombinant human erythropoietin (rHuEPO) are routine treatments in the management of anemia in patients with chronic renal failure. We investigated the oxidative stress acutely induced by these therapies and whether pretreatment with oral melatonin (MEL) would have a beneficial effect. Nine patients (four women) were studied within 1 month of entering a chronic hemodialysis program in the interdialytic period. Plasma malondialdehyde (MDA), red blood cell glutathione (GSH), and catalase (CAT) activity were measured in blood samples obtained before (baseline) and 1, 3, and 24 hours after the administration of Fe (100 mg of Fe saccharate intravenously over 1 hour) or rHuEPO (4,000 U intravenously). One hour before these treatments, patients were administered a single oral dose of MEL (0.3 mg/kg) or placebo. Each patient was studied on four occasions, corresponding to studies performed using either placebo or MEL in association with intravenous Fe and rHuEPO administration. Baseline data showed increased oxidative stress in patients with end-stage renal failure. Increments in oxidative stress induced by Fe were more pronounced at the end of the administration: MDA, baseline, 0.74 +/- 0.09 nmol/mL; 1 hour, 1.50 +/- 0.28 nmol/mL (P: < 0.001); GSH, baseline, 2.51 +/- 0.34 nmol/mg of hemoglobin (Hb); 1 hour, 1.66 +/- 0.01 nmol/mg Hb (P: < 0.001); and CAT activity, baseline, 27.0 +/- 5.7 kappa/mg Hb; 1 hour, 23.3 +/- 4.2 kappa/mg Hb (P: < 0.001). rHuEPO-induced increments in oxidative stress were more pronounced (P: < 0.001) at 3 hours (MDA, 1.24 +/- 0.34 nmol/mL; GSH, 1.52 +/- 0.23 nmol/mg Hb; CAT activity, 18.0 +/- 3.1 kappa/mg Hb). MEL administration prevented the changes induced by Fe and rHuEPO and had no adverse side effects. These studies show that intravenous Fe and rHuEPO in doses commonly used to treat anemia in chronic hemodialysis patients acutely generate significant oxidative stress. Oral MEL prevents such oxidative stress and may be of clinical use.

Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study

BACKGROUND AND OBJECTIVES

We assessed the efficacy and safety of dipyrone in comparison with tramadol in the relief of early postoperative pain following abdominal hysterectomy.

METHODS

A total of 151 women between 18 and 60 years of age undergoing abdominal hysterectomy during general anesthesia participated in a randomized, double-blind, controlled, multicenter study. Seventy-three patients received dipyrone and 78 received tramadol. Patients received an intravenous loading dose of the study drug immediately after operation followed by intravenous (IV) maintenance infusion and IV on-demand boluses up to a maximum number of predetermined doses/day of 8 g dipyrone and 500 mg tramadol. The duration of the study was 24 hours.

RESULTS

The mean (SD) number of boluses in the dipyrone group was 3.8 (2.4) and 3.5 (2.5) in the tramadol group (95% confidence interval, -0.455 to 1.175), and the percentage of patients requiring rescue IV morphine (dipyrone 26.9%, tramadol 26.8%) was not statistically significant. Other analgesic efficacy parameters, such as pain intensity differences, sum of pain intensity differences, pain relief assessed by the patient, or patients who required the maximum number of demand doses, were not different between treatment groups. A significantly higher percentage of adverse gastrointestinal effects was found in patients given tramadol (42.1%) than in patients given dipyrone (20.2%) (P <.05). Also, a significantly higher number of tramadol-treated patients required ondansetron to control nausea and vomiting at 1 hour (19% v 7%), 2 hours (26% v 11%), and 24 hours (46% v 29%) (P <.05) after surgery. Patients and the investigators reported similar tolerability for both study arms.

CONCLUSIONS

Dipyrone and tramadol showed similar efficacy for early pain relief after abdominal hysterectomy. Nausea and vomiting, possibly caused by the tramadol, occurred more frequently in those patients. In this group, the need of the antiemetic drug ondansetron was also higher.

Tubular stress test detects subclinical reduction in renal functioning mass

BACKGROUND

To develop a test that would disclose subclinical impairment in renal function, we studied the increment in tubular secretion of creatinine (TS(Cr)) induced by intravenous creatinine administration.

METHODS

Studies were done in 14 normal individuals, 7 kidney donors (KDs), and 11 transplant recipients (Tx), all of whom had normal creatinine levels (P(Cr) <133 micromol/L). Creatinine infusion studies determined that maximal stimulation of TS(Cr) resulted from P(Cr) levels of 500 to 700 micromol/L. Therefore, in the tubular stress test, clearances, urinary excretion of creatinine (U(Cr)V) and TS(Cr) were determined before and after (15 to 105 min) a single bolus injection of 88.4 mmol/kg body wt, which resulted in the target P(Cr) levels.

RESULTS

Baseline determinations of P(Cr), U(Cr)V, and TS(Cr) were not significantly different in the study groups. Stimulated U(Cr)V (nmol/kg/min) was higher in normals (426 +/- 82) than in KDs (338 +/- 72, P < 0.05) and Tx patients (311 +/- 66, P < 0.01). Similarly, TS(Cr) (nmol/kg/min) was higher (P < 0.001) in normals (180 +/- 60) than in KDs (155 +/- 54) and Tx patients (86 +/- 35). Furthermore, the transplanted kidney responded worse than the solitary normal kidney (P < 0.05), despite having similar levels of glomerular filtration rate (GFR). The tubular stress test increased TS(Cr) 11.3 +/- 6.2 times in normals, 4.3 +/- 1.2 times in KDs (P < 0.01), and 2.5 times in Tx (P < 0.001).

CONCLUSIONS

Impaired tubular secretory response to a creatinine load is a more sensitive index of reduced functioning renal mass than levels of P(Cr) and GFR. The tubular stress test may be useful in following the natural history of kidney disease and the results of therapeutic interventions.

Endogenous hormone levels in habituated nucellar Citrus callus during the initial stages of regeneration

 Embryogenic nucellar callus cultures of different Citrus species and cultivars growing in hormone-free medium were transferred to medium containing either sucrose or glycerol as the only carbohydrate source. Glycerol has been reported to induce further development of Citrus somatic embryos, while in the presence of sucrose they continue to proliferate in an 'undifferentiated' manner. The endogenous hormone levels of the cultures were evaluated after 2 and 5  days to characterise the initial steps of embryo development. In most cases, differences among treatments were observed only after 5 days of culture. Higher cytokinin levels were found in most of the cultures transferred to the glycerol-containing medium. The effect of ageing sweet orange cultures on their endogenous hormone levels was determined by leaving them in the original culture medium without subculturing for 60 days. While no changes were observed in the free indoleacetic acid and gibberellin contents, lower levels of abscisic acid and cytokinins were found in the aged cultures than in those transferred at the normal interval, every 30 days. The endogenous hormone contents of Citrus callus of different genotypes were compared. Significant differences were observed in the levels of all hormones evaluated, even when the in vitro ontogeny of the different genotypes was very similar.

Tumor necrosis factor gene polymorphisms in patients with cirrhosis from chronic hepatitis C virus infection

Pro-inflammatory cytokines including tumour necrosis factor (TNF) mediate the pathogenesis of hepatitis C virus (HCV) infection. The distribution of TNF gene polymorphisms was examined among cirrhotic and non-cirrhotic patients infected with HCV. Thirty Caucasians with cirrhosis due to chronic HCV infection and 114 HCV-infected patients histopathologically free of cirrhosis were genotyped for genetic variants in TNF, lymphotoxin alpha and TNF-receptor type I using PCR-based techniques. Variability in the progression of HCV-related cirrhosis was assessed in a multivariate model including genetic and non-genetic factors such as gender, estimated duration of infection, alcohol consumption, and viral genotype. Viral genotype and non-genetic host features were not independently related to the occurrence or rate of development of cirrhosis in the patient population. In contrast, the TNF promoter variants TNF2 (-238A) and TNF3 (-308A) conferred a 3.2-fold and 5.1-fold risk of cirrhosis respectively (P = 0.03 for both). Reciprocal effects were observed with several TNF alleles and haplotypes defined by the -238G/A and -308G/A dimorphic sequences. Polymorphisms in the TNF alpha promoter appear to be associated with variability in the histological severity of chronic hepatitis C infection.

Assessment of hepatitis C virus RNA and genotype from 6807 patients with chronic hepatitis C in the United States

Hepatitis C virus (HCV) RNA status and HCV genotype have become important tools in the diagnosis and monitoring of therapy in chronic HCV infection. To establish a database with respect to HCV genotype and serum HCV RNA concentrations in chronic hepatitis C patients in the United States, we analysed 6807 chronic hepatitis C patients who had HCV RNA and HCV genotype tests conducted at a central laboratory. The HCV RNA concentration cut-off for the lower 25th percentile of this population (low titre) was 0.9 x 106 copies ml-1. The median HCV RNA concentration was 3.5 x 106 copies ml-1 and the cut-off for the upper 25th percentile (high titre) was 5 x 106 copies ml-1. Male patients had a median HCV RNA concentration of 3.9 x 106 copies ml-1, which was significantly higher than the median HCV RNA level for females (2.75 x 106 copies ml-1; P < 0.001). HCV genotype 1 was detected in 73% of patients; genotype 2 in 14%; genotype 3 in 8%; mixed genotype in 4%; and genotypes 4, 5 and 6 with a frequency of < 1%. Patients from the Northeast, Southeast and Midwest had significantly (P < 0.001) more infections with genotype 1 than patients from the Western and Southern regions. African-American patients were more likely to be infected with genotype 1 when compared with Caucasian, Hispanic or Asian Pacific Islanders (P < 0.001). Patients infected with HCV genotype 1 and mixed HCV genotypes had significantly higher serum HCV RNA concentrations when compared with HCV genotypes 2 and 3 (P < 0.001 for all comparisons).

Interleukin-1 polymorphisms associated with increased risk of gastric cancer

Helicobacter pylori infection is associated with a variety of clinical outcomes including gastric cancer and duodenal ulcer disease. The reasons for this variation are not clear, but the gastric physiological response is influenced by the severity and anatomical distribution of gastritis induced by H. pylori. Thus, individuals with gastritis predominantly localized to the antrum retain normal (or even high) acid secretion, whereas individuals with extensive corpus gastritis develop hypochlorhydria and gastric atrophy, which are presumptive precursors of gastric cancer. Here we report that interleukin-1 gene cluster polymorphisms suspected of enhancing production of interleukin-1-beta are associated with an increased risk of both hypochlorhydria induced by H. pylori and gastric cancer. Two of these polymorphism are in near-complete linkage disequilibrium and one is a TATA-box polymorphism that markedly affects DNA-protein interactions in vitro. The association with disease may be explained by the biological properties of interleukin-1-beta, which is an important pro-inflammatory cytokine and a powerful inhibitor of gastric acid secretion. Host genetic factors that affect interleukin-1-beta may determine why some individuals infected with H. pylori develop gastric cancer while others do not.

The responsiveness of the Hamilton Depression Rating Scale

In clinical studies of antidepressants, the Hamilton Depression Rating Scale (HAMD) total score has been the gold standard instrument for establishing and comparing the efficacy of new treatments. However, the HAMD is a multidimensional measure, which may reduce its ability to detect differences between treatments, in particular, changes in core symptoms of depression. Two meta-analyses were conducted to compare the responsiveness of the HAMD total score with several published unidimensional subscale scores based upon core symptoms of depression. The first compared the above instrument's ability to detect differences between fluoxetine and placebo across eight studies involving over 1600 patients. The second analysis involved four studies and over 1200 patients randomized to tricyclic antidepressants and placebo. In both meta-analyses, the unidimensional core subscales outperformed the HAMD total score at detecting treatment differences. The implications of this on sample sizes and power for clinical studies will be discussed. In fact, studies based on the observed effect sizes from the core subscales would require approximately one-third less patients than studies based on the HAMD total score. Effect sizes from each individual HAMD item will also be presented to help explain the differences in responsiveness between the scales.

Fecundity above the Species Level: Ovule Number and Brood Size in the Genisteae (Fabaceae: Papilionoideae)

Per-fruit components of fecundity (ovules per ovary, seeds per fruit, seed : ovule ratio, and patterns of seed maturation within pods) were studied in 33 species of the Genisteae, a legume tribe of mostly Mediterranean shrubs, e.g., Cytisus, Ulex, that also includes more widespread herbs such as Lupinus. Species identity explained most variance in both potential (ovules) and realized (seeds per fruit and seed : ovule ratio) fecundity, and although significant population-specific effects existed, these were relatively small, indicating that estimates of fecundity were not particularly prone to environment-induced changes. Average seed : ovule ratios varied between 20% (for a few species in which fixed rates of embryo abortion result into single seeded pods) and 100% (annuals), but most taxa were in the 40%-60% range. The probability that an ovule near the base of the ovary matured into a seed was significantly lower than the pod average in the majority of species. As indicated by the large size of stigmatic pollen loads, this was unlikely to result from insufficient pollination but rather from preferential embryo abortion. High abortion rates next to pod base occurred in both presumed selfers and obligate outcrossers. Evidence points to relatively stereotyped reproductive ways and high reproductive coherence in the tribe, with major departures from the norm being high seed : ovule ratios exhibited by annual Lupinus (associated with selfing), and low ratios shown by species with single seeded pods (associated with fixed rates of embryo abortion).

Microfungal Community Changes in Rodent Food Stores over Space and Time

> Abstract This paper reports the changes over time in the microfungal communities that inhabit three rodent species' food stores at two climatically different locations. Results reveal that microfungal diversity values calculated from above-ground food stores are highest in the more commonly disturbed portions of the rodent dens. Interactions among food-inhabiting microbes and between the rodents and food-inhabiting microbes also appear to influence the microfungal communities within the rodent dens. For example, our data suggest that transport by animal vectors, and not by air currents, is more effective at dispersing microbial propagules. Furthermore, although fungal communities inhabiting food stores within dens varied in composition and diversity over time, standardized substrates (sorghum seeds) simultaneously placed within the food stores converged in microfungal composition the longer they were left within the dens. We hypothesize that animal vectors, including rodents, make neighboring fungal communities more alike by introducing similar communities of microbes, which in turn initiate a cascade of biological interactions that, over time, result in similar microfungal communities inhabiting newly stored food items.http://link.springer-ny.com/link/service/journals/00248/bibs/38n1p79.html

Variation in volatile organic compounds in the breath of normal humans

We studied the variation in volatile organic compounds (VOCs) in the breath of 50 normal humans, using gas chromatography and mass spectroscopy. An average breath sample contained 204.2 VOCs (SD=19.8, range 157-241). The alveolar gradient of each VOC (abundance in breath minus abundance in air) varied with rate of synthesis minus rate of clearance. A total of 3481 different VOCs were observed: 1753 with positive alveolar gradients, 1728 with negative alveolar gradients. Twenty-seven VOCs were observed in all fifty subjects. This study confirmed previous reports of wide inter-individual variations. Two new findings were the comparatively small variation in total number of breath VOCs, and the presence of a 'common core' of breath VOCs in all subjects.

[Molecular diagnosis in an Argentinian family with multiple endocrine neoplasia type-1 (MEN-1)]

MEN-1 is a hereditary autosomal dominant syndrome characterized by the involvement of parathyroid glands, pancreatic islet cells and anterior pituitary gland. Today molecular genetics permit gene carrier analysis to compare the data obtained with the clinical biochemical tests. The twenty living members of the first, second and third generation of a family with MEN-1 were studied to determine the presence of genetic markers in MEN-1 loci 11q13, by linkage analysis and in affected individuals by biochemical tests and clinical examination. Two very informative polymorphic markers immediately flanking the MEN-1 gene on chromosome 11 band q13 were detected: PYGM and D11S987, haplotypes segregated by two members of the second generation, inherited from their father and two of the third generation: the affected one and one presymptomatic. The third generation had the affected member with renal stones and elevated PTH, PRL and glucagon. The presymptomatic carrier of MEN-1 allele showed elevated PTH. Among the members who inherited the normal allele we found one with elevated gastrin, one with elevated glucagon and one with elevated PTH, all asymptomatic. Of one Argentine family studied, molecular diagnosis allowed us to detect one presymptomatic carrier in the members at risk. As suggested by the available literature, accuracy of molecular diagnosis seems to make it the test of choice to exclude those members at risk for MEN-1 inheriting the normal allele.

Hormonal and psychological treatment: therapeutic alternative for menopausal women?

The purpose of this study was to determine whether psychological support associated with hormone replacement therapy (HRT) was more beneficial than replacement therapy alone. Our findings showed that HRT alone was more effective against vasomotor symptoms than HRT with psychological treatment (PT). While the combination of both treatment modalities (HRT + PT) was more effective against insomnia, nervousness, melancholy, fatigue, palpitations, and vertigo. Hormonal treatment alone and HRT with psychological treatment had little effect against paresthesia or tingling. Neither HRT alone nor HRT with psychological treatment was effective against joint and muscle pain or headache.

Clinical, cytogenetic, and molecular testing of Argentine patients with retinoblastoma

PURPOSE

The purpose of this study is to determine the clinical, chromosomal, and molecular characteristics of Argentine patients with unilateral and bilateral retinoblastoma.

STUDY DESIGN

Eighty-six patients belonging to 82 families were studied; 59% of them were examined during the first year of life. Leukocoria was the most common reason for consultation. Other presenting signs were strabismus and glaucoma. Enucleation of the affected eye was performed in 85% of the cases and the complication rate was 13%.

RESULTS

An appropriate therapy allowed the survival of 84 of the 86 patients. Two children with malformations and growth retardation had an abnormal karyotype with a deletion in 13q14. Segregation analysis of polymorphic sites within the retinoblastoma gene and the parental origin of the allele lost in the tumor were analyzed in 30 of the 82 families. Five mutant alleles transmitted through the germline and six de novo germline mutant alleles were identified in 12 patients with hereditary retinoblastoma. Most de novo germline mutant alleles were paternally derived. Molecular analysis of nonhereditary retinoblastoma showed loss of heterozygosity in three of eight cases. From these, two maternal alleles and one paternal allele were lost, thus not indicating a significant difference in the parental origin for the lost allele.

CONCLUSIONS

These data are useful for deoxyribonucleic acid diagnosis of susceptibility to retinoblastoma in relatives of hereditary patients, even if mutations have not been identified.

Stimulation of tubular secretion of creatinine in health and in conditions associated with reduced nephron mass. Evidence for a tubular functional reserve

BACKGROUND

The increment in glomerular filtration rate (GFR) after a protein load has been taken to reflect the renal reserve capacity; however, this response is preserved in end-stage kidney disease. Tubular secretion of creatinine is increased in relation to the GFR in renal failure, but little is known about the tubular functional response to stimulation despite the fact that tubulointerstitial lesions are always pre-eminent in chronic renal damage. Therefore we decided to compare the urinary creatinine excretion (UcrV) and tubular secretion of creatinine (TScr) induced by a test meat meal in normal individuals and in individuals with reduced nephron mass.

METHODS

We studied 12 normal subjects, seven healthy uninephrectomized (kidney donors) and eight patients with chronic renal disease (serum creatinine ranging from 212.2 to 486 micromol/l). They had been on a standard diet for 5 days before the studies. The test meal provided 80 g of animal protein. Three baseline and four stimulated (post-meal) 30-min simultaneous inulin and creatinine clearances were carried out.

RESULTS

We found that normals increased more than twice the UcrV (post-meal=329.5 +/-SEM 13.1 nmol/min/kg) and 3.4 times the TScr (114.4+/-12.7 nmol/min/kg) after the test meal. In contrast, patients were unable to raise their baseline values (P<0.001), despite a normal increment in GFR. The data in kidney donors fell between normals and patients. Strong correlation existed between the stimulated (but not the baseline) TScr (P=0.003) and GFR and between UcrV post-meal/pre-meal ratio and GFR (P<0.0001).

CONCLUSION

The increment in TScr resulting from a protein meal is related to the functioning nephron mass. Evaluation of this increment could have potential clinical relevance.

The deduced primary structure of a ribosomal protein S4 from Trypanosoma cruzi

Two cDNA clones encoding a protein homologous to ribosomal protein S4 from the protozoan parasite Trypanosoma cruzi were isolated and characterized. Both clones potentially encode for an identical basic protein of 273 amino acids. Sequence comparisons with other species indicate that this protein is highly conserved. Hybridization studies are consistent with the occurrence of two genes in T. cruzi encoding this ribosomal protein. An RNA of approximately 1 kb was present in both exponentially growing and stationary phase derived epimastigotes, and no significant differences were detected in its steady state concentration.

[Acute cholecystitis: analysis of the different therapeutic approaches in a General Surgery Service during the years 1994-1996]

INTRODUCTION

The commonly accepted approach in the treatment of acute cholecystitis is urgent cholecystectomy. Laparoscopy has renewed interest in the option of "cooling" the inflammatory process, in order to subsequently carry out a programmed cholecystectomy through the technique mentioned. We present an analysis of the data collected on hospital stay and medico-surgical complications in both therapeutic options. The aim of this work is to reflect on the results obtained in the treatment of acute cholecystitis and to evaluate the results of the application of laparoscopic cholecystectomy in the emergency area.

MATERIAL AND METHODS

152 patients diagnosed with acute cholecystitis are studied. They are distributed in 3 groups, analysing the simple and accumulated hospital stay, the index of medical and surgical complications and mortality.

RESULTS

Of the 152 patients with a diagnosis of acute cholecystitis, 91 (59.8%) were operated on in their first admission, 47 (30.9%) were treated using "cooling" of the process to be operated on in a second admission and 14 (9.3%) by means of percutaneous cholecystostomy. A total of 29 patients were readmitted, 4 for relapse of acute cholecystitis and 25 for programmed operations. Urgent conventional cholecystectomy shows a greater rate of infections. The cholecystectomy on second admission supposes a moderate increase of the accumulated average stay. 17% of these patients were operated on using open surgery.

CONCLUSIONS

Urgent surgery seems the most suitable approach in acute cholecystitis. The employment of laparoscopic surgery in these cases probably reduces the rate of the medical and surgical complications due to laparotomy in infectious acute pathology, and increases the comfort of the patient

[Giant gastric stromal tumor simulating a focal hepatic lesion]

Gastrointestinal stromal tumors (GIST), are unusual malignancies regarded for many years as being basically of smooth muscle nature and designated as leiomyomas, leiomyosarcomas or leiomyoblastomas. Histogenesis has been debated, though it is presently accepted that they are characterized by poorly differentiated cells, including tumors showing differentiation towards smooth muscle, neural elements, dual differentiation or lack of differentiation. Another group with ultrastructural and immunohistochemical features similar to those of gastrointestinal autonomic plexus has been described and designated as GAN tumors. Diagnosis and classification of these tumors are not possible using conventional pathological techniques, making ultrastructural and immunohistochemical studies necessary. Accurate classification is clinically essential due to prognostic implications. GIST present with few clinical symptoms even in cases of large tumors and are quite often incidentally found during surgical procedures or in postmortem studies. We report a case of a giant gastric stromal tumor showing differentiation towards smooth muscle which presented as a focal hepatic lesion.

The continuous performance test, identical pairs version (CPT-IP): III. Brain functioning during performance of numbers and shapes subtasks

The numbers and shapes subtasks of the CPT-IP are difficulty-matched measures of independent aspects of attentional skill that have been used to differentiate the impairments of schizophrenics and major depressives. Previous studies suggest that they tap into lateralized aspects of attentional performance. To investigate this hypothesis, seven subjects free of psychiatric illness were presented with these CPT-IP subtasks during a SPECT procedure. Subtasks--4-digit number strings and nonsense shapes--were administered on successive weeks, in counterbalanced order, simultaneous with administration of 10 mCi 99mTc HMPAO. Scanning took place after 10 min of test performance. Quantitative data were extracted from each scan via a semi-automated region of interest (ROI) analysis which defined eight cortical and four subcortical ROI on each of five transverse slices. Data for each ROI were normalized and compared between task conditions. Results indicate that the two tasks produce different patterns of functioning within two general areas of the brain. First, during Numbers task performance, left-sided activity was increased on multiple transverse slices in an anterior subcortical region that incorporated the anterior cingulate, frontal white matter, and much of the basal ganglia. Left-sided activity was also increased in a posterior subcortical region including the left side of the thalamus. Lateralization of function, defined as relative activity on the left and right sides, changed within these regions across tasks, but primarily as a result of the contribution of increased or decreased activity on the left side alone. Second, relative perfusion to occipital regions, bilaterally, was more extensive during the Shapes task. These results suggest that subtle alterations in stimulus parameters can affect activation patterns in regions that are critically associated with task performance. They also suggest that the Numbers task may provide more robust activation of anterior attention systems, that may better discriminate the functioning of these systems in normal and psychopathological groups.

[Utilisation of organs proceeding from donors with heart failure: review of the pathogenesis of organic damage and the possible mechanisms of prevention]

There is an evident imbalance between the number of patients awaiting a kidney transplant and the availability of organs proceeding from donors with brain death. A high number of patients die each day from heart failure, whose organs could be used for transplants if specific care is employed. Although centres do exist where these methods of extraction are established, the problems of organic damage have yet to be resolved, since one third of the organs are still lost, besides the increase in the need for early dialysis, and the number of dysfunctioning grafts two years after the transplant, when this type or organ is employed. There is increasingly detailed knowledge of the pathogenesis of organic damage following heart failure and reanimation, as well as of the damage following the conservation and reimplantation of the kidney. Knowledge of the maximum time of hot ischemic that an organ can withstand is of crucial importance if organs are not to be unduly discarded. Besides, the increasing understanding of the physiopathology of oxidative stress could make it possible for us, through the use of antioxidants, to attempt to improve the utilisation of the organs and diminish the incidence of dysfunctions and rejections.

Neuroleptic dosing in Asian and Hispanic outpatients with schizophrenia

Recent studies suggest that minorities may have higher plasma levels caused by ethnic variations in pharmacokinetics under standard neuroleptic treatment; they would be at increased risk for extrapyramidal side effects and more likely to be treatment noncompliant. This study examined the prescribing pattern of antipsychotic medication to minority schizophrenics in outpatient psychiatric programs developed to meet their treatment needs. A computer search was conducted of registered clients in a Hispanic and Asian outpatient clinic(s). Hispanic and Asian patients with schizophrenia were identified and for purposes of comparison, a third sample of consecutively drawn outpatients with a diagnosis of "schizophrenia" registered in the outpatient clinic proper were selected. All outpatient medical records were secured and neuroleptic dosing patterns extracted and quantified. Neuroleptic doses were converted to chlorpromazine equivalents and corrected for body weight to a standard of 68 kg. One way analysis of variance procedures were used to compare both the actual and standardized neuroleptic doses across the three samples and revealed a significant main effect for both actual (p < 0.05) and standardized dose (p < 0.05). With regard to the former secondary analysis yielded significant differences between the clinic sample and the Hispanic (p < 0.05) and Asian (p < 0.05) samples, which did not differ significantly from each other but which received significantly less drugs than the other patient population. These results were similar to the standardized dose comparison. The findings replicate previous inpatient reports and have implications for cross-cultural treatment programs.

Neuroleptic dosing in Hispanic and Asian Inpatients with schizophrenia

This study is the second in a series examining the prescribing of antipsychotic medication to patients with schizophrenia in cross-cultural clinical programs. A computer search identified all patients with the diagnosis of "schizophrenia" treated during a 1-year period in an inpatient Hispanic and Asian psychiatric unit(s); second computer search identified a matched (admission date) sample of Anglo patients from the general inpatient psychiatry services. The medication variables included type of neuroleptic drug used, the maximum dose, the stabilized dose (i.e., neuroleptic dose at discharged and the dose associated with first report of extrapyramidal symptoms. Neuroleptic doses were converted to chlorpromazine (CPZ) equivalents and corrected for body weight to a standard of 68 kg. Oneway analysis of variance procedures were used to compare both actual and standardized neuroleptic CPZ across the three samples, these statistical comparisons were completed for both maximum and stabilized dose(s). The analysis with maximum dose revealed a significant main effect for both actual (p < 0.05) and standardized CPZ (p < 0.05). Similar results were also found for stabilized dose with both actual (p < 0.05) and standardized CPZ (p < 0.05). Examination of the direction of mean differences for both medication dosing variables using both CPZ comparisons revealed that the patients in general sample received significantly larger doses of antipsychotic medication than either Asian or Hispanic patients.

Genotoxic effects of metronidazole

Metronidazole (MTZ) is an effective agent used in the treatment of parasitic infections. Its genotoxic effects have been shown in a variety of prokaryotic systems; however, negative results have been reported in human in vivo studies. Due to its wide spread use, a study was performed to evaluate the chromosomal aberration frequencies in peripheral blood lymphocyte cultures from 10 individuals, before and after metronidazole treatment. A significant increase in the percentage of cells with chromatid and isochromatid breaks was observed after metronidazole treatment (1500 mg per day for 10 days). The percentages of cells with aberrations did not correlate with the levels of MTZ found in plasma. Individual variability was observed with respect to both the induction of aberrations and the concentration of MTZ in plasma. They could represent differences at the metabolic level, since metronidazole is known to be biotransformed by a polymorphic P450 cytochrome, and its metabolites have shown mutagenic activity.

Sertoli cell conditioned media modulate the androgen biosynthetic pathways in rat Leydig cell primary cultures

Increasing evidence suggests the presence of local modulators that contribute to testicular function regulation in rats. The seminiferous tubules and Sertoli cell factors influence the steroidogenic activity of Leydig cells. Addition of Sertoli cell conditioned media to primary cultures of adult rat Leydig cells produces in a dose-dependent manner an inhibition of testosterone production with a concomitant decrease in the C21 delta 4-intermediates of the steroidogenic pathway, modifying the C21/C19 ratios in normal cells. The nature and mechanisms of action of this putative modulating activity are currently under study.

Pseudoaneurysm of the inferior epigastric artery. Pathogenesis, diagnosis, and treatment

We present a new case of pseudoaneurysm of the abdominal wall, subsidiary to the inferior epigastric artery, associated with the use of discharge sutures. Pseudoaneurysms are a well-known complication of surgery, puncture, or trauma. Pseudoaneurysms of the inferior epigastric artery are very infrequent. We know of only two cases in the literature. In both cases, the pseudoaneurysm was associated with the use of discharge sutures. We discuss its pathogenesis, diagnosis, and treatment.

[Safety in the switching traditional cyclosporin to microemulsion cyclosporin in stable renal transplant patients: cooperative study]

In an open clinical trial we assessed the tolerance and safety of the 1:1 conversion of traditional cyclosporine A (CyA) to a new cyclosporine formulation based on a microemulsion technology (CyN) in 18 patients with stable renal allografts. 56% patients were female. Median patient age was 40.9 +/- 3.2 years (range 18 to 65). Renal transplantation was performed in 24.1 +/- 4.6 months (range 6 to 67 months), prior to the beginning of the study, and 67% of the transplants were from cadaveric donor. The most frequent underlying renal disease was glomerulonephritis (44.4%). None of the patients entering the study were withdrawn prematurely. After 2 weeks of observation for graft function stability, the study was divided in two phases: I: during 4 weeks the patients received CyA traditional at fixed doses (Mean dose administered 3.056 +/- 0.25 mg/Kg/d) and II: during the consecutive 6 weeks with conversion to CyN, with doses adjustment as required (Mean dose 2.887 +/- 0.21 mg/Kg/d). Clinical events, adverse reactions and laboratory parameters were evaluated. Levels of 100-200 ng/ml measured by monoclonal specific fluorescence polarization immunoassay were considered appropriate. There were no significant changes in physical examination and laboratory parameters between phases. The incidence of adverse reactions reported in phase I was only gingival hypertrophy (5%) which persisted in phase II, qualified as probably related to the cyclosporine, and in phase II tremor in 17%, qualified as definitively related. Both drugs were well tolerated and there was no report of acute rejection during the study. We conclude that the tolerance and safety of the 1:1 conversion of CyA to CyN were confirmed by our results, and considering the improved pharmacokinetic properties of the second, the microemulsion presentation will be used preferentially as immunosuppressive drug in the treatment of stable kidney transplant patients.

Heroin addicts and methadone treatment in Albuquerque: a 22-year follow-up

All heroin addicts who registered for methadone treatment in Albuquerque in 1969-1971, 1019 in all, were the subjects of this follow-up study, conducted in 1991-1993. The cohort was almost entirely of Hispanic (Chicano) ethnicity, 86% male, with median age 27 at entry. We located 776, dead or alive, and we were able to interview 243 concerning many aspects of their lives. At least one-third of the original group had died during the 22-year period, representing standard mortality ratios 4.0 for males and 6.8 for females. Drug overdose, violence, alcohol, or suicide accounted for nearly all deaths of which the causes were known. Despite the availability of treatment, including methadone maintenance, both heroin use and criminality continued at a high rate. Of the 428 known survivors, 48% were currently enrolled in a methadone program after 22 years. They were using significantly less heroin, alcohol, and other drugs (except nicotine) than those not on methadone. Similar beneficial effects of methadone maintenance were reported retrospectively at interview. Our findings offer an insight into heroin addiction as a chronic lifelong relapsing disease with a high fatality rate.

The therapeutic approach to the control of hypertension. Its impact on health policy

The pharmacologic approach to the control of hypertension must consider both the clinical perspective and the Public Health approach policy in which social costs have to be balanced against benefits to the entire population. Cost-effectiveness analysis are at the core of decisions taken within this frame of reference. The issue of cost-effectiveness of preventive and therapeutic measures are crucial in the case of less developed countries. An analysis of studies undertaken in Mexico leads to the conclusion that, from a Public Health perspective, a program for the control of hypertension with a strong emphasis on drug therapy is likely to require a significant proportion of the health budget. Therefore, more emphasis must be placed on primary prevention based on modifications of life style.

Military emergency medicine physician assistants

For well over 200 years, non-physician practitioners have been providing quality, supplemental medical care in civilian and military communities worldwide. Physician shortages, increased accessibility, and cost-effectiveness have made supplemental health care especially appealing in the 1990s. Physician assistants are perhaps the most well-known of these physician extenders. Initially incorporated into the primary care system, physician assistants are now encouraged to specialize. One of the newest and most exciting areas of specialization is emergency medicine with residency programs available at Brooke Army Medical Center in Texas and Madigan Army Medical Center in Washington.