Lumbar spine bone density in Argentine children

It has been demonstrated that bone mineral density (BMD) in children and adolescents is influenced by individual height. The aim of the present work was to introduce a formula to include height in the BMD analysis. Postero-anterior (PA) (L2-L4) and lateral (L2-L3) lumbar BMD was assessed by dual X-ray absorptiometry (DXA) in 433 and 393, respectively, healthy Caucasian females from 2 to 20 years of age. A complete medical examination including weight, height, and Tanner puberal stage was performed in all the subjects. Bone age was assessed by left wrist radiographs and analyzed by the TW2 method to insure that it was within 1 year of chronological age. Bone mineral density adjusted for height (BMDcorr = BMC/projected area x height), was calculated for each individual. As analyzed by Tanner stage, both PA and lateral BMD increased up to stage 3, and there were no significant differences among stages 3-5. Results of BMDcorr variations related to Tanner stage suggested that the increase in lateral BMD before puberty might be related to height. PA BMDcorr increased up to Tanner stage 3, and there were no differences among stages 3-5. The BMDCORR approach can be used to get a more reliable analysis of BMD studies in children and adolescents.

Pityriasis rubra pilaris and human immunodeficiency virus infection

Recently, the occurrence of pityriasis rubra pilaris (PRP) has been reported in patients with HIV infection. It presents different clinical features, and has a poorer prognosis, than the classical adult type of PRP. We report the occurrence of severe PRP in an HIV-infected patient, and review the previously reported cases of this association. We propose the designation of a new category of PRP (type 6), characterized by the presence of HIV infection, usually without immunosuppression, a poor prognosis and response to treatment, and the development of nodulocystic and lichen spinulosus lesions.

Detection of hypoglycemic drugs in human urine using micellar electrokinetic chromatography

Micellar electrokinetic chromatography (MEKC) is evaluated as a potential analytical method for the separation and detection of a series of sulfonylurea drugs used in the treatment of hyperglycemia. These drugs are often surreptitiously abused, producing extremely low blood glucose levels and symptoms indistinguishable from those associated with an insulin-secreting tumor. Separation buffer containing 50 mM sodium dodecyl sulfate (SDS) was found to be adequate for the MEKC separation of the third generation drugs (glipizide and glyburide) but not the second generation drugs (acetohexamide chlorpropamide, tolazamide, and tolbutamide). At a pH of 8.5 in the presence of 20 mM borate/20 mM phosphate and 150 mM SDS, all seven components were adequately resolved with an analysis time of 17 min. Altering the concentration of the buffering components to either 5 mM borate/5 mM phosphate or 40 mM borate alone reduced the analysis time to less than 10 min with no observable loss in resolution. A series of other micelle-forming surfactants were evaluated, and only sodium cholate provided an improvement over the SDS-based system. Optimal separation was obtained with 75 mM sodium cholate and led to complete analysis with baseline resolution of all seven components in less than 8 min. These conditions were shown to be adequate for the detection of the hypoglycemic drugs spiked into normal urine and in patients taking these drugs. The precision associated with nine consecutive injections of six samples (n = 54) was found to be acceptable with percent coefficient of variance for absolute migration times (MTabs) for all peaks averaging 0.89 with peak area and peak height being 8.49 and 8.26, respectively. The between-sample precision was found to average 0.92% for MTabs and 8.56% and 8.45%, respectively, for the relative peak area and peak height. With a detection limit for the drugs in urine (following extraction) in the 50 ng/mL range, the potential exists for an MEKC-based assay for the detection of sulfonylurea drugs in urine.

[Comparative study of clonidine and lidocaine on the attenuation of the intraocular pressure increase associated with laryngoscopy and endotracheal intubation]

OBJECTIVE

To verify and compare the efficacy of clonidine and lidocaine for attenuating the ocular hypertensive response generated by manipulation of the laryngoscope and endotracheal intubation (EIT).

PATIENTS AND METHODS

In this prospective double blind study 45 patients undergoing non-ocular surgery were divided into 3 groups according to pretreatment protocol: A, approximately 3 micrograms/kg clonidine orally 90-120 min before surgery; B, 1.5 mg/kg intravenous lidocaine 1 min before EIT and C, control group. On all patients we recorded intraocular pressure (IOP), mean arterial pressure and heart rate at the following times: basal, just before EIT, immediately after EIT, 5 minutes later and 10 minutes later.

RESULTS

The patients pretreated with clonidine had significantly lower IOP levels than did the control group at all measurements times; patients pretreated with lidocaine had lower IOP after induction and after intubation. IOP was significantly lower in patients who received lidocaine than in control group patients after EIT, although IOP levels with lidocaine were higher than with clonidine.

CONCLUSIONS

Pretreatment with oral clonidine is an effective method for preventing increases in IOP after EIT, is more effective than pretreatment with lidocaine, and should therefore be used for that end. Intravenous lidocaine represents a valid alternative in emergency cases when the approximate wait time of 2 hours is contraindicated.

[Hepatitis C virus: results of detection in several high risk groups in the X region of Chile]

The aim of this study was to determine the prevalence of hepatitis C virus antibodies in high risk patients coming from Valdivia, Osorno and Puerto Montt. Fifty-six patients in hemodialysis, 51 renal graft recipients, 42 cirrhotics and 14 patients with acute non A non B hepatitis were studied. Antibodies were detected with a second generation ELISA technique and positive cases were confirmed with RIBA. All hemodialysis patients and renal graft recipients were negative for hepatitis C virus antibodies. In one non alcoholic patient with cirrhosis, a positive ELISA was confirmed with RIBA. Six patients with acute hepatitis had positive ELISA tests but none was confirmed with RIBA. It is concluded that the prevalence of hepatitis C virus antibodies in this region of Chile is very low.

Transjugular intrahepatic portal-systemic shunt in the treatment of refractory ascites: effect on clinical, renal, humoral, and hemodynamic parameters

Seventeen cirrhotics with refractory ascites were treated with transjugular intrahepatic portosystemic shunt (TIPS) and followed for 15.5 +/- 3.4 months. Five patients died, four within 3 months after TIPS (hepatocellular failure) and one after 22 months (cholangiocarcinoma). Six patients received transplants 1 to 10 months after the procedure. Actuarial survival at 6, 12, and 24 months was 75%, 75%, and 63%, respectively. Portosystemic venous pressure gradient decreased by 46% at 1 month and by 38% at 7 to 12 months. Eight patients presented 18 stenoses 1 to 18 months after TIPS. Twelve stenoses required balloon dilatation. Tense ascites was present before TIPS in 100% of the patients, whereas it was mild or absent in 56% at 1 month, in 66% at 3 to 6 months, in 57% at 7 to 12 months, and in 100% at 24 months after TIPS. Requirements for diuretics and paracentesis decreased after TIPS (P < .001, both). One month after TIPS, urinary and fractional sodium excretion increased (P < .001, both), plasma renin activity, plasma aldosterone (P < .005, both), and plasma norepinephrine (P < .05) decreased and cardiac output (P < .01) increased, systemic vascular resistances (P < .005) decreased, and arterial pressure did not change. Acute hepatic encephalopathy was frequent early after TIPS but was responsive to treatment and caused no long-term disability. In conclusion, TIPS is useful in the treatment of refractory ascites through lowering portal pressure and improving renal sodium excretion. This effect could be attributable to an increase in effective blood volume causing deactivation of vasopressor systems.

Transjugular intrahepatic portal-systemic shunt in the treatment of refractory ascites: effect on clinical, renal, humoral, and hemodynamic parameters

Seventeen cirrhotics with refractory ascites were treated with transjugular intrahepatic portosystemic shunt (TIPS) and followed for 15.5 +/- 3.4 months. Five patients died, four within 3 months after TIPS (hepatocellular failure) and one after 22 months (cholangiocarcinoma). Six patients received transplants 1 to 10 months after the procedure. Actuarial survival at 6, 12, and 24 months was 75%, 75%, and 63%, respectively. Portosystemic venous pressure gradient decreased by 46% at 1 month and by 38% at 7 to 12 months. Eight patients presented 18 stenoses 1 to 18 months after TIPS. Twelve stenoses required balloon dilatation. Tense ascites was present before TIPS in 100% of the patients, whereas it was mild or absent in 56% at 1 month, in 66% at 3 to 6 months, in 57% at 7 to 12 months, and in 100% at 24 months after TIPS. Requirements for diuretics and paracentesis decreased after TIPS (P < .001, both). One month after TIPS, urinary and fractional sodium excretion increased (P < .001, both), plasma renin activity, plasma aldosterone (P < .005, both), and plasma norepinephrine (P < .05) decreased and cardiac output (P < .01) increased, systemic vascular resistances (P < .005) decreased, and arterial pressure did not change. Acute hepatic encephalopathy was frequent early after TIPS but was responsive to treatment and caused no long-term disability. In conclusion, TIPS is useful in the treatment of refractory ascites through lowering portal pressure and improving renal sodium excretion. This effect could be attributable to an increase in effective blood volume causing deactivation of vasopressor systems.

Bilateral basal cell carcinoma of the breasts in a woman

Basal cell carcinomas (BCC) on covered sites of the body are rare (1). A case of a young woman with superficial basal cell carcinoma of both breasts is described. No history of sun bathing, X-ray, or arsenical exposure was reported. Simple excision of both lesions was performed without recurrence.

Plasma levels of substance P in liver cirrhosis: relationship to the activation of vasopressor systems and urinary sodium excretion

The mediators of the hyperdynamic circulation of liver cirrhosis are not well characterized. Substance P is a potent vasodilatory peptide produced by the enteric nervous system and partly cleared by the liver. In this work we have investigated the plasma levels of substance P and their relationship to the hemodynamic, neurohormonal, and renal function changes occurring in patients with cirrhosis. Seven healthy subjects (control group), 7 cirrhotic patients without ascites (group I), and 24 cirrhotic patients with ascites (group II) were studied. Cardiac output (CO), femoral blood flow (FBF), blood volume (BV), femoral arteriovenous difference of oxygen content (Ca-v O2), plasma renin activity (PRA), plasma aldosterone concentration (PAC), and plasma norepinephrine (NE) were determined. Five patients underwent trans-jugular intrahepatic porto-systemic stent shunt (TIPSS) because of refractory ascites. Immunoreactive substance P (irSP) was measured by radioimmunoassay after plasma extraction. irSP was higher in ascitic patients than in healthy controls (P < .01) and directly correlated with PRA, PAC, plasma NE, and Pugh's score and was inversely correlated with urinary sodium excretion, glomerular filtration rate, and Ca-v O2. No differences were observed between portal and peripheral vein irSP concentration. TIPSS placement induced a decrease in portal pressure and an increase in CO but circulating irSP remained unchanged. Our data show that circulating irSP is increased in decompensated cirrhotic patients and may be involved in the pathogenesis of the hemodynamic changes of cirrhosis. Alleviation of portal hypertension did not result in decreased plasma levels of this vasodilatory substance.

Mucocutaneous leishmaniasis and HIV

Mucocutaneous leishmaniasis is a rare disease in Europe. Relapses after treatment are more frequent than in visceral leishmaniasis. HIV patients infected by Leishmania have frequently visceral involvement, and responses to treatment are poor. Mucocutaneous leishmaniasis in HIV-infected patients has rarely been reported. A patient with centrofacial granuloma was diagnosed as having mucocutaneous leishmaniasis; simultaneously HIV infection was detected. To our knowledge this is the first case acquired in Europe. Intravenous meglumine antimonate 20 mg/kg/day for 28 days was proven to be useful.

Clinical and nutritional factors predictive of plasma lipid unsaturation deficiency in advanced liver cirrhosis: a logistic regression analysis

AIM

To identify those clinical and nutritional factors associated with plasma lipid unsaturation deficiency in cirrhosis.

METHODS

Fatty acid profiles of plasma phospholipids (PL) and cholesteryl esters (CE) were measured in 101 inpatients with advanced cirrhosis and in 44 age- and sex-matched healthy controls. Double-bond index (DBI) was calculated for each fraction and binarily categorized in each patient using the 5th percentile of the control group as the cut-off limit. The association of 12 routine clinical, biological, and nutritional variables with derangement of each DBI was multivariately assessed by means of stepwise logistic regression analysis.

RESULTS

The DBI of PL and CE were below the 5th percentile of the control group in 60 and 68 of 101 cirrhotic patients, respectively. After multivariate analyses, the variables found to be independent predictors of impaired unsaturation were: 1) The presence of moderate/severe malnutrition (odds ratio: 1.3-8.0 (95% CI); p < 0.05) and serum tau-GT > 1 mukat/L (odds ratio: 0.2-1.0; NS) for plasma PL, and 2) the presence of moderate/severe malnutrition (odds ratio: 1.8-17.4; p < 0.05), serum bilirubin > 50 mumol/L (odds ratio 1.7-14.5; p < 0.05) and serum tau-GT > 1 mukat/L (odds ratio 0.1-1.1; NS) for CE.

CONCLUSION

Malnutrition appears to be a major factor for impaired lipid unsaturation in advanced cirrhosis. Thus, the possibility of improving plasma lipid unsaturation in these patients by means of nutritional support should be further investigated.

Testicular changes in adult rat following bilateral partial (caput) epididymectomy

Adult Wistar rats were either partial (caput) and bilaterally epididymectomized or bilaterally efferentectomized, as controls of duct obstruction. The effects on testicular germinal epithelium were studied at 7, 9, 11, 13, 15, 17, 19, 21, 23 and 25 days after surgery. No abnormalities were detected in sham-operated animals. Epididymectomized animals showed different levels of alterations with progressive disruption of the seminiferous epithelium, emergence of multinucleated bodies and some tubules obliterated by degenerated cells and cellular debris. Half way through the experiment there were tubules lacking their epithelia, as well as the Sertoli cells. On the 25th day degeneration was so important that is affected not only the epithelium (missing in almost all tubules) but also the tubular morphology. Eventually efferentectomized animals showed a progressive alteration, but its level was much lower than that observed after partial epididymectomy, indicating a possible specific function of the caput epididymidis in the control of testicular function.

A comparison of the effects of bilateral efferent duct ligation and of partial epididymectomy on the testes of rats

Testis weight as a percentage of body weight did not change following bilateral ligation of the efferent ducts (EDL) close to the epididymis, whereas following removal of part of the epididymis between the site of ligation and a point close to the junction between the caput and corpus (PCE), testis weight first rose linearly until Day 4 and then showed an exponential decrease between Days 4 and 28. After EDL, the perimeter of the seminiferous tubules rose for the first 7 days and then remained elevated, whereas after PCE, there was a linear decrease between Days 4 and 28. Following EDL, the percentage of altered and degenerated tubular cross-sections rose to about 30% and 10%, respectively, during the first 7 days after operation and then remained constant; after PCE, the percentage of altered tubules reached a maximum of 54% by 4 days and then fell, whereas the percentage of degenerated tubules continued to rise to 95% by 28 days. It would appear that all the effects of removal of a portion of the epididymis cannot be explained by blockage of the excurrent ducts, and a specific endocrine effect of the epididymis on the testis is proposed.

[Nephrotoxicity of gentamicin and netilmicin in the rat. Quantification and qualification of glomeruli]

The application via i.v. jugular, in rats, of two fluorochromes (rhodamine 6GO and phosphine 3R) with a 10 min interval, allows the direct observation of nephronal corpuscles using an epifluorescent microscopical technique, as well as their eventual quantification and qualification into normal or semifunctional corpuscles. In rats previously treated by i.p. injection of gentamicin or netilmycin a decrease of the active nephronal population as well as an increase of the percentage of semifunctionality has been noticed.

[Changes produced by the administration of rhodamine 6GO in the albino mouse]

The two doses, 5 and 7 mg/kg/day, were applied for periods of 14 or 28 days, with a 21 day break between two 14 days treatments in the latter case. Controls were only treated with physiological saline. A decrease in corporal weight and rectal temperature, as well as a decrease in ingestion and faeces together with urine increment were observed in the experimental animals during the first period of treatment. Normal levels were recovered during the break time, but the previous pattern reappeared during the second period of treatment. Suprarenals, liver, kidneys and spleen increased in some experimental groups when compared with controls whereas the thymus presented no significant differences. The studied organs showed signs of impairment.