Pilot project of biogas production from pig manure and urine mixture at ambient temperature in Ventanilla (Lima, Peru)

Parque Porcino de Ventanilla has an extension of 840ha with 2200 farmers dedicated to pig production. There is a lack of services in the area (i.e., water supply, electricity, or waste collection). Anaerobic treatment of pig manure would replace current dumping and incineration, reducing environmental pollution and hazards to public health, as well as providing an organic fertilizer and biogas. The objective of the present work was to study the viability of ambient temperature anaerobic digestion of pig manure diluted in urine, by means of on-site pilot scale reactors. The final goal was to establish design parameters for anaerobic digesters to be implemented; since it was part of a project to improve life conditions for the farmers through the incorporation of better management techniques. Experiments were carried out in a low-cost pilot plant, which consists of three anaerobic digesters (225L total volume), without heating or agitation, placed in a greenhouse. The start-up of the digestion process was performed with a mixture of temperature adapted pig manure-sludge and fresh rumen, and showed a good performance regardless of the dilution of pig manure with water or urine, which is a key parameter due to the scarcity of water in the area under study.

[Hypothyroidism and terminal renal failure in the neonatal period]

It has been described alterations of the thyroid function in patients with chronic renal disease without primary disease of the thyroid gland. Nevertheless primary hypothyroidism is more frequent in this population than in other non renal chronic disease. Authors report two cases of hypothyroidism diagnosed in infants with terminal renal failure in the neonatal period, secondary to renal hypoplasia / dysplasia, both in peritoneal dialysis programme. The diagnosis was made by elevated value of thyrotropin (TSH) on the metabolic screening test (TSH/PKU screening test) and confirmed later by measure of serum TSH, total triiodothyronine (T3), total thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4) and thyroglobulin (TGB). It was also investigated antithyroid autoantibodies. Both infants initiated hormonal substitution with thyroxin, which have been suspended in one of them by two years of age when thyroid function was normal.

Outcome of three cases of untreated maternal glutaric aciduria type I

We report, for the first time, the outcome of three children born to two women with untreated glutaric aciduria type I (GA I). Isolated hypocarnitinemia in neonatal screening in one baby allowed the identification of the disease in his mother, who was undiagnosed so far and had had a previous daughter. The other baby was born to an already diagnosed mother who was not treated; newborn screening in the child reflected the metabolic state of the mother. Biochemical abnormalities returned to normal within one week. At the age of 4 months, neuroimaging showed Sylvian enlargement in both infants and bilateral temporal arachnoid cysts in one. Physical and neurological developments were normal for the three patients at ages 2 and 5 years. We conclude that long-term follow up will determine the true impact of GA I in such children.

The effect of alcohol swabs and filter straws on reducing contamination of glass ampoules used for neuroaxial injections

We have investigated the incidence of contamination of the contents of glass ampoules used for neuraxial injections, and whether this was reduced by wiping the outsides of the ampoules with isopropyl alcohol or using a filter straw. One hundred fentanyl and diamorphine ampoules used for routine regional anaesthesia were either wiped or not wiped with alcohol before their contents were aspirated, and the residual contents were swabbed and incubated. None of the swabs from the wiped ampoules grew organisms compared with nine (18%) from non-wiped ampoules (p = 0.004). In a second, laboratory study, 100 glass ampoules of saline were coated with Staphylococcus aureus and divided into four groups: wiped/not wiped with alcohol and with/without a filter straw. The contents of the ampoules were aspirated; the remnants and the aspirate were swabbed and incubated as before. Most contamination occurred in the unwiped groups and although numbers were small, filtering appeared to reduce contamination further. As filter straws also reduce the risk of injecting glass particles (even if not contaminated), our results suggest that wiping glass ampoules with isopropyl alcohol and using a filter straw should be part of routine practice when performing regional anaesthesia.

Androgen-replacement therapy depresses the ex vivo production of inflammatory cytokines by circulating antigen-presenting cells in aging type-2 diabetic men with partial androgen deficiency

Androgens are considered to have immunomodulatory effects but their cellular mechanisms of action remain largely unknown. In the present study we prospectively analyzed the serial effects of androgen-replacement therapy on both the distribution of peripheral blood lymphocytes, monocytes and dendritic cells as well as on the production of interleukin (IL)-1beta, IL-6 and tumor necrosis factor alpha (TNFalpha) inflammatory cytokines by circulating monocytes and CD33 myeloid, CD16 and plasmacytoid dendritic cell subsets, the most potent antigen-presenting cells (APCs) in type-2 diabetic men with partial androgen deficiency. Analyses were performed before therapy and at 1, 3, 6 and 12 months after treatment with 150 mg testosterone enanthate every 2 weeks in a group of 13 type-2 diabetic men. Our results show for the first time that testosterone-replacement therapy is associated with a reduction or complete abrogation of spontaneous ex vivo production of IL-1beta, IL-6 and TNFalpha by APCs. Meanwhile, the in vitro production of inflammatory cytokines by these cells after stimulation with lipopolysaccharide plus recombinant human interferon-gamma remained unchanged, suggesting that APCs preserve their constitutive machinery to produce inflammatory cytokines under androgen treatment. These results confirm and extend previous observations about the anti-inflammatory effects of androgen therapy on APCs in a new, previously unexplored model of androgen deficiency; namely, aging type-2 diabetic men. A decreased production of inflammatory cytokines by APCs might have important consequences for sex differences in susceptibility to autoimmune diseases, inflammatory response to injury and atheromatosis.

Diagnostic pitfalls in fine-needle aspiration cytology of temporomandibular chondroblastoma: report of two cases

Chondroblastoma is a benign bone neoplasm, which usually presents in the epiphysis of long bones, but can occur in unusual locations. This report describes the clinical, radiologic, and cytologic features on FNA of two chondroblastomas of the temporomandibular region that were only recognized by histopathologic study. This emphasizes the diagnostic pitfalls of this entity and expands the cytologic differential diagnosis of tumors of the parotid region.

Classical genotropic versus kinase-initiated regulation of gene transcription by the estrogen receptor alpha

Elucidation of kinase-initiated routes by which the estrogen receptors alpha and beta (ERalpha and ERbeta) control gene transcription, along with evidence of distinct biologic outcomes in response to ligands that can selectively activate nongenotropic signaling of the ERs or the androgen receptor, suggest that the ERs control a range of genes wider than that regulated by their direct association with DNA. To ascertain the extent and significance of nongenotropic ER-mediated transcription, we employed transduced HeLa cells expressing wild-type ERalpha or the ligand binding domain of ERalpha localized to the cell membrane (E-Mem), the OB-6 osteoblastic cell line, MCF-7 breast carcinoma cells and uteri from mice treated with 17beta-estradiol (E(2)), or the nongenotropic signaling activator 4-estren-3alpha,17beta-diol (estren). E(2) and estren induced ERK1/2 and Akt phosphorylation in ERalpha or E-Mem stably transfected HeLa cells; however, the phosphorylation kinetics differed between the two cell lines. In all four models, nongenotropic ER actions regulated a population of genes distinct from those regulated by genotropic ER actions. Specifically, the expression of Wnt2, Frizzled10, Egr-1, and c-Fos was strongly up-regulated in E-Mem-containing HeLa cells treated with E(2) or estren, or in ERalpha-containing HeLa cells treated with estren. Up-regulation of Frizzled10 by estren was reproduced in MCF-7 cells. Egr-1 was up-regulated by both estren and E(2); but complement 3, only by E(2) in the uteri. Estren had no effect on complement 3, cathepsin D, progesterone receptor, bcl-2, and cyclin D1 in MCF-7 cells, whereas E(2) up-regulated all these estrogen response element or activating protein-1-containing genes. These results support an extensive divergence in gene expression depending on the mode of ER activation.

Immunosuppression With Antithymocyte Globulin in Renal Transplantation: Better Long-Term Graft Survival

We analyzed the impact of antithymocyte globulin (ATG) in renal transplantation. We retrospectively studied 1217 recipients performed from July 83 to December 03. ATG-Fresenius-S (ATG-F) was used for induction therapy in 492 patients (40.4%; group I) and compared with group II, 725 patients (59.6%), without antilymphocyte induction. Groups were comparable in terms of recipient gender and race distribution; time on dialysis; cause of renal disease; number of human leukocyte antigen (HLA) mismatches; donor age, gender, and creatinine; and cold ischemia time. Patients with ATG-F were younger (35.8 +/- 13.8 vs 38.9 +/- 12.5 years, P < .001), more frequently hypersensitized (10% vs 3%, P < .001), and had more second transplants (15.7% vs 5.8%, P < .001). The incidence of acute rejection episodes was lower among ATG-F patients (23.6% vs 32.1%, P = .004). Admission time and incidence of delayed graft function (DGF) were similar in the two groups. Graft survival at 1, 5, 10, and 15 years was 88.9%, 80.7%, 71.3%, and 64.9% in group I and 86.4%, 77.4%, 60.7%, and 48.4% in group II (P = .003). The difference in patient survival over the same follow-up did not reach statistical significance. Multivariate analysis showed that the risk of graft failure was higher for those who did not receive ATG-F (HR = 1.51; 95% CI, 1.14 to 2.00; P = .004). Donor age and DGF were also independent predictors of graft failure. Our results showed a better long-term graft survival among patients who received ATG-F, despite their higher immunological risk. The absence of induction with ATG-F, donor age, and DGF were independent risk factors for graft failure.

Conversion to Sirolimus in a Population of Kidney and Kidney-Pancreas Transplant Recipients

INTRODUCTION

Calcineurin inhibitors (CI) are associated with nephrotoxicity that might reduce long-term graft survival. We report our experience with sirolimus (SRL) conversion among a population of kidney and kidney pancreas transplant recipients.

METHODS

Thirty transplant recipients (6 women, 24 men; age 41 +/- 10.5 years old) were converted to SRL therapy at 25.97 +/- 32.5 months after transplantation. Indications for conversion were: intolerance to mycophenolate mofetil (n = 13), diabetes mellitus (n = 3), CI nephrotoxicity (n = 11), CI nephrotoxicity with chronic allograft rejection (n = 2), and side effects of azathioprine (n = 1). Follow-up after conversion is 3 to 45 months.

RESULTS

No significant changes were observed in the 3 months postconversion in renal function, hematological profile, and mean arterial blood pressure. In contrast there was a significant increase in cholesterol values (pre: 198.7 +/- 49.4, versus post 221.2 +/- 60.8, P = .018). At a follow-up of 15.2 +/- 9.9 months after conversion two patients (6.7%) died with functioning allograft (one because of infection and one to myocardial infarct) three kidney allografts (10.7%) have been lost: two chronic rejection; one infection. In two patients SRL therapy was discontinued (one infection, one refractory edema). Neither significant change in renal function nor episodes of acute rejection were observed.

CONCLUSIONS

Conversion to SRL was safe. There was no deterioration in renal function nor episodes of acute rejection. There was a significant increase in cholesterol values after conversion. The size of the sample and the time of follow-up may have determined our results.

[Acute renal ischemia--unusual cause of lumbar pain]

Acute renal artery occlusion is rarely found in daily clinical practice. Its rarity and inespecific clinical presentation are responsible for late diagnosis or diagnostic errors, with symptoms frequently being erroneously attributed to other more common entities. There is no consensus in what concerns therapeutic options. Multiple treatment modalities are described in the available literature. Some defend anticoagulant therapy and support measures only while others recommend other more invasive alternatives reaching even open surgery. The authors present two additional case reports of acute embolic renal ischemia. A thorough literature review is also presented comprehending etiological, clinic, diagnostic and therapeutic aspects.

High magnetic field induced charge density wave state in a quasi-one-dimensional organic conductor

The quasi-one-dimensional organic conductor (Per)2Pt(mnt)2 exhibits a charge density wave ground state below 8 K. Magnetoresistance and magnetization measurements show that the charge density wave is suppressed with magnetic fields of order 20 T, above which a high resistance state, with a cascade of subphases, appears. This new state, tentatively identified as a field induced charge density wave, reenters a low resistance state above 40 T. The results are presented in light of theoretical work [D. Zanchi et al. Phys. Rev. B 53, 1240 (1996)]] involving field induced charge density wave ground states in high magnetic fields.

Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control

Aging in the male is associated with both a higher incidence of type 2 diabetes and hypogonadism. However, little information is available about the complex of symptoms and hormonal changes related to partial androgen deficiency in aging (called andropause) in type 2 diabetic men. Here, for the first time, we used a combination of clinical and hormonal criteria to define andropause and to analyze the relationships between the androgen environment and glucose metabolism in 55 type 2 diabetic men (63.6 +/- 7.9 years, mean +/- SD). Low plasma levels of total testosterone (< or =3.4 ng/mL) and free testosterone (< or =11 pg/mL) were found in 20% and 54.5%, respectively, of the diabetic men. The fraction of diabetic men with subnormal levels of total testosterone increased with aging: 14.2% (50 to 59 years), 17.4% (60 to 69 years) and 36% (> 70 years). The corresponding figures for subnormal values of free testosterone were 38%, 69.6%, and 54.5%, respectively. In the whole group of type 2 diabetic men, no significant linear correlations between total or free testosterone with fasting plasma glucose, insulin, C-peptide, or fructosamine values could be established. Total testosterone was positively correlated with glycosylated haemoglobin (HbA(1c)) levels (r =.322, P =.01). Although fasting plasma glucose was marginally higher in aging type 2 diabetic patients with andropause than in those without andropause (162 +/- 6.9 v 139 +/- 8.9, mean +/- SEM, P =.05), there were no differences between both subgroups for plasma fasting insulin, C-peptide, fructosamine, or HbA(1c) levels. Replacement therapy (150 mg intramuscular [IM] of enanthate of testosterone every 14 days for 6 months) was applied in 10 type 2 diabetic men with clinical features of andropause associated with subnormal concentrations of serum testosterone. The treatment induced significant increases in total plasma testosterone (baseline: 3.9 +/- 0.3; at 6 months: 7.1 +/- 0.9 ng/mL, mean +/- SEM, P =.003) and free testosterone (baseline: 9.3 +/- 0.6; at 6 months 17.6 +/- 2.4 pg/mL, P =.003), but had a neutral effect on overall glycemic control. These data show a high prevalence of andropause in aging type 2 diabetic men and suggest that the endogenous androgen environment, as well as correction of the partial androgen deficiency, do not have a meaningful effect on glycemic control.

[A case of epilepsy simulating a pheochromocytoma]

INTRODUCTION

Autonomic epilepsy is a rare entity that results from an epileptogenic focus involving certain structures belonging to the autonomous nervous system; it is characterised by the occurrence of convulsive seizures that consist in autonomic phenomena.

CASE REPORT

We report the case of a 28-year-old female patient who suffered paroxysmal episodes similar to those accompanying a pheochromocytoma. Following a thorough examination, both the presence of a tumour and the anomalous production of catecholamines were excluded and, although it was not possible to provide electroencephalographic evidence, the patient was diagnosed as suffering from autonomous epilepsy, which was later confirmed by the clinical efficacy of valproic acid therapy.

CONCLUSIONS

Autonomic seizures often show characteristics that are singular or similar to those of other clinical entities. This makes the disorder difficult to diagnose and sometimes requires therapeutic testing with anticonvulsive drugs.

Siringocele imperforado de las glándulas de cowper. tratamiento por vía laparoscópica

OBJECTIVES

The authors present a clinical report of an imperforate syringocele diagnosed on a male patient and treated by laparoscopic surgery.

MATERIAL AND METHODS

A forty-four year old patient attends the emergency room with acute urinary retention. With a former history of mild obstructive voiding symptoms, he presented, at rectal examination, a bump on the left rectal wall. This patient also underwent urethrocistoscopy, sonography and retrograde urethrography. To establish the diagnose, Computerized Tomography (CT) scan and MRI were used.

RESULTS

The syringocele marsupialization by laparoscopic surgery, allowed the resolution of the clinical problem, with a good outcome. The patient was discharged 48 hours after surgery, with no need of a vesical catheter. A six month follow-up showed no recurrence.

CONCLUSIONS

The syringocele is a rare deformity which usually is asymptomatic. Of acquired or congenital etiology, it can be classified in four different morphological types: simple, perforate, imperforate and ruptured. The most frequent treatment is the marsupialization of the syringocele by endoscopic surgery, leaving a broad opening of the cavity to the urethra. Some authors recommend an open surgery excision, specially in the presence of an abscess. The laparoscopic approach becomes a minimally invasive alternative with good therapeutically outcome. In the incidentally discovered asymptomatic patients, an expectant approach is the correct approach.

[Burch colposuspension]

OBJECTIVE

This study was undertaken to evaluate the subjective success rates, and complications, of Burch colposuspension.

DESIGN

A retrospective review.

SAMPLE

Fortynine women undergoing surgery - Burch colposuspension - for genuine stress incontinence, between 1994 and 2000, were reviewed.

METHODS

Choice of surgical procedure was made on the basis of clinical and urodynamic findings and physician preference. The subjective cure rate was determined by means of historical report and defined as no or occasional stress or urge incontinence (< one episode per week). Clinical follow-up started six weeks after the surgical procedure and continued for one to seven years.

RESULTS

Thirty-six (73.5%) of the 49 women submitted to Burch colposuspension were subjectively cured of the stress urinary incontinence and three (6,1%) had improvement with mainly urge incontinence, while ten (19.2%) operations failed (n= 52).

CONCLUSION

Burch colposuspension is an effective and safe procedure for women with urinary stress incontinence (even after retropubic continence surgery).

The reliability of immunohistochemistry as a prescreening method for the diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC)--results of an international collaborative study

Hereditary nonpolyposis colorectal cancer syndrome (HNPCC) is an autosomal dominant condition accounting for 2-5% of all colorectal carcinomas as well as a small subset of endometrial, upper urinary tract and other gastrointestinal cancers. An assay to detect the underlying defect in HNPCC, inactivation of a DNA mismatch repair enzyme, would be useful in identifying HNPCC probands. Monoclonal antibodies against hMLH1 and hMSH2, two DNA mismatch repair proteins which account for most HNPCC cancers, are commercially available. This study sought to investigate the potential utility of these antibodies in determining the expression status of these proteins in paraffin-embedded formalin-fixed tissue and to identify key technical protocol components associated with successful staining. A set of 20 colorectal carcinoma cases of known hMLH1 and hMSH2 mutation and expression status underwent immunoperoxidase staining at multiple institutions, each of which used their own technical protocol. Staining for hMSH2 was successful in most laboratories while staining for hMLH1 proved problematic in multiple labs. However, a significant minority of laboratories demonstrated excellent results including high discriminatory power with both monoclonal antibodies. These laboratories appropriately identified hMLH1 or hMSH2 inactivation with high sensitivity and specificity. The key protocol point associated with successful staining was an antigen retrieval step involving heat treatment and either EDTA or citrate buffer. This study demonstrates the potential utility of immunohistochemistry in detecting HNPCC probands and identifies key technical components for successful staining.

[Kidney failure associated with Plasmodium falciparum infection]

Plasmodium falciparum infection may be a cause of acute renal failure (ARF). Whereas renal failure appears to be a common complication of severe malaria in adults, it seldom occurs in children. The authors report a case of a previously healthy 9-year-old child, who was admitted with fever, vomits, diarrhoea, jaundice and obnubilation of consciencious. The results of laboratory tests performed confirmed the diagnosis of falciparum malaria. At the 2nd day of hospitalization she was in ARF and dialysis was necessary. We admitted that the probable underlying factors leading to this complication were: intravascular haemolysis, volume depletion, hypotension and hyperparasitaemia. Despite the presence of predictive factors of bad outcome the evolution was favourable with gradual recuperation of renal function.

Modelling in-sewer pollutant degradation processes in the Costa do Estoril sewer system

Characteristics of wastewater vary during transportation through sewer systems as a result of a number of processes. Under aerobic conditions, in long sewer systems, the reduction of the BOD or COD may be similar to the reduction obtained in conventional primary settling tanks. The mathematical model that was developed is based on a number of different existing models: the ASM n. 1 and ASM n. 2 models, the AEROSEPT model and the WATS model. The model also includes a prediction of reaeration at falls. The module of the anoxic conditions was adapted from the ASM n. 2 model. This module is a first attempt to model the degradation of organic matter in sewer systems under anoxic conditions. The mathematical model was applied to the Costa do Estoril intercepting sewer, and the obtained results are discussed taken into account the experimental data that was collected during a three-month period. Average removals of dissolved COD over 20% have been obtained. In the paper special emphasis is given to the importance of the performance of the Costa do Estoril sewer system as a biological reactor.

Rheological behavior of aqueous suspensions of hydroxyapatite (HAP)

The aim of this study is to characterize the influence of organic dispersants on the stability of hydroxyapatite (HAP) dispersions, using viscosity measurements, electrokinetic sonic amplitude (ESA) measurements and adsorption isotherms. Colloidal stability of aqueous suspensions of HAP as a function of solids loading and of the type and concentration of deflocculant has been studied. The interaction between particles and dispersant molecules was characterized. Adsorption measurements of the amount of dispersants on the particles surface, viscosity and electrophoretic measurements as a function of the dispersant concentration are correlated. Suspension parameters have been adjusted in order to obtain a high solids loading slurry with a plastic viscosity which will allow its use in colloidal processing.

r-Sm14 - pRSETA efficacy in experimental animals

Previous studies carried out with Sm14 in experimental vaccination against Schistosoma mansoni or Fasciola hepatica infections were performed with recombinant Sm14 (rSm14) produced in Escherichia coli by the pGEMEX system (Promega). The rSm14 was expressed as a 40 kDa fusion protein with the major bacteriophage T7 capsid protein. Vaccination experiments with this rSm14 in animal models resulted in consistent high protective activity against S. mansoni cercariae challenge and enabled rSm14 to be included among the vaccine antigens endorsed by the World Health Organization for phase I/II clinical trials. Since the preparation of pGEMEX based rSm14 is time consuming and results in low yield for large scale production, we have tested other E. coli expression systems which would be more suitable for scale up and downstream processing. We expressed two different 6XHis-tagged Sm14 fusion proteins in a T7 promoter based plasmids. The 6XHis-tag fusions allowed rapid purification of the recombinant proteins through a Ni+2-charged resin. The resulted recombinant 18 and 16 kDa proteins were recognized by anti-Sm14 antibodies and also by antiserum against adult S. mansoni soluble secreted/excreted proteins in Western-Blot. Both proteins were also protective against S. mansoni cercariae infection to the same extent as the rSm14 expressed by the pGEMEX system.

[Constrictive pericarditis: an early diagnosis?]

The authors report a case study of a 73-year-old male, with signs of right-sided heart failure with 6 months of evolution. It was constrictive pericarditis, without radiologic, echocardiographic and magnetic resonance imaging manifestations, diagnosed on the basis of the clinical situation and hemodynamic evaluation during cardiac catheterization. The authors suggest that the lack of imagiologic manifestations might have been the result of an early diagnosis, before the development of the classic picture. Pericardiectomy, performed with success, was followed by resolution of the heart failure. It was not possible, histologically, to draw conclusions about the etiology. The development of mitral regurgitation after pericardiectomy has enriched this case with an unusual, but previously described, complication of this type of surgery.

Use of stents for small coronary arteries. Results of the Multi-Link 2.5 Portuguese Registry

INTRODUCTION

Stents are being used with increasing frequency in percutaneous transluminal coronary angioplasty (PTCA) but their use in small vessels is still controversial, due to the possibility of excessively high rates of adverse events and restenosis.

OBJECTIVE

To assess the safety and clinical efficacy of ACS RX Multi-Link (ML) 2.5 mm stents, in "de novo" coronary stenosis.

DESIGN

Prospective Registry, with 6 months clinical follow-up, involving all Portuguese centers of Interventional Cardiology.

POPULATION

Between April 7 and November 20 1998, 102 patients were enrolled, 82 male and with ages ranging from 30 to 86 years (average 58 +/- 11). Clinical presentation for PTCA was stable angina in 53%, unstable angina in 36% and silent ischemia in 11%. There was a history of previous myocardial infarction in 29% of patients. The main risk factors were hypertension (58%), hyperlipidemia (57%), smoking (25%) and diabetes (20%). Multivessel coronary artery disease was present in 46% of patients and left ventricular function was normal in 89%. Of the 217 existing lesions, 188 (87%) were treated: 35 with balloon angioplasty and 153 with stent implantation, 114 of which were ML 2.5 mm: 79 of 15 mm in length and 35 of 25 mm.

METHODS

Angiographic success with ML stent implantation and major adverse cardiac events (MACE)--myocardial infarction (MI), coronary artery bypass graft (CABG), new target vessel revascularizations and death--were evaluated during hospital stay, and at 1 and 6 months clinical follow-up.

RESULTS

Angiographic success was 97.4%. In one patient it was not possible to cross the lesion, in another there was stent migration and in a third distal coronary flow after stenting was TIMI grade 1. Clinical success was 96.1% and there were no cases of death, Q-wave MI or urgent CABG. Two patients had non-Q wave MI and two required urgent repeat angioplasty. Subacute stent thrombosis occurred in 1 patient. There were no additional MACE at 1 month follow-up. At 6-month follow-up (in 97% of patients) MACE had occurred in 14.1%: 2 deaths (one non-cardiac), 3 MI (one non-Q) and 14 new PTCA (one in a non-ML stent). There was no need for CABG in any patient. Six-month survival rate was 97.9%, 94.9% were free of infarction and 84.8% were free of infarction and new revascularization.

CONCLUSIONS

Multi-Link 2.5 mm stent implantation appears to be safe and efficient with a low incidence of immediate and 6-month adverse events in the range of centers and operators of the Registry.

Results of the quantitative coronary angiographic analysis in the angiographic subgroup of the Multi-Link 2.5 Portuguese Registry

INTRODUCTION

The restenosis rate of stents implanted into small coronary arteries is considered higher than that of stents in arteries > or = 3 mm, but could be influenced by clinical parameters and by the type and length of the stents.

OBJECTIVE

To assess the incidence of angiographic restenosis at 6 months after implantation of 2.5 mm ACS RX Multi-Link (ML) stents, 15 and 25 mm length, in de novo coronary stenosis.

DESIGN

Angiographic substudy of the Portuguese Multi-Link 2.5 Registry, which included Interventional Cardiology centers with facilities for coronary angiographic recordings allowing quantitative analysis.

POPULATION

Between April 7 and November 20 1998 and in the 5 hospitals that agreed to participate, 61 patients were enrolled and 40 selected as having procedural and 6-month angiographies of sufficient quality for quantitative analysis. The only significant differences in the demographic, clinical and angiographic characteristics of the patients relative to those of the Registry were the lower prevalence of unstable angina and smoking in the angiographic substudy. There were 43 lesions and 46 ML stents were implanted. In 37% the lesions were located in the LAD, in 37% in the LCx and 26% in the RCA. 29 stents of 15 mm length and 17 stents of 25 mm were used.

METHODS

The morphologic characteristics of the lesions were analyzed subjectively using the AHA/ACC classification. Quantitative coronary analysis (QCA) was performed, in an independent laboratory using the CAAS 2 system, for reference vessel diameter, lesion length, percentage of stenosis, minimum lumen diameter (MLD) and related parameters. Restenosis was defined as > or = 50% lumen obstruction at 6-month angiography.

RESULTS

In the subjective analysis, 2 lesions were type B1, 27 type B2 and 14 type C. The overall restenosis rate was 32.6%. Restenosis was 27.7% for 15 mm stents and 36% for 25 mm stents (p = 0.4). For the QCA parameters analyzed, only MLD at the end of stent implantation was a predictor of 6-month restenosis (2.19 +/- 0.30 without vs. 2.03 +/- 0.18 with restenosis, p = 0.048).

CONCLUSIONS

The restenosis rate of the Multi-Link 2.5 mm stents, of 15 and 25 mm length, was similar to that described with other types of stents in small coronary arteries. Minimum lumen diameter after stenting was found to be the best predictor of 6-month restenosis.

Vanadium haloperoxidases from brown algae of the Laminariaceae family

Vanadium haloperoxidases were extracted, purified and characterized from three different species of Laminariaceae--Laminaria saccharina (Linné) Lamouroux, Laminaria hyperborea (Gunner) Foslie and Laminaria ochroleuca de la Pylaie. Two different forms of the vanadium haloperoxidases were purified from L. saccharina and L. hyperborea and one form from L. ochroleuca species. Reconstitution experiments in the presence of several metal ions showed that only vanadium(V) completely restored the enzymes activity. The stability of some enzymes in mixtures of buffer solution and several organic solvents such as acetone, ethanol, methanol and 1-propanol was noteworthy; for instance, after 30 days at least 40% of the initial activity for some isoforms remained in mixtures of 3:1 buffer solution/organic solvent. The enzymes were also moderately thermostable, keeping full activity up to 40 degrees C. Some preliminary steady-state kinetic studies were performed and apparent Michaelis-Menten kinetic parameters were determined for the substrates iodide and hydrogen peroxide. Histochemical studies were also performed in fresh tissue sections from stipe and blade of L. hyperborea and L. saccharina, showing that haloperoxidase activity was concentrated in the external cortex near the cuticle, although some activity was also observed in the inner cortical region.

Antioxidant activity of hydroxytyrosol acetate compared with that of other olive oil polyphenols

Hydroxytyrosol acetate was synthesized, and the antioxidant activity of this olive oil component was assessed in comparison with that of other olive oil components, namely hydroxytyrosol, oleuropein, 3,4-DHPEA-EA, and alpha-tocopherol in bulk oil and oil-in-water emulsions. The activity of the compounds was also assessed by scavenging of 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals. Hydroxytyrosol acetate had a weaker DPPH radical scavenging activity than hydroxytyrosol, oleuropein, or 3,4-DHPEA-EA but it had a radical scavenging activity similar to that of alpha-tocopherol. In oil, the antioxidant activity of hydroxytyrosol acetate was much higher than that of alpha-tocopherol or oleuropein, but in an emulsion 3,4-DHPEA-EA and alpha-tocopherol were more effective as antioxidants than hydroxytyrosol acetate. The antioxidant activity of hydroxytyrosol acetate was rather similar to that of hydroxytyrosol in oil and emulsions despite the difference in DPPH radical scavenging activity.