Adult celiac disease with severe or partial villous atrophy: a comparative study

BACKGROUND AND AIMS

While severe villous atrophy (SVA) is the most typical histological feature in adult celiac disease (ACD), partial villous atrophy (PVA) is now also frequently found. So far, the impact of the severity of villous atrophy on the clinical presentation of ACD has been scarcely investigated. We aimed to compare the clinical, biological and immune features and outcomes in ACD patients presenting with PVA at diagnosis versus patients with SVA.

PATIENTS AND METHODS

Medical files of 48 patients with ACD diagnosed between 1992 and 2003 were retrospectively studied. The diagnosis was based on the presence of intestinal villous atrophy, with increases in intraepithelial lymphocytes and circulating celiac specific antibodies. Villous atrophy was classified as severe (subtotal and total) or partial. Symptoms, biological signs of malabsorption, immune markers, bone mineral density at diagnosis and response to gluten-free diet were recorded.

RESULTS

At diagnosis, ten patients (four M/six F) had PVA and 38 patients (five M/33 F) had SVA, with a median age of 54 and 33 years, respectively (p<0.05). Positivity for specific antibodies, HLA typing and frequency of autoimmune disease at diagnosis were similar in both PVA and SVA patients, as was their response to gluten-free diet. Diarrhea, malabsorption syndrome and osteopenia were independent of the degree of villous atrophy.

CONCLUSION

PVA was observed in 21% of patients with ACD. Except for their older age at diagnosis, patients with PVA presented with similar clinical, biological and immune characteristics and outcomes as did patients with SVA.

Rapid and deep control of inflammation in rheumatoid arthritis with infliximab and its correlation with acute-phase reactants

Rheumatoid arthritis (RA) is a chronic inflammatory disease with predominant joint involvement and possible systemic compromise, which leads to a handicapped status and poor quality of life. An optimal approach to treat RA requires early and intensive intervention with close monitoring of treatment response. Tumor necrosis factor (TNF) blockers are recommended in cases of active RA after the unsuccessful use of effective disease-modifying antirheumatic drugs (DMARDs); even adding them to treatment or replacing these drugs. Anti-TNF therapies have been demonstrated to reduce significant joint damage and to relieve symptoms during a prolonged time (see Scott and Kingsley, 2006). The efficacy of infliximab in an open-label trial is summarized with respect to speed of onset of action, durability of response, and its correlation between clinical and laboratory parameters. Safety for long-term treatment is also summarized. We studied 105 RA patients with more than 3 years' history of disease during 24 months on i.v. infliximab (75 completed study). We evaluated ACR responses at base line, and at 1, 6, 12, 16, 52, 77, and 104 weeks. Morning stiffness, swollen and tender joints, HAQ, SF-36% (PCS/MCS), polymerase chain reaction (PCR), erythrosedimentation rate (ESR), transaminases, rheumatoid factor (RF) levels, hemogram, and adverse events profile were all assessed. The treatment offered rapid and sustained clinical improvements as revealed by ACR responses and marked changes in the parameters previously described. Important changes were made in functional status and acute-phase reactants. Finally, infliximab was considered well tolerated and did not affect the safety profile of this trial.

Habitat use and phenology of the large insular endemic grasshopper Acrostira euphorbiae (Orthoptera: Pamphagidae)

The habitat use and the phenology of the large grasshopper Acrostira euphorbiae García and Oromí endemic to La Palma (Canary Islands) are studied. This grasshopper is entirely dependent on the Canarian endemic shrub Euphorbia lamarckii both for food and to avoid predation. Adults stay on subapical branches during the day, probably to reduce the risk of predation, and climb up to the apex at night to feed. While females seem to ensure the genetic diversity of offspring by waiting for visits by different males, the latter have to move to guarantee their reproductive success. Monophagy in this species may be related to the year-round presence of tender shoots, and to the predator-repellent toxic latex found in the host plant. Unlike related species from continental areas, adults and nymphs of A. euphorbiae are present almost all year round, probably in adaptation to the particular climate of the islands. Nymphs are more abundant in winter, when Euphorbia leaves are most available. However, adults are more abundant than nymphs in spring, summer and autumn. Males develop more quickly than females, an apparent reproductive strategy based on achieving sexual maturity to coincide with females undergoing imaginal moulting. Matings start immediately after adult females emerge. Densities oscillated between 73 and 193 individuals ha(-1), which can be considered a low value compared with other continental pamphagid species.

Digitization and synchronization method for electrocardiogram printouts

A method of digitization and synchronization of ECG signals for use in vectorcardiography is hereby presented. It is intended to allow the computerized use of the ECG printout used by most cardiologists. The problem is solved by digitizing the printout, which can then be used for vectorcardiography and other modern techniques, once it is synchronized using cross-correlation. Cross-correlation was found to be a superior technique for synchronization over other methods, like R-peak synchronization that can be erroneously used, due to time correspondence. The highest and lowest normalized rms error of the digitized and original signals was found to be 13.49% and 9.85% for recording V1 and Lead III, respectively. The error found was expected because of the comparison of an image with many points in a single instant of time, in comparison to only one point as it is in a digital signal. The result obtained from the work presented here is that the ECG printout needs no longer to remain only as a graphical report, but could also be used for computerized analyses.

[Glomerulopathies associated to HIV infection: a Spanish perspective]

HIV nephropathy (HIVAN) is the most frequent cause of chronic renal failure in HIV-infected black patients. However, the prevalence of other glomerulopathies mediated by immunocomplexes has increased in the last years. We report on the glomerular diseases observed in HIV patients in our Hospital.

METHODS

A retrospective study of all patients with HIV infection and glomerular diseases diagnosed by renal biopsy.

RESULTS

We found 27 patients with the following glomerular diseases: membranoproliferative glomerulonephritis (MPGN) in 8 patients, non-collapsing focal segmental glomerulosclerosis (FSGS) in 7, IgA nephropaty (IgA N) in 6, collapsing glomerulosclerosis in 4 (HIVAN, and membranous nephropaty (MN) in 2. Most of patients were young white men. A high prevalence of coinfection with hepatitis C virus (HCV) (77.8%) and hepatitis B virus (HBV) (37%) was found. At diagnosis, most of patients (90%) had proteinuria, with nephrotic syndrome in 52% of them; 59% presented with acute renal failure. Nine patients (33%) showed malignant hypertension at diagnosis: this complication was particularly common among IgA N patients (4/6, 66%).

CONCLUSION

In our Hospital, immunocomplex-mediated glomerulonephritis were more frequent than HIVAN among HIV-infected patients. HCV-associated MPGN was the most frequently detected glomerular disease. A high prevalence of malignant hypertension was observed at diagnosis, particularly among patients with IgAN.

Characterization of latex-antineoplastic drug complexes by differential scanning calorimetry and microphotography

Choline kinase inhibitors have recently been identified as potentially useful antitumoral agents. Here we determine the best conditions for obtaining drug-polymer complexes with 5-fluorouracil (5-FU), and JCR791B, a new drug representing a significant advance in the development of new molecules to inhibit tumour proliferation. As polymers we used the cellulose derivatives Aquacoat and Aquateric. The variables in the adsorption process measured were time to adsorbent-adsorbate equilibrium, pH and concentration. The drug-polymer complexes were characterized by differential scanning calorimetry and microphotography. Our results show that adsorption of 5-FU and JCR was similar with both polymers although slightly greater with Aquacoat. The chemical structure of the drug and its solubility in water and oil are fundamental characteristics that determine the performance of polymers as drug carriers able to provide controlled release.

Morphogenesis of rat experimental pulmonary emphysema induced by intratracheally administered papain: changes in elastic fibres

The ultrastructural changes of elastic fibres in emphysematous lungs have been studied in men, but few works exist on this topic in experimental emphysematous animals. In this paper, the morphogenesis of emphysema and alterations of the elastic fibres produced by the instillation of papain are described by light and electron microscopy. Wistar rats were instilled through the trachea with papain at a rate of 3 mg/100 g animal weight. The animals were sacrificed 12 h, 3 days, 10 days and 60 days after enzyme instillation. The "Mean Linear Intercept" (MLI), the "Number of fenestrations/respiratory units" (NF) the "Number of macrophages per mm of alveolar wall" (NM) and the "Number of respiratory unit/mm2" (RU), both in the control and experimental groups were studied. Two months after treatment, the experimental group showed a strong increase in the MLI (p<0.001) and NF (p<0.001), and a diminished number of RU (p<0.05) compared with the control group. Partial correlation analysis showed a positive correlation only between MLI and NF. Twelve hours after papain instillation an inflammatory response was observed, the elastic fibres were ruptured, while the microfibrilar component remained. New formations of eulanin elastic fibres were observed three days post papain instillation. After ten days the interalveolar oedema had disappeared and the elastic fibres were of normal morphology although irregular groups of strips of elastic fibres were evident. A mixed pattern of panlobular, centrilobular and normal lung zones were observed. Two months after papain instillation abundant accumulations of elastic fibres of irregular outline were observed associated to collagen fibres. In conclusion, the morphometric parameters studied showed a significant progression of the emphysema. The strong correlation between NF and MLI suggested that papain-induced emphysema is principally caused by breaches of the alveolar walls. The results seem to point to a very abnormal remodelling process associated with elastic fibre regeneration, although there were no signs of destruction of these new fibres formed in emphysematous rat lung induced by papain.

Efficacy and Safety of Valsartan, an Angiotensin II Receptor Antagonist, in Hypertension After Renal Transplantation: A Randomized Multicenter Study

BACKGROUND

The prevalence of posttransplant hypertension is high, and it appears to be a major risk factor for graft and patient survival. The aim of this study was to assess the efficacy and safety of valsartan, an angiotensin-receptor blocker (ARB), in the treatment of posttransplant hypertension.

METHODS

A multinational, multicenter, prospective, randomized, double-blind, placebo-controlled study was performed on the treatment of hypertension (systolic blood pressure [BP] >/= 140 and/or diastolic BP >/= 90 mm Hg) in adult cyclosporin-treated renal transplant recipients randomized to receive either valsartan (80 mg once daily) or a matching placebo for 8 weeks. After the first 4 weeks, furosemide 20 mg twice daily was added on a open basis if systolic BP remained >/= 130 mm Hg and/or diastolic BP remained >/= 85 mm Hg.

RESULTS

One hundred fifteen (valsartan = 57, placebo = 58) uncontrolled hypertensive patients despite monotherapy for hypertension, other than angiotensin-converting enzyme inhibitor or ARB, were randomized. In the valsartan group, significant decreases were seen in systolic BP (from 153 +/- 11 to 140.9 +/- 18.35 mm Hg at 4 weeks, and 136.5 +/- 15 mm Hg at 8 weeks) and diastolic BP (from 93 +/- 9 to 85.2 +/- 11.28 mm Hg at 4 weeks, and 83.8 +/- 9.2 mm Hg at 8 weeks). There was no significant change in the placebo group. In the valsartan group, a statistically but not clinically significant reduction was observed in the mean hemoglobin concentration (12.9 +/- 1.6 g/dL versus 13.8 +/- 1.6 g/dL at 4 weeks, P < .01; and 12.3 +/- 1.6 versus 13.8 +/- 1.7 at 8 weeks; P < .001) as well as a significant increase in serum potassium (4.4 +/- 0.5 mmol/L versus 4.1 +/- 0.4 mmol/L at 4 weeks, P < .01) vs placebo.

CONCLUSIONS

Valsartan is effective in the treatment of posttransplant hypertension and is well tolerated.

Organotin contamination in the Atlantic Ocean off the Iberian Peninsula in relation to shipping

Imposex in female snails, a bioindicator of TBT contamination, and the presence of organotins in snails' tissue and sediments were studied at nine sites off the western Iberian Peninsula. The study was part of a European project (acronym HIC-TBT) co-financed by the EU-LIFE programme, intending to investigate and communicate the impact of organotins from ships in marine ecosystems. Snails and sediments were sampled during two cruises in May/June 1999 and in January 2000 in areas of high, intermediate and low-shipping density. Imposex was found in female snails from several sampling sites, some of which had an imposex incidence of 100%. Differences in sensitivity were found between species; hence comparison of imposex levels between locations where different species were collected was not straightforward. Total organotin concentrations in sediments (sum of butyl and phenyltin compounds) ranged from 21 to 185 ng Sn g(-1) with higher values for most sites sampled in the vicinity of shipping lanes. Organotin concentration in snails' tissue ranged from <5 to 196 ng Sn g(-1), which are similar to those found in snails from other offshore areas contaminated by TBT. Overall, these results give further support to the recent ban on the use of organotin based antifouling paints to all ship size.

A phase II trial of epirubicin (E), estramustine phosphate (EP), and celecoxib (C) as second line treatment of patients (pts) with hormone resistant prostate cancer (HRPC)

14567

Background: Celecoxib, epirubicin, and estramustine phosphate affect prostate cancer cells through different mechanisms. All three could be synergistic. We studied the effects of this combination on PSA, response, toxicity and survival in pts with HRPC. Methods: Pts after progression from first line taxane-based chemotherapy with rising PSA and radiographic progression were eligible. Treatment was E30 mg/m2 iv on day 1 and 8 of each 4 week cycle; EP 280 mg po bid daily × 3 days every wk × 2 followed by 2 wks rest; C 400 mg po bid daily for 28 days. All pts were assessed for response every 2 cycles. Dose modifications for hematologic and hepatorenal toxicity were made. RECIST criteria and PSA decline>50% were used to define response. Results: Sixteen pts enrolled, and 13 are evaluable for toxicity and response. Two withdrew before treatment and one for toxicity. The Median (M) age was 71.5 yrs (59–87), ECOG PS 1 (0–1), Gleason score 7 (4–9), LDH 172 (131–244), Hgb 11.1 (8.8–11.9), PSA 75 (6–814). Pts received M 4 cycles (2–10). Nine (69%) pts had soft tissue and 12 (92%) pts had bone metastases. For radiographic response, 11 pts were evaluable; 6 had stable disease and 2 had complete response by CT. Two pts had response by bone scan. Nine (69%) pts had PSA response. The M survival was 441 days (10–995). There were 5 SAE - DVT, diarrhea, bowel obstruction, cord compression and myocardial infarction. There was good renal and cardiac tolerance. Conclusions: This combination was safe and showed good and durable response as a second line regimen.

[Table: see text]

Combination therapy with docetaxel (D) and celecoxib (C) in patients (pts) with hormone resistant prostate cancer (HRPC)

14519

Background: Cox-2 expression is an independent predictor of survival and is over expressed in 89.3% of pts with HRPC. Cox-2 expression has angiogenic and cytoprotective effects. Its suppression could lead to angiogenesis inhibition and increase chemotherapy sensitivity. D in low doses and C are angiogenesis inhibitors. The main objectives were to study the effects on PSA, time to progression (TTP), toxicity and survival. Methods: In a two stage, phase II trial designed for 66 pts, 30 pts with HRPC and evidence of biochemical and radiographic progression were treated with D 30 mg/m2 IV/wk for 3 wks and C 400 mg po bid for 4 wks of each cycle. Response evaluation after every two cycles was made. RECIST criteria and PSA reduction by >50% for biochemical response were used. Independent safety monitoring for renal (R) and cardiovascular (CV) toxicity were made. Results: Thirty (30) evaluable pts received minimum of 2 cycles, median (M) 4.5 (range 2–8). The M age was 74 yr (55–94), ECOG PS 1 (0–2), Hb 11.8 g/dl (8.6–14.6), and PSA 92.5 ng/dl (15.3–4192). Metastases were present in 24 pts (80%) by bone scan and 25 pts (83.3%) by CT scan. Twelve (12) pts (40%) had PSA response of >50% and 4 pts (13.3%) had PSA normalization. By CAT scan, 3 pts (10%) had CR, 5 pts (16.7%) had PR, and 12 pts (40%) had SD. By bone scan 1 pt (4.8%) had a major response. The M TTP by PSA was 3.65 mos (0.87–12.0). With 27% pts still alive, the M survival was 10.9 mos (3.0– 30.7+), with 95% CI for the mean (9.3–15.2). One pt (3.3%) withdrew due to abdominal discomfort, 2 pts (6.6%) had grade III diarrhea and 1 pt (3.3%) had grade III nail toxicity. Conclusions: 66.7% pts had soft tissue response (CR+PR+SD), and 13.3% pts had PSA normalization. Safety analysis for R and CV toxicity demonstrated excellent safety of this regimen. Considering the unfavorable prognostic indicators of this population the MST of 10.9 mos indicates the activity of this combination.

[Table: see text]

Survey of Neospora caninum infection by nested PCR in aborted fetuses from dairy farms in Aguascalientes, Mexico

The aim of this study was to determine by nested PCR probe the presence of Neospora caninum in fetal brain tissue from aborted dairy fetuses in Aguascalientes, a state in the central part of Mexico. Forty-four fetal brains from eight dairy farms were analyzed using single tube nested PCR probe with primers NF1, NS2, NR1 and SR1, with histopathology as the reference technique. From the 44 bovine fetuses studied, 35 (80%) were diagnosed as being infected by N. caninum using PCR probe and 20 (45%) were considered positive by histopathology, because they had lesions suggestive of bovine neosporosis. Fair agreement was observed (31%) between both probes. The age of aborting cows ranged from 1.6 to 2.9-year-old in 17 (49%) of the positive cases diagnosed by PCR. Gestational ages of aborted fetuses ranged from <3 to 9 months, with average of 5.6 months, and no statistical significant difference was observed when ages of infected and no infected fetuses were compared (P > 0.05). The frequency of N. caninum positive cases observed could be considered to be higher than other areas of Mexico and other countries.

Incidence of Pancreas Graft Thrombosis in Portoiliac and Portocaval Venous Anastomosis

BACKGROUND

Pancreas graft thromboses represent more than 70% of all technical failures; multiple risk factors have been implicated. We analyzed the thrombosis rates using portoiliac versus portocaval vein anastomoses.

PATIENTS AND METHODS

The series includes 53 patients who underwent pancreas transplantation: 49 simultaneous pancreas-kidney and 4 pancreas after kidney. There were 27 men and 26 women, of mean age of 37.2 +/- 7.0 years. We compared two groups of recipients that were classified according to venous anastomosis: (A) portoiliac (n = 30), and (B) portocaval (n = 23).

RESULTS

The recipients did not show significant differences in age, gender, or duration of diabetes mellitus, but body mass index was significantly higher among the portocaval group. A bladder-drained pancreas technique was more frequently performed in the portoiliac group (93% of patients) versus an enteric-drained pancreas in the portocaval group (81%; P < .001). Heparinization was performed in 12 recipients: 11 (36.6%) in the portoiliac group and 1 (4.3%) in the portocaval group (P < .01). Vascular graft thrombosis (venous in six and arterial in one) developed in seven patients (13.2%) all in the portoiliac group (23%) (P < .02). Two-year patient survival was 93% in the portoiliac group and 94% in portocaval group (P = NS). Two-year graft survival was 66.6% in the portoiliac group and 85.9% in portocaval group (P = .07).

CONCLUSION

There was no graft thrombosis among patients with a portocaval vein anastomosis.

Immunohistochemical detection of antigens of distemper, adenovirus and parainfluenza viruses in domestic dogs with pneumonia

The lungs of 35 dogs that died in Mexico from acute or subacute pneumonia were examined immunohistochemically for canine distemper virus (CDV), canine adenovirus (CAV) and canine parainfluenza virus (CpiV), to determine their frequency and occurrence and possible associations. CDV was identified in 27 (77%) cases, CAV in 20 (57%) and CpiV in 18 (51%). The most frequent dual association was that between CDV and CpiV (five cases; 14%). All three viruses, however, were identified in the same lung in 10 cases. Immunolabelling occurred in alveolar macrophages, monocytes, pneumocytes, epithelial cells and syncytial cells. It was concluded that immunohistochemistry is a useful diagnostic tool in canine respiratory disease to complement histopathological examination.