Partially deleted SRY gene confined to testicular tissue in a 46,XX true hermaphrodite without SRY in leukocytic DNA

True hermaphroditism is an uncommon form of intersexuality in which testicular and ovarian tissue develop in the same individual. Most true hermaphrodites are 46,XX and lack SRY, the testis-determining gene. We describe results of molecular studies performed in a 46,XX true hermaphrodite SRY-negative in DNA from blood leukocytes but SRY-positive in DNA obtained from the testicular portion of the ovotestis. Surprisingly, the SRY identified in gonadal DNA carries a partial deletion at the 5' end of the gene. Our patient is the first case of a naturally occurring deletion within the SRY ORF (with a normal HMG box) and provides a new explanation for the abnormal gonadal development observed in 46,XX true hermaphrodites.

Upper body obesity and hyperinsulinemia are associated with anovulation

The objective of this study was to determine the effect of body fat distribution and hyperinsulinemia on the occurrence of ovulation. Fifty-six women (20-35 years old) either with overweight or obesity (body mass index >/=25) were studied. They were classified in two groups according to waist/hip ratio (WHR); one with predominance of adiposity in the upper body segment (n = 29, WHR >0.85) and the other with predominant adiposity in the lower body segment (n = 27, WHR </=0.85). Basal body temperature and serum progesterone were determined in each cycle during 6 months. Serum insulin levels were measured at baseline and 30, 60, 90, 120 and 180 min after a 75-gram oral glucose load. The mean insulin values in response to oral glucose load in patients with upper body segment obesity were significantly higher than those corresponding to women with lower body segment obesity. Furthermore, the ratio between ovulated cycles and all the cycles studied in patients with upper body segment obesity was significantly lower than that observed in patients with lower body segment obesity. Upper body obesity seems to affect the ovulatory process and this may be related to the presence of hyperinsulinemia.

Inhibitory and lytic effects of phenothiazine derivatives and related tricyclic neuroleptic compounds, on Entamoeba histolytica HK9 and HM1 trophozoites

It has been shown previously that tricyclic neuroleptics like clomipramine and chlorpromazine have lethal effects on Leishmania donovani and L. major, and other studies indicate that the phenothiazine inhibitors of trypanothione reductase are potential anti-trypanosomal and anti-leishmanial drugs. With this in mind and our original observation on the presence of trypanothione in Entamoeba histolytica HK9, we examined the possible inhibitory effects of various phenothiazine and tricyclic derivatives on this human parasite. We found that drugs like clomipramine (KD002), the most potent in vitro inhibitor of trypanothione reductase among 30 tricyclic compounds tested, at 25 microM after 24 h of culture under aerobic conditions, caused a substantial decrease in the number of E. histolytica HK9 trophozoites, from approx. 15 x 10(6) to 5.37 x 10(6) cells, and at 100 microM to 0.8 x 10(6) cells. A substantial inhibitory effect on cell proliferation could also be demonstrated with metronidazol (used clinically against amoebiasis). Under similar experimental conditions other tricyclic and phenothiazine derivatives (OFKs), designed originally to inhibit the trypanothione reductase of trypanosomatides, had an inhibitory effect of 16 to 95%. For comparison, similar results were obtained using clomipramine and a phenothiazine derivative (OFK006) with Trypanosoma cruzi and Crithidia luciliae, except that with the latter the inhibitory effect of clomipramine was less dramatic. Experiments comparing two E. histolytica strains showed that normal cell proliferation under anaerobiosis was higher in strain HK9 than in HM1, which is highly virulent, but that metronidazol and clomipramine were less effective against HM1. Two other drugs tested, diphenydramine (KD005) and a phenothiazine derivative (OFK008), also had significant but lower inhibitory effects on both strains. The inhibitory activity on cell proliferation and the lytic effects on this human parasite by the tricyclic compounds clomipramine, chlorpromazine and others, as well as by the phenothiazine derivatives, indicate that they can be considered potential anti-amoebic agents.

Evaluation of topical anesthetics by laser-induced sensation: comparison of EMLA 5% cream and 40% lidocaine in an acid mantle ointment

BACKGROUND AND OBJECTIVE

Current techniques for assessing local anesthetics (e.g., pin-prick test) cannot elicit a specific afferent activity without contamination from mechanosensitive receptors. This study was aimed to validate the use of non-scarring laser pulses as a reproducible method to assess effectiveness of topical anesthetics by comparing EMLA 5% cream and 40% lidocaine ointment.

STUDY DESIGN/MATERIALS AND METHODS

Thirty-two evaluations per compound were achieved in a total of eight healthy subjects. Non-scarring pulses from a 585 nm Pulsed-dye laser and a double-frequency Nd:YAG laser were investigated as pain inducers and the results were statistically analyzed by using a Student t-test.

RESULTS

Discrimination of anesthesia was better assessed with the 1,064 nm Nd:YAG laser. Anesthesia obtained by EMLA 5% cream was significantly higher than for 40% lidocaine ointment (P <0.0001). For EMLA cream, the number of evaluations with complete anesthesia was twice as much as for 40% lidocaine.

CONCLUSIONS

Non-scarring laser pulses are reliable and reproductive pain inducers for assessing topical anesthetics showing a low intra-individual variation. This technique demonstrated that EMLA 5% cream is significantly more effective than 40% lidocaine ointment.

Detection of fusarin C and trichothecenes in Fusarium strains from Spain

A group of 49 strains of Fusarium sp. isolated from different Spanish samples of cereals and mixed feedstuffs were screened for their ability to produce trichothecenes like T-2 toxin (T-2), HT-2 toxin (HT-2), diacetoxyscirpenol (DAS) and deoxynivalenol (DN), as well as other mycotoxin produced by Fusarium named fusarin C. The production of these mycotoxins was analyzed by means of spectrophotometry, thin layer chromatography (TLC), high performance liquid chromatography (HPLC) and gas chromatography (GC). Results showed that from 19 Fusarium strains in which cultures trichothecene production was detected, 15 were HT-2 producers, 9 T-2 producers, 14 DAS producers and 10 DN producers. On the other hand, from 28 Fusarium strains in which cultures fusarin C production was detected, 22 were low fusarin C producers (ranged from 0.04 to 1 microgram/l ICI medium), 5 Fusarium strains were intermediate-level producers (ranged from 1 to 10 micrograms/l ICI medium) and one Fusarium strain produced 240 micrograms/l ICI medium. The identified Fusarium strains that produced trichothecenes and fusarin C were F. moniliforme and F. oxysporum.

Double versus single renal allografts from aged donors

BACKGROUND

The age limit of the cadaver kidney donors is increasing in response to the growing demand for renal transplantation. Simultaneous double kidney transplantation (SDKT) with kidneys obtained from elderly adults has been proposed to increase the transplantation number and improve its results. However, if SDKT is performed when there are no clear indications, a negative effect could be produced on the total number of transplanted patients as both kidneys would be used for only one recipient.

MATERIAL AND METHODS

In December 1996 we designed a transplantation protocol to be able to extend the selection of cadaver kidney donors with normal serum creatinine levels without establishing any age limit. A pregraft renal biopsy was always performed to analyze the glomerulosclerosis (GE) percentage whenever the donors were 60 years of age or older. A SDKT was performed in a single recipient when the donor age was 75 years or older or when the donors between 60 and 74 years old had a GE rate of more than 15%. On the contrary, a single kidney transplantation was performed in two different recipients for kidneys from donors between 60 and 74 years of age with a GE rate of less than 15%. Kidneys having GE rates of more than 50% were discarded for transplantation. Donor kidneys from subjects younger than 60 years of age were always used for a single kidney transplantation.

RESULTS

Based on the above mentioned protocol, from December 1996 to May 1998, 181 patients received a kidney transplantation in our hospital. These patients were divided into three groups: group I which included the SDKT recipients (n=21), group II or single kidney recipients from 60- to 74-year-old donors (n=40), and group III or recipients from <60-year-old donors (n=120). The mean follow-up time was 15+/-5 months (range 6-24). Mean donor age was 75+/-7 years in group I, this was significantly higher than in group II (67+/-4, P<0.001) and group III (37+/-15, P<0.001). The primary nonfunction rate was low in the three groups, there being no statistically significant differences (5, 5, and 4%, respectively). A significantly greater percentage of patients from group I (76%) presented immediate renal graft function as compared with group II (43%, P<0.01) and III (50%, P<0.05). The acute rejections rate was very low in all three groups (9.5, 7.5, and 22%, respectively) with significant differences between groups II and III (P<0.05). No significant differences between the different groups were observed for one year actuarial patient survival (100, 95, and 98%, respectively) or graft survival rates (95, 90, and 93%, respectively). The 6-month serum creatinine levels were excellent in the three groups, although there were significant differences between groups I and II (1.6+/-0.3 vs. 1.9+/-0.6 mg/dl, P<0.05), II and III (1.9+/-0.6 vs. 1.4+/-0.4 mg/dl, P<0.001), and I and III (P<0.05).

CONCLUSIONS

Simultaneous double kidney transplantations make it possible to use kidneys from extremely elderly donors (>75 years) or those whose GE>15%. In addition, kidneys from donor 60-74 years old in which the GE<15% can be used for single kidney transplantations in two different recipients with excellent results.

Spectrum of CFTR mutations in Mexican cystic fibrosis patients: identification of five novel mutations (W1098C, 846delT, P750L, 4160insGGGG and 297-1G-->A)

We have analyzed 97 CF unrelated Mexican families for mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Our initial screening for 12 selected CFTR mutations led to mutation detection in 56.66% of the tested chromosomes. In patients with at least one unknown mutation after preliminary screening, an extensive analysis of the CFTR gene by single stranded conformation polymorphism (SSCP) or by multiplex heteroduplex (mHET) analysis was performed. A total of 34 different mutations representing 74.58% of the CF chromosomes were identified, including five novel CFTR mutations: W1098C, P750L, 846delT, 4160insGGGG and 297-1G-->A. The level of detection of the CF mutations in Mexico is still lower than that observed in other populations with a relatively low frequency of the deltaF508 mutation, mainly from southern Europe. The CFTR gene analysis described here clearly demonstrated the high heterogeneity of our CF population, which could be explained by the complex ethnic composition of the Mexican population, in particular by the strong impact of the genetic pool from southern European countries.

Familial microscopic hematuria caused by hypercalciuria and hyperuricosuria

We report 12 patients belonging to five different families in whom persistent isolated microhematuria was associated with hypercalciuria and/or hyperuricosuria. Four patients had episodes of gross hematuria, three patients had passed renal stones, and a history of nephrolithiasis was obtained in four of the families (80%). Calcium oxalate and uric acid crystals were commonly observed in the urine sediments. Urinary erythrocytes had a normal appearance on phase-microscopic examination. Reduction of calciuria and uricosuria by thiazide diuretics, allopurinol, forced fluid intake, and dietetic measures led to a persistent normalization of urine sediment with complete disappearance of hematuria. Determination of calcium and uric acid urinary excretions should be included in the study of familial hematuria.

Spatial Ca(2+) distribution in contracting skeletal and cardiac muscle cells

The spatiotemporal distribution of intracellular Ca(2+) release in contracting skeletal and cardiac muscle cells was defined using a snapshot imaging technique. Calcium imaging was performed on intact skeletal and cardiac muscle cells during contractions induced by an action potential (AP). The sarcomere length of the skeletal and cardiac cells was approximately 2 micrometer. Imaging Rhod-2 fluorescence only during a very brief (7 ns) snapshot of excitation light minimized potential image-blurring artifacts due to movement and/or diffusion. In skeletal muscle cells, the AP triggered a large fast Ca(2+) transient that peaked in less than 3 ms. Distinct subsarcomeric Ca(2+) gradients were evident during the first 4 ms of the skeletal Ca(2+) transient. In cardiac muscle, the AP-triggered Ca(2+) transient was much slower and peaked in approximately 100 ms. In contrast to the skeletal case, there were no detectable subsarcomeric Ca(2+) gradients during the cardiac Ca(2+) transient. Theoretical simulations suggest that the subsarcomeric Ca(2+) gradients seen in skeletal muscle were detectable because of the high speed and synchrony of local Ca(2+) release. Slower asynchronous recruitment of local Ca(2+) release units may account for the absence of detectable subsarcomeric Ca(2+) gradients in cardiac muscle. The speed and synchrony of local Ca(2+) gradients are quite different in AP-activated contracting cardiac and skeletal muscle cells at normal resting sarcomere lengths.

Modeling of air pollution and its relationship with mortality and morbidity in Madrid, Spain

OBJECTIVE

Evaluation of the association between air pollution and mortality and morbidity is becoming ever more complex owing to changes in inner-city air pollution, marked by decreasing values for all main pollutants save those associated with traffic. This has led to the need for the study of new epidemiological scenarios in which most pollutants are below guideline values. Nonetheless, the health effects are significant.

METHODS

This report presents the results of a statistically based model for real-time forecasting of mortality and morbidity in Madrid, with meteorological and pollution series serving as inputs.

RESULTS AND CONCLUSIONS

Not only did the models perform well with correlation coefficients between predicted and observed values (r = 0.683 for mortality, r = 0.681 for morbidity), but they enabled quantification of the impact of air pollution on mortality and morbidity (with increases ranging from 1. 8% to 12% for mortality and from 2.3% to 18% for morbidity for a 25-microg/m(3) increase in pollutants). Moreover, attention should be drawn to the observation that the model proved to be easy to implement and operate on a routine basis.

Cytokines, growth factors, and oxidative stress in HepG2 cells treated with ethanol, acetaldehyde, and LPS

Inflammatory mediators, including cytokines, growth factors, and reactive oxygen species, are associated with the pathology of chronic liver disease. In the liver, cytokine and growth factor secretion are usually associated with nonparenchymal cells, particularly Kupffer cells. In the present studies, the effect of 24 and 72 h administration of ethanol (50 mM). acetaldehyde (175 microM), and LPS (1 microg/ml) were studied on the expression and secretion of TNF-alpha, IL-1beta, IL-6, and TGF-beta3, lipid peroxidation damage and glutathion content in HepG2 cell cultures. A 24 h exposure to ethanol induced the expression of TNF-alpha and TGF-beta1, and the secretion of IL-1beta and TGF-beta1. With the same period of treatment, acetaldehyde markedly increased TNF-alpha expression, and stimulated IL-1beta secretion, while LPS exposure induced the expression of TNF-alpha, IL-6, and TGF-beta1, and the secretion of IL-1beta, IL-6, and TGF-beta1. A reduced in TNF-alpha response and TGF-beta1 expression were observed after 72 h exposure to ethanol. A 72 h acetaldehyde exposure decreased markedly TNF-alpha expression and stimulated a previously absent TGF-beta1 response. With the same time of exposure, LPS reduced slightly TGF-beta1 expression, and decreased its secretion. IL-1beta and IL-6 were not detected under 72 h exposure conditions. Lipid peroxidation damage was increased in all treatments, but higher values were found in 72 h treatments. Glutathion content diminished in all treatments. These findings suggest that HepG2 cells, independent of other cells such as Kupffer or macrophages, participate in a differential cytokine, growth factor and oxidative stress response, which differs according to the toxic agent and the time of exposure.

Insecticidal, anti-juvenile hormone, and fungicidal activities of organic extracts from different Penicillium species and their isolated active components

Organic extracts from mycelium and culture broth of 21 Penicillium isolates have been tested for insecticidal, insect anti-juvenile hormone (anti-JH), and antifungal activities. Culture broth extracts were the most active, mainly against insects; nearly 25% of them have shown high entomotoxicity (100% mortality at 100 microg/cm(2)). A strong in vivo anti-JH activity against Oncopeltus fasciatus Dallas was detected in the culture broth extracts from P. brevicompactum P79 and P88 isolates. The two new natural products isolated from P79, N-(2-methyl-3-oxodec-8-enoyl)-2-pyrroline (1) and 2-hept-5-enyl-3-methyl-4-oxo-6,7,8,8a-tetrahydro-4H-pyrrolo[2,1-b]-1, 3-oxazine (2), possessed anti-JH and insecticidal activity, respectively, against O. fasciatus. Synthesized natural compound 1 has shown an ED(50) of 0.7 microg/nymph when assayed on newly molted fourth-instar nymphs of O. fasciatus. Promising biological activities have also been detected in the synthetic precursors.

Effects of short courses of different doses of prednisone and dexamethasone on serum third component of complement (C3) levels in dogs

The effect of different doses of prednisone and dexamethasone on serum C3 levels was determined in 35 dogs. Dogs in Group A (n = 15) were administered prednisone (1.1 mg/kg/day) for 14 days; dogs in Group B (n = 10) were given prednisone at 2.2 mg/kg/day for 7 days; dogs in group C (n = 10) were administered dexamethasone (0.25 g/kg/day) for 7 days. Serum C3 concentrations were determined using a sandwich ELISA in samples obtained before and after glucocorticoid administration. Concentrations were expressed as a percentage of a reference standard. No statistically significant differences were found after glucocorticoid administration in all groups. Thus, short-term administration of prednisone and dexamethasone at commonly used doses did not result in significantly lower serum C3 levels.

Simple and complex stent strategies for bifurcated coronary arterial stenosis involving the side branch origin

Coronary lesions located in major bifurcations constitute a challenge for the use of stents. Although the occlusion of a side branch covered by a stent is infrequent, the maintenance of a patent, stenosis-free bifurcation may result in a complex procedure. Between September 1994 and April 1998, 70 patients were treated by stent implantation for coronary bifurcation stenosis. The side branch always had a diameter >2 mm. The pairs of treated arteries were: left anterior descending (LAD)/diagonal artery in 32 patients, circumflex/obtuse marginal in 26, right coronary/posterior descending artery in 5, and LAD/circumflex in 7. We applied 2 different techniques of stent implantation: (1) deployment of 1 stent in the parent vessel covering the takeoff of the side branch and subsequent angioplasty of the side branch across the metallic structure (group A, n = 47 patients), and (2) implantation of 1 stent at the ostium of the side branch and complete reconstruction of the entire bifurcation with additional implantation of 1 or 2 stents at the parent vessel (group B, n = 23 patients). There were no significant differences between groups at baseline variables. Procedural success was similar in both groups: 42 (89%) in group A versus 21 (91%) in group B. However, major cardiac events at 18 months follow-up were higher in group B (event-free probability 44% vs 75%, p <0.05). Selected patients with coronary stenosis at major bifurcations can be treated with an acceptable rate of primary and late success. Complex techniques providing radical stent reconstruction of the bifurcation seems to provide no advantages over the simpler stent jail followed by ostial side branch balloon dilation.

Trimetazidine prevents cochlear lesions induced by intraperitoneal and perilymphatic administration of kainic acid

The protective activity of trimetazidine (TMZ) against cochlear neurotoxicity induced by intraperitoneal and intracochlear administration of kainic acid (KA) has been analyzed. The amplitude of the CAP N1 wave was significantly higher in KA rats pretreated with TMZ, independently of the administration route, than in those only treated with KA. However, CAP N1 amplitude of both TMZ pretreated and non-pretreated animals was always lesser than the N1 wave amplitude observed in the control group. The CAP N1 latency did not show any significant difference between KA and TMZ+KA groups except at high intensities of 8 and 12 kHz. As a complementary control, we have demonstrated that the intraperitoneal administration of TMZ (5 mg/kg) alone did not affect either the electrophysiological activity or the morphology of the auditory nerve. Morphological results fit well with electrophysiology. Some isolated swollen afferent fibers were observed in TMZ+KA cochleae, the swollen dendrites being sparser than in the KA only treated animals. In TMZ+KA animals, the cochlear apical coils were less affected than the basal coils. Our results are in agreement with recent clinical studies and suggest that TMZ could be an active drug on cochlear impairment linked to hypoxic-ischaemic syndromes.

Immediate and follow-up findings after stent treatment for severe coarctation of aorta

Experimental studies have shown that stents implanted at the aorta become incorporated within the aortic wall and can be further expanded in growing animals. Few clinical studies have shown that the stent repair of severe coarctation of aorta provides excellent initial results, and little is known on the follow-up of these patients. We assessed the immediate and follow-up results obtained in a series of 48 patients (mean age 14+/-12 years) with severe coarctation of the aorta who were treated by Palmaz stent implantation; 30 of them (63%) underwent angiographic follow-up studies at a mean of 25+/-11 months after treatment. Quantitative serial analysis of the aortogram (baseline, after treatment, and at follow-up) was performed. Significant relief (mean residual gradient 3+/-4 mm Hg) was always obtained after stent implantation. The isthmus, when hypoplastic (60%), was always expanded with the stent. One associated aneurysm became occluded after the implant. Complications included aortic disruption, stent migration, and decreased or absent femoral pulses. At angiographic follow-up, the stent remained always in place, without recoil. In 22 patients (73%), there were no detectable neointimal proliferation at late angiogram; however, 8 patients (27%) had some degree of intimal thickening (1 to 5 mm), causing mild restenosis in 3 patients treated at early age, and nonsignificant lumen reduction in 5. The serial aortogram analysis revealed a minor but significant increase in nonstented aortic diameters that seemed related to the normal growth of children. No need for stent reexpansion was observed at 2-year follow-up (mean). Two patients (7%) developed late small aneurysm formation at the stented wall; both were occluded by the insertion of coils through the stent orifices. We conclude that stent treatment for severe coarctation of aorta provides excellent immediate and long-term results in young adults and children. However, at early age, restenosis by intimal growth may develop.

Uptake, cellular distribution and DNA damage produced by mercuric chloride in a human fetal hepatic cell line

A human hepatic cell line (WRL-68 cells) was employed to investigate the uptake of the toxic heavy metal mercury. Hg accumulation in WRL-68 cells is a time and concentration dependent process. A rapid initial phase of uptake was followed by a second slower phase. The transport does not require energy and at low HgCl2 concentrations (<50 microM) Hg transport occurs by temperature-insensitive processes. Subcellular distribution of Hg was: 48% in mitochondria, 38% in nucleus and only 8% in cytosolic fraction and 7% in microsomes. Little is known at the molecular level concerning the genotoxic effects following the acute exposure of eucaryotic cells to low concentrations of Hg. Our results showed that Hg induced DNA single-strand breaks or alkali labile sites using the single-cell gel electrophoresis assay (Comet assay). The percentage of damaged nucleus and the average length of DNA migration increased as metal concentration and time exposure increased. Lipid peroxidation, determined as malondialdehyde production in the presence of thiobarbituric acid, followed the same tendency, increased as HgCl2 concentration and time of exposure increased. DNA damage recovery took 8 h after partial metal removed with PBS-EGTA.

Effect of adjuvants in the isotypes and bactericidal activity of antibodies against the transferrin-binding proteins of Neisseria meningitidis

Twenty-eight Neisseria meningitidis strains of different serogroups, serotypes, and TbpB isotypes were used to test the effect of five adjuvant formulations on the immune response to the meningococcal transferrin-binding proteins (Tbps) in mice. Levels of anti-Tbps antibodies were relatively low when purified TbpA-TbpB complexes were used for immunization, those obtained with the RAS adjuvant being the highest, and the isotype distribution reveals a prevalence of the non-bactericidal IgG1. Specific anti-Tbps antibody levels were five to 125 times higher immunizing with whole outer membrane vesicles, with bactericidal isotypes prevailing, which suggests that presentation of these antigens in their natural conformation is crucial to elicit a good response. Nevertheless, bactericidal activity did not correlate with these characteristics, confirming that it must be also influenced by other factors, and direct evaluation of the killing ability is necessary to draw conclusions about the efficacy of antigens or adjuvants in vaccine design.

Effect of acute lead treatment on coproporphyrinogen oxidase activity in HepG2 cells

Acute toxic effects of lead were evaluated on porphyrin synthesis and coproporphyrinogen oxidase (CO) activity in an in vitro model, using HepG2 cells, a hepatoma cell line of human origin. Lead concentrations for exposure treatments were 0.5, 1.0, 2.5, 5.0 microM. No significant changes were found in treated cells with respect to uroporphyrin cellular or media concentrations. Cellular protoporphyrin increased in dose response shape, but no changes in extracellular content were found. Extracellular coproporphyrin concentration increased in a dose response manner without changes in cellular content. The CO activity was depressed in dose response shape, reaching 62% of control activity at 5.0 microM of lead treatment. The CO activity in Pb-treated cells was recovered after dithiothreitol (DTT) treatment, suggesting that sulphydryl groups play an essential role in the enzyme activity. The dose-response increase of coproporphyrin secretion accompanied by the depression of CO activity supports the suggestion that lead causes CO inhibition, as observed in this cellular model.

[Prone position: postural treatment for patients with adult respiratory distress syndrome. The nurse's point of view]

The prone position is a therapeutic strategy that can be beneficial in the treatment of adult respiratory distress syndrome (ARDS). In order to evaluate the advantages and possible complications associated with this postural change within the context of nursing, we analyzed retrospectively 71 turns carried out in 32 patients who met criteria for ARDS. The patient was turned by a team of 4 or 5 persons following a strict protocol. The PaO2/FIO2 ratio and SatO2 significantly increased in prone position, without any hemodynamic repercussions. No extubation or loss of vascular accesses or drainage tubes occurred. Complications included: facial edema, low-pressure lesions, and regurgitation of enteral nutrition.

Ca2+-channels involved in neostriatal glutamatergic transmission

The actions of peptidic toxins that work as Ca2+-channel antagonists were investigated on neostriatal glutamatergic transmission. Both intracellularly recorded excitatory postsynaptic potentials (EPSPs) and extracellularly recorded population spikes (PS) evoked by afferent stimulation were evaluated in the presence of 10 microM bicuculline. Percentage of block (mean +/- SEM; n = 4) for these events (EPSP and PS, respectively) was: omega-AgTxIVA (100-200 nM): 35 +/- 2 and 54 +/- 4%; omega-CgTxGVIA (1 microM): 37 +/- 3 and 63 +/- 6%; omega-CgTxMVIIC (500 nM): 40 +/- 4 and 50 +/- 2%; and calciseptine (500 nM): 5 +/- 4 and 9 +/- 6%. When given together, toxins had additive effects. The calciseptine effects were nonsignificant. The toxins were also tested on Ca2+-dependent random synaptic responses induced by 100 microM 4-AP. Each toxin reduced the frequency of spontaneous EPSPs by more than 60% (n = 2). The summed actions of individual toxins yields more than 100% block (superadditivity); suggesting that several terminals may possess more than one channel type. The reduction in frequency was not accompanied by a reduction in amplitude confirming that toxins' actions were presynaptic. It is concluded that at least three different Ca2+-channel subtypes are involved in glutamate release in neostriatal afferents: N-type, P/Q-type, and a type resistant to the toxins used. The L-type Ca2+-channel had little, if any, participation.

Incidence and distribution of Fusarium species associated with feeds and seeds from Spain

Samples of seeds and feeds (corn-based and mixed) were collected during surveys in 1991-92 and 1992-93 from two regions of Spain, one in northern Spain where the annual rainfall is over 900 mm, and the other in southeastern Spain where the annual rainfall is about 400 mm. The level of Fusarium contamination was determined in the 657 samples analysed, and results were analysed statistically to assess the effects of type of sample and meteorological conditions on Fusarium proliferation. The predominant Fusarium species was Fusarium moniliforme, which represented 92.2% of the total Fusarium strains isolated. Other species isolated were Fusarium oxysporum (5.9%), F. oxysporum var. redolens (0.6%), Fusarium poae (0.6%) and Fusarium sporotrichioides (0.6%).

Antiproteinuric effect of angiotensin-converting enzyme inhibition and C5b-9 urinary excretion in membranous glomerulonephritis

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors have an antiproteinuric effect in membranous glomerulonephritis (MGN). However, no studies have investigated whether this antiproteinuric effect is influenced by urinary C5b-9 excretion, a marker of immunological activity in this disease.

METHODS

Eleven patients with biopsy-proven MGN were treated with captopril for 8 weeks. The evolution of several clinical and biochemical parameters, including 24-h urinary protein excretion was evaluated every 4 weeks. Urinary C5b-9 excretion was measured at the onset and at the end of captopril treatment.

RESULTS

Patients with MGN had significantly higher C5b-9 excretions than a group of 14 healthy controls (89 +/- 23 vs 3.7 +/- 1.4 ng/mg UCr; P < 0.001). A significant correlation was found between urinary C5b-9 and the magnitude of proteinuria, both at the onset and at the end of treatment. After 8 weeks of captopril treatment, proteinuria had decreased from 8 +/- 1.8 to 5.2 +/- 1.3 g/day (P < 0.05). Four weeks after captopril discontinuation, proteinuria rose to 7.3 +/- 1.7 g/day (P < 0.05). A marked variability in the antiproteinuric response was observed, ranging from 0 to 85% with respect to baseline values. No correlation between decrease in proteinuria and baseline urinary C5b-9 levels was observed. Several patients with elevated urinary C5b-9 levels had captopril-induced decrease in proteinuria.

CONCLUSIONS

ACE inhibition induces an antiproteinuric effect in patients with MGN. The urinary C5b-9 excretion does not predict the magnitude of this response.

In-laboratory removal of femoral sheath following protamine administration in patients having intracoronary stent implantation

Two hundred twenty-eight patients with successful coronary stent implantation were randomized either to protamine administration and femoral sheath removal (group I, n = 117) or no heparin neutralization and delayed sheath removal (group II, n = 111). The hospital stay after treatment was shorter in patients receiving protamine; therefore, protamine use for neutralizing circulating heparin may be safely administered immediately after stent implantation.

[Patients with human immunodeficiency virus admitted to the emergency service of a general hospital]

BACKGROUND

The description of the demographic, toxicologic, immunologic and clinicopathologic characteristics of patients with known human immunodeficiency virus infection (HIV) admitted to hospital through the emergency department is presented.

METHODS

A cohort study of patients with known HIV seropositivity who consecutively attended the emergency department of the Hospital del Mar in Barcelona, Spain, from January to March 1995 and who required hospitalization with follow up until discharge from hospital was performed. From the clinical history of each patient the following parameters were analyzed: age, sex, domicile, toxicologic history, risk factors 'for HIV infection, epidemiologic and pathologic history, CD4 lymphocyte count, clinical stage, the complementary tests carried out, as well as the diagnosis on admission and hospital discharge.

RESULTS

During the study period, 6,379 patients were attended in the emergency department, 323 of whom corresponded to HIV seropositive patients. Of 1,460 admissions, 126 (77 males [61%] and 49 females [39%]) corresponded to known HIV patients, of whom 75.5% were or had been intravenous drug addicts. Eighty-three point three percent were from the health care area assigned to the hospital. According to the AIDS clinical stage, 26 (20.6%) belonged to group A, 14 (11.1%) to group B and 86 (68.2%) to group C. The complementary tests performed were: thorax radiography in 80%, abdomen radiography in 4%, cerebral computerized axial tomography (CAT) in 9.5%, lumbar punction in 5%, thoracocentesis in 3%, paracentesis in 4% and clinical analysis in 95%. The most frequent cause of admission was pulmonary disease (40%) with 21.5% corresponding to tuberculosis. Homogenesis among diagnoses on admission and discharge was 75%.

CONCLUSIONS

The high percentage of hospitalary admissions in known HIV patients requiring medical attention in the emergency department is of note. The patients are usually from the health care area of the center, belong to group C, require a high number of complementary tests with pulmonary disease being the most frequent cause of admission.

Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success

BACKGROUND

New methods of rapid opiate detoxification, under intravenous sedation, can detoxify heroin-addicted patients in 24 hours. Their clinical application has been limited by the lack of studies establishing both efficacy and safety.

METHOD

In a randomised, controlled study, 300 treatment-refractory, heroin-addicted patients received rapid intravenous detoxification treatment (naloxone infusion, 0.06-0.08 mg/kg, then oral naltrexone 50 mg/day) under either monitored light intravenous sedation or unmonitored deep intravenous sedation.

RESULTS

All patients were successfully detoxified and 93% remained abstinent one month later. Severity of withdrawal, according to the Wang Scale modified by Loimer, was 4.9 (s.d. 3.0) points in the light sedation group and 4.8 (s.d. 2.9) in the deep sedation group (P = 0.26). Two patients (1.3%) in the light sedation group and four (2.6%) in the deep sedation group required tracheal intubation (P = 0.31). There was only one severe complication, a case of nosocomial aspirative pneumonia which improved with antibiotic treatment.

CONCLUSIONS

Successful rapid intravenous detoxification can be achieved using relatively light levels of sedation.

Subconjunctival carboplatin therapy and cryotherapy in the treatment of transgenic murine retinoblastoma

OBJECTIVES

To determine the efficacy and dose response of subconjunctival carboplatin with and without cryotherapy in the treatment of murine transgenic hereditary retinoblastoma.

METHODS

Fifty-one 5-week-old transgenic BLH SV-40 (Charles Rivers Laboratories, Boston, Mass) T-antigen-positive mice with retinoblastoma were administered 6 subconjunctival injections of carboplatin in 1 eye at drug doses of 10, 15, 20, 25, 62.5, 125, and 250 microg. Six control eyes received 6 subconjunctival injections of balanced salt solution. Fourteen of the 51 subconjunctivally treated eyes received a single application of transconjunctival cryotherapy immediately prior to each carboplatin injection. Six control eyes received 6 single applications of transconjunctival cryotherapy using the above schedule but did not receive carboplatin. All experimental and control eyes were obtained at 16 weeks of age for histopathologic examination.

RESULTS

A dose-dependent inhibition of intraocular tumor growth by subconjunctivally delivered carboplatin was observed in these transgenic retinoblastoma mice. Tumor development was inhibited in 50% of the mouse eyes at doses of 180 microg. In animals treated with cryotherapy alone, no tumor control was noted (0 of 6). In animals treated with subconjunctival carboplatin coupled with cryotherapy, a tumor control dose of 417 microg was found. No evidence of histopathologic treatment toxicity was noted.

CONCLUSIONS

Subconjunctival delivery of carboplatin in serial doses effectively inhibits intraocular tumor growth in a dose-dependent fashion in a transgenic murine retinoblastoma model. Cryotherapy does not increase tumor control in this murine retinoblastoma model.

Obliteration of femoral pseudoaneurysm complicating coronary intervention by direct puncture and permanent or removable coil insertion

We report on percutaneous obliteration of femoral pseudoaneurysm complicating percutaneous coronary interventions in 6 patients. Our findings suggest that permanent or transient direct coil insertion may be an useful alternative in the treatment of pseudoaneurysm in patients who do not respond to mechanical compression.

[Medical care in 7 Chilean cities]

BACKGROUND

In countries with an intermediate development level such as Chile, health care is the main factor that improves the health status of the community.

AIM

To inform the results of morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco.

MATERIAL AND METHODS

A random sample of 951 dwellings with 4,192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time.

RESULTS

Half of sick people received medical care and the rest was managed with self care techniques. Sixty nine percent of subjects with acute diseases received medical care, compared to 32% of those with chronic diseases. The National Health Fund (FONASA) financed most of these medical attentions, half of these were done in private centers and the rest in public premises. Private centers took care of 71% of acute patients, 48% of chronic patients and 27% of health controls. The proportion of private care in different cities paralleled the income of their populations. An estimation of 3.5 medical attentions per capita per year in these cities can be reached. Health care was considered very good by 33% of patients, as good by 55%, as regular by 9% and as deficient by 3%. Quality of care of private centers was perceived as better than that of public centers. Eighty five percent of sick people that did not seek medical care, did so due to the mildness of their ailments. People had to afford a mean of US$ 30 per episode of acute disease, US$ 32 per episode of chronic disease and US$ 56 per each dental attention.

CONCLUSIONS

Two thirds of patients with acute diseases and one third of patients with chronic diseases received medical care during the study period.

Elevation of von Willebrand factor levels in patients with IgA nephropathy: effect of ACE inhibition

The von Willebrand factor (vWF) has been used as a marker of endothelial dysfunction in several diseases. We measured plasma vWF in patients with immunoglobulin A nephropathy (IgAN). In a group of 10 IgAN patients with normal renal function, normal blood pressure, and no proteinuria, vWF plasma levels were significantly higher than in a group of 21 healthy volunteers (134% +/- 38% v 80% +/- 22%; P < 0.01). In another group of 16 IgAN patients with normal renal function and proteinuria ranging between 0.3 and 3.8 g/d, vWF levels were also significantly higher than in the control group (148% +/- 63% v 80% +/- 22%; P < 0.001). Afterward, we studied the effects of enalapril administered for 4 weeks on vWF levels and proteinuria in a group of 11 IgAN patients with normal renal function and proteinuria > or = 1 g/d. After 2 weeks on enalapril treatment, both vWF levels and proteinuria had significantly decreased (vWF: 158% +/- 122% to 117% +/- 72%, P < 0.05; proteinuria: 1.6 +/- 0.7 g/d to 0.9 +/- 0.4 g/ d, P < 0.05). After enalapril withdrawal, both vWF and proteinuria significantly increased. A significant correlation between the variations in vWF levels and proteinuria was observed (r = 0.6; P < 0.05). No correlations between blood pressure and changes in vWF or proteinuria were found. We conclude that endothelial dysfunction is observed in patients with IgAN. This abnormality is already present in some patients with normal blood pressure, normal renal function, and absence of proteinuria. Angiotensin-converting enzyme inhibition induced a significant decrease in both vWF levels and proteinuria.

[Characteristics and management of morbidity in seven Chilean cities]

BACKGROUND

Health population inquiries give information about morbidity as perceived by people, the quality of medical care and the costs of diseases.

AIM

To inform the results on morbidity and medical care surveys performed in the Chilean cities of Antofagasta, La Serena, Concepción, Temuco, Llay Llay, Tiltil y Lampa-Batuco.

MATERIAL AND METHODS

A random sample of 951 dwellings with 4.192 people was selected and studied three times, in 1995 and 1996. All health events (acute and chronic disease episodes, accidents, health examinations, dental care) and the main features of medical care were registered in the interviews which covered a 2-week period each time.

RESULTS

Health events were registered in 30.1% people. When extrapolating fortnight findings to a one year period, each person had 2.37 annual episodes of acute diseases, 0.94 health examinations and 0.69 dental attentions. The prevalence of chronic diseases was 13.2%. The frequency of health events was higher among women and in elders. Hospital stays and deaths were less frequent in higher income levels. Most acute diseases were respiratory illnesses, followed by communicable diseases. The most important chronic diseases detected were hypertension, diabetes mellitus, bronchial asthma and heart diseases. Medical care was provided in 66% of acute and 34% of chronic diseases.

CONCLUSIONS

When comparing these results with previous surveys, an increase in the frequency of acute and chronic diseases is found.

Processes of change assessment in heroin addicts following the Prochaska and DiClemente transtheoretical model

The processes of change dimension of Prochaska and DiClemente's transtheoretical model of change is tested in a sample of opiate addicts for the first time. A self-report (The Processes of Change Inventory for Opiate Addicts, PCI-OA) designed to assess the frequency of processes of change was administered in a sample of 178 heroin addicts in order to study its reliability, validity and discriminative efficiency. An alpha-reliability coefficient of 0.87 was obtained. A principal component analysis of the measure revealed a three-component solution which accounted for 34% of the variance: 'contemplation and preparation processes', 'processes of action', and 'processes of the final part of the action phase and maintenance'. Comparisons between abstinent and non-abstinent subjects revealed significant differences (P < 0.0001) in two of the ten processes considered: counterconditioning and stimulus control. A stepwise discriminant analysis yielded a linear combination of eight processes that correctly identified 78% of the total sample. Theoretical and clinical implications of the results are discussed, suggesting that the PCI-OA can be considered as a useful self-report instrument for identifying which processes of change are being used by a specific opiate-dependent patient.

Fusarin C Production by Fusarium spp. from Spain

From 657 samples of grains and feedstuffs (1991 to 1992 and 1992 to 1993 surveys), collected in two different geographical areas of Spain, 154 isolates of Fusarium spp. were obtained. The isolates were screened for their ability to produce fusarin C in a modified 10% ICI N synthetic liquid medium. The production of fusarin C was verified by means of spectrophotometry, thin layer chromatography, high-performance liquid chromatography, and nuclear magnetic resonance. Results showed that more than 57% of tested isolates were able to produce fusarin C at levels of 0.04 to 200 μg/liter of ICI medium. There were no statistically significant differences (P < 0.05) between levels of fusarin C production and the geographical origin of the Fusarium isolates. The Fusarium isolates that produced fusarin C were identified as F. moniliforme , F. oxysporum , F. sporotrichioides , and F. poae . This is the first report of fusarin C production by F. oxysporum .

[The evaluation of a newborn in a coma]

Coma is differentiated from sleep by the absence of a normal arousal response and from death by the presence of heart beats and the absence of brain death criteria. Most causes of coma are readily diagnosed and treated. Others require a test whose results are not immediately available, transportation or a risky procedure and empirical treatment has to be considered. In addition to treating the cause of coma, treatment of the systemic and neurological causes of secondary brain damage is paramount.