[Prevalence of hereditary hemochromatosis among healthy workers. Diagnostic value of transferrin saturation assay]

AIM

Hereditary hemochromatosis is the most common inherited disorder in white population (2-8 cases per 1000 habitants). Hemochromatosis is characterized by increased intestinal absorption of iron leading to its deposition into multiple organs. An early diagnosis and proper management with frequent phlebotomies are known to improve life expectancy and quality of life. Diagnosis is suggested by an elevated Transferrin saturation (TS) (more than 60%).

METHOD

Prospective study of the level of TS among 1131 healthy workers, who came to the Security and Hygiene Official Centre for their annual revision had been undertaken.

RESULTS

Twenty-wo workers had high TS; in 10 of them the increase of TS was confirmed on repeated determinations. Liver biopsy was performed in six (and refused by the other four), eventually a diagnosis of hemochromatosis was confirmed in three (in-group prevalence of 2.6 per 1000 people).

CONCLUSIONS

In our experience, TS is the most appropriate initial screening test for detecting hereditary hemochromatosis in a normal population.

Keratin 9 is a component of the perinuclear ring of the manchette of rat spermatids

Previous work in our laboratory has shown that a 62- to 64-kDa protein was a major component of the perinuclear ring of manchettes fractionated from rat spermatids. Mass spectrometry analysis of this protein indicated the presence of a glycine-rich domain homologous to human keratin 9 (K9). Several antibodies to K9, raised against synthetic peptides of human K9, recognized the 64- to 62-kDa protein in the perinuclear ring of the manchette as well as in keratinocytes of the suprabasal layer of the rat and human footpad/sole epidermis in both immunoblotting and immunocytochemical experiments. Based on these data, human-derived K9 primers were used to clone rat K9 cDNA from epidermis by RT-PCR. Rat-specific K9 primers were then used to perform a two-step (nested) PCR to amplify the K9-specific rat testicular RNA and to obtain cDNA to demonstrate K9 gene expression in rat testis. The deduced amino acid sequence of rat K9 cDNA contains 618 amino acids with an estimated molecular mass of 63,020 Da, in agreement with that obtained by electrophoretic fractionation of rat manchette and epidermis footpad proteins. The deduced protein structure correlates with the recognizable pattern of keratins: a rod domain of 304 amino acids with well-conserved initiation and termination sequences (MQNLNSRLASY and EIETYRKLLEG, respectively), flanked by glycine/serine-rich head and tail domains of 141 and 173 amino acids, respectively. A high content of phenylalanine was detected in the head domain and a repetitive motif (SGGSYGGGS) in the tail domain. A comparison with human keratin 9 showed an overall nucleotide and amino acid similarity of 75%. An increased level of K9 transcripts was detected in a cDNA library prepared from fractionated round spermatids. Results of this study show that rat testis expresses K9 and that this protein is a component the perinuclear ring of the manchette of rat spermatids.

[Fibrinogen serum levels in patients with stable coronary artery disease and acute coronary syndrome]

Increased plasma fibrinogen level is an important prognostic factor of recurrent unstable angina and myocardial infarction in patients with acute coronary syndrome (ACS). The aim of our study was to assess the plasma fibrinogen level at baseline condition in patients admitted to hospital due to coronary artery disease (CAD). Plasma fibrinogen was measured in 51 consecutive patients presenting with ACS within the last 24 hours and in 50 patients with angiographically proven CAD that was stable for the past 30 days. For statistical analysis Mann-Whitney U test, Student t-test, chi-square test and Pearson correlation was used, p < 0.05 being considered statistically significant. There was significant correlation between fibrinogen level and diagnosis of ACS or CAD (r = 0.29, p = 0.002). In our population plasma fibrinogen levels (g/L +/- SD) were significantly different in patients with ACS when compared to CAD subjects (3.87 +/- 1.2 vs. 3.26 +/- 0.65, p = 0.002). There was difference between ACS and CAD subjects in male:female ratio (40/11 vs. 47/4, p < 0.001) and age (63.4 +/- 10.1 vs. 58.4 +/- 10.0, p = 0.014). Our results confirm the role of fibrinogen in pathogenesis of CAD. In our opinion plasma fibrinogen level may be an important diagnostic tool in assessment of patients with chest pain.

Pharmacologic suppression of target cell recognition by engineered T cells expressing chimeric T-cell receptors

Adoptive therapy with autologous T cells expressing chimeric T-cell receptors (chTCRs) is of potential interest for the treatment of malignancy. To limit possible T-cell-mediated damage to normal tissues that weakly express the targeted tumor antigen (Ag), we have tested a strategy for the suppression of target cell recognition by engineered T cells. Jurkat T cells were transduced with an anti-hapten chTCR tinder the control of a tetracycline-suppressible promoter and were shown to respond to Ag-positive (hapten-coated) but not to Ag-negative target cells. The engineered T cells were then reacted with hapten-coated target cells at different effector to target cell ratios before and after exposure to tetracycline. When the engineered T cells were treated with tetracycline, expression of the chTCR was greatly decreased and recognition of the hapten-coated target cells was completely suppressed. Tetracycline-mediated suppression of target cell recognition by engineered T cells may be a useful strategy to limit the toxicity of the approach to cancer gene therapy.

Recognition of ERC-induced pancreatitis in patients with choledocholithiasis by an analysis of laboratory findings

BACKGROUND/AIMS

This study retrospectively analyses the relative value of various laboratory tests in the diagnosis of procedure-related pancreatitis in patients submitted to endoscopic retrograde cholangiography with sphincterotomy due to choledocholithiasis.

METHODOLOGY

A detailed laboratory assessment was performed on 238 patients 4, 10, 24, 48 and 72 hours after undergoing endoscopic sphincterotomy.

RESULTS

Of the 238 patients analyzed, 16 (6.7%) had a complication, including pancreatitis in 6 (2.5%), hemorrhage in 4 (1.7%), acute cholangitis in 3 (1.3%), and perforation in 3 (1.3%). In patients developing acute pancreatitis a significant rise was noted not only in serum amylase but also in the white blood cell count and aspargine transaminase at 24 hours following endoscopic sphincterotomy. Endoscopic procedure (difficulty in cannulating the bile duct and/or obtaining cholangiogram) was a significant risk factor for complications.

CONCLUSIONS

It is possible to stratify patients according to their risk of developing pancreatitis according to serum amylase, white blood cells and aspargine transaminase levels monitored for at least 24 hours following ERC. Patients for whom the procedure was difficult and selective cholangiogram was not obtained are at increased risk of developing procedure-related complications.

[Comparison of primary care teams in Barcelona according to management formulas]

OBJECTIVE

The aim of the study is to compare, among socio-economically similar areas, the use of medical services, clinical practice and pharmacy costs depending on the how the primary healthcare teams, that provide these services, are organized according to different managemental formulas.

DESIGN

Descriptive study of the evaluation of health care services.

PATIENTS AND METHODS

The population units (basic health areas) attended by the reformed primary health care services in Barcelona were classified into three levels according to the population's socioeconomic status (high, medium or low). For each level, two primary health care teams were selected representing different primary health care providers: "Institut Catala de la Salut"; and others. The influence of both the provision option and the population characteristics on service use, clinical practice and costs of prescription were compared.

MAIN RESULTS

The services offered by the two provision options differ. However, the use of medical services is related to the socioeconomic characteristics and not to the option for service provision. Whilst there are no relevant differences in clinical practice between the different options, we observed variations among different primary care teams, notably in referrals to specialists and influenza vaccine coverage. The greater source of variation in prescription costs seems to be related to an external confounding factor.

CONCLUSIONS

Empirical data have not identified relevant differences in the pattern of use, clinical practice, or costs between the different options for service provision within the model of reformed primary care services. Observed variations seem to be associated mainly with the population's characteristics, its pattern of health service use or other external confounding factors.

Monitoring of biologically effective UV irradiance at El Arenosillo (INTA), Andalucia, in Spain

Biological UV (ultraviolet) dosimetry was applied using the biofilm-technique (DLR patent) to determine the UV levels weighted of biologically weighted UV radiation at the INTA Sounding Station of El Arenosillo at Huelva, Spain (37 degrees 06'N, 6 degrees 44'W, 50 m a s 1=above sea level) on 2 days in 1997 [correction of 1977] (April 1, and May 5). Exposure periods were calculated for clear sky days using a radiative transfer model for erythemal doses to reach 1.3 to 1.5 MED (minimal erythemal dose). Reliability of the radiative transfer model was demonstrated by the doses registered by a Yankee-UV biometer for the same exposure periods as used for the biosensor. This work presents the methodology employed (biofilm-technique utilized [correction of utiliced], calculation of exposing periods with radiative transfer model, etc) and the results obtained with the Yankee biometer and the biofilm. At noon, the ratio of biofilm measurements (Ieff, W/m2=biological effective irradiance, in W/m2) to the UV Biometer data (in MED/h) was 3-4.

[An evaluation of the impact of primary care reform on health]

OBJECTIVE

Evaluation of the impact of the reform of primary health care services on the population health.

DESIGN

Comparative analysis of mortality rates for the 1984-96 period in three zones of homogeneous socioeconomic level, assessing the effect of the differential development of the reform of public primary health care services.

SETTING

The study is restricted to the 23 health areas with lower socioeconomic status in the city of Barcelona (443092 inhabitants).

MEASUREMENTS AND MAIN RESULTS

The study areas are categorized in three groups, according to the sequence of the reform: reformed between 1984 and 1989, RAP1 zone, reformed between 1990 and 1991, RAP2 zone, and those still served by the old scheme in 1992, NORAP zone. General mortality rates are analyzed, and also mortality rates by those avoidable conditions. Significant differences among the three zones are initially visible. The mortality decline is 13.6% in the RAP1 zone and 10.3% in the NORAP zone, so that the decline in the RAP1 zone is 32% greater than in the NORAP zone. At the end of the study, mortality due to stroke and hypertension is lower in the RAP zones than in the NORAP zone. Perinatal mortality shows a clear decline in the three zones. No relevant changes are seen for tuberculosis or cervical cancer. Lung cancer mortality increases except in RAP1 zone where it declines, to the point that the excess mortality from that cause estimated by comparison with the NORAP zone in the initial phase of the study vanishes. Death rates from cirrhosis and motor vehicle accident decline in all zones.

CONCLUSIONS

There is a clear association between the process of reform of primary care and the decrease in general mortality in these zones of low socioeconomic level. These results suggest that the reform of primary health care services in Spain may have a significant impact in the mortality of the population of lower socioeconomic level. The study highlight the cost in health and human lives of maintaining obsolete and overburdened services for some segments of the population, and justify the need and urgency of completing the process of reform initiated in 1984 and still unfinished in 1999.

Safety of dobutamine-atropine stress echocardiography: A prospective experience of 4,033 consecutive studies

Dobutamine-atropine stress echocardiography (DASE) is an established method and has been shown to be accurate for the detection of coronary artery disease. Still, there are few large clinical studies that analyze the safety of DASE in general or the safety of performing it on an ambulatory basis. Most studies use a target heart rate as the primary end point regardless of whether asymptomatic ischemia occurs. Such studies have shown a serious cardiac event rate of approximately 0.3%. We prospectively studied 4,033 consecutive patients on an ambulatory basis and in the hospital with the use of DASE from July 1991 to December 1998. All tests were performed by an experienced physician, and all clinical and DASE data were stored in a large database organized at the beginning of the study. Dobutamine was infused in scalar doses of 5, 10, 20, 30, and 40 microg/kg per minute in 3-minute stages. Development of a new wall motion abnormality, achievement of 85% of target heart, and end of the DASE infusion protocol were used as an end point. If 85% of the target heart rate was not achieved, atropine was infused up to 1 mg in the absence of myocardial ischemia, which was used in 1,280 studies. There were 3,645 diagnostic tests, and 388 (10%) were found to be nondiagnostic. This result was due to poor image quality in 115 (3%), end of protocol in negative-submaximal examinations in 124 (3%), and limiting side effects in 149 (4%). Thirty-seven percent of the tests showed positive results for myocardial ischemia. Major test-related cardiac complications occurred in 10 (0.25%) patients and included 1 ventricular fibrillation, 1 case of myocardial infarction, and 8 cases of sustained ventricular tachycardia. Atropine poisoning was observed in 5 (0.12%) patients. No deaths occurred as a direct or indirect consequence of DASE. We conclude that dobutamine-atropine stress echocardiography is a reasonably safe method for detection of coronary artery disease in the hospital or in an ambulatory basis. The use of new wall motion abnormality as 1 of the end points may prevent further ischemia-related complications.

[Epidemiology of sudden cardiac death in Spain]

Sudden cardiac death is a remarkable public health problem though its incidence in Spain is lower than in other industrialised countries. Approximately 12% of all natural deaths occur suddenly, and 88% of them are of cardiac origin. This is the form of death in more than 50% of coronary heart disease patients. Moreover, it is the first symptom in 19-26% of cases. This close relationship with coronary heart disease results in cardiovascular risk factors being also risk factors for sudden death. Several factors, such as physical activity or certain drugs may act as sudden death triggers. The more effective strategy addressed to sudden cardiac death prevention includes identification high-risk subgroups of patients (i.e. patients with previous coronary heart disease, heart failure, out-of-hospital sudden death survivors and patients who developed a ventricular fibrillation or tachycardia after a myocardial infarction) and development of efficacious therapeutic interventions. Given that most sudden death are related to coronary heart disease, those primary preventive measures directed to reduce the coronary heart disease incidence rates will also prevent sudden cardiac deaths in population. Finally, community programs directed to reduce the time to reach cardiac emergencies by trained personnel, and to train general population in cardio-respiratory reanimation have shown to be efficacious owing to the fact that most sudden cardiac deaths occur out of hospitals.

Topical versus Systemic 5-Aminolevulinic Acid Administration for Photodynamic Therapy of the Colon in B10.RBP Mice

5-aminolevulinic acid (5-ALA) is an interesting photosensitizing substance for photodynamic therapy (PDT), successfully applied topically for urological malignancy. In gastroenetrology it has proven efficacy for treatment of some GI neoplasms after systemic administration. This study was aimed at investigating the possibility of topical 5-ALA administration also for the PDT of gut cancer in a mice model. 5-ALA solution at different concentrations (5%, 1.5%, and 0.5%) was instilled in the colon of mice, which was later removed and examined by fluorescence microscopy. The results of fluorescence studies were compared with those obtained in a control group treated with 5-ALA given systemically. Satisfactory epithelial fluorescence levels and good selectivity between gut layers was obtained after intracolonic 5-ALA instillation. However, mean fluorescence intensity was higher after systemic drug application. Our results suggest that 5-ALA may probably be used topically for the PDT of some gut neoplasms. © 1999 Society of Photo-Optical Instrumentation Engineers.

Phaeohyphomycosis in kidney transplant patients

Dematiaceous fungi are being increasingly recognized as pathogens in organ transplant recipients. This investigation reports five cases of subcutaneous phaeohyphomycosis that occurred in five kidney transplant recipients in the Renal Unit at the San Vicente de Paul Hospital, Medellin, Colombia. Fungi of the genus Exophiala were isolated in three cases, but the agent was not identified in two cases. Physicians are likely to develop increased awareness of the clinical manifestation of infection with the dematiaceous fungi as the population of immunocompromised hosts continues to grow.

Long-term results of the Spanish trial on treatment and survival of patients with predominantly mild heart failure

A randomized open-label clinical trial was conducted to determine whether mortality, readmission, or quality of life differed between heart failure patients managed with captopril plus diuretics and those with digoxin plus diuretics. A total of 345 heart failure patients in New York Heart Association functional classes 2 and 3 without atrial fibrillation, dyspnea of bronchopulmonary origin, or hypertension not controlled with diuretics was randomized for digoxin (n = 175) or captopril (n = 170) treatment and followed up for a median of 4.5 years. Socioeconomic, demographic, electrocardiographic, echocardiographic, spirometric, and chest radiograph data were obtained at the initial examination. In a random sample of half the patients, ergometric, echocardiographic, and Holter records were obtained at entry and at 3 and 18 months. Patients were followed up for > or = 3 years. The end points were mortality, hospitalization for cardiac events, deterioration in quality of life, worsening of functional class, and need for digoxin or captopril in the captopril and digoxin groups, respectively. The trial had to be terminated prematurely owing to the difficulty in finding candidates free of angiotensin-converting enzyme (ACE)-inhibitor treatment. Baseline patient characteristics were similar in both groups. From the clinical point of view, only the 48-month mortality was relevantly lower (20.9 vs. 31.9%, respectively) among patients treated with captopril than that in those receiving digoxin (log rank test, p = 0.07). No statistically or clinically relevant differences were found in other end points or adverse effects. The results suggest but do not confirm the hypothesis that captopril treatment in mild to moderate heart failure might provide better long-term survival than digoxin.

Relationship of therapeutic improvements and 28-day case fatality in patients hospitalized with acute myocardial infarction between 1978 and 1993 in the REGICOR study, Gerona, Spain. The REGICOR Investigators

BACKGROUND

The aim of this study was to analyze 28-day case fatality trends between 1978 and 1993 among hospitalized acute myocardial infarction (AMI) patients in the REGICOR registry, Gerona, Spain, and relate them to thrombolytic and antiplatelet drug use and changes in patient characteristics.

METHODS AND RESULTS

A total of 2053 consecutive patients 25 to 74 years of age with a first Q-wave AMI admitted to the reference hospital between 1978 and 1993 were registered. Clinical characteristics and patient management were recorded. Four 4-year periods were considered: 1978 to 1981, 1982 to 1985 (prethrombolytic therapy), 1986 to 1989 (thrombolytic and antiplatelet drugs introduced), and 1990 to 1993 (thrombolytic and antiplatelet drugs used routinely). The end point was death at 28 days. Case fatality at 28 days decreased 6% per year between 1978 and 1993. A logistic model adjusted for comorbidity and severity showed the last 3 periods to present a steep decrease in the OR of death at 28 days: 0.86 (95% CI, 0.52 to 1.41), 0.59 (95% CI, 0.35 to 0.99), and 0.40 (95% CI, 0.24 to 0.69), respectively, compared with the first period. After 1986, 85.7% of the 112 lives saved could be attributed to the use of antiplatelet and thrombolytic drugs. Adjusted relative risk reduction was 56.0% for antiplatelet drugs, 34.1% for thrombolytic drugs, and 77.9% for the 2 combined.

CONCLUSIONS

Our results strongly suggest that new therapies introduced since 1986 have contributed to the decrease in 28-day case fatality of patients admitted with a first Q-wave AMI. This decrease could be attributable mainly to the use of antiplatelet and thrombolytic drugs. These findings should encourage the routine use of thrombolytic and antiplatelet drugs and particularly their combination in the acute phase of AMI.

Production and characterization of an antibody specific for a novel protein serine/threonine kinase, MPK38, highly expressed in hematopoietic cells

We report an antibody that selectively recognizes MPK38, a new protein serine/threonine kinase closely related to the SNF1 serine/threonine kinase family. This antibody recognized a region of the N-terminal kinase catalytic domain and part of the remaining C-terminal portion and was sensitive enough to detect a 72-kDa recombinant MPK38 in insect cells by Western blotting. Immunoblot analysis showed that the recombinant MPK38 was expressed in a time-dependent manner and reached a maximum after 48 h postinfection. In addition, the immune complex kinase assay revealed that the recombinant and endogenous MPK38 protein autophosphorylated in vitro. Phosphoamino acid analysis of autophosphorylated MPK38 protein showed that the phosphorylation was exclusively on serine and threonine residues, suggesting that MPK38 is a protein serine/threonine kinase. Thus, this antibody could be helpful for elucidating the biological functions of MPK38 in the MPK38-expressing cells.

Isolation of speech area syndrome (ISAS): a follow-up study--a rehabilitative approach

PURPOSE

In this study we present our findings concerning the dynamics of language modalities in the isolation of the speech area syndrome (ISAS). The aim of the study was to establish: (1) the linguistic characteristic features of this group of patients; (2) the course of dynamics of language of each patient; (3) whether this course of dynamics is common for the whole group; (4) whether the course of dynamics we found matches with the report in the literature.

METHOD

Over a period of 5 years, nine patients with ISAS were diagnosed and treated in our department. They received varying lengths of treatment, and four were followed for 2-6 years after discharge.

RESULTS

Despite the common belief that the prognosis for language rehabilitation for these patients is poor, we found that some ISAS patients improved, even dramatically, after prolonged language treatment.

CONCLUSION

It is hoped that these findings will alter clinicians' attitudes towards these patients, and provide some hope for rehabilitation outcome.

MPK38 expression is upregulated in immature T cells activated by concanavalin A

We have previously identified a cDNA clone from a murine teratocarcinoma PCC4 cDNA library, which we have termed MPK38 for murine protein kinase 38. MPK38 is a new member of the SNF1 serine/threonine kinase family. To understand the role of the MPK38 in thymocytes, we have investigated the level of MPK38 expression by Northern blot analysis. Interestingly, incubation of thymocytes at 37 degrees C resulted in the loss of the MPK38 transcript, however the transcript could be reinduced by treatment with Con A or PHA, but not with PMA and growth factors such as IL-2, IL-7, TGF-beta, TNF-alpha, and EGF. In addition, stimulation of mature T cells from the spleen with Con A failed to reinduce the MPK38 transcript, indicating a developmental regulation of MPK38 expression, whereas non-T cell populations significantly reinduced the transcript. These results suggest that MPK38 may play a functional role as one of the signal regulators in early T cell activation and, potentially, certain lineages of hematopoietic cell activation induced by Con A.

Efficacy of radiotherapy for malignant gliomas in elderly patients

PURPOSE

Age above 65 years is a strong negative prognostic factor for survival in patients with malignant gliomas (MG) treated with radiotherapy (RT) and its value has been questioned. We analyzed the effect of RT on the survival of elderly patients with malignant gliomas.

METHODS AND MATERIALS

We examined 85 consecutive elderly patients with a histological diagnosis of MG. Age ranged from 65 to 81 years (median 70 years). Glioblastoma multiforme (GBM) was diagnosed in 64 patients (75.3%). Surgical treatment included needle biopsy in 32 patients (37.6%). Median postoperative Karnofsky Performance Status (KPS) was 60 (range: 30-100). Survival probability was estimated using Kaplan-Meier method and compared with the log-rank test. Crude and adjusted hazard ratios (HR) were calculated using Cox's regression models.

RESULTS

Median survival time for all patients was 18.1 weeks. In multivariate analysis, RT was the only independent prognostic variable for survival (HR: 9.1 [95% CI: 4.5-18.7]). Forty-two patients did not start RT mostly due to low KPS (<50). The median survival of the 43 patients who started RT was 45 weeks. In these patients, Cox multivariate analysis indicated that age was independently associated with prolonged survival (HR: 2.85 [95% CI 1.31-6.19]). Median survival of patients age 70 years and younger was 55 weeks compared with 34 weeks for patients older than 70 years.

CONCLUSIONS

The overall survival for elderly patients with MG is poor. RT seems to improve survival in patients up to 70 years, but in older patients treated with RT the survival is significantly shorter.

Epidemiology of peptic ulcer disease in cirrhotic patients: role of Helicobacter pylori infection

OBJECTIVE

The aim of this study was to investigate the clinical and epidemiological factors associated with the appearance of peptic ulcer in patients with cirrhosis and, in particular, the role of Helicobacter pylori infection.

METHODS

A total of 201 of 220 consecutive patients included in a prospective study that aimed to evaluate the effect of dietary intervention on cirrhotic complications and survival underwent upper gastrointestinal endoscopy. At entry, an epidemiological and clinical questionnaire was completed and the presence of peptic ulcer disease or esophageal varices at endoscopy was prospectively collected. Sera were obtained and stored at -70 degrees C until analyzed, being tested afterward for Helicobacter pylori antibodies using a commercial ELISA kit.

RESULTS

Eleven of 201 patients had borderline anti-Helicobacter pylori IgG titers and were excluded from further analysis. In the remaining 190 patients, point prevalence of peptic ulcer was 10.5% and lifetime prevalence 24.7%. Multivariate analysis selected male sex (OR 2.3; 95%CI 1.09-4.89) and Helicobacter pylori seropositivity (OR: 1.7, 95%CI 1.02-2.81) as the variables independently related to peptic ulcer disease.

CONCLUSIONS

Male sex and seropositivity for Helicobacter pylori are the major risk factors for peptic ulcer in cirrhosis.

[The improvement of echocardiographic assessment of the left ventricle by the use of perflenapent and harmonic imaging]

Contrast echocardiography and harmonic imaging (HI) are promising new modalities applied in order to obtain improved visualisation of the left ventricle. Perflenapent (EchoGen, Abbott) is a new generation echocardiographic contrast agent that crosses the pulmonary capillary bed and produces long-term ventricle opacification. Our aim was to assess the left ventricle endocardial visualisation after perflenapent infusion and HI technique. We studied a pilot group of 10 patients (mean age 52.5 +/- 7.6, mean weight 76.9 +/- 10.1 kg, one female) with previously obtained sub-optimal non-contrast echocardiograms. Perflenapent was injected intravenously at dosis 0.05 ml/kg. Echocardiography was performed before perflenapent injection and during the time between injection and LV image disappearance. Images were assessed using four-point scale, 0 standing for the poorest and 3 for excellent visualisation. Perflenapent produced full chamber opacification in all pts. Contrast effect was observed for 550-15824 sec and myocardial enhancement was seen for 176-2116 sec after i.v. administration. After perflenapent administration, endocardial border was significantly better visible than before (1.9 +/- 0.57 vs. 2.9 +/- 0.31, p < 0.001). No hemodynamic effects were noted, as assessed by oxygen saturation, blood pleasure and heart rate. A mild, transient somnolence was seen in one pt. Perflenapent improved left ventricular function diagnostic capabilities, and provided enhanced visualisation of the myocardium.

Association between giardiasis and allergy

BACKGROUND

Previous studies have indicated that there may be an association between infection by the intestinal protozoan Giardia lamblia and the expression of allergic disease.

OBJECT

We evaluated a group of children who attended the Outpatient Clinic of the Children's Hospital in Caracas, Venezuela, a group in which both allergic disease and giardiasis were common.

METHODS

We performed feces examination and measured total and specific serum IgE (immunoglobulin E) in these children.

RESULTS

We found that 70% of the children infected with G. lamblia presented symptoms of allergy, in contrast to 43% of the non-Giardia parasitized group (P <.05). In addition, the G. lamblia parasitized children showed significantly higher levels of total serum IgE (1194 IU/mL) than the non-Giardia group (822 IU/mL) (P <.005). Children infected with G. lamblia showed higher levels of specific serum IgE antibody against food allergens compared both with the non-parasitized group (P <.0001) and children infected with parasites other than Giardia (P <.05). In contrast, IgE responses against the house dust mite Dermatophagoides pteronyssinus were similar in all the groups studied.

CONCLUSIONS

These results reveal a clear relationship between giardiasis and allergy, possibly because infection by this protozoon enhances sensitization towards food antigens, due to increased antigen penetration through damaged intestinal mucosa.

Rat liver genesine: a biochemical approach

Genesine, the naked autoglucosylating protein involved in glycogen biosynthesis, was partially purified from rat liver and some of its biochemical properties were characterized. Its activity was strongly activated by Mn2+ and two-pH optimums were obtained. UDP-14C-Glc was the preferred glucosyl donor substrate, but also UDP-14C-Xyl was. It was additionally found that more than one glucose was transferred to the protein or to that alpha1,4 glucan already linked to the protein from UDP-Glc. Glucose, maltose, xylose and UDP were inhibitors of genesine activity.

Helical CT versus CT arterial portography in the detection of hepatic metastasis of colorectal carcinoma

OBJECTIVE

The study is a prospective comparison of helical CT with nonhelical CT arterial portography (CTAP) in the detection of liver metastases from colorectal carcinoma, using surgical and histologic findings as the gold standard.

SUBJECTS AND METHODS

Thirty-five patients with colorectal carcinoma and suspected liver metastases were prospectively examined with helical CT and CTAP before surgery. In nine cases, surgery was not performed. In the remaining 26 patients, imaging results were correlated with surgical and pathologic findings. Three radiologists prospectively assessed metastatic involvement with both techniques. The results were compared with pathologic and surgical findings on a lesion-by-lesion basis. In a second phase, three radiologists not directly concerned in the design of the study independently assessed metastatic involvement of the liver as revealed on helical CT and CTAP on a segment-by-segment basis with a five-level scale of confidence. Results were analyzed by receiver operating characteristic methods.

RESULTS

The results of the histologic study disclosed 50 metastatic lesions. Helical CT had a sensitivity of 76% (38/50) and a positive predictive value of 90%. CTAP had a sensitivity of 74% (37/50) and positive predictive value of 69%. Receiver operating characteristic analysis revealed a greater area under the curve (Az index), 0.96, for helical CT than for CTAP (0.86). Differences were statistically significant (p < .001).

CONCLUSION

Helical CT is superior to nonhelical CTAP in the detection of hepatic metastases from colorectal carcinoma.

[Prescription habits in a primary health care district: approach to an indication-prescription study]

OBJECTIVE

To analyse the profile of medical prescription and prescription habits in the most common illnesses in a Primary Health Care district.

DESIGN

Descriptive crossover study.

SETTING

Algeciras-La Línea (Cádiz) Primary Care district.

MEASUREMENTS AND MAIN RESULTS

A randomised sample of clinical histories stratified by months was selected. This included 338 Paediatrics cases (< 8 years old) and 665 general medical cases (> 8). The therapeutic groups most commonly prescribed for the children were R (45.7%) and J (27.1%) The therapeutic groups most used among the > 8 group were C (17.9%), R (14.8%), N (14.7%) and A (14.3%). Hypertension was the most common chronic pathology in this group (8.9%), treated most often by ACEIs (44.9%).

CONCLUSIONS

1) In our ambit, the most widespread pathology signified the greatest consumption of therapeutic groups. 2) The indication-prescription analysis detected prescription habits that need to be watched: the use of antibiotics and expectorants/mucolytics in ARI and the use of fixed-dose combinations which are hard to justify. Prescription habits in Hypertension treatment and Hyperlipidaemia also merit a consensus analysis.

Chronic immobilization stress appears to increase the role of dopamine in the control of active behaviour in the forced swimming test

Previously, we have demonstrated that chronic exposure to immobilization (IMO) did not modify the influence of catecholamines on active behaviour of rats in the holeboard, but clearly increased the role of these amines in the forced swimming test (FST). In the present experiment, it was studied whether or not chronic IMO altered the role of dopamine in the two tests. Adult male Sprague-Dawley rats were left either undisturbed or subjected daily to 2 h of IMO stress for 12 days. On the following day, half of the rats were administered saline and the others the dopamine antagonist haloperidol (0.5 mg/kg). Then the rats remained undisturbed in the animal room (controls) or were subjected to acute IMO for 2 h. Finally, all animals were exposed consecutively to the holeboard (4 min) and the FST (5 min). In non-chronically stressed rats, acute IMO depressed behaviour in the holeboard but not in the FST. In chronic IMO rats the inhibitory effect of acute IMO on holeboard activity was slightly reduced as compared to controls. Acute IMO increased struggling in rats previously exposed to chronic IMO but did not alter struggling in non-chronically stressed rats. Whereas the inhibition caused by haloperidol treatment in the active behaviour of rats in the holeboard was not altered by chronic IMO, the inhibitory effect of haloperidol in the active behaviour of rats in the FST was greater after chronic IMO, particularly in rats also subjected to acute IMO. These data suggest that chronic IMO stress potentiates the role of dopamine in a specific behavioural task such as the FST and adds support to the previously published data demonstrating enhanced behavioural and neurochemical responses to dopamine-related drugs after chronic stress.

[Correction of social inequalities in health: reform of primary health care as a strategy]

OBJECTIVES

To evaluate the impact of a policy to define priorities for the reform of primary health care services among small areas according to health and social indicators.

DESIGN

Qualitative study of the changes in the provision of primary health care services after a priority setting exercise based in social and a health indicators.

SETTING

The city of Barcelona (Catalonia, Spain).

PARTICIPANTS

The 66 basic health areas in which the city is divided for health care planning.

INTERVENTION

Areas are ranked according to their health and social indicators, giving greater priority to those areas with unfavorable indicators for the development of the reform of primary health care services and a associated allocation of resources.

RESULTS

Although at first new investments were determined by preexisting processes based in opportunity criteria, clear changes are observed. Three years after, there are improvements in the provision for services in all priority areas, or they are in the midst of change.

CONCLUSIONS

In a context of tightening resources and of resistance to change, it is possible to introduce objective criteria to set priorities to improve primary health care services selectively in areas with most unfavorable indicators. This process has the capacity to overrun obstacles and resistances.

[Endoscopic polypectomy in the large bowel--the pathologist's view]

Colonoscopy remains the main diagnostic tool in colorectal diseases. Endoscopic polypectomy is a routine therapeutic method for colorectal adenomas, but its yield must be verified histologically. Complete endoscopic and histologic resection of an adenoma is regarded as a sufficient method of its treatment. Some early colon cancers can also be managed endoscopically, providing that strict histologic criteria are fulfilled. It is the duty of clinicians to supply pathologists with all the clinical data on the patient and to properly mark the resected specimen. Pathologists must understand the therapeutic technique, its limits, and provide physicians with a detailed histopathological report that includes not only a proper histological assessment of the resected tissue, but also a comment on completeness of the neoplasm resection. This article should help both clinicians and pathologists to benefit from the potential of histological examination.

Manual nucleofragmentation and endothelial cell loss

PURPOSE

To compare corneal endothelial cell loss with two cataract surgery techniques: manual nucleofragmentation performed with the Keener nucleus divider and planned extracapsular extraction.

SETTING

Department of Ophthalmology "Memorial Cristóbal Garrigosa," Hospital de l'Esperança, Universitat Autònoma de Barcelona, Spain.

METHODS

Contact specular microscopy was performed before and 8 weeks after surgery in 51 patients who had been prospectively randomized into 2 groups: 26 patients had manual nucleofragmentation (NF) with the Keener divider and 25, planned extracapsular cataract extraction (ECCE). The analyzed parameters were preoperative and postoperative endothelial cell density and variations in cell size (polymegethism) and cell shape (pleomorphism). The results were compared and statistically analyzed.

RESULTS

The mean percentage of endothelial cell loss in the NF group was 11.08% and in the ECCE group, 9.86%. This difference was not statistically significant. Postoperative variation in cell shape and size did not differ significantly between the two groups and was fairly constant.

CONCLUSION

The percentage of endothelial cell loss that occurred with manual NF using the Keener nucleus divider was similar to the one that occurs with other cataract surgery techniques. The small variation detected in postoperative endothelial morphology suggests that this endothelial cell population is stable.

Cloning and expression of a cDNA encoding a novel protein serine/threonine kinase predominantly expressed in hematopoietic cells

We have isolated a cDNA clone of a new member of protein serine/threonine kinases, MPK38, from a cDNA library constructed from the murine teratocarcinoma PCC4 cell line by the polymerase chain reaction. MPK38 was transcribed as an approx. 2.5 kb mRNA encoding for a protein of 643 amino acids. N-terminus of MPK38 contains the kinase catalytic domain which exhibits approximately 60% protein sequence identity with the SNF1 serine/threonine kinase family. The MPK38 cDNA directs the in vitro translation of two protein species of approx. 70 and approx. 50 kDa, which appear to result from an internal initiation of translation. MPK38 was predominantly expressed in thymus and spleen, but was not detectable in kidney, liver, and muscle in the adult tissues. In addition, MPK38 was apparently expressed in T lineage cells and a macrophage/monocyte cell, but was not detectable in a B cell line and an embryonic cell line. However, a low level of MPK38 transcript was detectable in a mast cell line after a longer exposure. Furthermore, MPK38 gene product showed the kinase activity which was assessed by immune complex kinase assay. Thus, MPK38 gene product seems to play an important role in signal transduction of certain lineages of hematopoietic cells.

Seroprevalence and epidemiology of Helicobacter pylori infection in patients with cirrhosis

BACKGROUND

Helicobacter pylori infection is the major pathogenic factor for peptic ulcer disease. Its epidemiology is not fully known; few data are available in patients with chronic liver disease.

AIMS

To investigate the seroprevalence and factors associated with Helicobacter pylori infection in a series of liver cirrhosis patients.

METHODS

Two hundred and twenty consecutive patients were prospectively included in a study aimed to evaluate the effect of dietary intervention on cirrhosis complications and survival. At inclusion, an epidemiological and clinical questionnaire was completed. Sera were obtained and stored at -70 degrees C until analyzed. They were tested for Helicobacter pylori antibodies using a commercial ELISA kit.

RESULTS

Eleven out of 220 patients had borderline anti-Helicobacter pylori IgG titers. Of the remaining 209 patients, 105 (50.2%) showed positive titers of Helicobacter pylori IgG. Univariate analysis showed that Helicobacter pylori infection was more frequent in older patients, those born outside Catalonia, and in patients with a low educational level. Past ethanol consumption and current smoking correlated negatively with Helicobacter pylori infection. Multivariate analysis selected age (OR 3.1. 95% CI 1.46-6.45), educational level (OR 2.2. 95% CI 1.18-4.2) and alcohol consumption (OR 0.7. 95% CI 0.45-0.99) as the variables independently related to Helicobacter pylori infection.

CONCLUSIONS

Helicobacter pylori infection in cirrhosis has the same epidemiological pattern as in the general population. Suggestions that the etiology or the severity of the liver disease could be related to Helicobacter pylori infection were not confirmed by our study.

Endoscopic sphincterotomy for choledocholithiasis: a prospective single-center study on the short-term and long-term treatment results in 483 patients

BACKGROUND AND STUDY AIMS

Endoscopic sphincterotomy (EST) is the method of choice for the treatment of choledocholithiasis. The aim of the present study was to assess the impact of various prognostic factors on the short-term and long-term results of EST.

PATIENTS AND METHODS

Data from 483 EST procedures carried out due to choledocholithiasis without concomitant neoplasms or hepatic cirrhosis, and without subsequent bile duct surgery, were analyzed prospectively. The 324 patients (67%) who agreed to take part in the follow-up examinations and fulfilled the inclusion criteria for the study were divided into four groups, depending on the presence of the gallbladder or cholecystolithiasis prior to EST and on the time of diagnosis, and were prospectively followed up by physical examination laboratory tests, abdominal ultrasound, and endoscopic retrograde cholangiography examinations to evaluate the short-term and long-term outcomes.

RESULTS

EST was successful in 95.7% of cases. Early complications were noted in 6.8% of cases. No early complications were seen in the group after cholecystectomy with a T-tube present, whereas this rate was highest in the group with concurrent choledocholithiasis and cholecystolithiasis (six of 48, 12.5%). Recurrent choledocholithiasis was observed in 5.6% of the cases overall. This rate was at its lowest in patients with choledocholithiasis alone, and was highest in the group with concurrent choledocholithiasis and cholecystolithiasis. Among the latter patients, the highest rates of papillary stenosis, chronic pancreatitis, and cholangitis were also observed, the latter complication being noted only in cases of recurrent common bile duct stones.

CONCLUSIONS

EST is a relatively safe and effective procedure in the treatment of choledocholithiasis. The best prognostic factor is the presence of choledocholithiasis alone. Concurrent choledocholithiasis and cholecystolithiasis carry a more adverse prognosis, and in these cases cholecystectomy should be considered after EST.

Posterior tibial tendon dysfunction as a cause of acquired flatfoot in the adult: value of magnetic resonance imaging

Dysfunction of the posterior tibial tendon is the most common cause of acquired flatfoot in adults; despite this, the condition is not commonly recognized. We report three cases with flatfoot secondary to spontaneous tendon rupture, in whom magnetic resonance imaging (MRI) was a helpful non-invasive technique to confirm the suspected diagnosis. This disabling entity, and the usefulness of MRI in the diagnosis and planning the appropriate treatment, are reviewed.

[Electrical status epilepticus during sleep]

INTRODUCTION

Sleep electrical status epilepticus (SESE) is a rare entity whose diagnosis depends or showing spike and wave complexes on the EEG during more than 85% of the duration of NoREM sleep. Typically it presents in children, most of whom have subjacent epilepsy. It is currently accepted that SESE is asymptomatic, although its persistence may give rise to severe neuropsychological sequelae. There are no references to sleep disorders in these patients. We present the case of a seven year old girl with SESE, hypersomnia and secondary nocturnal enuresis.

CLINICAL CASE

The seven year old patient had a past history of simple partial crises with motor symptoms. There was progressive hypersomnia and nocturnal enuresis. The polysomnogram showed SESE. The Test for Multiple Latencies in Sleep (TMLS) showed pathological diurnal somnolence. HLA DR2 typing was negative. Neuropsychological study showed severe alterations in the language area, with a normal intelligence quotient.

CONCLUSIONS

The new findings presented suggested that SESE is an intrinsic sleep disorder and not merely an EEG pattern. Since it occurs in children, sometimes with neuropsychological deficits, systematic TMLS should be done. The association of hypersomnia, changes in immediate visual memory and autistic regression suggest involvement of the limbic system.

Transforming growth factor-beta1 inhibits human keratinocyte proliferation by upregulation of a receptor-type tyrosine phosphatase R-PTP-kappa gene expression

We studied regulation of a receptor-type tyrosine phosphatase R-PTP-kappa gene expression in a human keratinocyte cell line, HaCaT. Addition of TGF-beta 1 to the HaCaT cells markedly induced the expression of R-PTP-kappa mRNA in a time- and dose-dependent manner. The induction of R-PTP-kappa mRNA expression was observed at a dose as low as 0.02 ng/ml TGF-beta1 and reached a peak at 2 ng/ml TGF-beta 1 after 6 h treatment. The TGF-beta 1-induced R-PTP-kappa mRNA expression was suppressed by sodium orthovanadate, a tyrosine phosphatase inhibitor, and H7, a serine/threonine kinase inhibitor, but not by genistein, a tyrosine kinase inhibitor. In addition, the inducing effect is not dependent on de novo protein synthesis. Taken together, these results suggest that TGF-beta 1 inhibits the human keratinocyte proliferation in vitro, possibly through induction of R-PTP-kappa gene expression.

[Kaposi's sarcoma of the bile ducts with cutaneous involvement in a patient with AIDS]

A 30 year-old man with acquired immunodeficiency syndrome was admitted because of abdominal pain, jaundice and fever. A severe pancreatitis without gallstones was detected. Later, dilation of biliary tract and clinical worsening appeared. Cholangiography revealed sclerosing cholangitis and papillary stenosis. Kaposi's sarcoma of the gallbladder invading the biliary tract was found. Only two reports of Kaposi's sarcoma of the biliary tract without cutaneous lesions have been published in a living patient. Pancreatitis has not been previously described as a clinical presentation of this malignancy.

Giant cavernous hemangioma of the liver: atypical CT and MR findings

The CT and MR appearance of giant cavernous hemangiomas can be confusing, and some atypical radiographic findings have been described. We report the CT and MR features of a giant cavernous hemangioma of the liver with atypical presentation. CT showed a large hypodense geographical lesion involving the majority of the liver and multiple scattered peripheral lesions. The T2-weighted MR images revealed a huge hyperintense lesion with multiple satellite nodules.