Ribavirin Levels in Post Liver Transplant Patients Treated for Recurrent Hepatitis C Viral Infection

Hepatitis C virus (HCV) infection is the most common indication for liver transplantation (LTx) in the United States. Ribavirin with pegylated interferon is the only treatment option for HCV recurrence in post-LTx patients. In clinical practice, for more than 50% of patients, ribavirin dose needs to be modified.

AIM

The aim of this study was to examine the role of ribavirin level and its relevance in the management of post-LTx patients in terms of renal dysfunction, efficacy, toxicity, and potential drug interactions.

PATIENTS AND METHODS

Thirty-four blood samples were available from 22 post-LTx patients. Ribavirin concentrations in plasma (all samples) and whole blood concentrations (16 samples) were examined. The dose of ribavirin ranged from 400 mg/d to 1000 mg/d, but concentrations were normalized to 800 mg/d.

RESULTS

There was a wide variation in plasma concentration of ribavirin, ranging from 1.8 to 122.1 mg/mL. The concentrations were similar in whole blood and plasma. Dose-normalized concentration with creatinine clearance below 70 mL/min were significantly higher when compared with creatinine clearance above 70 mL/min (P = .015). Eleven patients required erythropoietin; their mean ribavirin dosage was higher but mean ribavirin concentration was lower compared to the 11 patients who did not require erythropoietin factor. There was no difference in mean ribavirin concentration in patients who cleared the virus (n = 7) compared and who did not clear the virus (n = 9). Three patients were on nucleoside reverse transcriptase inhibitors (NRTI) had significantly higher concentration (mean 87.1 microg/mL) compared to those who did not receive NRTI (mean 34.4 microg/mL, P = .00)

CONCLUSION

Ribavirin concentration in plasma and whole blood were similar, with a wide variation. Patients with impaired renal function and those who were on NRTI had significantly higher concentrations of ribavirin. The ribavirin concentrations did not predict either the clearance of HCV RNA or the need for erythropoitin factor.

Secular trends in waist circumference in Spanish adolescents, 1995 to 2000-02

Two studies, in 1995 and 2000-02, were compared to assess changes in waist circumference in adolescents. Between the two time periods, waist circumference increased significantly in males at 13 years and in females at 14 years. Significant changes in waist circumference were observed during the study period; the rates of change were 0.53 and 0.86 cm/y in boys and 0.67 and 0.87 cm/y in girls. Future morbidity in adolescents may be affected due to accumulation of excess central fat.

Inflammatory mediators in overweight and obese Spanish adolescents. The AVENA Study

OBJECTIVE

The aim of this study was to clarify if there is an association between overweight and a state of chronic, low-grade inflammation in adolescents.

DESIGN

The study is a part of the cross-sectional multicenter study AVENA, designed to evaluate the nutritional status of a representative sample of Spanish adolescents. The adolescents were divided into two groups: (1) nonoverweight and (2) overweight/obesity using the International Obesity Task Force (IOTF) standards.

SUBJECTS

A geographically representative subsample of the AVENA study including 493 Spanish adolescents, aged 13-18 y (236 females/257 males), participated in this study.

MEASUREMENTS

Serum C-reactive protein (CRP) and in vitro production of interleukin 6 and tumor necrosis factor alpha were measured, together with a detailed anthropometry.

RESULTS

The inflammatory markers showed generally higher values in subjects with overweight/obesity than in those with nonoverweight, with only CRP showing significant differences (the means were 0.83 and 1.27 mg/l in the nonoverweight and overweight/obesity groups, respectively).

CONCLUSION

Although we have not studied if adolescent overweight and obesity play an initiating role in the development of future diseases, we suggest it may induce a chronic low-grade inflammatory state, which points out the importance of maintaining an appropriate body weight, to avoid obesity-related diseases in adulthood.

Reversal of Acute Cellular Rejection After Renal Transplantation With Campath-1H

Between September 2002 and February 2004, 40 kidney transplant (27 from deceased and 13 from living donors) recipients (25 male and 15 female, aged 50.3 +/- 15.1 years) were treated with Campath 1H (C 1H; 30 mg/dose IV) for biopsy-proven steroid-resistant rejection (SRR) or rejections equal to or worse than Banff 1B. All transplantations occurred between August 2001 and May 2003. All patients had received antibody preconditioning (RATG 5 mg/kg, n = 34; C 1H 60 mg, n = 4; C 1H 30 mg, n = 2) preoperatively and were treated with Tacrolimus monotherapy (target level 10 ng/ml) postoperatively and subsequent spaced weaning. Elevated creatinine levels at follow-up were evaluated by renal transplant biopsy. Rejection was treated with steroids, reversal of weaning, addition of sirolimus, and/or antibody treatment, depending on grade of rejection. The mean duration of follow-up was 453 +/- 163 days after C 1H administration. Twenty-nine patients received C 1H for SRR and 11 patients for Banff 1B or worse rejections; 26 patients received more than 1 dose of C 1H. Graft survival was 62.5% (25 patients); 6 of the 15 allografts (40%) that failed had presented with rejections because of noncompliance. Graft survival in compliant patients with SRR or rejections equal to or worse than Banff 1B was 73.5% (25 of 34). Fourteen patients (35%) had infectious complications, of whom 2 patients (5%) died. C 1H is an effective agent for SRR and Banff 1B or worse rejections, with 95% patient survival and 73.5% graft survival (in compliant patients). The number of doses of 30 mg C 1H should be restricted to two, as there is a high incidence of potentially fatal infectious complications.

Tacrolimus for Primary Liver Transplantation: 12 to 15 Years Actual Follow-Up With Safety Profile

BACKGROUND

Tacrolimus has been increasingly used for liver transplantation during the last decade. The drug has immunological advantages in short- to medium-term follow-up. However, data on longitudinal follow-up are lacking.

AIM

The aim of the present report was to examine the impact of tacrolimus in primary adult and pediatric liver transplantation (LTx) patients.

MATERIAL AND METHOD

One thousand consecutive primary LTx patients were performed under tacrolimus between August 1989 and December 1992 were followed up until August 2004. Mean follow-up was 13.4 +/- 0.92 (range, 11.7-15) years. There were 600 males and 400 females with a mean age of 42.6 +/- 20.2 years. There were 166 children (age 18 years or younger) and 834 adults, of whom 204 were older than 60 years (seniors).

RESULTS

Four hundred ninety-seven (49.7%) patients died in the follow-up period. The overall 15-year actuarial patient survival rate was 51.4%. The survival rate for children was significantly better (81.3%) compared with adults (47.5%) and seniors (36.4%) (P = .0001). One hundred fifty-one patients received a second LTx, 22 patients received a third LTx, and 4 patients received a fourth LTx. Over all 15 years the actuarial graft survival rate was 46.1%. At last follow-up, 69.1% of patients were off steroids. The majority of late deaths were due to age-related complications, recurrence of disease, and De novo cancers.

CONCLUSION

The data on longitudinal follow-up have shown actuarial survival for children to be significantly better than in adults and seniors. Graft loss from immunological causes are rare even with long-term follow-up.

Cytomegalovirus prophylaxis using oral ganciclovir or valganciclovir in kidney and pancreas–kidney transplantation under antibody preconditioning

We investigated retrospectively the risk factors for cytomegalovirus (CMV) infection under ganciclovir or valganciclovir prophylaxis (oral ganciclovir 1 g tid, valganciclovir 450 mg/d) in our kidney and simultaneous pancreas-kidney (SPK) transplant patients undergoing transplantation between July 1, 2001 and February 28, 2003. Two hundred eleven patients receiving prophylactic oral ganciclovir or valganciclovir were included in the study. All patients were given antibody preconditioning (thymoglobulin 178, alemtuzumab 33). Duration of prophylactic treatment was between 3 and 8 months. Fifteen (7.1%) patients developed a positive CMV antigenemia in the first 6 months after transplantation, and 18 of 176 (10.2%) patients developed a positive CMV antigenemia during the first year. No patient developed tissue invasive CMV disease. At 6 months after transplantation, valganciclovir was slightly more effective than ganciclovir prophylaxis (P=.052). Positive donor CMV serology significantly increased the risk of CMV infection compared to CMV-negative donors (P=.014 and P=.003 at 6 and 12 months, respectively). Duration of CMV prophylaxis for more than 3 months decreased the risk of CMV infection (P=.04 and P=.009 at 6 and 12 months, respectively). Either valganciclovir prophylaxis (450 mg/d) or high-dose oral ganciclovir (1 g tid) is effective in preventing tissue-invasive CMV disease, and results in a low incidence of CMV antigenemia in patients undergoing kidney and SPK transplantation.

Clostridium difficile colitis in patients after kidney and pancreas-kidney transplantation

Limited data exist about Clostridium difficile colitis (CDC) in solid organ transplant patients. Between 1/1/99 and 12/31/02, 600 kidney and 102 pancreas-kidney allograft recipients were transplanted. Thirty-nine (5.5%) of these patients had CDC on the basis of clinical and laboratory findings. Of these 39 patients, 35 have information available for review. CDC developed at a median of 30 days after transplantation, and the patients undergoing pancreas-kidney transplantation had a slightly higher incidence of CDC than recipients of kidney alone (7.8% vs. 4.5%, P>0.05). All but one patient presented with diarrhea. Twenty-four patients (64.9%) were diagnosed in the hospital, and CDC occurred during first hospitalization in 14 patients (40%). Treatment was with oral metronidazole (M) in 33 patients (94%) and M+oral vancomycin (M+V) in 2 patients. Eight patients had recurrent CDC, which occurred at a median of 30 days (range 15-314) after the first episode. Two patients (5.7%) developed fulminant CDC, presented with toxic megacolon, and underwent colectomy. One of them died; the other patient survived after colectomy. CDC should be considered as a diagnosis in transplant patients with history of diarrhea after antibiotic use, and should be treated aggressively before the infection becomes complicated.

Recurrent Hepatitis C in Liver Allografts

RATIONALE AND DESIGN

The accuracy of a prospective histopathologic diagnosis of rejection and recurrent hepatitis C (HCV) was determined in 48 HCV RNA-positive liver allograft recipients enrolled in an "immunosuppression minimization protocol" between July 29, 2001 and January 24, 2003. Prospective entry of all pertinent treatment, laboratory, and histopathology results into an electronic database enabled a retrospective analysis of the accuracy of histopathologic diagnoses and the pathophysiologic relationship between recurrent HCV and rejection.

RESULTS

Time to first onset of acute rejection (AR) (mean, 107 days; median, 83 days; range, 7-329 days) overlapped with the time to first onset of recurrent HCV (mean, 115 days; median, 123 days; range, 22-315 days), making distinction between the two difficult. AR and chronic rejection (CR) with and without co-existent HCV showed overlapping but significantly different liver injury test profiles. One major and two minor errors occurred (positive predictive values for AR = 91%; recurrent HCV = 100%); all involved an overdiagnosis of AR in the context of recurrent HCV. Retrospective analysis of the mistakes showed that major errors can be avoided altogether and the impact of unavoidable minor errors can be minimized by strict adherence to specific histopathologic criteria, close clinicopathologic correlation including examination of HCV RNA levels, and a conservative approach to the use of additional immunosuppression. In addition, histopathologic diagnoses of moderate and severe AR and CR were associated with relatively low HCV RNA levels, whereas relatively high HCV RNA levels were associated with a histopathologic diagnosis of hepatitis alone, particularly the cholestatic variant of HCV.

CONCLUSIONS

Liver allograft biopsy interpretation can rapidly and accurately distinguish between recurrent HCV and AR/CR. In addition, the histopathologic observations suggest that the immune mechanism responsible for HCV clearance overlap with those leading to significant rejection.

Possible roles of magnesium on the immune system

During the last few years, magnesium (Mg) has been subject of research due to its functionality in the organism. It is one of the most important micronutrients, and therefore its role in biological systems has been extensively investigated. Particularly, Mg has a strong relation with the immune system, in both nonspecific and specific immune response, also known as innate and acquired immune response. The aim of this paper is to review the state of the art about the interactions between Mg and the immune system. We discuss the link between dietary Mg and inflammation, apoptosis and alterations in number and function of innate immune cell populations, described in animal models. Furthermore, the immune system can be compromised in human populations under certain circumstances, including athletes and elderly people. The importance of a balanced Mg homeostasis and its interaction with the immune system in these groups has also been reviewed. Although emerging data support the relevant role of Mg in the immune response, further research is needed; and special efforts should be made to establish the most adequate dose in nutritional supplements to reach beneficial effects on health.

Changes in the immune system are conditioned by nutrition

Undernutrition due to insufficient intake of energy and macronutrients and/or due to deficiencies in specific micronutrients impairs the immune system, suppressing immune functions that are fundamental to host protection. The most consistent abnormalities are seen in cell-mediated immunity, complement system, phagocyte function, cytokine production, mucosal secretory antibody response, and antibody affinity. There is a number of physiological situations such as ageing and performance of intense physical exercise associated with an impairment of some immune parameters' response. Nutrition can influence the extent of immune alteration in both of them. There are also numerous pathological situations in which nutrition plays a role as a primary or secondary determinant of some underlying immunological impairments. This includes obesity, eating disorders (anorexia nervosa and bulimia nervosa), food hypersensitivity and gastrointestinal disorders as some examples. The implications of nutrition on immune function in these disorders are briefly reviewed.

[Feeding and assessment of nutritional status of spanish adolescents (AVENA study). Evaluation of risks and interventional proposal. I.Methodology]

BACKGROUND

Adolescence is a decisive period in human life due to the multiple physiological and psychological changes that take place. These changes will condition both nutritional requirements and eating/physical activity behavior. It has been demonstrated that these "adolescence" factors are of significant influence in health status during adult life. Due to its importance and adequate development the project has been granted by the Fondo de Investigación Sanitaria of the Institute of Health Carlos III.

OBJECTIVE

To develop a methodology to evaluate the health and nutritional status of a representative population of Spanish adolescents. Specific attention is paid to three specific health problems: obesity, anorexia nervosa/bulimia, dislipidemia.

METHODOLOGY

The following magnitudes will be studied: 1) dietary intake, food habits and nutrition knowledge; 2) daily physical activity and personal approach; 3) physical condition; 4) anthropometry and body composition; 5) hematobiochemical study: plasma lipid phenotypic and metabolic profile, blood cell counts; 6) genotipic profile of cardiovascular risk lipid factors; 7) immune function profile related to nutritional status; 8) psychological profile.

CONCLUSION

This project includes the co-ordinate activity of five Spanish centers of five different cities (Granada, Madrid, Murcia, Santander, Zaragoza). Each center is specialized in a specific area and will be responsible for the corresponding part of the study. From the data obtained, we will elaborate a specific intervention program in order to improve nutrition and neutralize the risk for nutritional related problems in adolescence. By this, we will contribute to improve the health status of the Spanish population in the new millennium.

The effect of fermented milk on interferon production in malnourished children and in anorexia nervosa patients undergoing nutritional care

For several years cytokine production has been associated with infections but it was not suspected that some types of food could also induce cytokines, even in a state of non-infection. Lactic bacteria can induce interferon (IFN) production in human healthy subjects, thus, a better protection against infections would be expected. Therefore, we planned to evaluate the effect of two diets including yoghurt or milk on IFN-gamma production during nutritional recovery in two different situations of malnutrition: (1) children with diarrhoea; and (2) patients with anorexia nervosa (AN). Both the diet including yoghurt of that including milk seemed to increase IFN-gamma production at the end of nutritional recovery in the malnourished children with diarrhoea. The significance of interferon production and the lymphocyte subset increase should be explored to know if a better resistance against pathogens is related to them. Regulation of intestinal absorption and moderate stimulation of interferon production make the yoghurt-based diet a good choice in the nutritional care of children. In the same way, an increase in the IFN-gamma production was observed in AN patients consuming yoghurt. This increase of IFN-gamma production could be considered a biological marker to detect the effect of probiotics on the immune response, especially in the improvement of a deficient nutritional status.

The need to review the Spanish recommended dietary energy and nutrient intakes

BACKGROUND

In the last decade, research in the field of nutrition has grown both in width and depth, and has incorporated the advances of other scientific fields, like artificial intelligence theories. Specifically in the case of recommended nutrient intakes, the fuzzy theory is an interesting contribution to the development of a new concept for the recommendations. The recommended intakes have passed from avoiding deficiency status to preventing several pathological aspects and reducing risk factors.

OBJECTIVE

To establish whether the recommended dietary intakes for Spain (IREs) must be reviewed, taking into account the current scientific state of the art.

METHODS

We have compared IREs, published in 1994, with the recently published 'Dietary Reference Intakes' (DRIs) for the American and Canadian population, the 'Referenzwerte für die Nährstoffzufuhr' (DACH) for the German, Swiss and Austrian population. In addition, the main guidelines of the EURODIET criteria (Nutrition and Diet for Healthy Lifestyles), which was developed for the population of the European Union Member States, were taken into account. As an example, comparisons were made for the elderly population group, establishing differences and similarities between the different scientific communities and the adequacy of Spanish recommended intakes for energy and nutrients.

RESULTS

Recommended intakes for folate, calcium and vitamins C, D and E are lower in the IREs and probably should be increased. Recommended intakes for nutrients which have not previously been included in the IREs, such as vitamin K, selenium, copper, chromium, molybdenum, manganese, phosphorus, sodium, potassium, and water need to be developed.

CONCLUSIONS

The current recommended intakes for the Spanish population need to be reviewed in order to encompass current scientific knowledge. Moreover, the opportunity to include non-nutrients (bioactive compounds) should be considered.

Probiotics as a help in children suffering from malnutrition and diarrhoea

Malnutrition is associated with a significant impairment of cell-mediated immunity, phagocyte function, immunoglobulin A concentrations and cytokine production. This situation-which is unfortunately very frequent in infants and children from developing countries-leads to a high risk of infection, and often to episodes of diarrhoea, hence aggravating the nutritional status. Fermented milks are known to exert a beneficial influence on the host's health. They act by modulating gut microflora, regulating any alteration of gut mucosa and stimulating immune response. A number of studies have shown that probiotics shorten the duration of diarrhoea and prevent recurrence of other episodes. Furthermore, probiotics can prevent diarrhoea from infection in infants with malnutrition. In addition, it has been shown that cytokines could be used as biological markers of both impaired immune system and the immune stimulation of probiotics. The aim of this review is to update the effect of fermented milks in situations of malnutrition and diarrhoea as a consequence of infection as well as the role of cytokines produced by fermented milks in these deficient conditions.

Influence of alcohol consumption on immunological status: a review

The aim of this review is to present and discuss the effect of different levels of alcohol consumption on the immune system. Not only the amount consumed but also the type of alcoholic beverage have to be taken into account in order to determine the consequences on activity, number, distribution, balance, interaction and response of immunocompetent cells. The association between alcohol exposure and the risk of developing an alcohol-related disease is multifactorial. In fact, age, gender, smoking habits, dietary intake and exercise are involved among other factors. The evaluation of the host cellular and humoral immune responses has shown that alcohol may induce some benefits when consumption is moderate. Moreover, those alcoholic beverages that contain antioxidants, such as red wine, could be protectors against immune cell damage. According to the literature consulted, the daily consumption of 10-12 g and 20-24 g of alcohol for women and men, respectively, is considered to be a moderate intake; the type of beverage has been established not to be important when defining moderation. Particular attention is often focused on the U- or J-shaped curve which also suggests that light to moderate drinking produces a protective effect. Such an inverse relationship indicates a reduction of risk for both light and moderate consumers and a higher risk not only for hard drinkers, but also for non-consumers.

The implication of the binomial nutrition-immunity on sportswomen's health

The diet of many athletes is inadequate due to overly restrictive habits and an obsession with losing weight in order to maintain a particular level of body weight. Many female athletes, particularly those who participate in sports that emphasize leanness (gymnastics, distance running, diving, figure skating and classical ballet), have suboptimal energy and nutrient intakes and are at risk of compromised nutritional status, including fatigue, dehydration, nutrient inadequacies, delayed growth and an impaired immunocompetence. It is very well known that active women and girls who are driven to excel in sports may develop the so-called female athlete triad in which malnutrition, amenorrhoea and osteoporosis appear as typical signs of medical complications, frequently linked to serious psychological alterations. This outcome is mainly related to that found in eating disorders-syndromes in which athletes have been defined to be at increased risk. As a consequence of all these alterations, the immune system may be affected in athletes, and subsequently they might be more prone to infections. As there is a lack of knowledge about how the immune system may be affected in basal conditions of athletes, the study of immunocompetence as an index of the nutritional status is reviewed. In summary, it is necessary to encourage all professionals surrounding athletes to be aware of the importance of taking care of their nutritional status in order not only to avoid physical and psychological complications but also to improve performance and, thus, to achieve sporting goals.

Chronobiological features of the immune system. Effect of calorie restriction

The circadian organization of living organisms is fully established being a key component the activity of the neuro-endocrin-immune system that maintains the homeostasis. Secondary lymph organs, such as submaxillary lymph nodes and spleen, have been shown to exhibit a 24 h variation in blastogenic proliferative capacity and distribution of B and T subsets, with specific achrophases depending on the parameter studied or the lymphoid organ considered. However, less is known about the thymus. The immune system has been shown to change by calorie restriction, although no information is available about possible effects in 24 h variations. Similar questions can be posed for the neuro-endocrine system. As an example, some data are shown in this article about the effects of calorie restriction on the neuro-endocrin-immune system in growing male Wistar rats. Calorie restriction blunted the circadian secretory pattern of TSH observed in the control group that was characterized by the existence of two peaks at 17:00 or 01:00 h and that explained the low basal metabolic rate of these animals under this experimental condition. Concerning the immune system, the thymus gland exhibited 24 h variations in T, B and immature cells in both control and calorie-restricted male rats, thus confirming the circadian organization of the immune system. Moreover this circadian organization was changed by calorie restriction.

The adaptive response of the immune system to the particular malnutrition of eating disorders

Despite the seriously undernourished state of patients with anorexia nervosa (AN) and bulimia nervosa (BN), controversial findings have been published regarding some aspects of the immune system that are otherwise impaired in more typical types of malnutrition, such as protein-energy malnutrition. In general, adaptation processes seem to occur enabling immune function to be preserved during long periods of the illness. However, cell-mediated immunity is usually altered in AN and BN as reflected by lymphocyte subset counts and the response to delayed hypersensitivity tests. Regarding the helper/cytotoxic T cell ratio (CD4:CD8), an immunological marker of the nutritional status, the results of our studies on AN and BN patients showed that the duration of the eating disorder and the time when appropriate treatment is achieved are likely contributors to the alteration of this ratio. Despite these findings, it has been repeatedly pointed out that anorexic patients seem to be free of common viral infections at least until the most advanced stages of debilitation. Some hypotheses that could explain the lack of infection symptoms are reviewed. Cytokines and the altered acute phase response to infection, as well as cortisol and leptin, are considered to be potential factors involved in the adaptation processes occurring in these syndromes. Further progress in the knowledge of the psychoneuroendocrine-immune interactions established in AN and BN will be relevant to the understanding of the aetiology and maintenance mechanisms of these pathologies.

Functional foods and the immune system: a review

In the last decade, preventive medicine has undergone a great advance, especially in developed countries. Research has demonstrated that nutrition plays a crucial role in the prevention of chronic diseases, as most of them can be related to diet. Functional food enters the concept of considering food not only necessary for living but also as a source of mental and physical well-being, contributing to the prevention and reduction of risk factors for several diseases or enhancing certain physiological functions. In reference to the immune system, many studies have pointed out that not only pre- and probiotics, but also single micronutrients incorporated into functional foods contribute to an enhancement of immunocompetence. In fact, one of the authorized claims consists of pointing out the immunomodulator properties of functional foods. In this article, the effect of some functional foods and ingredients such as probiotics, selenium and dietary antioxidants (vitamins A, E and C) on the immune function are reviewed. However, the optimum intake level and recommended amounts of functional foods have not yet been established. Thus, in order to remove the controversy surrounding functional food, further research studies are necessary, both in experimental animals and in humans. Finally: efforts should be directed towards the ultimate goal, that is, a 'functional diet'.

Wheat germ agglutinin-binding glycoproteins are decreased in Alzheimer's disease cerebrospinal fluid

A number of biomarkers (e.g. Abeta, tau) has been identified in Alzheimer's disease CSF. However, none fulfils the criteria of sensitivity and specificity (> 80%) needed for the development of an accurate diagnostic test. The lack of a suitable marker has prompted the search for new CSF biomarkers. In this study, the glycosylation of CSF proteins was examined using lectin blotting. Lumbar CSF was collected ante mortem from 22 non-Alzheimer's disease and 12 probable Alzheimer's disease cases and ventricular CSF collected post mortem from 7 non-Alzheimer's disease and 16 Alzheimer's disease cases confirmed by pathologic examination. When CSF glycoproteins were stained with wheat germ agglutinin (WGA), the staining intensity was found to be significantly lower in the Alzheimer's disease group. No difference in staining was found using other lectins (Canavalia ensiformis agglutinin, Ricinus communis agglutinin, Lens culinaris agglutinin). The measurement of WGA-reactive glycoproteins in CSF may be a useful biomarker for diagnosis of Alzheimer's disease.

Double aortic arch in a dog (Canis familiaris): a case report

We herein report a case of a double aortic arch in a 10-week-old male dog of no defined race, which presented episodes of regurgitation at the time of weaning. This vascular malformation was characterized by the persistence of two aortic arches, right and left, of varying dimensions. The right aortic arch was observed to be larger. During post mortem examination the vessels of the animal were injected with coloured latex bi-centrifuged CIS 1-4 polisopreno which revealed the patency of the two aortic arches. Concomitantly, dilation of the cranial oesophagus causing constriction was observed, indicating megaesophagus. Apart from the constriction, the oesophagus presented normal morphometric parameters in relation to its dimensions.