Prognostic value of the expression of E-cadherin and beta-catenin in bladder cancer

The purpose of this study was to assess the prognostic effect of the expression of E-cadherin, beta-catenin and CD44 adhesion molecules in bladder carcinoma. 22 superficial and 18 invasive bladder tumour samples were studied by immunohistochemistry. The median follow-up was 24 months (range: 1-50 months). Loss of E-cadherin and beta-catenin immunoreactivity was found in 14 (35%) and 17 (43%) tumours, respectively, and was significantly associated with invasiveness, high grade and p53 overexpression. There was no correlation between CD44 variant expression and clinicopathological findings. Loss of E-cadherin expression was an independent predictor of poor survival in a multivariate analysis, when assessed with age, grade, stage and p53 status (hazards ratio adjusted (HRa)=4.45 [95% confidence interval (CI), 1.06-18.63]). This effect was particularly augmented in patients with invasive bladder cancer. When expression of E-cadherin and beta-catenin were evaluated simultaneously, loss of immunoreactivity of both proteins was a strong predictor of poor survival (HRa=13.06 [95% CI, 0.95-178.55]). The same pattern was found when progression-free survival in relation to these variables was assessed. In conclusion, assessment of E-cadherin and beta-catenin immunoreactivity may be a useful prognostic marker in bladder cancer complementary to established prognostic factors.

Blood cells of sea bass (Dicentrarchus labrax L.). Flow cytometric and microscopic studies

Studies of fish blood cells made to date presented numerous problems derived from both the nomenclature and the techniques used. A combination of quantitative and morphological methods is needed if the classification of fish blood cells is to advance from it present provisional state. The aim of the present paper was first to isolate sea bass blood cell populations by flow cytometry and second to characterize then microscopically. Blood cell populations from sea bass (Dicentrarchus labrax L.) were isolated according to their FSC (size) and SSC (granularity) properties by flow cytometry. The isolated populations were then processed for light and transmission and scanning electron microscopic characterization. Sea bass blood leukocytes isolated by flow cytometry consisted of two main cell subpopulations. Subsequent microscopic study of these cells revealed that the first subpopulation was composed of small cells (3-5 microm) of low granularity and consisted of thrombocytes and lymphocytes whereas, the second subpopulation was formed of 6-9 microm sized cells of high granularity consisting of granulocytes and monocyte/macrophages. The combined use of flow cytometry and electron microscopy makes it possible to characterize the different cell types present in sea bass peripheral blood with a high degree of certainty. Although sea bass basically follows the common vertebrate hematological pattern, significant modifications such as the presence of circulating immature erythrocytes, plasma cells and monocyte/macrophages and different forms of thrombocytes can be established with respect to this pattern.

Effect of propranolol on the factors promoting bacterial translocation in cirrhotic rats with ascites

Bacterial translocation appears to be an important mechanism in the pathogenesis of spontaneous infections in cirrhosis. Cirrhotic patients are commonly treated with beta-adrenoceptor blockers, but the impact of this treatment in the factors promoting bacterial translocation has not been investigated. This study was aimed at investigating in cirrhotic rats with ascites the effect of propranolol on intestinal bacterial load, transit, and permeability of the bowel and on the rate of bacterial translocation. Bacterial translocation to mesenteric lymph nodes and intestinal bacterial overgrowth, permeability (urinary excretion of (99m)Tc-diethylenetriaminepentaacetic acid [(99m)Tc-DTPA]), and transit (geometric center ratio of (51)Cr) were assessed in 29 rats with carbon tetrachloride (CCl(4)) cirrhosis and 20 controls. These variables were then measured in 12 placebo- and in 13 propranolol-treated ascitic cirrhotic rats. Bacterial translocation was present in 48% of the cirrhotic rats and in none of the controls. Cirrhotic rats with intestinal bacterial overgrowth had a significantly higher rate of translocation and slower intestinal transit than those without it. Among the 15 rats with overgrowth and a (99m)Tc-DTPA excretion greater than 10%, 15 had translocation and 2 had bacterial peritonitis. Only 1 of the 14 rats with either intestinal overgrowth or a (99m)Tc-DTPA excretion greater than 10% presented translocation. Compared with the placebo group, propranolol-treated animals had significantly lower portal pressure, faster intestinal transit, and lower rates of bacterial overgrowth and translocation. In ascitic cirrhotic rats, bacterial translocation results from intestinal overgrowth and severe damage to gut permeability. In this setting, intestinal overgrowth is associated with intestinal hypomotility. Propranolol accelerates the intestinal transit, decreasing the rates of bacterial overgrowth and translocation.

[The NADPH-oxidase complex in chronic granulomatous disease: preliminary description of a cluster in Mérida-Venezuela]

Chronic Granulomatous Disease (CGD) is a primary immunodeficiency characterized by an unusual predisposition to develop bacterial and fungal infections due to a failure of phagocytic leukocytes to generate superoxide, required for the intracellular killing of microorganisms. The lack of superoxide production is secondary to a defect in the NADPH-oxidase enzymatic complex activation, as a result of mutations of any of the components. Both, X-linked and autosomal recessive patterns of inheritance have been demonstrated in this disease, being the X-linked the most frequent and characterized by mutations in gp91phox. Mutations in p47phox, p67phox and p22phox have been shown in the autosomal recessive pattern. The molecular and genetic characteristic of NADPH-oxidase complex and its pathology in CGD are reviewed along with a brief description of the preliminary findings in two families from Mérida, Venezuela.

Autosomal recessive chronic granulomatous disease caused by novel mutations in NCF-2, the gene encoding the p67-phox component of phagocyte NADPH oxidase

Chronic granulomatous disease (CGD) is a rare inherited immunodeficiency disease that leads to severe recurrent infections. CGD is caused by defects in the phagocyte NADPH oxidase, a multiprotein enzyme that reduces oxygen to superoxide, a precursor of microbicidal oxidants. Less than 6% of CGD patients have an autosomal recessive form of the disease caused by mutations in NCF-2. This gene encodes p67-phox, a cytosolic oxidase subunit that associates with membrane-bound flavocytochrome b558 and regulates electron transfer. We studied six patients from five families with p67-phox deficiency and identified seven different mutant alleles. Patients from three of the kindreds were homozygous for their respective mutation, although the parents of only one family were known to be related. Five of the mutations have not previously been identified: (1) a missense mutation (383C-->T) in exon 5, (2) a nonsense mutation (196C-->T) in exon 3, (3) a missense mutation (230G-->A) in exon 3, (4) a nonsense mutation (298C-->T) in exon 4, and (5) a dinucleotide deletion (835-836 AC) from exon 9. Phagocytes from each of the patients analyzed failed to generate a measurable respiratory burst and had no detectable p67-phox protein. Our results further demonstrate that there is great heterogeneity among the mutations in p67-phox-deficient CGD patients, with no evidence for mutational hot-spots or a founder effect. Our data also support the hypothesis that the stability of p67-phox is particularly sensitive to missense mutations that cause amino acid substitutions within its N-terminal domain. In contrast, mutations predicting single amino acid changes elsewhere in the protein generally represent benign polymorphisms.

Impaired kidney transplant survival in patients with antibodies to hepatitis C virus

BACKGROUND

With a few exceptions, most published studies do not show an influence of antibodies to the hepatitis C virus (HCV) on the success of a kidney transplant.

METHODS

We studied all our renal transplant recipients who had received kidneys from cadaver donors (n = 335) and had been treated with quadruple immunosuppression (steroids, azathioprine, and antilymphocyte antibodies, followed by cyclosporin). We had information on the status of the hepatitis C antibodies before and/or after the transplant in 320 cases (95.5%; in 300, pre-transplant). Patients with HCV antibodies before and/or after the transplant were considered to be HCV positive (HCV+).

RESULTS

The HCV+ patients had more time in dialysis and a greater number of transfusions, hyperimmunized cases, and re-transplants. The evolution in the first post-transplant year was similar in both groups, but afterwards, the HCV+ patients had proteinuria more often as well as worse kidney function. The survival rate of the graft was significantly less in the HCV+ cases: 90.6, 68.3 and 51.0% at respectively 1, 5 and 10 years, compared with 91.5, 84.7 and 66.5% in HCV-patients (P<0.01). The patient survival rate was: 96.4, 87.0, and 71.9% in the HCV+ patients at 1, 5, and 10 years, compared with 98.2, 96.0 and 90.0% in the HCV- cases respectively (P<0.01). The differences remained the same in stratified studies according to time spent in dialysis or pre/post-transplant evolution of HCV antibodies, even when immunologically high-risk patients were excluded. In multivariant analysis, the presence of HCV antibodies acted as a independent prognostic factor for the survival of the kidney and the patient: 3.0 (1.8-5.0) and 3.1 (1.2-7.8) odds-ratio (95% of the confidence interval), respectively. The main cause of death among HCV+ patients was cardiovascular; there was no apparent increase in mortality rate due to infections or chronic liver disease. The loss of organs was mainly due to chronic nephropathy or death with a functioning kidney.

CONCLUSION

The presence of hepatitis C antibodies, before or after transplantation, is associated with a worse long-term survival rate for both the patient and the transplanted kidney in our patients treated with quadruple therapy.

Biosorption of copper and zinc by Cymodocea nodosa

The adsorption of the two metal ions Cu and Zn in a single-component system by Cymodocea nodosa, a brown alga, under different pH conditions was investigated. The solution pH significantly affected the exhibited uptake, being maximum at a pH value of 4.5. Multi-component mixture biosorption in aqueous solutions is also reported. A comparison was made between the single-component saturation uptake and the multi-component uptakes. To evaluate the two-metal sorption system performance, simple isotherm curves had to be replaced by three-dimensional sorption isotherm surfaces. In order to describe the isotherm surfaces mathematically, three Langmuir-type models were evaluated. The isotherms indicate a competitive uptake with Cu being preferentially adsorbed. In addition, different tests were carried out to compare the process efficiency working continuously in small columns.

Supraceliac aortic clamping during the anhepatic phase of experimental orthotopic liver transplantation

BACKGROUND

The pig tolerates simultaneous clamping of the liver pedicle and inferior vena cava poorly, so venovenous bypass has to be used during the anhepatic phase of experimental orthotopic liver transplantation (OLT). The aim of this work is to assess whether clamping of the supracoeliac aorta during the anhepatic phase (AP) of experimental OLT in pigs allows transplantation in stable hemodynamic conditions.

METHODS

Fourteen pigs (weight, 16 to 18 kg) received whole liver grafts from 14 age-matched donors and were subsequently divided into two groups: group I, OLT without venovenous bypass during the AP, group II, OLT with supracoeliac aortic clamping during the AP. Variables analyzed were cardiac output (CO) and related variables, mean systemic arterial pressure (MAP), mixed venous oxygen saturation (SvO2), hepatic artery and portal vein blood flow, systemic and hepatic O2 supply and uptake (SDO2, SVO2, HDO2, HVO2, respectively), liver enzymes, glucose, creatinine, and electrolytes.

RESULTS

In group I, CO, MAP, and SvO2, decreased during the AP (anhepatic) in comparison with baseline (preanhepatic) values (CO, 3.60+/-0.74, preanhepatic, v. 1.21+/-0.25 L x min(-1), anhepatic; P<.05. MAP, 97+/-12, preanhepatic, v. 43+/-17 mm Hg, anhepatic; P<.05. SvO2, 91.6+/-5.6, preanhepatic v. 70.0+/-12.5%, anhepatic; P<.05), and SDO2/SVO2 increased by 16% (preanhepatic) to 33% (anhepatic; P<.05). In group II, CO decreased during the anhepatic phase by only 21% (3.82+/-0.81, preanhepatic, v. 3.07+/-0.99 L x min(-1), anhepatic; not significant), the MAP increased significantly (100+/-8, preanhepatic, v. 135+/-4 mm Hg, anhepatic; P<.05), and SVO2, SDO2, SVO2, and SDO2/SVO2 remained unchanged. After revascularization, none of these variables differed significantly between groups, and levels of liver enzymes, glucose, creatinine, urea, and electrolytes were similar in both groups, both before and aftertransplantation.

CONCLUSIONS

Experimental OLT can be carried out in pigs without venovenous bypass, but it leads to severe hemodynamic disturbances. Clamping of the supraceliac artery during the AP is well tolerated and results in excellent hemodynamic stability, so it may prove to be a useful technique in liver transplantation in animals, such as dogs or pigs, that do not tolerate simultaneous clamping of the liver pedicle and inferior vena cava as well as human beings.

[Pyrimethamine and sulfadoxine as a preventive treatment for Pneumocystis carinii and Toxoplasma encephalitis]

BACKGROUND

Few studies have been reported on the potential usefulness of Fansidar combination at a fixed doses of pyrimethamine and sulfadoxine as prophylaxis for pneumonia by Pneumocystis carinii and toxoplasmic encephalitis.

METHODS

The clinical histories of the patients seen in our department from January, 1992 to December, 1994 who were prescribed pyrimethamine and sulfadoxine for the above prophylactic treatment were reviewed.

RESULTS

One hundred fifty clinical histories fulfilled the requisites for evaluation. Thirty-seven patients (24%) had a previous diagnosis of AIDS, with the median CD4 count being of 134/mm3. The median follow up of treatment with Fansidar was of 31 months. Twenty-eight cases of pneumonia by Pneumocystis carinii (6.9 cases for 100 patients-years) and 10 cases of toxoplasmic encephalitis (2.5 cases for 100 patients-years) were diagnosed.

CONCLUSIONS

These values are similar to those presented with respect to other pharmacologic interventions commonly used for the prevention of pneumonia by Pneumocystis carinii and toxoplasmic encephalitis and suggest that pyrimethamine and sulfadoxine is a useful alternative and requires consideration in individualized cases for the prophylaxis of these diseases.

Improvement in liver fibrosis, functionality and hemodynamics in CCI4-cirrhotic rats after injection of the Liver Growth Factor

BACKGROUND/AIMS

Most substances used in experimental models of cirrhosis are chosen either as protectors of lipid peroxidation, as antifibrogenic agents or as vitamins, among others. In this report, we analyze the improvement produced, in established cirrhosis (CCl4 plus phenobarbital) in rats, by intraperitoneal injection of Liver Growth Factor, a hepatic mitogen with activity both in vivo and in vitro.

METHODS

Following confirmation of CCl4-induced cirrhosis, Liver Growth Factor (4.5 microg per ratx2 injections/week for 3 weeks) was administered to one group of rats (Cirr+LGF). The remaining rats (Cirr) received saline. The groups were compared in terms of serum enzymes, tissue damage, total liver collagen, collagenase activity, microsomal enzyme activities, splanchnic and systemic hemodynamics and portosystemic shunting.

RESULTS

Treatment of rats presenting CCl4-induced cirrhosis with Liver Growth Factor decreased serum aminotransferase levels and increased levels of serum albumin and total protein. The Liver collagen content was lower in rats treated with Liver Growth Factor (2.96 vs. 4.32 mg/g liver, p<0.01). Microscopic studies revealed that the livers of rats receiving Liver Growth Factor showed decreases in fibrosis, necrosis and inflammatory infiltration, as well as a recovery of architectural integrity. Liver function was improved after treatment with Liver Growth Factor, as indicated by the rate constant for elimination of aminopyrine, which increased from 0.0063 to 0.0170 (p<0.05). This increase was accompanied by a higher total amount of cytochrome P-450 as well as of certain P-450 isoenzymes, especially those that are hormone-dependent, such as P-450 3A. The improved liver histology and function observed in Cirr+LGF rats was associated with decreases in portal pressure (14.4 vs. 9.4 mm Hg, p<0.01) and portosystemic shunting (55.8 vs. 11.5%, p<0.01), as well as increases in mean arterial pressure and systemic vascular resistance, and a reduction in ascites.

CONCLUSIONS

Administration of the hepatic mitogen, Liver Growth Factor, to CCl4-cirrhotic rats decreased liver collagen and reorganized the hepatic extracellular matrix, resulting in an improvement in liver function, reduced portal pressure and amelioration of ascites.

Feasibility of ESHAP + G-CSF as peripheral blood hematopoietic progenitor cell mobilisation regimen in resistant and relapsed lymphoma: a single-center study of 22 patients

The purpose was study the feasibility of ESHAP + G-CSF for peripheral blood hematopoietic progenitor cell (PBPC) mobilisation in resistant/relapsed Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Twenty-two consecutive patients with HD (8) and N-HL (14) received ESHAP chemotherapy and G-CSF (5 microg/Kg/d). When a minimum number of 10,000 peripheral blood CD34+ cells/mL was observed patients underwent leukapheresis until a CD34+ cell dose > or = 2.5x10(6)/Kg was collected or the PBPC peak was lost. Blood cells kinetics and toxicity were analysed. Data concerning the day of first apheresis, number of procedures per patient, and cellular yield of the aphereses were recorded. Correlation between the CD34+ cell content in the apheresis product and the two diagnosis groups was attempted. Twelve patients (54%) developed short-lived severe neutropenia (<0.5x10(9)/L). Thrombocytopenia (<25x10(9)/L) had a median duration of 1 day. Fever appeared in 4 patients and CN Staph bacteriemia in 2 cases. Bleeding events did not supervene and no deaths occurred. Aphereses started at day +15 (median) and the median number of apheresis/patient was 2. Seventeen patients underwent 1 or 2 leukaphereses. Thirteen patients (59%) achieved the CD34+ cell target in the first apheresis. NHL patients obtained statistically significant better CD34+ cell collections than HD. Only 2 HD patients failed to mobilise, 1 previously treated with high-dose therapy and autologous bone marrow transplantation. ESHAP + G-CSF has been shown to be feasible for PBPC mobilisation in resistant/relapsed lymphoma. Toxicity was low and CD34+ cell yield high, especially in N-HL. This mobilisation regimen should be further explored in a larger patient population.

Stevens-Johnson syndrome caused by indinavir

A case is presented of an HIV-infected man who developed Stevens-Johnson syndrome shortly after the initiation of treatment with indinavir. This is the first case ever reported of this adverse drug reaction occurring with an HIV protease inhibitor.

[The publication of cardiology books in Spain. A bibliometric approach]

INTRODUCTION AND OBJECTIVES

We analyze Spanish production of cardiology books published in Spain and put together in the database ISBN between 1988 and 1997.

MATERIAL AND METHODS

For every book various things are considered: author, year of publication, ISBN classification, language, place published and publishers were analyzed.

RESULTS

There are 565 books analyzed which are classified in the database under 27 different classes. The principal class is "General pathology. Clinical Medicine. Therapeutics", with 346 books. The places in which most books were published was Barcelona (46.90%) and Madrid (38.41%). The publishing houses were the ones which published more books (64.07%). 79.46 per cent of the books were originally written in Spanish, with at 20.54 per cent which were translated into by other languages. The ones that were translated were principally English (78.45%) and German (14.66%).

CONCLUSIONS

These results confirm the tendency observed in other projects and indicate the increase of Spanish publications on cardiology, this is observed over the years. Although, in the years 1996 and 1997 we observe a slight decrease, that we will have to continue analysing with posterior studies to this one; to see if it is an isolated fact or a tendency to the diminution of the production of books published in our country, as a consequence of the evolution of works in other type of supports.

Factors mediating the hemodynamic effects of tumor necrosis factor-alpha in portal hypertensive rats

Nitric oxide, prostacyclin, and glucagon have been implicated in promoting the hyperdynamic circulatory state of portal hypertension. Recent evidence also indicates that increased tumor necrosis factor-alpha (TNF-alpha) production is involved in the pathogenesis of this hemodynamic abnormality. This study was aimed at investigating in rats with portal vein stenosis (PVS) the effects on splanchnic hemodynamics of blocking circulating TNF-alpha and the factors mediating the vascular action of this cytokine in this setting. Anti-TNF-alpha polyclonal antibodies or placebo was injected into rats (n = 96) before and 4 days after PVS (short-term inhibition) and at 24 h and 4, 7, 10 days after PVS (long-term inhibition). Short-term TNF-alpha inhibition reduced portal venous inflow and cardiac index and increased splanchnic and systemic resistance. Portal pressure was unchanged, but portal-systemic shunting was decreased. After long-term TNF-alpha inhibition, portal venous inflow and portal pressure were unchanged, but arterial pressure and systemic resistance rose significantly. Anti-TNF-alpha PVS rats exhibited lower increments of systemic resistance after Nomega-nitro-L-arginine methyl ester and indomethacin administration and lower serum levels of TNF-alpha, nitrates-nitrites, and 6-keto-PGF1alpha, both over the short and the long term. Serum glucagon levels rose after long-term inhibition. In conclusion, the specific role played by TNF-alpha in the development of the hyperdynamic state of portal hypertension appears to be mainly mediated through an increased release of nitric oxide and prostacyclin. Maintenance of the splanchnic hyperemia after long-term TNF-alpha inhibition could be due to a compensatory release of glucagon.

BAX somatic frameshift mutations in endometrioid adenocarcinomas of the endometrium: evidence for a tumor progression role in endometrial carcinomas with microsatellite instability

Microsatellite instability (MI) has been observed in endometrioid adenocarcinomas of the endometrium, either arising sporadically or in association with the hereditary colon cancer syndrome. Genes known to contain mononucleotide short tracts in their coding sequence are regarded as targets for mutations in these tumors. BAX is a proapoptotic gene that contains a tract of eight consecutive deoxyguanosines in its third coding exon. DNA of 26 patients with endometrial carcinoma was extracted from blood and from fresh-frozen and paraffin-embedded tumor tissue. For MI analysis, microsatellite loci on chromosomes 3, 5, 10, 12, and 18 were amplified by PCR. Frameshift mutations in the (G)8 tract of BAX were detected by single-strand conformation polymorphism (SSCP) analysis. MI at three or more loci was detected in 13 cases. BAX frameshift mutations were detected in seven MI+ tumors (53.8%), but in none of the 13 MI- neoplasms. In two cases, identical BAX frameshift mutations were detected in different areas of the neoplasm, whereas in the other five cases, BAX mutations were heterogeneously distributed throughout the tumor. Immunostaining with antibodies against the carboxy terminus of BAX protein was very useful in assessing the heterogeneous distribution of BAX frameshift mutations in the neoplasms. The results suggest that BAX frameshift mutations are frequent in endometrial carcinomas with MI, probably playing a role in the process of tumor progression of these neoplasms.

[Risk of the development of dementia after interruption of zidovudine treatment]

BACKGROUND

Epidemiologic data suggest that zidovudine (ZDV) could prevent the AIDS dementia complex (ADC), but this hypothesis has been specifically studied.

PATIENTS AND METHODS

We have reviewed the medical records of all patients with human immunodeficiency virus (HIV) infection admitted to our section between January 1990 and December 1993 who were diagnosed with ADC, and we have compared them to those of a control group with regard to the interruption of ZDV at least 3 months before. Controls were selected from the remaining HIV-related admissions, matched by calendar year, CD4-cell count and previous HIV-disease stage.

RESULTS

Thirty-nine cases and 39 controls were available for analysis; twenty-nine (74%) and 25 (64%) were male. The median age was similar for both groups: 30. Thirty-one patients (79%) in each group had a previous diagnosis of AIDS, six (15%) in each group had an AIDS-related complex and in two (5%) the ADC was the first complication of their HIV disease. The median CD4-cell counts were 79.6 and 79.4 x 10(6)/l. Twenty-three patients in each group had taken ZDV. Six of these from the ADC had withdrawn treatment, as compared to 2 from the control group (odds ratio [OR] 3.36; 95% confidence interval [CI]: 0.54-35.76). On the other hand, 16 patients with ADC were still on ZDV at the time of diagnosis, as compared to 21 controls (OR: 0.66; 95% CI: 0.22-1.60).

CONCLUSION

In this case-control study, the interruption of treatment with ZDV was not found to be a risk factor for the development of ADC.

Dermatophagoides sp. and IgE anti-D. pteronyssinus and D. farinae detection in a Venezuelan community at more than 2000 m above the sea level

BACKGROUND

It has been reported that the concentration of Dermatophagoides sp. population, the main trigger of asthma in sensitized atopic subjects, is inversely related with altitude and probably directly with humidity and that this population are scarcely found over 1750 m above sea level.

OBJECTIVE

We studied the presence of Dermatophagoides sp. in a Venezuelan community between 2040 and 2600 m above sea level, and also the IgE response to D. pteronnyssinus and D. farinae in atopic subjects living on that region.

METHODS

The presence of Dermatophagoides sp. was determined by microscopic identification of mites in dust, obtained by brushing the mattresses surface in 93 randomly selected houses between 2040 and 2600 m above sea level. The indoor relative humidity was also measured. The specific IgE serum levels were studied in 65 subjects classified as asthmatics, allergic non-asthmatics and non-allergic.

RESULTS

A mean concentration of 188 mites/g of room dust was determined in 82.4% of houses with an indoor relative humidity ranging from 89% and 92% independently of altitude. The density of Dermatophagoides sp. was sufficiently high to sensitize the atopic subjects, IgE levels were 6.8 PRU mean value for asthmatic, against 0.38 PRU in non-atopic.

CONCLUSIONS

We conclude that: (a) Dermatophagoides sp. can be found up to 2600 m above sea level in a Venezuelan neotropical region where a high indoor relative humidity is characteristic of most dwellings; (b) sensitization by D. pteronyssinus and D. farinae were demonstrated in atopic subjects resident at that region.

[Evaluation of the hemodynamic effects of tumor necrosis factor alpha factor in rats with portal hypertension using the radioactive microsphere technique]

This study was aimed at investigating the effects of blocking circulating TNF on the hyperdynamic circulatory state developed in rats with portal vein stenosis (PVS), and the factors mediating the hemodynamic action of this cytokine in this setting.

MATERIALS AND METHODS

Murine antiTNF polyclonal antibodies (100 microgram) or placebo were intravenously injected into PVS rats (n = 24) before and 4 days after PVS. Hemodynamic studies were performed the day after the last antiTNF injection.

RESULTS

Short-term TNF inhibition led to reductions in cardiac index (p < 0.05) and portal venous inflow (p < 0.01), and significant increases in splanchnic and systemic vascular resistances. Portal pressure was unchanged, but portal-systemic shunting was decreased (p < 0.05).

CONCLUSION

TNF plays a key role in promoting the development of the hyperdynamic state of portal hypertension. The effect of TNF is mediated through an increased release of nitric oxide.

Methodological aspects of assessing phagocytosis of Vibrio anguillarum by leucocytes of gilthead seabream (Sparus aurata L.) by flow cytometry and electron microscopy

In this paper we optimize a flow cytometric method for evaluating the phagocytic activity of leucocytes in gilthead seabream (Sparus aurata L.) and characterize the phagocytic cells observed. Optimal conditions were established for the fluorescein-labelling and analysis of the bacterium Vibrio anguillarum by flow cytometry. Head-kidney leucocytes were incubated with the heat-killed fluorescein isothiocyanate (FITC)-labelled bacteria for different periods, during which the kinetics of phagocytosis was studied. Attached and interiorized bacteria were distinguished. Although phagocytic ability reached a maximum after 60 min, phagocytic capacity reached its maximum at 20 min. The amount of ingested bacteria per phagocyte was estimated from the mean fluorescence of the leucocytes. Cytochalasin B or colchicine was used to inhibit phagocytosis. Monocyte-macrophages and acidophilic granulocytes showed phagocytic activity as demonstrated by transmission electron microscopy. In conclusion, the technique presented allows the screening of thousands of cells, and individual cell evaluation, by quantifying interiorized particles in fish phagocytes. Our ultrastructural results demonstrate that V. anguillarum is actively phagocytized by seabream macrophages and acidophilic granulocytes.

The safety of pyrimethamine and sulfadoxine for the prevention of Pneumocystis carinii pneumonia

The medical records of 157 patients taking pyrimethamine-sulfadoxine for Pneumocystis carinii pneumonia prophylaxis were reviewed for assessment of safety and tolerance. 11 patients had experienced side effects, 7 (1 each: neutropenia, Stevens-Johnson, hepatic abnormalities; 2 each: subjective and hypersensitivity reactions) leading to a discontinuation of the drugs.

The muscle inhibitory period by transcranial magnetic stimulation. Study in stroke patients

Motor evoked potentials (MEPs) elicited over hand muscles by transcranial magnetic stimulation (TMS) were studied in healthy individuals and, bilaterally, in patients with cerebral infarction. Conduction time of the central motor pathways (CMCT), threshold intensity, and amplitude of the MEPs were correlated with recovery motor hand function after stroke. Following MEPs by TMS during tonic muscle contraction, there is a transient suppression of muscle action. This inhibitory period (IP) was significantly shorter in the upper paretic limb of stroke patients with spasticity than in normal limb of the patients and healthy individuals. Shortening of the IP duration was correlated to degree of upper limb spasticity (Ashworth scale) and may be due to supraspinal level reduction of the inhibitory function. The IP study contributes to a better quantification of the hand function in stroke patients.

Selective impairment of endothelium-mediated vasodilation in liver transplant recipients with cyclosporin A-induced hypertension

Arterial hypertension is commonly observed in orthotopic liver transplantation (OLT) recipients receiving cyclosporin A (CsA), but the precise pathogenetic mechanisms remain partially unknown. The aim of this study was to investigate endothelium-dependent and -independent dilation and adrenergic constriction of resistance vessels of OLT recipients treated with CsA. Vascular reactivity was examined in 22 OLT patients, 10 with and 12 without arterial hypertension, and in 10 control subjects by assessing the forearm blood flow response to the brachial artery infusion of increasing concentrations of methacholine chloride, sodium nitroprusside, and phenylephrine. In 10 OLT patients, the response to methacholine was also examined after acetylsalicylate. The ratio of serum nitrite and nitrate to serum creatinine was lower (P < .05) in OLT patients with hypertension than in nonhypertensive patients and controls. Basal forearm flow was similar in the three groups. Methacholine vasodilation was impaired in the hypertensive patients as shown by a lower maximum forearm vasodilator response and a shift in the dose response curve to methacholine to the right compared with the nonhypertensive OLT patients and the controls. The response to methacholine was not modified after salicylate. Forearm flow response to nitroprusside was similar in the three groups. No differences between the patients and the controls were found in the maximum forearm flow contraction in response to phenylephrine. An impairment in endothelium-dependent vasodilation could mediate arterial hypertension in OLT patients immunosuppressed with CsA.

Photosensitive polyurethanes applied to the development of CHEMFET and ENFET devices for biomedical sensing

Chemical microsensors based on ion-selective field effect transistor (ISFET) transducers with ion-selective and enzymatic membranes have been fabricated. In this case, photolithographically patterned membranes based on acrylated urethanes have been developed and applied onto the gate area of ISFET chips. Aliphatic urethane diacrylate has been used for K+ and NH+4 membranes, while a photocurable hydrogel formulation based on other type of acrylated urethane has been optimized for urea-FET sensors. Resulting potassium and ammonium sensors show similar performances to those found when PVC membranes are employed. An integrated packaging process for ISFET-based sensors has been developed giving the possibility of carrying out most of the encapsulation on wafer level. For this purpose, a photocurable polyurethane encapsulant formulation has been optimized to be microstructured by photolithography. Finally, a preliminary study of biocompatibility of photosensitive formulations containing urethane oligomers has been performed in order to examine future applications in biomedical and clinical analysis.

[Historical cohort study on bacterial pneumonias as predictors of the progression of the human immunodeficiency virus disease]

BACKGROUND

Recognition of the importance of bacterial pneumonias in the context of HIV infection has continuously grown throughout the pandemia. It has recently been suggested that these may be predictors of progression of the disease.

PATIENTS AND METHODS

The evolution of an historic cohort of patients with HIV infection who were studied in 1989 with pneumonia regarding the presentation of AIDS or death was investigated. A control cohort was established, being age matched for sex, CD4 lymphocyte count, previous HIV disease and the use of zidovudine. Kaplan-Meier curves of survival without AIDS were made and compared by the logarythmic range test. Other predictors of progression were studied by the Cox models.

RESULTS

Forty-nine patients were studied in each group, with a total of 121 and 153 patients/year of follow up. Final events were counted in 33 and 27 cases, respectively (p = 0.11). The relative risk of progression was 1.55 (confidence interval of 95%, 0.93 to 2.56) for the group of pneumonias. The estimated relative risk (hazard) performed by a Cox model of proportional risks was however 1.85 (confidence interval of 95%: 1.05 to 3.25, p < 0.05) when the lymphocyte count adjustment was carried out according to the real values rather than by categories.

CONCLUSIONS

The results of this historic cohort study support the existence of an association between history of bacterial pneumonia and the risk of HIV disease progression.

Accuracy of portal and forearm blood flow measurements in the assessment of the portal pressure response to propranolol

BACKGROUND/AIMS

The portal pressure response to propranolol varies significantly in individual patients with cirrhosis. At present, propranolol responders can be identified only by measuring the hepatic venous pressure gradient. The aims of this study were: 1) to investigate whether the noninvasive monitoring of portal blood flow by pulsed Doppler ultrasound and forearm blood flow by strain-gauge plethysmography can predict the hepatic venous pressure gradient response to propranolol in patients with cirrhosis, and 2) to analyze the factors that may influence this response.

METHODS

Hemodynamic measurements were undertaken in 80 patients with cirrhosis before and after receiving propranolol (0.15 mg/kg i.v., n = 60) or placebo (n = 20).

RESULTS

No changes were observed in the placebo group. Propranolol lowered (p < 0.01) hepatic venous pressure gradient from 17.6 +/- 3.8 to 14.7 +/- 3.8 mmHg, portal blood flow from 1122 +/- 363 to 897 +/- 332 ml/min and forearm blood flow from 7.52 +/- 3.1 to 6.12 +/- 2.3 ml/min%. Changes in hepatic venous pressure gradient were correlated (p < 0.01) with those of portal blood flow (r = 0.82) and forearm blood flow (r = 0.54). The reduction in hepatic venous pressure gradient was > 20% in 23 patients ("responders"). The accuracy of portal Doppler flowmetry in identifying responders was higher than that of forearm plethysmography (88.3 vs. 68.3%, p < 0.05). Multivariate analysis proved that previous variceal bleeding was the only factor independently associated with a lack of response to propranolol (relative risk 3.42, 95% CI 1.5-7.4, p < 0.01). Hepatic venous pressure gradient reduction by propranolol was higher in non-bleeders than in bleeders (-19.9 +/- 9.4 vs. -11.3 +/- 8.6%, p < 0.01).

CONCLUSIONS

Portal Doppler ultrasound can be used as a reliable surrogate indicator of the hepatic venous pressure gradient response to acute propranolol administration. In addition, our study indicates that this response is mainly influenced by previous variceal hemorrhage.

[Contribution of thalamic somatosensory evoked potentials to stereotaxic thalamometry]

INTRODUCTION

In order to use short latency somatosensory thalamic evoked potentials (PES) to locate therapeutic targets in functional surgery, thalamic PES were recorded during stereotactic thalamotomy in 25 patients with Parkinson's disease, using a concentric bipolar semi-micro-electrode, 4 mm in diameter. In the 72 trajectories planned. 628 registers were made, obtaining 314 PES in 55 trajectories. These recordings were divided into 5 groups, according to the electrical variables evaluated in each case (absolute latency, inter-peak latency, absolute amplitude and number of phases).

MATERIAL AND METHODS

The electrophysiological characteristics of the PES groups obtained, and the spatial representation of these in a tridimensional system of coordinates, is shown. We analyze the sequence of the groups of potentials in each of the trajectories followed.

CONCLUSIONS

We consider that the limit between adjacent nuclear edges, ventral intermediate (Vim)-ventro-caudal (Vc), may be represented by the transition of potentials in group 1 to potentials in group 4 and/or potentials of group 3 to those of group 2. This study shows that thalamic PES are useful for locating targets during stereotactic thalamotomy.

[Tracheostomy in the intensive care unit]

During the last 22 months, a total number of 85 tracheostomies have been performed in our ICU, 40 of which have been surgical, and 45 percutaneous to patients under mechanical ventilation. This period has coincided with the learning process of the technique of percutaneous tracheostomy by our staff. The choice of the type of tracheostomy was not taken at random, but guided by clinical criteria. Our results confirm a lower rate of infection of the estoma in percutaneous tracheostomies than in surgical ones (5 percutaneous and 29 surgical, p < 0.001). The most serious complication was a tracheal perforation in a percutaneous tracheostomy. 17 of the 85 patients died in ICU, and 33 of the 68 patients who were discharged, survived the hospital, 27 of whom left with a closed tracheostomy. The other 6 permanent tracheostomies had been performed surgically and corresponded to 4 patients with worsening EPOC, one neurological patient and another patient suffering from anoxic encephalopathy. No percutaneous tracheostomy was left as permanent. The patients who benefitted especially from the tracheostomy presented the following characteristics: acute respiratory insufficiency with prolonged intubation, neurological patients, and worsening EPOC. The tracheostomy in persistent vegetative status allowed their moving to more suitable areas. Our study proves the existence of a learning curve in the practice of percutaneous tracheostomy. This aspect should be taken into account by other groups who are interested in including this technique in their services.

Use of subdiaphragmatic bupivacaine instillation to control postoperative pain after laparoscopic surgery

Although postoperative pain has been reduced significantly since the advent of laparoscopic surgery, many patients still complain of moderate abdominal and shoulder pain during the first 48 to 72 h after surgery. In this study, the effect of subdiaphragmatic instillation of bupivacaine after laparoscopic cholecystectomy was investigated. The evaluation of postoperative pain was done according to a numerical verbal scale and the dose of analgesia required. The results showed a considerable reduction of postoperative pain during the first 48 h after surgery in patients who received bupivacaine instillation. Although the literature shows certain controversy as to the effects of similar methods, our study concludes that instillation of a long-acting anesthetic, such as bupivacaine, into the subdiaphragmatic space after laparoscopic procedures is effective in postoperative pain reduction.

Diagnostic imaging of tibial periosteal ganglion

A case of a soft tissue tumor situated in the anterior surface of the proximal end of the tibia in an adult patient is demonstrated by conventional radiographs, CT, and MRI. The lesion was well defined with respect to the adjacent soft tissue. The CT exam showed a soft tissue mass with external cortical erosion and thick spicules by periosteal reaction. On T1-weighted images the mass was homogeneous and of low signal intensity, whereas on T2-weighted images it showed a high signal intensity, with some septa in the mass. The differential considerations include a periosteal chondroma, a lipoma, a subperiosteal hematoma, an inflammatory process, a giant cell tumor of tendon sheath, and a parosteal osteosarcoma. The CT and MR features of these entities are reviewed as an aid in differential diagnosis of the periosteal ganglion.

Human granulocytic ehrlichiosis: a case series from a medical center in New York State

BACKGROUND

Human granulocytic ehrlichiosis (HGE) is a newly described illness with few reports in the literature.

OBJECTIVE

To describe the clinical and laboratory feature of HGE.

DESIGN

Case series.

SETTING

Tertiary care facility in New York State.

PATIENTS

18 adult patients with HGE.

MEASUREMENTS

Epidemiologic, clinical, and laboratory features; treatment; and outcome of patients with HGE.

RESULTS

Patients presented with such symptoms as fever (94%) and myalgia or arthralgia (78%). Thirteen patients (71%) recalled being bitten by a tick before onset of symptoms. Leukopenia or thrombocytopenia was seen in 82% of patients, and abnormal liver enzyme levels were seen in 81%. Results of polymerase chain reaction were positive in 9 of 12 patients (75%); morulae were seen in 3 of 12 patients (25%); and the agent that causes HGE was cultured from 2 patients. All but one patient (94%) developed antibodies to Ehrlichia equi. Five patients (28%) were briefly hospitalized, and none died. All patients were successfully treated with doxycycline.

CONCLUSIONS

The illness associated with HGE in these patients from the northeastern United States was more mild than that originally described in reports of HGE in the midwestern United States.

Overexpression of the 67-kD laminin receptor correlates with tumour progression in human colorectal carcinoma

The high affinity 67-kD laminin receptor (67LR) is a cell surface protein whose expression is increased in a number of human carcinoma models. To date, 67LR expression in colorectal carcinomas has been examined in a small number of cases. 67LR expression has been immunohistochemically analysed in a large series of human colorectal neoplasms, using the MLuC5 monoclonal antibody. The study included 59 samples of non-neoplastic mucosa, 45 polyps (11 hyperplastic, 34 adenomas), 196 carcinomas, and lymph node metastases of 87 carcinomas. Epithelial cells of normal mucosa and hyperplastic polyps were negative or showed weak positivity in the paranuclear and apical areas of the cytoplasm. In adenomas and carcinomas, the staining was stronger, with a membranous or cytoplasmic pattern. The expression of 67LR correlated significantly with the progression from normal mucosa (22 per cent) to adenoma (44 per cent), carcinoma (61 per cent), and lymph node metastasis (75 per cent) (P < 0.0001). Expression of the laminin receptor showed a tendency to be more frequently positive in advanced stage (III+IV; 67 (III+IV; 67 per cent) when compared with early stage (I+II) carcinomas (54 per cent). The difference, however, was not statistically significant (P = 0.058). In addition, 14 out of 28 (50 per cent) primary carcinomas without 67LR expression became positive in lymph node metastases, while most (86 per cent) of the MLuC5-positive primary carcinomas were also immunoreactive in metastases. In conclusion, these results indicate that 67LR is up-regulated in the progression of human colorectal carcinomas and may play a role in the local and metastatic progression of these tumours.

Mobilization of peripheral stem cells with intensive chemotherapy (ICE regimen) and G-CSF in chronic myeloid leukemia

Seventeen patients with Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) were treated with the ICE regimen plus G-CSF with the aim of mobilizing and collecting Ph-negative peripheral stem cells (PSC) in the setting of an autotransplant program. Fifteen patients had CML in first chronic phase (CP), and two in accelerated phase (AP). Three patients had been previously treated with interferon alpha 2a (IFN). Twelve patients underwent leukaphereses and a mean of 4.7 x 10(8)/kg mononuclear cells were obtained. Four CP patients did not show a significant mobilization peak of CD34+ cells and leukapheresis was not performed; finally, one patient died before apheresis could be performed. Six of the 12 who underwent leukaphereses obtained more than 1.0 x 10(6)/kg CD34+ cells. Eight of the 12 mobilized patients (67%) obtained a major cytogenetic response, including two complete and six partial; in the remaining four patients minimal or absent cytogenetic responses were observed. A higher rate of Ph purging was obtained in patients mobilized early or showing residual Ph-negative cells before mobilization, even if they were in AP. Infectious complications were frequent with a 38% rate of bacteremia recorded and one case of pulmonary aspergillosis resulting in a toxicity similar to that occurring in acute myeloid leukemia-induction chemotherapy. The ICE regimen can promote 'in vivo' purging of the Ph+ cells in 67% of CML mobilized patients (8/12). Failure of mobilization occurs in 65% of patients (11/17), mainly because of poor CD34+ cell yield.

[An experimental model of hepatointestinal transplant in the pig with clinical applications]

A model of experimental hepatointestinal transplant in pigs, with clinical applications is presented. Ten animals received a graft composed by the liver and the full length of the small bowel. Two pigs died during the transplant and in eight the surgical procedure was well tolerated with a good revascularization of the grafts. The coagulation parameters were normal after the transplant and only minor biochemical disturbances were found. The main difficulties of the surgical technique are related with the poor tolerance of the pig to the portal and caval clamping, and the close relationships of the duodenum, pancreas and distal colon, produced by the 360 degrees anti-clockwise bowel rotation around the mesenteric vessels. Clamping the supraceliac aorta during the implant of the graft keeps the animal hemodynamically stable and makes unnecessary the use of the more complicated veno venous shunt.

Overexpression of the 67-kD laminin receptor correlates with tumour progression in human colorectal carcinoma

The high affinity 67-kD laminin receptor (67LR) is a cell surface protein whose expression is increased in a number of human carcinoma models. To date, 67LR expression in colorectal carcinomas has been examined in a small number of cases. 67LR expression has been immunohistochemically analysed in a large series of human colorectal neoplasms, using the MLuC5 monoclonal antibody. The study included 59 samples of non-neoplastic mucosa, 45 polyps (11 hyperplastic, 34 adenomas), 196 carcinomas, and lymph node metastases of 87 carcinomas. Epithelial cells of normal mucosa and hyperplastic polyps were negative or showed weak positivity in the paranuclear and apical areas of the cytoplasm. In adenomas and carcinomas, the staining was stronger, with a membranous or cytoplasmic pattern. The expression of 67LR correlated significantly with the progression from normal mucosa (22 per cent) to adenoma (44 per cent), carcinoma (61 per cent), and lymph node metastasis (75 per cent) (P < 0.0001). Expression of the laminin receptor showed a tendency to be more frequently positive in advanced stage (III+IV; 67 (III+IV; 67 per cent) when compared with early stage (I+II) carcinomas (54 per cent). The difference, however, was not statistically significant (P = 0.058). In addition, 14 out of 28 (50 per cent) primary carcinomas without 67LR expression became positive in lymph node metastases, while most (86 per cent) of the MLuC5-positive primary carcinomas were also immunoreactive in metastases. In conclusion, these results indicate that 67LR is up-regulated in the progression of human colorectal carcinomas and may play a role in the local and metastatic progression of these tumours.

[Histiocytosis X and ankylosing spondylitis. A common pathogenesis?]

Histiocytosis X is considered a group of diseases of unknown origin. Nevertheless, the presence of certain lymphocytes disorders and immunocomplexes has permitted us to think that it is an immunologic disease. The ankylosing spondylitis is also a disease of unknown origin, but like the histiocytosis X, might be of immunologic origin. In both entities, a defect of T-lymphocytes has been demonstrated. We present a patient in whom both diseases are associated, which is not reported before in the medical literature. We think that these disorders may be related by a common immunologic alteration.

[Bacterial pneumonia as a risk marker for new bacterial diseases in patients with HIV infection]

BACKGROUND

Bacterial pneumonias are a main cause of morbidity and mortality among patients infected by the HIV. Furthermore, recent data suggest that, under certain circumstances, they can be prognostic markers.

METHODS

The evolution of a cohort of HIV-infected patients, prospectively defined by having suffered a pneumonia, was studied with regards to the occurrence of a new pneumonia or death from a bacterial disease; the evolution of a control cohort of patients matched according to sex, CD4-cell count, previous HIV-disease and zidovudine-treatment was compared to the former cohort by means of survival-analysis techniques.

RESULTS

Forty-nine patients in each group were followed up for a total of 1389 and 1893 patient-months respectively. In the first group, 17 new first pneumonia episodes were diagnosed, as compared to 7 in the second group (relative-risk: 3.23, 95% confidence interval: 1.34 to 7.79, p = 0.005). Eight of the 31 deaths that occurred in the first group were attributed to a bacterial disease, as compared to none of the 24 deaths in the second group (p = 0.007, Fisher's exact test) (in five of those cases, a bacteria was isolated which was thought to be directly related to the death).

CONCLUSIONS

HIV-infected patients who suffer a bacterial pneumonia have an increased risk of suffering new severe bacterial diseases (pneumonia or fatal diseases) as compared to HIV-infected patients with similar prognostic features but no previous episodes of pneumonia.

Ventricular tachycardia in Duchenne's muscular dystrophy

We report a case of a 31-year-old man with severe Duchenne's muscular dystrophy and sustained ventricular tachycardia. Serial electrophysiologic studies demonstrated the inefficiency of antiarrhythmic drugs in our patient who died after the implant of an automatic cardioverter defibrillator. A literature review is made.

[Cardiac angiosarcoma]

We report a case of a 29-year-old patient with recurrent hemorrhagic pericardial effusion secondary to a right atrial mass detected by transthoracic echocardiography. A more detailed anatomic study was provided by transesophageal echocardiogram and nuclear magnetic resonance imaging. During surgery, a biopsy confirmed the diagnosis of angiosarcoma. We discuss the contribution of echocardiography and other noninvasive methods to evaluate intracardiac tumors. A brief review of treatment and prognosis is made.