[Gastric pneumatosis]

Gastric pneumatosis is an infrequent entity. The clinical course may oscillate from an asymptomatic or mild condition (gastric emphysema) to a severe disorder with high mortality (emphysematous gastritis). Diagnosis with imaging techniques is based on radiological evidence of air in the gastric wall.

Evaluation of wastewater toxicity: comparative study between Microtox and activated sludge oxygen uptake inhibition

Microtox is a frequent toxicity tool for the screening of wastewaters discharged into wastewater treatment plants. There is currently an increasing controversy between this test and others using activated sludge. A Microtox and electrolytic respirometry comparative study for toxicity determination has been performed. Seven organic and five inorganic toxic compounds have been assessed for comparing both methods. Microtox proved to have a higher sensitivity to toxicants but was less representative of effects on activated sludge compared to respirometry. For instance, assays accomplished with LAS, a biodegradable reference surfactant, showed a toxic effect by Microtox but good biodegradability and no toxicity in respirometry. This could be explained by the different nature of the biological material used, as Microtox utilises the seawater Vibrio fischeri, whereas respirometry uses the bacterial consortium in activated sludge. For the evaluation of the potential toxicity of a compound on a WWTP, the preferred biological material be used should be activated sludge itself. Results obtained with any other biological material would be just an approach to reality.

[Community-acquired pneumonia in the elderly: prognostic factors]

The incidence and mortality rates of community-acquired pneumonia are far higher in the elderly than among younger populations. However, the explanation may lie in the presence of comorbidity rather than in age itself. We performed a retrospective study of 226 patients over the age of 65 years who were admitted to our hospital with a diagnosis of community-acquired pneumonia over a period of 36 months, with the objective of identifying factors predicting mortality and to describe clinical features. The patients' mean age was 78.71 (65-96) years. One hundred forty-two were men (63%) and 84 were women (37%). Upon admission, 27.4% showed signs of altered mental state. The crude mortality rate was 20.8%. Multivariate analysis demonstrated the following independent risk factors associated with higher mortality: serum creatinine > 1.2 mg/dL (RR = 13.93; 95% CI 8.14-16.08); patient previously bedridden (RR = 5.73; 95% CI 3.41-6.79), PaO2/FiO2 < 200 (RR = 5; 95% CI 2.67-6.62) and neoplastic disease (RR = 4.08; 95% CI 1.96-5.24). The presence of chest pain was associated with a lower risk of mortality (RR = 0.11; 95% CI 0.01-0.54). Age itself was not a risk factor. We conclude that pneumonia in the elderly requires hospitalization and that it commonly presents with severe symptoms and high risk of mortality. Risk factors such as those identified in this study may help in the diagnosis and treatment of patients requiring special care.

Suicide attempts in bipolar patients

BACKGROUND

Between 25% to 50% of patients with bipolar disorder make suicide attempts during their lives, but there are some controversies about factors related to suicide attempts in this group of patients. The aim of this study is to investigate the association between suicide attempts and the predictive factors previously described in the literature.

METHOD

The sample included all 169 patients with DSM-III-R bipolar I disorder identified in a delimited area (northern Spain). Sociodemographic, clinical, and family history variables measured by Research Diagnostic Criteria-Family History were analyzed. Significant variables were introduced in a logistic regression analysis to control for the effects of other variables.

RESULTS

There were 56 patients (33%) who had one or more suicide attempts. Early age at onset, history of hospital admission during depressive episodes, drug abuse, and family history were significantly associated with suicide in the univariate analyses (p < .05). A much higher proportion of patients with onset at or before 25 years of age than patients with onset after 25 years of age attempted suicide (23% vs. 10%). The age at onset was no longer significant after controlling for the other 3 variables included in the logistic regression analysis.

CONCLUSION

Suicide attempts are highly prevalent in bipolar patients and are related to drug abuse, family history of affective disorders, and severe depressive episodes. This study suggests that the risk of suicide in patients with an early age at onset could reflect other variables such as drug abuse, a history of hospital admissions for depression, or family history.

[Risperidone in the treatment of psychotic patients with opiate abuse and dependence]

INTRODUCTION

180 psychotic patients with opiate dependence and abuse (ICD-10) were included in an open label study. The study objectives were to evaluate safety and efficacy of risperidone for a six month follow-up period. The total mean dose was 4.4 (SD: 2.4 mg/daily; range: 0.5-12 mg/daily).

METHODS

BPRS, CGI and DDS-SV were used to assess efficacy and UKU subscale for neurological side effects and spontaneous reports for safety.

RESULTS

Risperidone treatment improved symptoms, disability of the included patients with a significant reduction in the mean total scores of BPRS, CGI and DDS-SV observed from the first month of treatment onwards. Risperidone also reduced illegal opiate abuse patients from 39% basedate to 18% at month 6. There was a significant reduction (p< 0.0001) in the total UKU subscale for neurological side effects scores from visit 1 onwards for studied sample. Risperidone was well tolerated by the study patients. From 165 elegible patients, just 10 (6.1%) discontinued treatment due to adverse reactions, 94% of the patients did not suffer any adverse event; the most frequent adverse events according spontaneous reports were extrapyramidal effects (3%) and anxiety (1.8%).

DISCUSSION

Risperidone improved disability, psychotic symptoms and tolerability of these patients. Those results could mean an outstanding breakthrough in the treatment of these type of disorders and, if it is confirmed that risperidone can lead to abstinence, we would be before a new line of treatment for dual pathology.

Differential [(3)H]idazoxan and [(3)H]2-(2-benzofuranyl)-2-imidazoline (2-BFI) binding to imidazoline I(2) receptors in human postmortem frontal cortex

[(3)H]2-(2-benzofuranyl)-2-imidazoline (2-BFI) and [(3)H]idazoxan are the most used tools to characterise imidazoline I(2) receptors. We evaluated the binding of both radioligands to human postmortem frontal cortex membranes. Saturation binding analyses revealed that [(3)H]idazoxan (in the presence of 2 microM efaroxan to avoid radioligand binding to alpha(2)-adrenoceptors and imidazoline I(1) receptors) and [(3)H]2-BFI bound with high affinity to an apparent single population of sites. However, in competition studies whereas [(3)H]idazoxan (10 nM) binding was displaced monophasically by idazoxan and 2-BFI, both drugs displayed biphasic curves for [(3)H]2-BFI (1 nM). The proportion of the low-affinity binding site increased from 17% to 25% when 10 nM [(3)H]2-BFI was displaced by idazoxan. Amiloride inhibited [(3)H]2-BFI (10 nM) binding with low affinity and in a monophasic way. These data indicate that [(3)H]2-BFI recognises in human postmortem brain membranes a second binding site different from the imidazoline I(2) receptors labelled by [(3)H]idazoxan.

Inflammatory pseudotumor of the median nerve. Case report and review of the literature

The authors report the presence of an inflammatory pseudotumor of the median nerve in a young woman who presented with a sensorimotor deficit in the median nerve area. Magnetic resonance (MR) images revealed a fusiform mass in the nerve, and the patient underwent surgery for a suspected peripheral nerve-sheath tumor. Her clinical condition improved slowly and notably. Histological study revealed a heterogeneous lymphoid infiltration with mononuclear cells, lymphocytes (mostly T cells), and plasmocytoid cells. Because of the unknown significance of this infiltration, the patient was examined to exclude the possible diagnosis of a systemic tumoral process. All the studies yielded negative results and no systemic disease was found. Later, control MR imaging revealed no tumoral remains, and electromyography demonstrated progressive improvement of median nerve function. The follow-up period has been 8 years. The cause of the lesion is unknown. The differential diagnosis includes benign and malignant peripheral nerve-sheath tumors, lymphoma, and all tumorlike lesions of peripheral nerves.

[Study of cytokines kinetics in severe sepsis and its relationship with mortality and score of organic dysfunction]

BACKGROUND

The Infectious Systemic Inflammatory Response syndrome and multiple organic dysfunction have common physiopathological mechanisms. Multiple organic dysfunction can be assessed using severity scores.

AIM

To relate cytokine kinetics with a multiple organic dysfunction score during sepsis.

MATERIAL AND METHODS

Tumor necrosis factor alpha (TNF alpha) and interleukin 6 (IL6) kinetics were studied in 25 patients with severe sepsis with less than 48 h of evolution and interleukin 1 beta (IL beta) kinetics was studied in 13 patients. Measurements were made at 0, 12, 24 and 48 hours after admission to the study, using an ELISA technique. These parameters were correlated with the Marshall multiple organic dysfunction score and survival.

RESULTS

Mean age of study subjects was 70 years, the APACHE II score was 16.9 +/- 6 and the Marshall score was 6.8 +/- 3.6. Sepsis was of pulmonary origin in 56% of patients and intra abdominal in 32%. Mortality was 36%. TNF alpha increased during the study period (24.1 pg/ml initially and 37.8 pg/ml at 24 hours, with a slight posterior reduction, p < 0.02). These levels had no association with mortality or organic dysfunction. IL6 remained elevated during the first hours and had a tendency to decrease thereafter. Decreased patients had higher values than survivors (306 pg/ml and 55.4 pg/ml respectively, p = 0.011). Its values were tightly correlated with Marshall score, with the number of failing organs, with the presence of shock and with probability of dying during hospitalization. IL1 beta remained low and was not associated with clinical parameters.

CONCLUSIONS

There is a tight correlation between the elevation of IL6 and the severity of the Systemic Inflammatory Response and mortality in these patients with sepsis.

Prediction of relapse among heroin users treated in Spanish therapeutic communities. A comparison of different models

The roles of selected heroin use "relapse" theoretical models were studied by analyzing the composition of each predictive model, comparing their predictive capacity on relapse and abstinence, and integrating them into an overall model. This study is based on two groups of heroin misusers (one "relapsed," n = 130; one "abstinent," n = 130) treated in 15 Spanish therapeutic communities. Data were collected by using a structured interview and urine analysis. A logistic regression model was used to build up and cross-validate six different predictive models. This study resulted in several partial models with a predictive capability ranging between 47 and 78% of abstinence and relapses, while the overall model reached 85 and 89%, respectively. The authors conclude that it is advisable to integrate several models in order to prevent relapse more effectively: motivational-conditioned, situational, cognitive-affective, and coping skills models.

[Involuntary hospitalization in the first psychotic episodes: associated factors]

INTRODUCTION

The great majority of involuntary admissions at acute hospital units are related to severe psychiatric diseases. The aim of this study is to determine which are the characteristics and associated factors in first psychotic episodes not due to medical illness.

METHOD

It had been evaluated, 61 first psychotic episodes hospitalised in a General Hospital Psychiatric Unit. It was used a protocol with the SCID, SCID-PANSS, DSM-IV criteria, unified clinical history, and PANSS, and Philips scales.

RESULTS

67.2% of the patients were committed to the hospital. Only the PANNS positive subscale was significantly associated with the involuntary admission.

CONCLUSIONS

There is a high admission rate of involuntary inpatients with first psychotic episode. The involuntary admission is highly related to psychotic positive symptoms.

I2-Imidazoline receptors and monoamine oxidase B enzyme sites in human brain: covariation with age

An association between monoamino oxidase B enzyme (MAO-B) sites and I(2)-imidazoline receptors (I(2)-IR) has been established in human brain on the basis of correlational studies of radiolabelled binding sites. Because both MAO-B and I(2)-IR densities increase with aging, the age at death could be partially involved in the observed correlations. The evaluation of two independent but similar datasets demonstrated that the linear correlation between MAO-B and I(2)-IR densities dropped from 0.70 (P=0.02) and 0.41 (P=0.14) in the crude analyses to the negligible values of 0.07 (P=0.84) and 0.09 (P=0.75) when the age at death was controlled for in the statistical analyses. The results lead to conclude, contrary to former interpretations, that there is not any statistical association linking both MAO-B catalytic unit sites and I(2)-IR densities in the human brain.

[Influencing factors in the control of phosphorus in peritoneal dialysis. Therapeutic options]

Impaired phosphate excretion resulting in hyperphosphatemia is one of the earliest consequences of chronic renal failure. To control serum phosphate levels, we can use the following therapies: 1) Restriction of dietary phosphate (but on CAPD, obligatory protein losses via peritoneal fluid makes impractical any reduction of phosphate diet. 2) Reduction of phosphate absorption, using phosphate binders. 3) Peritoneal phosphate removal.

OBJECTIVE

1) To evaluate the factors affecting peritoneal phosphate removal such as plasma phosphate, peritoneal membrane transport type, peritoneal dialysis modality prescription (CAPD or APD) and daily dialysate volume. 2) To test the best calcium concentration in the peritoneal dialysis fluid (5, 6 or 7 mg/dl) in order to permit the use of calcium carbonate or acetate without the risk of hypercalcemia or hyperparathyroidism.

METHOD

Phosphate was measured in seventy 24-hour dialysate collections, 33 from patients on CAPD and 37 from patients on APD. 24-hour peritoneal phosphate removal (mg/24 hours) and weekly peritoneal phosphate clearance was calculated (L/week). The peritoneal membrane was studied by the peritoneal equilibrium test (PET), using a 2.27% glucose. We calculated also the peritoneal calcium balance in 25 daily peritoneal fluid collections from patients using a calcium dialysate concentration of 5, 6 or 7 mg/dl each one. IPTH levels and doses of vitamin D were compared at 6 months in patients using a calcium concentration of 5, 6 or 7 mg/dl from the beginning of peritoneal dialysis (5 patients of each calcium dialysate concentration).

RESULTS

Weekly peritoneal phosphate clearance (WPC) were higher or APD than on CAPD (51 +/- 21 vs 41 +/- 14, p < 0.005). Daily dialysate volume was also higher on APD (14 +/- 4 vs 7.8 +/- 1.8 L/day, p < 0.001). WPC was higher on APD when a mild-day exchange was done (61 +/- 23 vs 45 +/- 15, p < 0.005), instead an equal total daily volume of the dialysate. Peritoneal calcium balance was significantly more negative in patients using a calcium in the dialysis fluid of 5 than 6 or 7 mg/dl (-125 +/- 7 vs -18 +/- 41 vs -11 +/- 49, p < 0.001). At 6 months, patients using a calcium fluid concentration of 5 mg/dl increased iPTH levels (from 160 +/- 101 to 332 +/- 153, p < 0.001) and vitamin D needs (from 0 to 1.87 +/- 0.37 mcg/week, p < 0.001). In summary, peritoneal phosphate clearance depends on plasma phosphate levels, daily volume of dialysate prescribed and peritoneal membrane transport characteristics. It can be improved by increasing the total peritoneal fluid. On APD, a mild-day exchange may improve phosphate clearance, without total volume increase. The risk of secondary hyperparathyroidism can be decreased with a calcium fluid concentration of 6 mg/dl, which was shown to be better than 5 mg/dl when calcium phosphate binders are not correctly taken.

Hemorheological profile in chronic venous insufficiency after surgery

In recent years, there have been rheological abnormalities reported in chronic venous insufficiency (CVI), mainly an increase of erythrocyte aggregability (EA), which probably take part in the pathophysiology of the disease. The aim of this study was to analyze the hemorheological profile after stripping in 45 patients suffering from CVI. Follow-up included laboratory tests on the 7th, 60th and 180th day after surgery. EA was assessed with a photometric aggregometer (MA1, Myrenne) in stasis and low shear (3 s(-1)). The results show an increase of EA on the 7th day after surgery (p<0.001). Two and 6 months later, EA values returned to those found prior to surgery. The plasma fibrinogen level changes in a way parallel to EA. The association between rheological disturbances and thrombogenesis is well known, so the hyperaggregability found supports the antithrombotic prophylaxis in the early postsurgical period. On the other hand, the hemorheological abnormalities persist after stripping, so postsurgical treatment to inhibit EA may be beneficial.

Intrathecal N-methyl-D-aspartate (NMDA) induces paradoxical analgesia in the tail-flick test in rats

The intrathecal (IT) administration of NMDA in rodents has usually been reported to produce hyperalgesic reactions, although some articles describe that spinal NMDA can lead to analgesia. We show here that the nociceptive behavior (biting, scratching, licking; BSL) observed after NMDA injection (1-8 microg/rat; IT) is followed by a long period of increased tail-flick latencies, not longer detected 24 h after NMDA administration. The NMDA-receptor antagonist CPP (10-100 ng/rat; IT) blocked the BSL behavior induced by NMDA. In the tail-flick test, this antagonist induced analgesia by itself, and was able, at 30 ng/rat, to prevent the NMDA-mediated analgesia. The implication of opiate mechanisms was discarded since naloxone (3 and 10 mg/kg; IP) did not antagonize NMDA-induced analgesia. Finally, the involvement of the intracellular calcium binding protein calmodulin was assessed. The calmodulin inhibitor, calmidazolium (30-300 microg/rat; IT) only blocked the excitatory effect (BSL) without modifying the tail-flick analgesia produced by NMDA (4 microg). These results show that a single intrathecal administration of NMDA sequentially induces both nociceptive and antinociceptive, nonopiate responses in rats.