Doxepin incorporated into a dermatologic cream: an assessment of both doxepin antipruritic action and doxepin action as an inhibitor of papules, in allergen and histamine-caused pruritus

"Doxederm", a 5% doxepin hydrochloride ("doxepin") cream, has been used for assessments on patients' response to histamine and allergens by means of a prick test. Parameters selected papule diameters, and pruritus intensity. Doxederm was applied: (a) immediately before tests, (b) 10 minutes after tests, and (c) 72 hours before tests. All test reactions have been compared to similar tests that had been performed with a placebo cream. Tests yielded the following findings: (1) a remarkable remission of pruritus when doxederm was applied according to above mentioned (a), (b), and (c) schedules; (2) no inhibition of papule size --should either antigens or histamine be administered, could be observed when doxederm was applied immediately before tests or 10 minutes after tests had been performed (p > 0.10 vs placebo); (3) an evident remission of papules when doxederm had been applied 72 hours before tests were performed. No difference, however, could be detected with patientś forearms placebo cream had been applied whereon (difference among previously observed papules, and papules observed 72 after doxederm application: p > 0.005. Difference between doxederm and placebo: p > 0.10). Pursuant to the above mentioned observations, it can be suggested that doxederm evidences a highly siwft response on pruritus. Doxederm local effect, however, does not alter histaminic responses. Responses, however, are likely to be altered after a doxederm percutaneous absorption.

Results of the surgical treatment of chronic atrial fibrillation

OBJECTIVE

Report clinical experience in surgical treatment of atrial fibrillation (AF) by Cox-maze procedure.

METHODS

61 patients underwent surgical treatment for AF. Two had primary AF and 59 AF secondary to heart disease (2 atrial septal defects, 57 mitral). Ages ranged from 20 to 74 years (mean = 49). There were 44 females (72%). The surgical technique employed was Cox 3 without cryoablation. The patients were follow-up in specific at patient clinics and underwent periodical ECG, exercise tests, echocardiogram and Holter monitoring.

RESULTS

In-hospital mortality was 4.9% and late mortality 1.6%. A temporary pacemaker was used in 28 (46%) and a definitive in 7 patients (11.4%). On hospital discharge, AF remained in 17%; 63.9% had sinus rhythm, 6.9% atrial rhythm, 1.7% junctional rhythm, and 10.3% had pacemaker rhythm. In the last evaluation, AF was present in 19.5%; (70.5% sinus rhythm, 4% atrial rhythm, 2% atrial tachycardia, and 4% pacemaker rhythm). There was no report of thromboembolic episodes. Chronotropic response was considered adequate in 19%, intermediate in 29%, and inadequate in 42%. In Holter monitoring, the mean heart rate was 82 +/- 8 bpm, with a minimum of 57 +/- 7 bpm and maximum of 126 +/- 23 bpm, with supraventricular extrasystoles in 2.3 +/- 5.5% of the total heartbeats and ventricular extrasystoles in 0.8 +/- 0.5%. In the echocardiogram, the A wave was present in the left atrium in 87.5%.

CONCLUSION

Maze procedure is effective and has acceptable surgical risk. Atrial or sinus rhythms remain stable with a small but remarkable frequency of atrial and ventricular arrhythmias. Left atrial contraction is present, although attenuated, as well as the chronotropic response to exercise.

An engineered closterovirus RNA replicon and analysis of heterologous terminal sequences for replication

Citrus tristeza virus (CTV) populations in citrus trees are unusually complex mixtures of viral genotypes and defective RNAs developed during the long-term vegetative propagation of the virus and by additional mixing by aphid transmission. The viral replication process allows the maintenance of minor amounts of disparate genotypes and defective RNAs in these populations. CTV is a member of the Closteroviridae possessing a positive-stranded RNA genome of approximately 20 kilobases that expresses the replicase-associated genes as an approximately 400-kDa polyprotein and the remaining 10 3' genes through subgenomic mRNAs. A full-length cDNA clone of CTV was generated from which RNA transcripts capable of replication in protoplasts were derived. The large size of cDNA hampered its use as a genetic system. Deletion of 10 3' genes resulted in an efficient RNA replicon that was easy to manipulate. To investigate the origin and maintenance of the genotypes in CTV populations, we tested the CTV replicase for its acceptance of divergent sequences by creating chimeric replicons with heterologous termini and examining their ability to replicate. Exchange of the similar 3' termini resulted in efficient replication whereas substitution of the divergent (up to 58% difference in sequence) 5' termini resulted in reduced but significant replication, generally in proportion to the extent of sequence divergence.

Specific prognostic factors for secondary pancreatic infection in severe acute pancreatitis

BACKGROUND/AIMS

The aim of the present study was to investigate whether there are specific prognostic factors to predict the development of secondary pancreatic infection (SPI) in severe acute pancreatitis in order to perform a computed tomography-fine needle aspiration with bacteriological sampling at the right moment and confirm the diagnosis.

METHODS

Twenty-five clinical and laboratory parameters were determined sequentially in 150 patients with severe acute pancreatitis (SAP) and univariate, and multivariate regression analyses were done looking for correlation with the development of SPI.

RESULTS

Only APACHE II score and C-reactive protein levels were related to the development of SPI in the multivariate analysis. A regression equation was designed using these two parameters, and empiric cut-off points defined the subgroup of patients at high risk of developing secondary pancreatic infection.

CONCLUSION

The results showed that it is possible to predict SPI during SAP allowing bacteriological confirmation and early treatment of this severe condition.

New defective RNAs from citrus tristeza virus: evidence for a replicase-driven template switching mechanism in their generation

Defective RNAs (D-RNAs) ranging in size from 1968 to 2759 nt were detected in four citrus tristeza virus (CTV) isolates by hybridization of electroblotted dsRNAs with two probes specific for the 5'- and 3'-terminal genomic regions. The RNAs that hybridized with both probes were eluted, cloned and sequenced. Comparison with the sequences of the corresponding genomic regions of the helper virus showed, in all cases, over 99% nucleotide identity and direct repeats of 4-5 nt flanking or in the vicinity of the junction sites. The presence of the repeats from two separate genome locations suggests a replicase-driven template switching mechanism for the generation of these CTV D-RNAs. Two of the CTV isolates that differed greatly in their pathogenicity contained an identical D-RNA, suggesting that it is unlikely that this D-RNA is involved in symptom modulation, which may be caused by another factor.

The haplotype distribution of two genes of citrus tristeza virus is altered after host change or aphid transmission

Genetic variability of citrus tristeza virus (CTV) was studied using the haplotypes detected by single-strand conformation polymorphism (SSCP) analysis of genes p18 and p20 in six virus populations of two origins. The Spanish group included a CTV isolate and subisolates obtained by graft-transmission to different host species. The other included two subisolates aphid-transmitted from a single Japanese isolate. The homozygosity observed for gene p20 was always significantly higher than that expected under neutral evolution, whereas only three populations showed high homozygosity for p18, suggesting stronger host constraints for p20 than for p18. Sequential transmissions of a Spanish isolate to new host species increased the difference between its population and that of the successive subisolates for gene p18, as estimated by the F statistic. Analysis of molecular variance indicated that variation between both groups of populations was not statistically significant, whereas variations between populations of the same group or within populations were significant for both genes studied. Our data indicate that selection affects the haplotype distribution and that adaptation to a new host can be as important or more as the geographical origin. Variation of the CTV populations after host change or aphid transmission may explain in part the wide biological variability observed among CTV isolates.

The complete genome sequence of the major component of a mild citrus tristeza virus isolate

The genome of the Spanish mild isolate T385 of citrus tristeza virus (CTV) was completely sequenced and compared with the genomes of the severe isolates T36 (Florida), VT (Israel) and SY568 (California). The genome of T385 was 19,259 nt in length, 37 nt shorter than the genome of T36, and 33 and 10 nt longer than those of VT and SY568, respectively, but their organization was identical. T385 had mean nucleotide identities of 81.3, 89.3 and 94% with T36, VT and SY568, respectively. The 3' UTR had over 97% identity in all isolates, whereas the 5' UTR of T385 had 67% identity with VT, 66.3% with SY568 and only 42.5% with T36. In the coding regions, the nucleotide differences between T385 and VT were evenly distributed along the genome (around 90% identity); this was not observed between T385 and the other isolates. T385 and T36 had nucleotide identities around 90% in the eight 3'-terminal ORFs of the genome, but only 72.3% in ORF 1a, a divergence pattern similar to that reported previously for T36 and VT. T385 and SY568 had nucleotide identities close to 90% in the 5'- and 3'-terminal regions of the genome, whereas the central region had over 99% identity. Our data suggest that the central region in the SY568 genome results from RNA recombination between two CTV genomes, one of which was almost identical to T385.

Evaluation of secondary haemostasis in canine leishmaniasis

Secondary haemostasis was evaluated in 26 dogs with leishmaniasis and 10 normal dogs by measurements of modified one-stage prothrombin time (m-OSPT), activated partial thromboplastin time (APTT), thrombin time, fibrinogen concentration and fibrin degradation products. There were no significant differences between the groups in the m-OSPT, fibrinogen concentration, or levels of fibrin degradation products. The APTT was significantly (P = 0.006) longer in the infected dogs than in the control group, and in infected dogs with alanine aminotransferase (ALT) activities > 50 U/litre. There was a significant linear regression between ALT and APTT. Thrombin time was significantly (P = 0.003) longer in the infected dogs than in the normal dogs. There were no significant differences between the thrombin times of sick dogs with different levels of creatinine or activities of ALT, or between male and female dogs, whether diseased or normal.

Catalonian population study of the tetranucleotide repeat loci D3S1358, D8S1179, D18S51 and D19S253

Allele frequencies for four short tandem repeat loci were determined in a population sample from Catalonia (NE Spain). After denaturing PAGE electrophoresis, 8 alleles were identified for D3S1358 (n=201), 10 alleles for D8S1179 (n=198), 13 alleles for D18S51 (n=197) and 11 alleles for D19S253 (n=201). No deviation from Hardy-Weinberg equilibrium was found. Complete and relative uniformity in Caucasoid populations has been observed for D18S51 and D8S1179 respectively. Pronounced differences were found between different ethnic groups for both systems. Catalonia and Portugal do not differ for D3S1358 locus. Multiplex PCR amplifications of three loci (D3S1358, D18S51 and D19S253) without overlapping fragment size ranges could be interesting for monochrome automated laser fluorescence devices.

Effects of haemolysis, lipaemia and bilirubinaemia on an enzyme-linked immunosorbent assay for cortisol and free thyroxine in serum samples from dogs

The possible interference of haemolysis, lipaemia and bilirubinaemia on commercially available enzyme-linked immunosorbent assays (test kits Enzymun-Test; Boehringer Mannheim) for cortisol and free thyroxine (FT4) in canine plasma samples was studied. Serum samples from 20 clinically normal dogs were enriched in vitro with different amounts of fresh haemolysate, lipid and bilirubin and compared with the original sera. The tests were used in connection with the analyser system Enzymum-Test (Boehringer Mannheim) System ES300. Haemolysis significantly (P = 0.039) interfered with the accuracy of FT4 determination independent of haemoglobin concentrations. Thus, haemolysis should be avoided in FT4 testing by competitive enzyme immunoassay. Lipaemia significantly interfered (P = 0.0015) with cortisol determination but not with FT4 determination (P = 0.41). Regression analysis showed that FT4 concentration significantly increased as triglyceride levels increased, especially at concentrations greater than 125 mg dL-1. The positive bias observed was of no diagnostic importance for cortisol results and the increase of FT4 levels could be precisely predicted by linear regression analysis. The addition of bilirubin significantly (P = 0) interfered with cortisol testing but, as with lipaemia, the magnitude of the differences were of no clinical significance.

Efficacy and safety of an early discharge protocol in low-risk patients with upper gastrointestinal bleeding

PURPOSE

The outcome of patients with upper gastrointestinal hemorrhage is greatly influenced by recurrence of bleeding, but it may be possible to identify patients who have a low risk for rebleeding, and can be discharged after a short hospitalization. To examine the effect of an early discharge protocol (length of hospital stay < or =3 days), we conducted a 2-year prospective study in patients with upper gastrointestinal bleeding at low risk for rebleeding, as selected by clinical and endoscopic criteria.

METHODS

During the first year of the study, patients were managed according to the standard criteria by any of six surgical teams (control period). During the second year, patients were managed by only one surgical team under the early discharge protocol guidelines (study period).

RESULTS

Overall, 488 of 942 (52%) patients were considered as low risk. Early discharge was achieved in 26 of 230 (11%) patients in the control period and in 191 of 258 (74%) in the study period (P <0.001). Age and number of compensated comorbidities did not affect the rate of early discharge. Length of hospital stay was reduced from (mean +/- SD) 6 +/- 2.7 days (control period) to 3 +/- 2.3 days (study period, P <0.001). No differences were observed in rates of rebleeding, need for surgery, readmission or mortality. By contrast, no differences in lengths of stay were observed during that time period among patients admitted with coronary artery disease, colorectal cancer, or acute pancreatitis.

CONCLUSION

Most patients with upper gastrointestinal bleeding who are at low risk for rebleeding can be discharged early, leading to important cost savings.

Molecular variability of the 5'- and 3'-terminal regions of citrus tristeza virus RNA

ABSTRACT Isolates of citrus tristeza virus (CTV) differ widely in their biological properties. These properties may depend on the structure of viral RNA populations comprising the different isolates. As a first approach to study the molecular basis of the biological variability, we have compared the sequences of multiple cDNA clones of the two terminal regions of the RNA from different CTV isolates. The polymorphism of the 5' untranslated region (UTR) allowed the classification of the sequences into three groups, with intragroup sequence identity higher than 88% and intergroup sequence identity as low as 44%. The variability of an open reading frame (ORF) 1a segment adjacent to the 5' UTR supports the same grouping. Some CTV isolates contained sequences of more than one group. Most sequences from Spanish isolates belonged to group III, whereas a Japanese isolate was composed mostly of sequences of groups I and II. The mildest isolates contained only sequences of group III, whereas the most severe isolates also contained sequences of groups I, II, or both. The most stable secondary structure predicted for the 5' UTR was composed of two stem-loops and remained essentially unchanged as a result of compensatory mutations in the stems and accommodation of most of the variability in the loops. In contrast to the 5'-terminal region, the variability of the 3'-terminal region of CTV RNA was very much restricted, with nucleotide identity values higher than 90%. The presence of a conserved putative "zinc-finger" domain adjacent to a basic region in p23, the predicted product of ORF 11, suggests that this protein might act as a regulatory factor during virus replication.

Research in two large pediatric residencies in Argentina

PURPOSE

To obtain data about residents' research, knowledge of informatics, and proficiency in English in two pediatric residencies in Argentina.

METHOD

Data collected in 1996 using a ten-item questionnaire were evaluated using EpiInfo software. Regression coefficients, odd ratios, and confidence intervals were calculated using logistic multivariate regression analysis (Hosmer-Lemeshow test).

RESULTS

Of 249 residents surveyed, 227 (91.1%) answered the questionnaire. Of those, 224 (98.7%) thought that research during residency was useful; 63% believed that research should be required to obtain residency certification. One third of the respondents had presented at least one work or poster, or had published at least one research article. Among the two thirds who had not done so, the majority explained that they had been hindered by lack of mentors, time, or institutional support. Seventy-five percent of the respondents were reasonably proficient in English. A statistically significant association was found between knowledge of how to use statistical software and publication of papers (OR 4.5; 95% CI, 1.37-15.62; p < .003).

CONCLUSION

The vast majority of respondents thought that research was useful and should be included in pediatric residency programs. Most thought that it should be required to obtain residency certification. If it is to be required, it should include trained, full-time mentors, time exclusively devoted to research, and courses in research methodology, informatics, and statistics.

The assessment of knowledge in ankylosing spondylitis patients by a self-administered questionnaire

The aim of the present study was to assess ankylosing spondylitis (AS) patients' level of knowledge, using a self-administered multiple-choice questionnaire. The questionnaire, based on the Arthritis and Rheumatism Council (ARC) leaflet on AS, examined four areas: (A) general knowledge; (B) immunogenetic tests and inheritance; (C) general management; (D) joint protection, pacing and priorities. Statistical analysis was used to validate the questionnaire and to examine correlations with gender, age, disease duration and level of general education. The questionnaire was consistent, reliable and easy to read. The results showed AS patients to have a high level of knowledge (mean = 19.4, maximum possible = 25), although some wrong beliefs about the role of blood tests, the HLA-B27 antigen and inheritance were discovered. No statistical correlation was found between gender, age, duration of the disease, level of general education and the level of knowledge. These data suggest that this questionnaire is a simple way to detect the level of knowledge of patients with AS. The average score achieved by AS patients was outstanding, possibly reflecting the good quality of previous educational programmes. Patients' confusion regarding blood tests, genetics and inheritance was highlighted and should be addressed.

[Chronic cholestasis as a presentation form of portal cavernoma]

A 37 year-old-woman was evaluated in 1993 for a chronic asymptomatic cholestasis. An endoscopic retrograde cholangiopancreatography showed the biliary tract compressed, and a mesenteric angiogram disclosed that the cause of biliary obstruction was a portal cavernoma. In addition, large esophageal varices with "red spots" were observed at endoscopy. Propranolol and ursodeoxicolic acid were started and the patient has remained asymptomatic to date. The biliary features of portal cavernoma are reviewed, as well as its pathogenesis, diagnosis and management. Portal cavernoma should be considered in the differential diagnosis of chronic cholestasis.

Validation of a commercially available enzyme-linked immunosorbent assay (ELISA) for the determination of cortisol in canine plasma samples

Samples were obtained from clinically normal dogs before and after ACTH stimulation and dexamethasone suppression tests. The test kit Enzymun-Test (Boehringer Mannheim) for determining cortisol concentrations in human plasma was used in connection with the analyser system Enzymun-Test (Boehringer Mannheim) System ES300 following the manufacturer's instructions. The intra-assay and inter-assay coefficients of variation were 1.28% and 5.64%, respectively. The mean recovery when assaying samples with a cortisol content of more than 100 nmol/L was 95.41%, but this percentage decreased in samples with lower cortisol levels. The sensitivity of the assay was 2.76 nmol/L. The results of the ACTH stimulation and dexamethasone suppression tests were similar to those published previously. The ELISA method evaluated allows a precise and sensitive determination of cortisol concentrations in canine plasma samples. The major drawback observed was the loss of accuracy at low cortisol concentrations. Since the assay tends then to report lower cortisol concentrations, the generally accepted concentration of 40 nmol/L may not be suitable as the cutoff value in dexamethasone suppression tests.

[Electronic forum of Revista de neurología: 'Internet, Medicine and Neuroglia']

INTRODUCTION

In recent years Internet has drastically transformed the world of telecommunications. Questions about whether Internet and the global communication accessibility may be considered as a fundamental aspect in the medicine of today and tomorrow have been brought up.

OBJECTIVE

Discuss current and future applications of Internet to the field of Medicine and Neurology.

METHODS

Bibliographical review based on Medline and standard Web search engines. Forum sessions performed through Internet by means of Web-Chat. Forum coordination entirely performed by electronic mail.

RESULTS

There are several opinions regarding the influence of Internet on Medicine and Neurology. Currently, the communication and collaboration between teams is improving. It allows scientific publications on-line, improves continuous remote training and facilitates information to patients. New applications like telemedicine need more development.

CONCLUSIONS

Currently, Internet represents an efficient tool for collaboration, training and distribution of information in the field of Medicine and Neurology.

[Intracranial hemorrhage with fluid level. A case report without coagulation alterations]

The presence of intracranial hemorrhage with a fluid-blood level in patients receiving anticoagulant medication or with coagulopathy is an infrequent but well-documented complication. We reported a patient with a fluid-blood level with normal haemostasis. A 62-year-old-man was admitted with a left putaminal hemorrhage containing a fluid-blood level, but without abnormal haemostasis. Five months later the patient returned to the hospital because of a transient ischemic attack. A cranial CT demonstrated a hypodensity in the left putamen nucleus and corona radiata. Electrocardiogram revealed atrial fibrillation and a cardiac ultrasonographic examination showed mitral annulus calcification and left atrial enlargement. The finding of intracranial fluid-blood level has been seen in patients with arteriovenous malformations, primary and metastatic neoplasm, radiation-induced necroses, cerebral amyloid angiopathy, intrainfarct hematoma and without any identified aetiology. We suggest that in our patient this disorder was due to a intrainfarct hematoma.

Quechua Amerindian population characterized by HLA-DQ alpha, YNZ22, 3'APO B, HUMTH01, and HUMVWA31A polymorphisms

Allele and genotype frequencies of DNA polymorphisms were determined in a population sample of Quechua (n = 113) using the polymerase chain reaction (PCR). We report data on the frequencies of HLA-DQ alpha, YNZ22, 3'ApoB, HUMTH01 and HUMVWA31A alleles and the distribution of the different genotypes. No significant deviations between observed and expected numbers were found, thus assuming the Hardy-Weinberg equilibrium.

Population genetics of the D12S391, CSF1P0 and TPOX loci in Catalonia (Northeast Spain)

Allele and genotype frequencies for three short tandem repeat loci were determined in a population sample from Catalonia (NE Spain). After denaturing PAGE electrophoresis, 11 alleles were identified for D12S391 (n = 167), 9 alleles for CSF1pO (n = 282) and 6 alleles for TPOX (n = 283). No deviation from Hardy-Weinberg equilibrium was found. The allele frequencies observed are similar to those of other compared European populations.

Band erosion in patients who have undergone vertical banded gastroplasty: incidence and technical solutions

OBJECTIVES

To study the incidence of band erosion in patients who have undergone vertical banded gastroplasty and to describe the reparative techniques used.

DESIGN

A retrospective review case series.

SETTING

A university hospital-based tertiary referral center.

PATIENTS

Two hundred fifty consecutive morbidly obese patients who underwent vertical banded gastroplasty between 1987 and 1995.

MAIN OUTCOME MEASURES

The development of band erosion into the stomach, reparative surgical techniques, and long-term weight loss control.

RESULTS

Band erosion developed in 7 (2.8%) of the patients. Two patients had symptoms 1 month after undergoing forced endoscopy. Six patients required reoperation. The operative findings included 2 cases of "external" band erosion through the lesser curvature into the stomach and 4 cases of "internal" band erosion through the circular staple line. The surgical techniques used for repair depended on the radiological and endoscopic data and on the operative findings; the techniques included conversion into a gastric bypass, band replacement after the creation of a new stoma, and gastroplasty plus distal gastric bypass. There were no complications, and adequate long-term weight loss was achieved in all but 1 of the patients who underwent reoperation.

CONCLUSION

Band erosion may be corrected using appropriate surgical techniques to allow for adequate long-term weight loss in patients who have undergone vertical banded gastroplasty.

Evaluation of primary haemostasis in canine leishmaniasis

Primary haemostasis was evaluated by measurements of bleeding time and platelet count in 26 dogs with leishmaniasis and 10 normal dogs. Bleeding time was significantly (P = 0.02) longer in the infected dogs than in the control group, and in infected dogs with creatinine concentrations > 1.5 mg/dl than in infected dogs with normal creatinine levels. There was a significant linear regression between the concentration of creatinine and bleeding time (P = 0.02) although the coefficient of determination was low (r2 = 0.194). There were no significant differences in platelet counts between the normal and diseased dogs, and there were no significant differences between male and female dogs in either group.