[Giant adrenal myelolipoma: hypertension, renal failure and spontaneous rupture]

Adrenal myelolipoma is a rare, benign, slow-growing tumor composed of adipose tissue and hematopoietic elements. It is usually diagnosed incidentally, although there are reports of patients with symptoms and descriptions of retroperitoneal hemorrhage due to rupture of large tumors. The condition has been associated with obesity, high blood pressure and adrenal dysfunction. We present a patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma, hypertension, and renal failure secondary to nephroangiosclerosis.

Monitoring the Prestige oil spill impacts on some key species of the Northern Iberian shelf

Selected key components of the continental shelf benthic and demersal communities were monitored for the two years following the Prestige oil spill (POS) in order to identify the possible ecological effects of the oil. This work includes the first results regarding changes in abundance, distribution and food habits of hake (Merluccius merluccius), four-spot megrim (Lepidorhombus boscii), Norway lobster (Nephrops norvegicus) and Pandalid shrimp (Plesionika heterocarpus) populations of Galician and Cantabrian Sea shelves following the POS. Significant reductions in the abundance of Norway lobster, Plesionika heterocarpus and four-spot megrim were detected in the POS maximum impact area, located over the Galician shelf. Noteworthy recoveries were observed in the 2004 abundance indices of four-spot megrim and Plesionika. On the other hand, no significant effects were detected in the abundance or distribution of hake juveniles even though the tar aggregates were bound by the same oceanographic drift events as the hake recruits were during the winter of 2003 (Navidad current) in different water column layers of the Cantabrian Sea. Feeding patterns of the four species analysed did not present apparent modifications that can be related to the POS.

Characteristics of restructured beef steak with different proportions of walnut during frozen storage

Physicochemical (thawing loss, cooking loss, surface shrinkage, texture, colour and lipid oxidation) and sensory properties of restructured beef steak with different levels of added walnut (0%, 10% and 20%) were determined at various times during frozen storage up to 128 days. Cooking loss (CL), Kramer shear force (KSF) and binding strength (BS) of restructured beef decreased (P<0.05) as the proportion of walnut increased. Walnut enhanced (P<0.05) lightness and yellowness and reduced (P<0.05) redness. Frozen storage did not affect (P>0.05) CL, KSF and BS of restructured beef steak. Redness decreased (P<0.05) over storage for all samples. Lipid oxidation of restructured beef steak containing walnut was not a limiting factor for frozen stability of meat products. Frozen storage had no effect (P>0.05) on the sensory quality of restructured beef steak.

Effects of cinnarizine, a calcium antagonist that produces human parkinsonism, in parkin knock out mice

Cinnarizine, a calcium antagonist that produces parkinsonism in humans, induces behavioural changes such as alopecia, buco-lingual dyskinesia and reduction of motor activity in female parkin knock out (PK-KO) mice but not in wild-type (WT) controls. PK-KO mice have high striatal dopamine levels and increased dopamine metabolism in spite of low reduced tyrosine hydroxylase protein. Cinnarizine, which blocks dopamine receptors and increases dopamine release, further increased dopamine metabolism. PK-KO mice increased GSH levels as a compensatory mechanism against enhanced free radical production related to acceleration of dopamine turnover. Neuronal markers, such as beta-tubulin slightly increased in PK-KO and furthermore with cinnarizine. Astroglial markers were decreased in PK-KO mice, and this effect was potentiated by cinnarizine, suggesting abnormal glia in these animals. Microglia was hyperactivated in PK-KO midbrain, suggesting inflammation in these animals. Proapoptotic proteins were increased by cinnarizine and, to a lesser extent, in PK-KO mice. Our data indicate that mutation of parkin is a risk factor for drug-induced parkinsonism.

An improved outdoor calibration procedure for broadband ultraviolet radiometers

This article aims at improving the broadband ultraviolet radiometer's calibration methodology. For this goal, three broadband radiometers are calibrated against a spectrophotometer of reference. Three different one-step calibration models are tested: ratio, first order and second order. The latter is proposed in order to adequately reproduce the high dependence on the solar zenith angle shown by the other two models and, therefore, to improve the calibration performance at high solar elevations. The proposed new second-order model requires no additional information and, thus, keeps the operational character of the one-step methodology. The models are compared in terms of their root mean square error and the most qualified is subsequently validated by comparing its predictions with the spectrophotometer measurements within an independent validation data subset. Results show that the best calibration is achieved by the second-order model, with a mean bias error and mean absolute bias error lower than 2.2 and 6.7%, respectively.

[Left renal vein hypertension syndrome]

INTRODUCTION

[corrected] Left renal vein compression, causing retrograde hypertension, determines a syndrome characterized by the presence of hematuria, gonadal vein dilatation and varicocele. Being a rare cause of hematuria its aetiology is diverse but of precise characteristics. Diagnosis is not easy and treatment requires to rule out its precise aetiology and consider the intensity of the compression phenomenon because of interventionist attitudes have important implications and are not risk free.

MATERIAL AND METHODS

We report nine children, aged 8-15 years, presenting with hematuria of urologic characteristics. Diagnosis of left renal vein hypertension or nutcracker phenomenon was established through ultrasound (regular and doppler-ultrasound) and helical-TC performed in all, and left renal venography performed in six of them.

RESULTS

Retroaortic renal vein was present in two cases, a varicose accessorial renal vein due to anomalous drainage in one and compression at the aortomesenteric space in six. Because of the symptoms severity therapeutic attitude was interventionist in two cases, performing an auto-transplantation in one, and endovascular stent placement al the level of the left renal vein compression in other.

CONCLUSIONS

Diagnosis of this syndrome is not always easy because less invasive explorations usually show parameters that are difficult to distinguish from normality. Severity of clinical manifestations and therapeutic attitude are related with the presence of renal vein hyperpressure and collateral varicose circulation indicating the lack of compensation of a difficult drainage.

Antiphospholipid syndrome and asymptomatic carriers of antiphospholipid antibody: prospective analysis of 404 individuals

OBJECTIVE

We carried out a prospective analysis of clinical and analytical findings in individuals with antiphospholipid antibodies (aPL).

METHODS

We prospectively studied 404 individuals, classified in 2 groups: (1) patients with primary or secondary antiphospholipid syndrome (APS, n = 226); and (2) asymptomatic carriers of aPL (n = 178). Patients with APS and thrombosis were treated with dicumarin, and an international normalized ratio around 3.0 (range 2.5-3.5) was targeted. Asymptomatic carriers were not treated, but specific prophylaxis with low molecular weight heparin or aspirin was prescribed for the periods when individuals were at increased risk of thrombosis. Both groups of individuals were followed up at semester intervals for 36 months.

RESULTS

Patients with APS presented with venous (n = 106, 46.9%) and/or arterial (n = 70. 31%) thrombosis or fetal loss (n = 58 out of 112 women of fertility age, 51.8%). At the time of the first thrombotic event, 50.0% of patients with APS had coincident risk factors for thrombosis (previous surgery and prolonged immobilization were significantly associated with venous thrombosis, and hypercholesterolemia and arterial hypertension with arterial thrombosis). Eighteen patients with APS died during the study period. Recurrence of thrombosis in patients with APS was linked to insufficient anticoagulation. During the followup, no episode of thrombosis was detected in any asymptomatic carrier. The proportion of subjects with aPL was similar in patients and in asymptomatic carriers. The proportion of subjects with aPL decreased during the followup, in both patients and carriers.

CONCLUSION

Differences between patients and asymptomatic carriers with aPL are at least partially dependent on the proportion of coincident vascular risk factors. The decline in aPL during the followup defines a subgroup in which an anticoagulation suppression assay could be tried.

Direct screening and confirmation of benzene, toluene, ethylbenzene and xylenes in water

A novel, straightforward sample screening method for benzene, toluene, ethylbenzene and xylene isomers (BTEX) in water is proposed. The method is based on the direct coupling of a headspace (HS) sampler with a mass spectrometer by using a chromatographic column heated to 200 degrees C as an interface. Samples are acidified and subjected to the headspace generation process, the resulting volatile fraction being directly introduced into the source of the mass spectrometer. The large number of samples to be analyzed and the wide range of m/z ratios scanned (75-110) suggest the use of chemometric approaches based on pattern recognition techniques (PRT). For sample classification purposes, the detection limit of the method (overall response 4.0 ng/ml BTEX) was selected as the cut-off level. The method proved highly reliable as no false negatives were obtained at the legally established concentration levels. Positive water samples were confirmed by using the same instrumental setup as in the screening method, but by heating the chromatographic column at 40-200 degrees C to separate the analytes.

Efficacy of Directly Observed Treatment of HIV Infection: Experience in AIDS Welfare Homes

With the objective of analyzing the efficacy of directly observed treatment (DOT) of HIV infection in the management of severely immunodepressed patients, this method was examined in individuals cared for in two social welfare facilities for HIV-infected persons and compared to self-administered therapy in outpatients. Forty-seven patients with registered HIV infection, stage C, were assigned to DOT for 9 months, the majority of whom had previously received antiretroviral therapy. A group of 51 HIV-infected outpatients, who attended day clinics attached to the reference hospitals, served as a comparison group. Together with increases in weight (9.2+/-7.5 kg) and Karnofsky scores (16.9+/-12.2) in the DOT group, a significant improvement of surrogate markers, such as CD4+ T-cell counts (increase in DOT group, 113.4+/-151.0 cells/microl; control group, -2.8+/-114.1 cells/microl; P<0.001) and HIV load (decrease in DOT group, -1.7+/-2.3 log10 copies/ml; control group, -0.4+/-1.5 log10 copies/ml; P<0.01) was detected in the DOT group. Morbidity and mortality were similar in both groups. The results indicate that such welfare facilities provide a useful framework not only for social objectives but also for healthcare purposes.

Biogenic amines in restructured beef steaks as affected by added walnuts and cold storage

This article evaluates changes in biogenic amines and how these relate to microbiological growth in chilled, fresh restructured beef steaks containing transglutaminase as a cold binding agent and different amounts of walnut. Added walnut and chilling favored higher total and lactic acid bacteria counts during storage, whereas Enterobacteriaceae were not affected. The highest initial biogenic amine concentrations were identified as spermidine, spermine, and tyramine. Both added walnut and cold storage generally favored the formation of amines (tyramine, histamine, putrescine, and cadaverine), which was more obviously apparent by the end of the storage period. Agmatine, on the other hand, was not generally affected by the walnut.

Primary eosinophilic esophagitis

Eosinophilic esophagitis is an uncommon pathology that generally affects children with a history of allergies and intrinsic asthma. We present a clinical case of eosinophilic esophagitis in a 16-year-old boy with upper dysphagia for solids since childhood. The analytical study showed only a repeat serum eosinophilia. Barium transit disclosed a reduction in caliber of the whole esophagus. Functional esophageal tests with pH monitoring and manometry were normal. Endoscopy showed a small-diameter esophagus and fibrosis with a very friable mucosa. The histological study of the esophageal biopsies revealed a full thickness major eosinophil infiltration of the esophagus. These findings suggest a differential diagnosis with a great variety of pathologies that can cause similar lesions in the esophagus, especially between primary eosinophilic esophagitis and eosinophilic esophagitis secondary to gastro-esophageal reflux disease (GERD). We implemented medical treatment with oral corticoids and total suppression of allergens from the diet, and the patient was asymptomatic.

Patient-reported benefits of rizatriptan compared with usual non-triptan therapy for migraine in a primary care setting

The purpose of this open-label study was to compare rizatriptan with usual non-triptan therapy for migraine in patients who had never received a triptan. Patient-reported outcomes were examined for a prestudy migraine attack and after three consecutive study attacks, the first and third treated with rizatriptan 10 mg wafer and the second with usual non-triptan therapy. A total of 97 patients (83% women; mean age 39 years) completed the study. Two-thirds of patients reported severe or total disability during migraine attacks. All comparisons between rizatriptan therapy and usual non-triptan therapy significantly favoured rizatriptan (p < or = 0.01). Headache relief by 2 hours was reported by 78-83% of patients after rizatriptan and by 46-48% of patients after usual therapy; 41-47% and 12-18%, respectively, were pain free at 2 hours. Patient satisfaction and migraine-specific quality-of-life scores were also significantly better for attacks treated with rizatriptan. At study end, 62% and 17% of patients were very or completely satisfied with rizatriptan and usual non-triptan therapy, respectively. Among those patients who worked for pay, therapy with rizatriptan significantly reduced absenteeism and improved the amount and quality of time at work compared with usual non-triptan therapy. Allowing patients to have experience with rizatriptan may improve the level of medical care for migraine attacks.

Neoadjuvant radiation and chemotherapy in rectal cancer does not increase postoperative complications

BACKGROUND AND AIMS

Neoadjuvant radiation and chemotherapy in rectal cancer reduces local recurrences and increases the rate of conservative sphincter surgery. However, an increase in postoperative morbidity and mortality has also been observed. This study analyzed the operative difficulty and postoperative complications in patients with this treatment.

PATIENTS AND METHODS

Retrospective review of 103 patients with rectal cancer, divided into two groups: group A, 53 patients undergoing preoperative radiotherapy with 45 Gy combined with chemotherapy, and group B, 50 patients with rectal cancer who received surgery after diagnosis. Both groups were homogeneous. The two groups were compared for both technical difficulty, using intraoperative data and rate of complications.

RESULTS

There were no statistically significant differences between the two groups with regard to intraoperative or postoperative data. In group A there were 20 complications in 17 patients (32%) and in group B 22 complications in 19 patients (38%). The rates of perineal wound infection were similar. The percentage of anastomotic leaks was higher in group A. A greater number of anterior resections was performed in group A.

CONCLUSION

Preoperative radiation and chemotherapy in rectal cancer does not increase postoperative complications and increases the rate of sphincter-preserving surgery.

[Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis]

OBJECTIVE

We studied the influence of early vs late referral to nephrologist of patients with chronic renal failure over clinical situation at the onset of hemodialysis and outcome.

SUBJECTS AND METHODS

From january 1994 to december 1998, 139 patients started hemodialysis for end-stage renal disease at the Hospital General de Albacete, all of them included in the study and clinical follow-up concluded in december 2001. Patients with rapidly progressive glomerulonephritis were excluded. Early (ER) and late referral (LR) were defined by the time of first nephrology encounter greater than or less than 6 months respectively, before iniciation of hemodialysis.

RESULTS

106 patients (76.25%) were referred early; mean follow-up time 6.3 +/- 4.5 years. 33 patients (23.74%) had late referral, follow-up time was less then six months, 18 patients were followed during less than 4 weeks. There were no differences in demographic data and comorbid conditions between LR and ER patients (age, cardiac and vascular disease, diabetes, neoplasia...). Mean plasma concentration of creatinine and urea was significantly greater, whereas hematocrit and albumin were less in the LRA than the ER group. Emergency dialysis through central vein catheterisation was more frequent in the LR group. Number of admissions and duration of hospital stay were higher in the LR group. No significant differences in nutrition, dialysis doses or anemia were found between the two groups after 6 and 12 months of hemodialysis. Long term outcome was similar in both groups: no significant differences were found in percentage of patients transplanted or deceased after 3 years of treatment. Survival analysis failed to show a difference between ER and LR groups (mean survival time was 73.6 +/- 4.3 months and 73.0 +/- 6 months respectively).

CONCLUSION

Late referral to the nephrologist is associated with increased early morbidity vs early referral, although long term outcome is not worse if predialysis comorbid conditions are comparable and dialysis care achieve equal results in dialysis doses, nutrition and anemia in both groups in the first months of treatment. Improvement of outcome of patients referred early to the nephrologist will depend on the adoption of preventive measures over comorbidity factors that should be applied in early stages of renal disease.