[Quality of life and migraine]

OBJECTIVE

Nowadays, quality of life is considered to be important both in clinical investigation and patient care. Migraine is a particularly disabling illness, with a pronounced effect on general health and on the ability to take part in social activities. We review the instruments used for measuring quality of life and the published studies in which the relationship between migraine and quality of life is analyzed.

MATERIAL AND METHOD

In spite of increasing interest in quality of life and the means by which this is measured, there are many problems involved in studying this correctly since there is no agreement as to its definition or how to measure it. In recent years, most of the studies carried out have assessed the socio-economic cost of headache. However, at present, studies tend to focus on the human cost of the quality of life when suffering from headache. Migraine patients have a poorer quality of life than the general population and other populations with chronic illnesses which have always been considered to be severely disabling.

CONCLUSION

Research should be aimed at finding the specific and/or generic measures necessary to improve quality of life while suffering from headache. In the future, the aim of new treatments should be to eliminate the pain of the acute crisis and restore functional capacity, reduce the period of disability and improve quality of life.

Glass wool filtration reduces reactive oxygen species by elimination of leukocytes in oligozoospermic patients with leukocytospermia

PURPOSE

Two types of glass wool were used to remove leukocytes in semen for evaluation of reactive oxygen species production by spermatozoa in oligozoospermic patients with leukocytospermia.

METHODS

Semen samples were prepared using fine-structure glass wool (SpermFertil) and coarse-structure glass wool. In each treatment group, native semen was evaluated for sperm concentration, percentage motility, viability, leukocyte concentration, and production of reactive oxygen species.

RESULTS

Electron microscopically, SpermFertil showed a higher number of leukocytes attached to the fibers compared to coarse-structure glass wool. Leukocytes in native semen and after glass wool filtration as determined by peroxidase cytochemistry confirmed this observation. Reactive oxygen species decreased from 45.303 counts/10(7) viable cells in native semen to 15.806 counts/10(7) cells in coarse structure wool and 7.465 counts/10(7) cells in Spermfertil, respectively.

CONCLUSIONS

Removal of leukocytes from semen of oligozoospermic patients by means of glass wool filtration is a useful method to distinguish production of reactive oxygen species by leukocytes versus sperm cells.

Exposure of gilts in early gestation to porcine reproductive and respiratory syndrome virus

Twenty-five gilts without measurable serum antibody titres to porcine reproductive and respiratory syndrome virus (PRRSV) were identified and 16 were inoculated with PRRSV at seven, 14 or 21 days of gestation and killed 20 to 22 days later to determine the effect of the virus on their embryos. The remaining nine gilts were not exposed to PRRSV, but were killed at the same stages of gestation. The gilts were observed for clinical signs of infection and the gilts and their embryos were tested for PRRSV and homologous antibodies. The infection was demonstrated by the re-isolation of the virus and its detection by the reverse transcriptase polymerase chain reaction in serum and other tissue samples from the inoculated gilts, and also by seroconversion. However, the gilts remained healthy throughout the study, except for one which was depressed and anorexic for two days. Two of the litters from the gilts challenged with PRRSV on day 14 of gestation contained one and three infected live embryos; the other embryos from these two litters did not contain detectable virus, although most of the embryos in one of the litters were dead. The other nine litters from the gilts challenged with PRRSV and the control litters, showed no evidence of infection.

[Frequency and histopathologic features of chronic gastritis in 300 patients without endoscopic lesions]

Three gastric mucosal biopsies were obtained from 300 patients showing a normal upper digestive tract endoscopy. Histologically, in 9% of the patients the biopsies were normal: in 87%, showed a common-type chronic gastritis, and in 4% showed a reactive (chemical or reflux-type) gastritis. Helicobacter pylori was present in 25.9% of the patients without gastritis, in 33.3% of the patients with reactive gastritis, and in 87.7% of those with common-type gastritis. In 19.9% of the patients with common-type chronic gastritis there was intestinal metaplasia, consisting of type I metaplasia in 14.1%, type II in 3.1% and type III metaplasia in 2.3%. The association of type III intestinal metaplasia with the other forms of metaplasia, its lower frequency and its tendency to be present in older patients supports the hypothesis that type III incomplete colonic metaplasia represents a more advanced stage than complete and incomplete small bowed metaplasia of the gastric mucosa.

A clinical trial on the prevention of catheter-related sepsis using a new hub model

BACKGROUND

Catheter hub contamination is being increasingly recognized as a source of catheter-related sepsis. The authors have investigated the efficacy of a new hub design in preventing endoluminal catheter contamination and catheter-related sepsis arising at the hub.

METHODS

Adult surgical and intensive care patients requiring a subclavian catheter for at least 1 week were randomly assigned to receive catheters with standard connectors (control group, n=73) or equipped with a new hub model (new hub group, n=78). Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or because of suspicion of sepsis, in which case peripheral blood cultures were taken.

RESULTS

Of the 151 patients included, 15 (10%) developed catheter-related sepsis. Catheters were more often withdrawn because suspicion of infection in the control group (42 vs. 19%, p<0.005). Catheter sepsis rate was higher in the control group (16 vs. 4%, p<0.01) because of the low rate of catheter sepsis arising at the hub observed in the new hub group (1 vs. 11%, p<0.01). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (18 vs. 5%, P<0.03).

CONCLUSIONS

A new catheter hub has proved to be useful in preventing endoluminal bacterial colonization and catheter-related sepsis in subclavian lines inserted for a mean of 2 weeks.

Reverse mutation in fragile X syndrome

Images

Semen changes in boars after experimental infection with porcine reproductive and respiratory syndrome (PRRS) virus

Eleven boars seronegative to porcine reproductive and respiratory syndrome virus (PRRSV) were trained for semen collection: five boars were inoculated intranasally with 6 x 10(6)TCID(50)/ml of PRRSV (Group A); four boars were inoculated intranasally with 6 x 10(4)TCID(50)/ml (Group B); and two boars were used as uninfected control (Group C). Semen samples were collected at 7-d intervals from 49 d prior to experimental inoculation with PRRSV to 70 d after inoculation, and were examined for sperm volume, sperm concentration, sperm morphology, sperm motility and for the presence of PRRSV. The infection in boars was demonstrated by the reisolation of PRRSV from the serum of all inoculated boars. Rectal temperatures and general health of the boars were clinically normal throughout the trial. Differences were observed in the quality of semen collected from boars after experimental infection with PRRSV. This infection induced a significant decrease in sperm motility and in spermatozoa with normal acrosomes. Of the semen samples tested for virus isolation in swine alveolar macrophages PRRSV was only isolated in 1 boar from Group B. The virus was detected in an additional semen sample in Group A by the production of an antibody titer in a biological assay. All attempts to detect PRRSV by RT-PCR in semen samples were unsuccessful. Nevertheless, from our study it is possible to suggest that the PRRSV can occasionally be transmitted in the semen during the initial phase of the disease.

Comparison of two methods to obtain hemizonae pellucidae for sperm function tests

The development of a new generation of diagnostic techniques has provided objective data on the physiological function of the spermatozoon. The hemizona assay has been considered the best predictor for in-vitro fertilization results. Its clinical application has been limited to the availability of human oocytes and the use of a special micromanipulator. Here, the sperm binding capacity of hand-sectioned hemizonae was compared with that of oocytes bisected by a micromanipulator. The results obtained in parallel assays showed no statistical differences between the two methods. Therefore, the bisection of oocytes by hand is useful for hemizona assays even in normal clinical laboratories.

Trinucleotide models for DNA bending propensity: comparison of models based on DNaseI digestion and nucleosome packaging data

DNaseI digestion studies (Brukner et al, EMBO J 14, 1812-1818 1995) and nucleosomebinding data (Satchwell et al, J. Mol. Biol. 191, 639-659 1986, Goodsell and Dickerson, Nucleic trinucleotides. A detailed comparison of the two models suggests that while both of them represent improvements with respect to dinucleotide based descriptions, the individual trinucleotide parameters are not highly correlated (linear correlation coefficient is 0.53), and a number of motifs such as TA-elements and CCA/TGG motifs are more realistically described in the DNaseI-based model. This may be due to the fact that the DNaseI-based model does not rely on a static geometry but rather captures a dynamic ability of ds DNA to bend towards the major grove. Future refinement of both models of both models on larger experimental data sets is expected to further improve the prediction of macroscopic DNA-curvature.

Evaluation of the acrosome in oligozoospermic patients by simplified triple stain technique

The human acrosome, especially the acrosome reaction, is an important parameter for evaluation of sperm function. By histochemical staining, the acrosome is visualized at the light microscopic level. However, a high number of cells are lost due to the multiple centrifugation steps that are required for preparation of spermatozoa. In the present study, semen samples from oligozoospermic patients were stained by an improved method. Compared to the conventional triple-stain technique, optimal staining of the acrosome and a lower number of cells lost during sperm preparation were observed (P<0.025). Differences in the percentage of live acrosome-reacted spermatozoa were not statistically significant.

Pregnancy and birth after intracytoplasmic sperm injection with spermatozoa from a patient with tail stump syndrome

Tail stump syndrome, which may be associated with primary ciliary dyskinesia, is also associated with morphological defects of the flagellum resulting in severe asthenozoospermia. Until recently, these morphological anomalies caused definite male infertility. Today, however, new methods such as micromanipulation techniques provide a rational therapy for this patient group. A pregnancy followed by living offspring was achieved following the intracytoplasmic injection of immotile spermatozoa from a patient with tail stump syndrome.

Rationally designed helix-turn-helix proteins and their conformational changes upon DNA binding

Circular dichroism and electrophoretic mobility shift studies were performed to confirm that dimerized N-terminal domains of bacterial repressors containing helix-turn-helix motifs are capable of high-affinity and specific DNA recognition as opposed to the monomeric N-terminal domains. Specific, high-affinity DNA binding proteins were designed and produced in which two copies of the N-terminal 1-62 domain of the bacteriophage 434 repressor are connected either in a dyad-symmetric fashion, with a synthetic linker attached to the C-termini, or as direct sequence repeats. Both molecules bound to their presumptive cognate nearly as tightly as does the natural (full-length and non-covalently dimerized) 434 repressor, showing that covalent dimerization can be used to greatly enhance the binding activity of individual protein segments. Circular dichroism spectroscopy showed a pronounced increase in the alpha-helix content when these new proteins interacted with their cognate DNA and a similar, although 30% lower, increase was also seen upon their interaction with non-cognate DNA. These results imply that a gradual conformational change may occur when helix-turn-helix motifs bind to DNA, and that a scanning mechanism is just as plausible for this motif class as that which is proposed for the more flexible basic-leucine zipper and basic-helix-loop-helix motifs.

Automatic detection of auditory brainstem responses using feature vectors

The efficiency of several methods for the automatic detection of near threshold auditory brainstem responses (ABRs), based on feature vectors, was assessed on a sample of 374 recordings obtained from neonates. Features are quantitative descriptors of different aspects of the response commonly taken into consideration by expert ABR judges, such as: similarity with a template, reliability of the response, and intrinsic morphological characteristics. The classification methods used were: comparisons of individual features with a threshold, linear discriminant functions based on combination of features, artificial neural networks (ANNs) based on the raw ABR, and ANNs based on combinations of features. The network used was a modified version of the Fuzzy ART Map model. The accuracy of the classification into normal and abnormal (as previously scored by a panel of experts) was assessed with methods from signal detection theory. Our results showed that the approaches based on feature vectors (discriminant function and ANN) performed more efficiently than the ANN with raw data, or the individual features.

Sequence-dependent bending propensity of DNA as revealed by DNase I: parameters for trinucleotides

Structural parameters characterizing the bending propensity of trinucleotides were deduced from DNase I digestion data using simple probabilistic models. In contrast to dinucleotide-based models of DNA bending and/or bendability, the trinucleotide parameters are in good agreement with X-ray crystallographic data on bent DNA. This improvement may be due to the fact that the trinucleotide model incorporates more sequence context information than do dinucleotide-based descriptions.

In vitro activity of amphotericin B, flucytosine and fluconazole against yeasts causing bloodstream infections

The in vitro activity of amphotericin B, flucytosine and fluconazole against 95 yeasts causing fungemia in a single institution over the last eight years was determined by a broth macromethod recommended by the National Committee for Clinical Laboratory Standards. All strains were inhibited by amphotericin B concentrations of < or = 1 microgram/ml. With flucytosine in most species the MIC50 was between 0.12 and 0.25 microgram/ml and the MIC90 was between 0.25 and 1 microgram/ml. One exception with flucytosine was Candida krusei, with an MIC50 and MIC90 of 16 micrograms/ml and 32 micrograms/ml, respectively. Overall, 12% of the isolates needed at least 8 micrograms/ml of fluconazole to be inhibited. Fluconazole was very active against Candida albicans, Candida tropicalis and Cryptococcus neoformans, with MIC50 ranging from 0.12 to 0.5 microgram/ml and MIC90 of 1 microgram/ml, and somewhat less active against Candida parapsilosis (MIC50 of 1 microgram/ml and MIC90 of 4 micrograms/ml). Fluconazole exhibited poor in vitro activity against Candida krusei (MIC50 and MIC90 of 64 micrograms/ml) and Torulopsis glabrata (MIC50 of 4 micrograms/ml and MIC90 of 16 micrograms/ml). High MICs of fluconazole were found for four strains of Candida albicans, one with an MIC of 4 micrograms/ml and three (5.7%) with MICs of > or = 16 micrograms/ml. Previous exposure to fluconazole could be demonstrated in two of these strains. Further work must be done in order to determine appropriate breakpoints of antifungal agents, to assess the clinical relevance of azole resistance in yeasts causing bloodstream infections and to identify risk factors for infections with azole-resistant yeasts.

Induction of apoptosis in NIH3T3 cells after serum deprivation by overexpression of rho-p21, a GTPase protein of the ras superfamily

Oncogenes appear to influence apoptosis in two ways. Some activate cells from a growth-arrested state to one in which both apoptosis and entry to S-phase become possible, the choice between them being determined by a second signal, such as cytokine or growth factor. Cells in this state are often sensitive to apoptosis induced by a wide variety of agents, including several drugs used in cancer chemotherapy. Other oncogenes prevent activation of the apoptosis effector pathway, even in the presence of a death stimulus, the affected cells therefore being resistant to chemotherapeutic agents. In rodent fibroblasts, c-myc or the adenovirus oncogene E1A effect the first type of change, whereas bcl-2, v-abl, E1B or activated ras effect the second. Here we study in rodent fibroblast the effect of expression of rho genes, members of the ras superfamily which we have previously shown to be tumorigenic when highly expressed in this cell type. We show that expression of wild-type rho from Aplysia californica stimulates apoptosis in cultured cell lines and that the apoptotic index in tumors generated by these cell lines is similar to those induced by E1A-transformed cells. In contrast, mutated rho, activated by Val14 substitution in the GTP binding site, it less potent as a stimulator of apoptosis, generating a phenotype more similar to that obtained with activated ras. Thus, rho genes may play a critical role in the regulation of apoptosis.

Evaluation of the acrosomal membrane in bovine spermatozoa: Effects of proteinase inhibitors

Thawed bovine spermatozoa are characterized by a lack of homogeneity in the acrosomal membrane. Therefore, it is difficult to visualize the acrosome to assess morphology. Synthetic proteinase inhibitors were tested on thawed bovine semen for their effect on the integrity of acrosomal membranes. The proteinase inhibitors 4-nitrophenyl-4-guanidinobenzoate (NPGB) and N-L-p-tosyl-L-lysine-chloromethylketone (TLCK) were added to a medium containing spermatozoa separated on a percoll gradient. After incubation for 30 min at 38 degrees C in 5% CO(2), 95% air (final concentration 1 mM), the action of these inhibitors was controlled by measuring the activity of acrosome proteinases. The acrosomal membrane was evaluated by means of a dual stain procedure (trypan blue, Giemsa). In contrast to spermatozoa that had been incubated with proteinase inhibitor-free solution, samples that had been incubated with TLCK showed homogeneity in 90% of the acrosomal membranes and excellent visualization of the acrosome itself; in the NPGB-treated samples, homogeneous staining was observed in 83% of spermatozoa (P < 0.0005). It is concluded that alteration of the acrosomal membrane in thawed semen is not directly caused by freezing-thawing, but may be due to activation of acrosomal proteinases, which is increased during staining procedures. The addition of proteinase inhibitors before staining offers a new possibility for improved assessment of the acrosome in bovine spermatozoa.

Evolution of immunoglobulin A nephropathy into Henoch-Schönlein purpura in an adult patient

We report the first case of the evolution of immunoglobulin A (IgA) nephropathy into Henoch-Schönlein purpura in an adult patient. A 28-year-old man presented with an episode of gross hematuria and acute renal failure. The serum IgA level was increased and renal biopsy findings were diagnostic of IgA nephropathy. In addition, many renal tubuli were filled by red blood cell casts and presented a marked tubular necrosis. Coincidental with the disappearance of gross hematuria, renal function progressively improved. The patient continued to have microhematuria, normal renal function, and isolated bouts of macroscopic hematuria. Ten years later, the patient developed arthralgias, a purpuric rash in the legs, gross hematuria, and an elevated serum creatinine level. A skin biopsy showed leukocytoclastic vasculitis with IgA deposits. The renal biopsy showed histologic lesions very similar to those observed in the first biopsy 10 years before: mesangial proliferation with mesangial deposition of IgA and tubular necrosis with obstruction of renal tubuli by red blood cell casts. The serum creatinine level returned to normal. Recurrent episodes of purpura associated with macroscopic hematuria persisted during the follow-up, but without worsening of renal function. An interesting feature of our patient was the development of reversible renal failure associated with macroscopic hematuria on two different occasions. Although this complication has been described in IgA nephropathy, it has been rarely reported in Henoch-Schönlein purpura. It is possible that IgA nephropathy and Henoch-Schönlein purpura are different clinical manifestations of the same disease and probably share a common pathogenesis. Our case is a demonstrative example of this hypothesis.

[Effect of pravastatin on hypercholesterolemia associated with proteinuria]

BASIS

Hyperlipidemia associated to nephrotic syndrome has been involved in the deterioration of the renal function in these patients. The reduction in the synthesis of cholesterol with pravastatin, an hydrophilic inhibitor of such synthesis, may improve both the dyslipemia, the renal function and the proteinuria.

METHODS

We conducted a controlled open randomized study in 16 patients with proteinuria greater than 2 g/day, creatinine clearance greater than 0.5 ml/s (30 ml/min) and hypercholesterolemia with LDL cholesterol greater than 4.9 mmol/l (190 mg/dl) distributed in two groups. One of these groups received hypolipemiant dietetic treatment and 20-40 mg of pravastatin and the other group, only the dietetic treatment.

RESULTS

The patients receiving pravastatin showed a 27% decrease in total plasmatic cholesterol, compared to a 6.7% in the control group (p < 0.01). This decrease was more evident in the LDL cholesterol fraction (44 vs 9%; p < 0.01). No significant modifications were observed in the HDL cholesterol fraction, triglycerides, renal function or proteinuria. Neither clinical nor enzymatiz adverse effects from hepatic or muscular origin were observed.

A novel alpha-amylase inhibitor from amaranth (Amaranthus hypocondriacus) seeds

The major alpha-amylase inhibitor (AAI) present in the seeds of Amaranthus hypocondriacus, a variety of the Mexican crop plant amaranth, is a 32-residue-long polypeptide with three disulfide bridges. Purified AAI strongly inhibits the alpha-amylase activity of insect larvae (Tribolium castaneum and Prostephanus truncatus) and does not inhibit proteases and mammalian alpha-amylases. AAI was sequenced with the automated Edman method, and the disulfide bridges were localized using enzymatic and chemical fragmentation methods combined with N-terminal sequencing. AAI is the shortest alpha-amylase inhibitor described so far which has no known close homologs in the sequence data bases. Its residue conservation patterns and disulfide connectivity are related to the squash family of proteinase inhibitors, to the cellulose binding domain of cellobiohydrolase, and to omega-conotoxin, i.e. a group of small proteins termed "knottins" by Nguyen, D. L., Heitz, A., Chiche, L., Castro, B., Boigegrain, R., Favel, A., and Coletti-Previero, M. ((1990) (Biochimie 72, 431-435) The three-dimensional model of AAI was built according to the common structural features of this group of proteins using side-chain replacement and molecular dynamics refinement techniques.

Evolution of susceptibilities of Campylobacter spp. to quinolones and macrolides

Erythromycin, new macrolides, and quinolones are alternatives for the treatment of Campylobacter infections. Concerns related to the emergence of resistance to both groups of drugs have been raised. We studied the evolution of antimicrobial susceptibilities of 275 clinical isolates of microorganisms of the genus Campylobacter isolated in our institution during a 5-year period (1988 to 1992). The microorganisms studied were C. jejuni (n = 230), C. coli (n = 42), and C. fetus (n = 3). The overall resistance rates (determined by the agar dilution method and the recommendations of the National Committee for Clinical Laboratory Standards) were as follows: erythromycin, 2.3%; clarithromycin, 2.3%; azithromycin, 1.9%; ciprofloxacin, 28.5%; norfloxacin, 31%; ofloxacin, 26.3%; and nalidixic acid, 36.8%. The evolution of resistance (percent resistance in 1988 versus percent resistance in 1992) was as follows: erythromycin, 2.6 versus 3.1; clarithromycin, 2.6 versus 3.1; azithromycin, 2.6 versus 3.1; ciprofloxacin, 0 versus 49.5; norfloxacin, 2.6 versus 55.5; ofloxacin, 0 versus 45.6; nalidixic acid, 2.6 versus 56.8. Our data show stable macrolide activity against Campylobacter spp. and the rapid development of quinolone resistance over the last 5 years.

Evaluation of nuclear maturity in human spermatozoa obtained by sperm-preparation methods

Change in the nuclear maturity has been considered as an index of sperm quality. This is done by using aniline blue staining that stains spermatozoa with disturbances in the chromatin condensation. Therefore, this technique was used to evaluate the quality of sperm obtained by sperm preparation methods. In 14 semen samples from healthy donors with normal semen analysis and normal forms, the swim-up (SU), Percoll gradient centrifugation (PG), glass wool column filtration (GW) and sedimentation-migration (SM) were performed. GW and SM methods presented the lowest number of spermatozoa with alteration in the nuclear maturity (ANM), 11, 14% and 12, 42% compared to native semen (19%) (P < 0.005 and P < 0.05 respectively). SU and PG did presented no significant difference compared to native semen. In tests using the four methods, approximately 60% of the ANM occurred in normal spermatozoa. In the cells with pathologic abnormalities and ANM, 74.5% corresponded to macrocephalic forms, as this abnormality correlated mainly with ANM. It is concluded that in a semen sample with a higher percentage of normal forms, approximately 19% will have an ANM. GW and SM methods obtain the lowest percentage of ANM. ANM presents itself in 98% of the macrocephalic forms and they are effectively isolated with the PG method. The practice of this simple technique may orientate towards the sperm preparation methods to be used in assisted reproduction.

[Dengue: an disease imported from the Indian subcontinent]

BACKGROUND

The febrile syndrome is one of the most frequent diseases in travellers with transient clinical pictures, not being reported on many ocassions. In Spain no cases of dengue fever has been published so far.

METHODS

A prospective clinical study was carried out in travellers from endemic zones with serologic diagnosis for dengue viruses being performed: IgM/IgG by hemagglutination inhibition and ELISA enhancement.

RESULTS

Six cases of dengue are described in Spanish travellers (4 tourists and 2 workers) from the Indian subcontinent (1989-1992). Serologic diagnosis: IgM/IgG by hemagglutination inhibition and ELISA enhancement was carried out. Five cases presented with classical dengue fever picture and 1 with hemorrhagic dengue. In all cases, fever and thrombopenia were reported. The clinical picture was self-limited in 2 patients, complicated with post-dengue syndrome in 3 cases and with fatal outcome in 1.

CONCLUSIONS

Dengue fever should be included in the differential diagnosis of febrile syndrome in travellers coming from endemic zones. The authors present the first cases of imported dengue in Spain.

[Subdural hemorrhage of aneurysmal origin]

Although most subdural hematomas are considered to be venous in origin, they may also be of arterial origin. When subdural bleeding is due to the rupture of an intracranial aneurysm, most commonly at the middle cerebral or internal carotid arteries, the amount of subdural blood is usually small and of no clinical importance. We describe two patients with subdural hematomas secondary to rupture of an intracranial aneurysm, who needed prompt surgical treatment. The first patient had a left internal carotid artery aneurysm at the origin of the ophthalmic artery. In the second patient the aneurysm was at the anterior communicating artery and rebled into the subdural space directly through a right intraparenchymatous frontobasal hematoma. The most probable mechanism of subdural bleeding in our two patients was the existence of adhesions between the aneurysm and the arachnoid due to previous minor hemorrhages. The indication of cerebral angiography in a patient with subdural hematoma is based mainly upon the existence of meningeal signs, the presence of blood in more than one intracranial compartment or the rapid progression of bleeding.

Aeromonas peritonitis

Five new cases of peritonitis caused by Aeromonas species are reported, and 29 others described in the literature are reviewed. Males predominated (71%), and the mean age was 56.9 years. Acquisition was nosocomial in 20% of the cases. All patients except one (3%) had significant underlying diseases; 73% had chronic hepatic disease, 15% had chronic renal failure (treated with chronic ambulatory peritoneal dialysis [CAPD]), and 9% had an intestinal perforation. Symptoms were similar to those of peritonitis caused by other pathogens, with the exception of diarrhea, which occurred in 25% of cases. Blood cultures were positive in 74% of the cases. The species isolated were Aeromonas hydrophila (27), Aeromonas sobria (5), and Aeromonas caviae (2). The overall case-fatality rate was 57%. Three strains were resistant to cotrimoxazole. Aeromonas species should be taken into account as a cause of peritonitis in patients with cirrhosis or who are undergoing CAPD.

[Striatocapsular infarct in a young patient with heterozygous familial hypercholesterolemia and Klinefelter's syndrome]

Familial hyperlipidemia has received little attention as a possible cause of stroke in young patients. Some recent studies have demonstrated that lipoprotein (a) is a key factor for atherogenesis in familial hypercholesterolemia. Hypogonadism may also contribute to the elevation of serum lipids, but their influence as a risk factor for stroke is still less understood. A 34-year-old patient with heterozygous familial hypercholesterolemia presented with a left pure motor hemiparesis secondary to a right striatocapsular infarction. Arteriography showed atherosclerotic lesions in both internal carotid arteries. High levels of cholesterol, cLDL, apo B, and lipoprotein (a) were found. Clinical signs of hypogonadism were present and the karyotype led to the diagnosis of Klinefelter's syndrome (47,XXY). The early clinical course was excellent, and the levels of serum lipids were normalized with diet, lipid-lowering drugs and androgens. The importance of hyperlipidemia as a risk factor for stroke in the young, specially when it occurs in the context of familial hypercholesterolemia with elevated lipoprotein (a) levels, as well as the possible contribution of hypogonadism to the development of accelerated atherosclerosis in young patients, are discussed upon.

[Evaluation of 2 fast methods for the detection of rotaviruses in fecal samples]

BACKGROUND

Rotavirus is one of the major causes of acute gastroenteritis in childhood. Several rapid methods for rotavirus detection are currently available, although their efficacy have a great variability. We performed a prospective study to evaluate two rapid tests for detection of rotavirus antigens in faeces.

METHODS

Using electron microscopy as the reference method, we compared two techniques for diagnosis of rotavirus infection: a monoclonal ELISA (Rotaclone, Cambridge Bioscencer, Worcester) and a policlonal latex agglutination (Diarlex, Orion Diagnostics, Finland). We tested, in parallel, 192 stools samples received in our laboratory to investigate rotavirus.

RESULTS

ELISA showed significantly better sensitivity than latex (100 vs 66.6%), while both methods had similar specificity (98.6%).

CONCLUSIONS

Of the tested methods, ELISA was superior due to the high sensibility and specificity, good reproductibility and easy interpretation. It also permits the simultaneous performance of several tests.

Genetic stability and xanthan gum production in Xanthomonas campestris pv. campestris NRRL B1459

A transposon (Tn5-SC) was constructed that can be used to quantify genetic deletions or amplifications. This transposon was used to evaluate the genomic stability of Xanthomonas campestris pv. campestris NRRL B1459 and we found that the genome of this bacterium is as stable as other Gram-negative bacteria or even more stable. Homologous recombination between plasmid sequences was determined in strain NRRL B1459 and was found to occur at a similar level to that reported for other Gram-negative bacteria. We report here that in X.c.c. NRRL B1459 there is no straightforward correlation between the occurrence of genetic rearrangements and frequency of homologous recombination. These data are discussed with respect to the reported instability of strain NRRL B1459 for xanthan gum production.

Limits of habituation and extinction: implications for relapse prevention programs in addictions

Problems in the application of exposure techniques to the management of long term dishabituation in addicts are discussed in the light of human and animal evidence. Extinction and habituation of responses to drug cues or drug aftereffects are unstable and strongly dependent on context, thus limiting the effectiveness of cue exposure treatments in the prevention of relapse. Several strategies are suggested to improve the stability of extinction and habituation in order to enduringly prevent relapse in addictions. (i) Warning patients about the episodic resurgence of unexpected urges or cravings precipitated by conditioned contexts and exposing them to such contexts. (ii) To obtain a maximum protection against relapse, extinction should 'recreate' all the original learning contexts (i.e. all possible drug cues). (iii) The behavioral chains involved in self administering drugs ought to be incorporated into cue exposure treatments (without permitting consummatory responses) in order to decrease their signal value as cues for drugs.

Association of sleep-wake habits in older people with changes in output of circadian pacemaker

Many elderly people complain of disturbed sleep patterns but there is not evidence that the need to sleep decreases with age; it seems rather that the timing and consolidation of sleep change. We tried to find out whether there is a concurrent change in the output of the circadian pacemaker with age. The phase and amplitude of the pacemaker's output were assessed by continuous measurement of the core body temperature during 40 h of sustained wakefulness under constant behavioural and environmental conditions. 27 young men (18-31 years) were compared with 21 older people (65-85 years; 11 men, 10 women); all were healthy and without sleep complaints. The mean amplitude of the endogenous circadian temperature oscillation (ECA) was 40% greater in young men than in the older group. Older men had a lower mean temperature ECA than older women. The minimum of the endogenous phase of the circadian temperature oscillation (ECP) occurred 1 h 52 min earlier in the older than in the young group. Customary bedtimes and waketimes were also earlier in the older group, as was their daily alertness peak. There was a close correlation between habitual waketime and temperature ECP in young men, which may lose precision with age, especially among women. These findings provide evidence for systematic age-related changes in the output of the human circadian pacemaker. We suggest that these changes may underlie the common complaints of sleep disturbance among elderly people. These changes could reflect the observed age-related deterioration of the hypothalamic nuclei that drive mammalian circadian rhythms.

Trisomy 8: an additional case with unique manifestations [correction]

We report on an infant with multiple congenital anomalies and mosaic trisomy 8 [corrected]. Clinical findings are presented, and compared with those of the 24 cases previously reported. Some unusual characteristics found in this patient include macrocephaly, an extreme degree of palatal hypoplasia, and abnormally shaped long bones.

Purification and electrophoretic analysis of glycosylated chicken growth hormone (G-cGH): evidence of G-cGH isoforms

It has been shown that chicken growth hormone (cGH) exhibits functional and molecular heterogeneity. Mass and charge variants have been described in fresh pituitary extracts and in pure preparations of the hormone. In an attempt to further study the molecular heterogeneity of cGH we have purified the glycosylated variant of this hormone by affinity chromatography and analyzed it by different electrophoretic methods. Purification was achieved by homogeneizing chicken pituitaries in a protease inhibitor solution (0.5 mM PMSF and aprotinin, 50 KIU/ml); the supernatant of the alkaline extract (pH 9.5) was precipitated with 0.15 M ammonium sulfate and metaphosphoric acid, pH 4.0. The supernatant from this step was further precipitated with 80% ammonium sulfate, pH 6.5. After dialysis and lyophilization, the extract was chromatographed in a Con A-Sepharose column. The fraction eluted with 10 mM alpha-methylmannoside (which contained the glycoproteins) was passed through an immunoaffinity column (anticGH). Glycosylated cGH (G-cGH) was obtained pure after this step. Pure G-cGH was analyzed by nondenaturing electrophoresis (ND-PAGE), SDS-PAGE, isoelectrofocusing (IEF), and bidimensional electrophoresis (2D-PAGE) followed by Western blot and staining either with a specific antibody or with peroxidated Con A. Results showed that monomeric G-cGH has a MW of 29 kDa (under reducing conditions) and is heterogeneous, showing at least three important charge variants with pIs 6.5, 6.7, and 7.2. Mass variants of G-cGH were also detected under nonreducing conditions. Bidimensional analysis revealed that the charge variants had a similar MW (29 kDa).

Interstitial 15q deletion without a classic Prader-Willi phenotype

We report on a newborn boy with pronounced hypotonia, cryptorchidism, minor facial anomalies, congenital heart defect, neurologic anomaly, deafness, renal anomaly, and bifid uvula. The patient has a de novo proximal interstitial deletion of chromosome 15 reaching to band q14, larger than that usually seen in Prader-Willi and Angelman syndromes.