[Respiratory changes during laparoscopic cholecystectomy. A comparative study of three techniques]

OBJECTIVES

To analyze the repercussions of CO2 pneumoperitoneum on the ventilation of healthy patients undergoing laparoscopic cholecystectomy; to assess the influence of anesthetic technique and determine whether duration of procedure or CO2 volume are relevant factors.

PATIENTS AND METHOD

Prospective study of 132 patients undergoing laparoscopic cholecystectomy. The patients were selected based on disease and level of anesthetic risk and then randomly assigned to three groups to receive anesthesia with oxygen/nitrous oxide (group I), isoflurane in O2 and air (FIO2 0.4) (group II) or propofol in continuous infusion with O2 and air (FIO2 0.4) (group III). Analgesia and muscle relaxation were the same in all groups. Monitoring included blood pressure (BP), heart rate (HR), electrocardiography (ECG), central venous pressure (CVP), capnography (PETco2), pulse oximetry (SaO2), peak airways pressure (PAP), FIO2, intra-abdominal pressure (IAP), volume in insufflated CO2 and serial gasometry. Readings were taken before pneumoperitoneum after 20 minutes and every 30 minutes until end of surgery. After surgery parameters were recorded four more times at intervals of 30 minutes.

RESULTS

The groups were homogeneous. pneumoperitoneum caused a decrease in PaO2 (p < 0.001) and SaO2 and increases in PaCO2, PETco2 and CVP, although levels later stabilized. No relation was found between duration of pneumoperitoneum or CO2 volumen and any of the changes observed. Group I had the lowest mean PaO2 before pneumoperitoneum and 60 minutes later (p < 0.05). Group II had the smallest increase in PaCO2, although the difference was non significant.

CONCLUSIONS

CO2 pneumoperitoneum caused ventilatory changes dependent on uptake and increased abdominal pressure. The duration and volume of CO2 used did not influence the parameters studied. The clinical significance of these changes is slight in the healthy patient. The anesthetic agents used did not have substantial effects.

[The white coat effect in primary care. Analysis of patients with newly diagnosed arterial hypertension]

BACKGROUND

In a non-selected group of hypertensive patients with a new diagnosis at primary care, blood pressures obtained in the office (oBP) are compared to ambulatory ones (aBP). White coat hypertension (WCH) and white coat phenomenon (WCP) are estimated to evaluate a white coat effect on such population.

PATIENTS AND METHODS

An ambulatory blood pressure monitoring (ABPM) was performed to 91 hypertensive patients (55 females) from 21 to 70 years-old, with consecutive diagnosis in 4 office rooms in an health center (oBP mean > or = 140 mmHg for systolic blood pressure and/or 90 mmHg for diastolic blood pressure during three measures at least). WCH was defined by systolic aBP < or = 135 mmHg and diastolic < or = 85 mmHg, simultaneously, and WCP by oBP-aBP differences > or = 20 and/or 10 mmHg (for respective systolic and diastolic blood pressure).

RESULTS

oBP systematically exceeded aBP with wide variations for each subject (difference mean +/- SD: 15 +/- 13/7 +/- 9 mmHg for systolic/diastolic), sex (female: 19 +/- 12/11 +/- 9, male 8 +/- 11/2 +/- 9) and depending on the observer who made the measure. WCH was detected in 27 patients (22 females), and WCP in 47 (37 females), so 30% (confidence interval [CI]: 21-40%) and 52% (CI: 41-62%) respective prevalences are supposed.

CONCLUSIONS

Within primary care, white coat effect causes a substantial hypertension sobrediagnosis as quantitative as qualitatively. Confirming measures made by nurses and additionally, ABPM for women, seem to lessen this effect.

Risks of introducing foot and mouth disease through the importation of beef from South America

The safety of beef with respect to foot and mouth disease (FMD) is determined by the level of risk which the exporting region poses through disease prevalence, the reliability of the surveillance system of the region, the efficacy of the prevention and control measures, the efficiency of the Veterinary Services and the support of the private sector. The South American continent has been regionalised in accordance with these criteria. Today there are approximately 90 million cattle in a territory of over 5 million km2 comprising regions classified as having a very low to low level risk for FMD with regard to the export of animals and animal products. Another 50 million cattle live in regions classified as posing a moderate risk. These risk categories reflect varying levels of risk. The harvest of beef in the meat-exporting regions of South America includes a series of risk mitigation measures, from the origin of the source herd to the final packing of the beef. These measures reduce the unrestricted risk estimate by almost six orders of magnitude. Therefore, the final risk of FMD for the global trade of beef originating from the low risk regions in South America is extremely small.

Cinitapride protects against ethanol-induced gastric mucosal injury in rats: role of 5-hydroxytryptamine, prostaglandins and sulfhydryl compounds

This study was designed to determine the gastroprotective properties of cinitapride (CNT), a novel prokinetic benzamide derivative agonist of 5-HT4 and 5-HT1 receptors and 5-HT2 antagonist, on mucosal injury produced by 50% (v/v) ethanol. Results were compared with those for 5-hydroxytryptamine (5-HT: 10 mg kg-1). The possible involvements of gastric mucus secretion, endogenous prostaglandins (PGs) and sulfhydryl compounds (SH) in the protection mediated by CNT were also examined. Intraperitoneal administration of CNT (0.50 and 1 mg kg-1), 30 min before ethanol, significantly prevented gastric ulceration and increased the hexosamine content of gastric mucus. CNT (1 mg kg-1) also produced a significant increase in gastric mucosal levels of PGE2, but did not induce any significant changes in SH values. On the contrary, pretreatment with 5-HT worsened ethanol-induced erosions, however, did not affect gastric mucus secretion, glycoprotein content or PGE2 levels, although the non-protein SH fraction was significantly decreased. The present results demonstrate that the gastroprotective effects of CNT could be partly explained by a complex PG dependent mechanism. We suggest that 5-HT dependent mechanisms through 5-HT2 receptor blockade and 5-HT1 receptor activation could be also involved.

An outbreak of vampire bat-transmitted rabies in cattle in northeastern Mexico

An outbreak of bovine rabies occurred on a ranch when cattle were bitten by vampire bats. Microscopic lesions showed a nonsuppurative encephalitis with intracytoplasmic inclusion bodies. Immunohistochemistry demonstrated viral antigen in the brain, and monoclonal antibodies identified a serotype 1 (vampire strain) of the rabies virus.

Prevalence of multiple sclerosis in the province of Teruel, Spain

There have been few reports about the frequency of multiple sclerosis (MS) in Spain. We undertook a prevalence study in the province of Teruel, which is served by two hospitals as referral centres for a population of 143,680. We found a total of 46 patients who fulfilled Poser's criteria for clinically definite or probable MS with a prevalence rate of 32/100,000 [95% confidence interval (CI): 22.8-41.3]. The prevalence rates for males and females were 23.5 (95% CI: 12.3-34.7) and 40.6 (95% CI: 25.8-55.4) respectively. We found an incidence rate of 2.2/year per 100,000 in the last 5 years. The sex ratio (females/males) was 1.7. The mean age on prevalence day was 40.6 years (range: 15-76). The clinical course was relapsing-remitting in 82% of patients, progressive in 9% and secondary progressive in the other 9%. The mean EDSS score was 3.73 (range: 1-8.5). Our results confirm the hypothesis that Spain is an area at high risk for MS.

Congenital intrahepatic portocaval shunt associated with trimethylaminuria

A case of congenital portal-systemic shunting due to an intrahepatic connection diagnosed by ultrasound scanning and color Doppler in an 8-month-old girl is reported. She began to manifest trimethylaminuria 3 years later. At 7 years of age, she is asymptomatic without therapeutic measures except for diet. This is the seventh reported case and the third in a child to our knowledge.

Peritoneocele: visualization with defecography and peritoneography performed simultaneously

PURPOSE

To evaluate the use of simultaneous defecography and peritoneography (defecoperitoneography) in patients with an unexplained widening of the rectovaginal space noted at defecography.

MATERIALS AND METHODS

Twenty-two patients with unexplained widening of the rectovaginal space noted at defecography were studied with defecoperitoneography. Defecoperitoneography was a combination of defecography and peritoneography with water-soluble contrast medium administered intraperitoneally.

RESULTS

The outline and movements of the peritoneum and alterations in the pelvic peritoneal cavity could be visualized with defecoperitoneography during the dynamic act of defecation. Unexplained widening of the rectovaginal space was completely due to a peritoneocele in 14 patients and partially due to a peritoneocele in six patients. In two patients, there was no peritoneocele. Only nine of 22 patients had bowel in the unexplained widening (enterocele). Three patients had a rectal peritoneocele; six, a septal peritoneocele; one, a vaginal peritoneocele; and 10, a combination of these findings.

CONCLUSION

Visualization of the pelvic floor with defecoperitoneography is improved compared with visualization with defecography alone.

Reproductive seasonality of corriedale rams under extensive rearing conditions

The objective of the present study was to describe seasonal changes in scrotal circumference (SC), live weight (LW), sperm morphology and plasma levels of testosterone (T) and thyroxine (T4) in young Corriedale rams reared under extensive conditions typical for the southern Latin American region. A total of 31 Corriedale rams, 11 months of age and with a LW of 36 +/- 1.1 kg and (SC) of 23.0 +/- 0.5 cm at the beginning of the experiment (September) were kept on natural pastures. At monthly intervals LW was recorded, animals were clinically examined, and SC was measured. None of the animals were used for breeding. Fifteen animals were randomly selected and bled once a month from January to December and plasma concentrations of T and T4 were determined. In addition, one semen sample was collected by electroejaculation and morphological studies were performed. The mean individual LW increase was 18 kg (50% of the initial LW) during the experiment (p < 0.01). LW decreased in autumn, with the nadir in late autumn. SC reached mean maximum levels in late summer (31.1 +/- 0.4 cm, p < 0.01), then decreased until the beginning of winter (26.3 +/- 0.4 cm, p < 0.01) and remained low until early spring (27.5 +/- 0.5 cm, p > 0.05) to increase again between mid-spring and the end of the experimental period the following summer (30.7 +/- 0.5 cm, p < 0.01). The mean SC in winter was 16% lower than that in late summer. Semen could be collected from the rams throughout the experiment. Frequencies of sperm head, mid-piece and total abnormalities showed monthly variation (p < 0.05), but tail abnormalities were not affected by month. Low abnormalities were found in autumn (9.4% +/- 2.2%). T was high during autumn (p < 0.01). Minimal T4 concentrations were observed during late summer and early autumn (p < 0.01) when T levels were high. Maximum T4 concentrations were registered in late autumn (p < 0.01); when SC was decreasing; in mid-spring (p < 0.01) one month after shearing and in early summer (p < 0.01). The results suggest that Corriedale rams under Uruguayan extensive management systems show a reproductive seasonality that, in general terms, coincides with photoperiodic variations.

Hyperlipidemic nephropathy induced by adriamycin: effect of melatonin administration

The effect of melatonin (MEL) on the nephropathy and the oxidative stress induced by a single and high dose of Adriamycin (AD) has been studied in Wistar male rats. MEL (50 microg/kg/day) was injected intraperitoneally 3 and 7 days, respectively, before and after AD injection (20 mg/kg i.p.). Trunk blood was drawn and triglycerides, total cholesterol, phospholipids, high-density lipoprotein cholesterol, urea, creatinine, total protein, lipoperoxides, and reduced glutathione (GSH) levels and catalase activity (CAT) were determined in serum. In kidney homogenates, lipoperoxides, GSH, and CAT were measured as well as total protein in urine. AD administration resulted in hyperlipidemia and high-grade proteinuria and a marked increase in serum lipoperoxides, urea, and creatinine. In the kidney, the increase in lipoperoxides was accompanied by a significant decrease of GSH and CAT. The efficiency of MEL was specially remarkable in restoring GSH, CAT, and proteinuria to the levels of controls. These results confirm the involvement of free radicals in the pathogenesis of nephrotoxicity induced by AD. Likewise, they show the high antioxidative power of MEL and its marked effect on the prevention and suppression of this nephropathy.

Hepatitis B vaccination results in 140 liver transplant recipients

BACKGROUND/AIMS

Human autologous liver transplantation is possible due to an adequate suppression of the body's immune response. This also causes a higher hepatitis infection rate, making hepatitis prevention very important.

MATERIALS AND METHODS

We describe our experience with hepatitis B virus vaccination in 140 adult liver transplant recipients, transplanted from 1986 to 1994 with more than one year of follow-up. Excluded were those who had hepatitis B surface antigens or antibodies to those antigens before the transplant. The vaccination schedule was 0-1-2 months with a double dose of recombinant vaccine.

RESULTS

The total response rate (surface antigen antibodies > 10 U) was 40% (56/140); the rate was 47.7% in men and 26% in women. At the end of the study, only 17.1% (24/140) of the patients had antibodies > 10 U. The response rate was higher in patients with antibodies to hepatitis B core antigen (66.6%) than in those lacking antibodies (31.7%), and more long lasting (42.4% vs 11.2%). The response rate in 116 patients with booster doses was 12.9%. Six correctly vaccinated patients (4.28%) acquired new hepatitis B virus infections after the operation.

CONCLUSIONS

The total response rate in these patients is much lower than in the general population, and there is a rapid decline of titers, probably due to immunosuppression. The role of booster doses in these patients should be clarified.

Long lasting immunological effects of ethanol after withdrawal

The aim of the present study was to analyze on chronic alcoholic patients the effect of ethanol (EtOH) withdrawal on the immune system through the investigation of the distribution of PB lymphoid subsets, using multiple-stainings with monoclonal antibodies and flow cytometry. For this purpose a group of 20 patients with active alcoholism without liver disease, negative for hepatitis virus, and without malnutrition was analyzed and followed for 9 months after alcohol consumption had been discontinued. Twenty-five age- and sex-matched healthy volunteers were included in the study. The following panel of monoclonal antibodies combinations (FITC/PE/PerCP or PE-Cy5) was used: TCR alpha beta/CD3/HLA DR, CD25/CD56/CD3, TCR gamma delta/CD3/HLA DR, CD45RA/CD45R0/CD4, CD3/CD8, CD19/CD5, and CD3/CD11c. Analysis was performed on at least 1,500 events/tube at flow cytometry using the Lysys II software program. During the alcohol intake period, the most striking findings were a significant (P < 0.05) expansion of the CD8+ T-lymphocyte subset, which coexpresses the activation associated antigens HLA DR and CD11c, as well as a significant increase in both NK-cells (CD3-/CD56+) and the T-cell subset with NK activity coexpressing CD3 and CD56 (P < 0.05 and P < 0.01, respectively). In addition, a decrease in the CD5+ B-cells (P < 0.05), associated with reduced serum gamma-globulin levels, was also observed. During alcohol withdrawal, a rapid decrease towards normal values of activated CD8+/HLA DR+ and CD11c+ T-lymphocytes was observed as well as a normalization of CD19+/CD5+ B-cells and gamma-globulin serum levels; these changes might be directly related to EtOH suppression. Surprisingly, however, new immunological imbalances emerged in spite of the absence of alcohol intake. Thus, a progressive and significant expansion (P < 0.05) of CD4+ T-cells associated with an increased expression of the CD25 activation-related antigen and a preferential use of the CD45R0 isoform by CD4+ T-cells were observed. In parallel, there was an even more evident increase (P < 0.01) in the number of PB NK-cells. Our results show that EtOH consumption induces changes in the immune system, its effects persisting or even becoming more evident after suppression of EtOH intake for a 9 month period.

Distribution of peripheral blood lymphoid subsets in alcoholic liver cirrhosis: influence of ethanol intake

The aim of the present study was to investigate the effect of chronic ethanol (EtOH) consumption on the immune system in patients with alcoholic liver cirrhosis (ALC), as analyzed by the distribution of peripheral blood (PB-) T, B, and NK lymphoid subsets using multiple stainings with monoclonal antibodies and flow cytometry. For that purpose, we have analyzed a group of patients with ALC and active EtOH intake (ALCET group) which were re-evaluated 3 months after alcohol withdrawal. As controls, both ALC patients with at least 1 year of alcohol withdrawal (ALCAW group) and healthy subjects were used. Regarding the alcohol intake period, the most relevant findings were a significant activation of the PB T-cell compartment, and specifically of the TCR alpha beta + subset, as reflected by an increased expression of both the HLA DR and CD11c antigens as well as a significant increase of both the PB NK cells (CD3-/CD56+) and the cytotoxic T cells coexpressing the CD3 and CD56 molecules. In addition, a decrease of both the numbers of total B cells and their CD5+/CD19+ subset were observed. After a relatively short withdrawal period (3 months), the abnormalities of T, P, and NK cells disappeared. These findings suggest the existence of a close relationship between EtOH consumption and the abnormalities of the immune system observed during active alcoholism. Nevertheless, ALCAW individuals displayed marked alterations on the immunophenotypic profile, as reflected by a significantly decreased number of total T cells, due to reduced levels of the CD3+/TCR alpha beta+, CD4+, CD8+, and CD4+/CD45RA+ T-cell subsets. In addition, a significantly decreased number of total PB B cells was observed in this group of patients. Our results show that in patients suffering from ALC, the abnormalities of the immune system due to a direct effect of EtOH intake (or its metabolites) should be distinguished from the immunological alterations related to the liver disease itself.

Effects of cisapride on ulcer formation and gastric secretion in rats: comparison with ranitidine and omeprazol

1. The antiulcerogenic effects of cisapride, a potent benzamide-stimulating gastrointestinal motility agent, were studied on cold-resistant and pylorus-ligated gastric ulcers. Acidity, composition of gastric secretion, and quantitative and qualitative changes on mucus glycoprotein content were also determined. These effects were compared with those of ranitidine (50 mg/kg) and omeprazol (10 mg/kg). 2. Oral cisapride (10-100 mg/kg) dose-relatedly and significantly (P < 0.01, P < 0.05) decreased the severity of the lesions induced by cold-resistant stress. In stressed rats, cisapride increased the amount of mucus secretion and markedly enhanced the glycoprotein content. Morphometric evaluation of mucus secretion revealed a significant increase in both the PAS area (neutral glycoproteins) and Alcian blue area (sulfated glycoproteins). 3. In 4 h pyloric-ligated animals, cisapride (10-100 mg/kg) showed a significant reduction in the number and severity of ulcers (P < 0.01) and histamine concentration (P < 0.01, P < 0.001). In addition, at the highest doses (50-100 mg/kg), cisapride produced a significant decreases in acidity; however, it did not alter the gastric volume secretion or pepsin concentrations. 4. These results suggest that cisapride shows antiulcerogenic effects which could possibly be explained through antisecretory and cytoprotective mechanisms involving an enhancement of cuality and production of gastric mucus.

Serial analysis of the effects of methimazole therapy on circulating B cell subsets in Graves' disease

The immunosuppressive effects of antithyroid drug therapy are well recognized; however, the cellular mechanisms underlying their action remain largely unknown. In the present paper we have prospectively analyzed the in vivo effects of methimazole treatment on a large number of circulating B cell subsets, involved in the effector phase of the immune response, in a group of 18 hyperthyroid patients with Graves' disease (GD). The patients were sequentially studied before (day 0) and 7, 14, 30, 90 and 180 days after methimazole therapy. The results were compared with both a group of 19 age- and sex-matched healthy controls and a group of 20 untreated/euthyroid GD patients in long-term remission. The combination of flow cytometry and three colour immunofluorescence revealed a clear increase (P < 0.001) in the numbers of circulating total B cells (CD19+) due to a significant increase (P < 0.001) in the CD5+, FMC7+, CD5+/ FMC7+ and CD23+ B cell subsets in hyperthyroid GD patients with respect to both healthy individuals and to GD patients in long-term remission. The absolute numbers of all these B cell subsets analyzed before treatment, although abnormal, were not statistically different from those observed during the whole period of therapy. When comparing the percentages of these B cell subsets during treatment, significant changes (P < 0.001) were only observed in the proportion of CD5+, CD5+/FMC7+ and CD5- B cells at the end of the follow-up period with respect to those found both before and during the first month of therapy. Whereas CD5+ and CD5+/FMC7+ B cells decreased (P < 0.001) after 3 months of therapy, CD5- B cells showed a significant increase (P < 0.001) at the end of therapy. It is remarkable that the percentage of CD5+, CD5+/FMC7+, CD5- and CD23+ B cell subsets were abnormal during the whole period of treatment and that they never reached normal values. These results show that, in vivo, GD patients treated with methimazole exhibited an abnormal but rather stable pattern of B cell distribution, similar to that present in hyperthyroid untreated GD patients, except for the CD5+ and CD5- B cell populations. Our findings suggest that in vivo methimazole therapy would not directly have an important influence on circulating B cell subsets.

[Treatment with Ethibloc of lymphangiomas and venous angiomas]

Lymphangioma and venous angioma are a group of pathological entities which have required surgical treatment since years. Extension, localization and poor delimitation of some lesions have resulted in technical difficulties and serious complications. Our group began the sclerosing therapy with an injection of fibrin adhesive and, due to the lack of response in the first patient, a program with Ethibloc as an alternative substance was developed. We present 10 cases, 4 lymphangiomas and 6 venous angiomas. In 50% of our patients one single session of sclerotherapy was made, in 25% two sessions, and in the rest 25% three. From 10 cases, 4 are still on treatment, complete remission in 5 cases, and good evolution in one case (mixed lymphangioma). As a long-term complication, we have noticed fistulization in 3 cases, and expulsion of the sclerosing agent. In our experience, percutaneous sclerosis with Ethibloc should be the first therapeutic alternative.

[Intracranial hypertension syndrome due to giant frontoethmoidal osteoma]

Osteomas are benign lesions that may cause life-threatening complications. Their radiological diagnosis usually is casual. Once diagnosed, periodic radiological follow-ups should be carried out and if growth occurs, surgical measures should be taken to prevent complications. The case of a 53-years-old white male admitted for injuries produced by a traffic accident is reported. He had a history of frontalization syndrome with episodes of disorientation and behavioral changes. Plain radiography, CAT, MRI and bicarotid angiography revealed a bone mass that occupied almost the entire anterior fossa. Intracranial hypertension syndrome caused by a giant ethmoidal osteoma was diagnosed. Surgery using a frontal approach was undertaken.

Healing Process Induced by a Flavonic Fraction of Bidens aurea on Chronic Gastric Lesion in Rat. Role of Angiogenesis and Neutrophil Inhibition

Absrtract The aim of this study was to elucidate the mechanism of the healing process mediated by the flavonic fraction of Bidens aurea on chronic gastric ulceration induced by 5% acetic acid in rats. The diethyl ether extract (125 and 62.5 mg kg- 1 body weight) was administered in a single doses, 7 and 14 days after provocation of lesions. Our results demonstrated that both doses significantly decreased the macro and microscopic ulcer index. Usually after 14-days treatment the lesions were found completely covered with regenerative epithelium and also an important proliferation of blood vessels was observed. Myeloperoxidase (MPO) activity was assayed and used as an index of leucocyte infiltration. Application of acetic acid produced a significant increase of this activity 7 days after induction of chronic injury. Administration of 125 mg kg -1 of the ether extract provoked a sharp reduction on the enzymatic activity at the same period. After 14 days, this decrease was higher with both doses (p<0.001). In addition, the macroscopic examination showed a drastic reduction of leucocyte infiltration in treated groups. These results suggest that the recovery of vascularization of the ulcerated area and the decrease of neutrophil infiltration are involved in the antiulcerogenic effect of the flavonoid fraction of Bidens aurea.

Imipenem therapy of brain abscesses

The efficacy of imipenem versus standard chemotherapy (both in addition to neurosurgery) in the treatment of brain abscess was compared in a retrospective study. Cure was obtained in 52 of 60 (86.7%) patients in the standard group, and in 15 of 15 (including 5 patients with multiple brain abscesses) in the imipenem group. Cure without neurosurgery was observed in 2 of 60 (3.3%) and 3 of 15 (20%) of the cases, respectively (p = 0.08). Levels of imipenem in blood, cerebrospinal fluid, and brain pus were above the minimum inhibitory concentrations of most of the abscess isolates. Side effects of imipenem were rare and tolerance was excellent. Imipenem monotherapy (3-4 g/day) for five weeks seems a reasonable therapeutic choice for treatment of bacterial brain abscesses.

[Sensory-motor polyneuropathy associated with lung tuberculosis: presentation of two new cases]

The association of active tuberculosis with changes in the peripheral nervous system is not well defined, although it is included amongst the neuro-muscular disorders of the peripheral nerve diseases due to infective agents. We describe the case of two patients with sensory-motor polyneuropathy and coexistant active pulmonary tuberculosis which was untreated prior to diagnosis of the peripheral nervous system disorder. In both cases the condition was sub-acute and did not improve until treatment was begun. Anti-tuberculosis treatment was followed by marked improvement of both the pulmonary tuberculosis and of the polyneuropathy. The close chronological relationship of both clinical pictures with the therapeutic response supports the hypothesis of the pathogenesis of the peripheral nervous system disorder being mediated by an anomolous immune response, initiated by the infection with Koch's bacillus.

[Neonatal intravaginal testicular torsion in an undescended testis]

We report a case of intravaginal testicular torsion with an unusual debut in a 30 day old patient which had undescended testis. We emphasize the need of a complete physical exploration of the child that go to the emergency service with inspecific symptoms of abdominal pain, and supposing the hemiscrotum was empty, is essential to reject a torsion of a cryptorchidic testicle. An immediate surgery is necessary in order to diagnose and treat this disturbance.

Healing process induced by a flavonic fraction of Bidens aurea on chronic gastric lesion in rat. Role of angiogenesis and neutrophil inhibition

The aim of this study was to elucidate the mechanism of the healing process mediated by the flavonic fraction of Bidens aurea on chronic gastric ulceration induced by 5% acetic acid in rats. The diethyl ether extract (125 and 62.5 mg kg-1 body weight) was administered in a single doses, 7 and 14 days after provocation of lesions. Our results demonstrated that both doses significantly decreased the macro and microscopic ulcer index. Usually after 14-days treatment the lesions were found completely covered with regenerative epithelium and also an important proliferation of blood vessels was observed. Myeloperoxidase (MPO) activity was assayed and used as an index of leucocyte infiltration. Application of acetic acid produced a significant increase of this activity 7 days after induction of chronic injury. Administration of 125 mg kg-1 of the ether extract provoked a sharp reduction on the enzymatic activity at the same period. After 14 days, this decrease was higher with both doses (p < 0.001). In addition, the macroscopic examination showed a drastic reduction of leucocyte infiltration in treated groups. These results suggest that the recovery of vascularization of the ulcerated area and the decrease of neutrophil infiltration are involved in the antiulcerogenic effect of the flavonoid fraction of Bidens aurea.

Cytoprotective activity of cisapride on experimental gastric mucosal lesions induced by ethanol. Role of endogenous prostaglandins

The antiulcer effects and protective mechanisms of cisapride, a prokinetic benzamide agonist of 5-HT3 and antagonist of 5-HT4 receptors, were investigated in gastric mucosal injury induced by pretreatment with 50% v/v ethanol in rats. The duration of the protective effect was also studied and the results were compared with those of 5-HT. 240 min after administration of cisapride (10, 25 and 50 mg/kg) the total area of gastric lesions decreased significantly, in macroscopical and histological evaluations, and the mucus, hexosamine, and sulphated glycoprotein content were significantly increased. Indomethacin partially reversed cisapride protection suggesting that the beneficial antiulcer effects of this drug could be mediated in part by prostaglandins. This study confirms that this benzamide, in this experimental model, enhances gastric PGE2 production. We also investigated the time course of action of 5-HT, 30-240 min before ethanol administration, and our study not only demonstrates the ulcerogenic action of the amine (30 min of pretreatment) but also its protective nature, shown macroscopic and microscopically, after 240 min of its administration, without any effect on PGs production. These findings suggest a new gastroprotective feature of cisapride partly explained through a prostaglandin-dependent mechanism and possibly independent of its 5-HT activity.

Determination of lithium in alcoholic beverages by inductively coupled plasma atomic emission spectometry (ICP/AES)

The inductively coupled plasma atomic emission spectrometry (ICP/AES) determination of lithium in spirituous liquors has been investigated. The results have been statistically compared with those obtained using a spectrophotometric method with 1-(2-arsenophenylazo) 2-hydroxy 3,6-naphthalene disulfonic acid (APHNDS) as reagent.

CD5+ B cells in Graves' disease: correlation with disease activity

In the present paper the distribution of peripheral blood CD5+/CD19+ (CD5+B) and CD5-/CD19+ (CD5-B) B-lymphocytes in Graves' disease (GD) patients is analyzed in order to correlate them with disease activity, interleukin-2 (IL-2) and IL-6 binding to T and B cells as well as with anti-thyrotropin (TSH) receptor antibodies and the thyroid hormone serum levels. The combination of flow cytometry and 3-color immunofluorescence revealed a remarkable increase in the absolute numbers of CD5+ B cells in hyperthyroid-untreated GD patients (218 +/- 137 x 10(6)/l vs. 66 +/- 69 x 10(6)/l in healthy subjects, p < 0.01) that gradually fell to normal values once hyperthyroidism had been controlled by methimazole. However, relative numbers of CD5+ B cells persisted at a relatively stable but increased level in GD patients in long term remission of an average of 3.1 years. This was also confirmed in a follow-up study of a group of 12 newly diagnosed patients during the first 90 days of anti-thyroid drug therapy with methimazole. No correlation was observed between either CD5+ B cells or CD5- B cells and the serum levels of pathogenic anti-TSH receptor antibodies. Increased numbers of CD5+ B cells were related to the increased free thyroxine and total triiodothyronine serum levels. In addition, a strong correlation between both the absolute levels of B cells binding to exogenous IL-2 and IL-6 and the absolute number of CD5+ B cells in hyperthyroid GD patients (LR = 0.798, p < 0.001; LR = 0.569, p < 0.01, respectively) was observed. These results suggest that CD5+ B cells in GD are partly regulated by thyroid hormone serum levels as well as by IL-2 and IL-6 binding to B cells. Nevertheless, they are not involved, at least directly, in the production of anti-TSH receptor antibodies.

Toxicity of potential irritants in mammalian cells in vitro

Four bioactive materials were tested for their ability to produce toxicity in vitro in two cell lines: rabbit corneal cells (SIRC) and human fibroblasts. These compounds are widely used by industries, causing toxic effects to ecosystems and particularly having an impact on human health. Different chemicals were chosen which were structurally unrelated: triethanolamine, zinc pyrithione, sodium lauryl sulfate, and oleamine. Cytotoxicity was evaluated measuring the total protein content (inhibition of cell growth). Results indicated that zinc pyrithione produced the highest inhibition of cell growth when two cell lines were treated in the two doses tested. The lowest cytotoxic effect was observed with oleamine. Triethanolamine and sodium lauryl sulfate produced a similar cytotoxic effect in Fe cells, although sodium lauryl sulfate revealed higher inhibition of cell growth than triethanolamine on SIRC cells. From these results, it can be concluded that some products as triethanolamine and zinc pyrithione should be observed in future special toxicological studies.

Pharmacokinetics of conventional formulation versus fat emulsion formulation of amphotericin B in a group of patients with neutropenia

The pharmacokinetics of amphotericin B administered in a conventional 5% dextrose (glucose) (5% D) solution and in a 20% fat emulsion formulation (Intralipid; 20% IL) were compared in 16 patients (mean age, 42 years [range, 18 to 70 years]) who had been hospitalized for hematological malignancies and with proven or suspected fungal infections. All of the patients received 50 mg (approximately 1 mg/kg of body weight per day) of amphotericin B daily in random order, either as a 50-ml lipid emulsion (20% IL) (group I) or in 500 ml of 5% D (group II). Five serum samples were taken during the 24 h after drug administration, and the levels of amphotericin B were measured by high-pressure liquid chromatography. Serum amphotericin B concentrations declined rapidly during the first 6 h, and subsequent measurements revealed a slow terminal elimination phase in both groups. The maximum serum amphotericin B concentration was significantly lower when the drug was administered in 20% IL (1.46 +/- 0.61 versus 2.83 +/- 1.17 micrograms/ml; P = 0.02). The area under the concentration-time curve from 0 to 24 h was also much lower in group I (17.22 +/- 11.15 versus 28.98 +/- 15.46 micrograms.h/ml). The half-life of the distribution phase was approximately three times longer in group I (2.92 +/- 2.34 h versus 0.64 +/- 0.24 h; P = 0.011). Conversely, the half-lives of the elimination phase were approximately equal in the two groups (11.44 +/- 5.18 versus 15.23 +/- 5.25 h). The mean residence times were also similar in both groups (19.41 +/- 11.13 versus 19.65 +/- 7.86 h). The clearance and the steady-state volume of distribution of amphotericin B in group I were about twice as great as those in group II (62.97 +/- 35.51 versus 33.01 +/- 14.33 ml/kg/h and 1,043.92 +/- 512.10 versus 562.32 +/- 152.05 ml/kg [P = 0.034], respectively). Finally, the volume of distribution in the central compartment was greater in group I than in group II (618.17 +/- 231.80 versus 328.19 +/- 151.71 ml/kg; P = 0.013), but there were no differences in the volume of distribution in the peripheral compartment (425.75 +/- 352.87 versus 234.14 +/- 75.92 ml/kg). These results suggest that amphotericin B has a different pharmacokinetic profile when it is administered in 20% IL than when it is administered in the standard 5% D form and that the main difference is due to a clear-cut difference in the steady-state volume of distribution, especially that in the central compartment.

The role of gastric mucosal sulphydryls in the ulcer-protecting effects of cisapride

The present study was designed to examine the role of endogenous sulphydryls (SHs) in the gastro-protection induced by cisapride (CIS) (10, 25 and 50 mg kg-1 i.p.), a potent benzamide stimulating gastrointestinal motility in mucosal injury induced by 50% v/v ethanol. Results were compared with those of 5-hydroxytryptamine (5-HT) (10mg kg-1). Ethanol mucosal damage was significantly reduced by treatment with CIS and 5-HT. On the contrary, administration of n-ethylmaleimide (NEM) (10 mg kg-1) an SH alkylator, markedly worsened lesion formation and counteracted the protective effect of CIS. Rats pretreated with CIS significantly increased the total sulphydryls as reflected in the non-protein and protein fractions however, 5-HT treatment showed a fall in the non-protein level. The present results suggest that 5-HT-ergic dependent mechanisms have no relation to the gastro-protection afforded by CIS in this experimental model. It is possible that mucosal SHs could be involved.

[Skin fragments carried by spinal needles in cadavers]

Epidural or intradural puncture with inappropriately stiffened or improperly placed needles can carry cells or fragments of epithelial tissue into the epidural or intradural space. These skin fragments feed by imbibition, possibly leading to the development of epidermoid cysts. We aimed to study the ability of today's needles to transport cells or epithelial fragments. We studied 120 needles in 6 groups of 20, as follows: group 1, Touhy G-16; group 2, Touhy G-17; group 3, Quincke G-22; group 4, Quincke G-26; group 5, Sprotte G-22, and group 6, Sprotte G-24. These needles were used to make intradural and epidural insertions, as indicated, with stiffeners fully in place. Insertions were made into 3 cadavers, epidermal cells or skin fragments were then isolated from the solutions used to wash the needles, and the samples were studied under an optical microscope. We identified groups of cells or epidermal tissues in 45% of the Touhy G-16 samples and in 30% of the Touhy G-17 samples. Squamous epithelial cells were found in 15% of the Quincke G-22 samples and in 30% of the Sprotte G-22 samples. There was a significant difference between the amount of tissue transported by the Touhy needles in comparison with the Quincke (p < 0.01) and Sprotte (p < 0.05) needles. Needles from some manufacturers transport epithelial fragments during lumbar puncture. We believe that better quality control during manufacture of epidural and intradural needles can help to eradicate the rare neurological complications derived from the removal of epithelial cells and their subsequent deposit inside the spinal channel.

In vitro bromodeoxyuridine-labelling of single cell suspensions: effects of time and temperature of sample storage

The present study was aimed to explore how the in vitro BrdUrd-labelling of rat thymocytes might be affected by both the time elapsed between obtaining the sample and the beginning of the labelling (0, 15, 30 or 60 min) and the effect of the temperature of storage (4 degrees C versus room temperature). Single cell suspensions obtained after in vivo labelling with BrdUrd were used as controls. The S phase fraction was calculated by flow cytometry both according to BrdUrd-immunolabelling and DNA content. Immediate incubation with BrdUrd after the sample was obtained resulted in a slight decrease of the proportion of S phase cells analysed either according to DNA content or to BrdUrd-immunolabelling. Regardless of storage-temperature, the S phase fraction decreased in samples kept for 15 min or more before BrdUrd incubation. No BrdUrd-positive cells were detected in samples stored for 60 min at room temperature. This effect was related to temperature since positive cells were found when the samples were kept at 4 degrees C during the same time period. Our results suggest that during in vitro incubation a relative loss of S phase cells exists and that a delay beyond 15 min between obtaining the sample and the in vitro labelling seriously compromises the results of this technique.

Presentation of an acquired factor VIII inhibitor with a muscular haematoma mimicking a deep venous thrombosis in a patient with breast cancer

Acquired haemophilia is a rare disorder that it is associated with several diseases. Patients may present with spontaneous haematomas in different places which can sometimes be fatal. We present a 69-year-old woman with breast carcinoma who developed a factor VIII inhibitor. The initial haemorrhagic event was a spontaneous deep muscular haematoma in the right leg mimicking a deep venous thrombosis. She was successfully treated with prednisone.

[3H]dexamethasone binding activity in liver microsomes is modulated differently by 17 alpha-alkylated androgens and testosterone in vivo

Rat liver microsomes contain a single class of steroid binding sites, capable of binding various glucocorticoids and progesterone. In a previous article, we have described the in vitro interaction of several androgens with this binding site. Unlike natural androgens, the 17 alpha-alkyl derivatives stanozolol and danazol were capable of interacting with this binding site through a negative allosteric pattern. Now, the effects these steroids exert on the microsomal [3H]dexamethasone binding site have been studied in vivo. The administration of a single dose of stanozolol to rats provoked a significant reduction in the microsomal [3H]dexamethasone binding capacity. This effect was maximal two hr after stanozolol administration and persisted for six hr. The restoration of the [3H]dexamethasone binding level after stanozolol administration was dependent on protein synthesis, since it was blocked by the concomitant administration of cycloheximide. None of the other androgens tested (danazol, methyltestosterone, fluoxymesterone, and testosterone propionate) was capable of provoking a similar effect when administered 2 or 24 hr prior to sacrifice. In rats treated for seven days with a daily dose of diverse androgens and sacrificed 24 hr after the last treatment, none of the 17 alpha-alkyl androgens assayed provoked significant changes in the microsomal [3H]dexamethasone binding level, although stanozolol, danazol, and methyltestosterone provoked a significant increase in glucocorticoid receptor concentration. In contrast, the administration of testosterone propionate provoked a 50% reduction in the [3H]dexamethasone binding level without causing changes in the glucocorticoid receptor concentration. These results provide new evidence on the existence of different effects on the liver of 17 alpha-alkyl androgens, compared to the effects produced by natural androgens.

[Gastric emphysema associated with gastric volvulus]

The gastric volvulus is an infrequent entity requiring surgical treatment in both the acute and chronic cases. The case of an 81-year old female patient attended for an episode of gastric obstruction caused by a volvulus and whose simple stomach radiography showed an image of gastric emphysema is reported. The possible causes of gastric emphysema and its differential diagnosis with emphysematous gastritis are discussed.

[Complications of ultrasound-guided transperineal puncture biopsy of the prostate]

Between June 1988 and February 1993, 520 ultrasound-guided transperitoneal prostate biopsy punctures were performed in patients with prostate disease. Of these, 89 (17.1 %) were positive for malignancy. An analysis is made of the highly uncommon complications observed, which corresponded to 17 cases of haematuria (3.26%) and 3 of fever (0.5%). Likewise, reference is made to perineal neoplastic implantation, since such complication was evident in one of the cases contributed (0.19%). Also, a review of the literature relative to the complications is made, concluding by stating the relevance of this diagnostic technique in spite of said complications.

Spatial interaction between neighbouring counties: cancer mortality data in Valencia Spain

The statistical analysis of geographical mortality data has usually been approached via regression models that include appropriate covariates. These models assume stochastic independence of mortality counts for neighbouring sites, a questionable assumption that spatial automodels (Besag, 1974, Journal of the Royal Statistical Society, Series B 36, 192-236) make unnecessary. This paper presents the use of the autopoisson distribution in order to detect spatial interaction between neighbouring sites. If this interaction results in being nonsignificant, the auto-Poisson distribution reduces to a usual Poisson regression model, a particular case of generalized linear models (McCullagh and Nelder, 1989, Generalized Linear Models, 2nd edition. London: Chapman and Hall) which can be analyzed with the GLIM package.

The diversity principle in the testing of arguments

According to the diversity principle of scientific reasoning, hypotheses receive greater confirmation when they are supported by diverse rather than similar sets of data. This article examines whether people reason like intuitive scientists by conforming to the diversity principle in the testing of arguments. The results of two experiments demonstrate that people do indeed conform to the diversity principle by choosing a set of diverse rather than similar premises to test the conclusion of an argument. These findings are discussed in terms of the different reasoning processes involved in argument evaluation, argument testing, and rule discovery.

Adult respiratory distress syndrome in a dog with necrotizing pancreatitis

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