Ebstein's anomaly, atrial paralysis and atrio-ventricular block: an uncommon association

We report here the case of a 22-year-old female patient with an incomplete Ebstein's anomaly, complete heart block and atrial standstill. Atrial paralysis associated with Ebstein's anomaly is the most important feature, since there is a report of familial Ebstein's anomaly associated with atrial standstill but isolated cases have not been described. The patient presented with atypical chest pain and a symptomatic bradycardia of 37 beats per minute. A VVIR pacemaker was implanted. She has subsequently been symptom free.

Extra-gastrointestinal stromal tumour--semiology and clinical therapy peculiarities

The gastrointestinal stromal tumor with extragastrointestinal location are very infrequent. We often diagnose them when they show a big size. Their bening or malignant nature is difficult to fix. The best histological parameters to evaluate their prognosis are a high cellularity, the tumor-like necrosis presence and having more than two mitosis per fifty high-power fields. We introduce an asyntomatic patient's case by a routine echographical control for chronic hepatitis by C virus, that has been diagnosed of a mesentery tumor. The patient has been treated surgically. The inmunohistological study of the tumor had confirmed a stromal gastrointestinal tumor. The showed case's analysis and the considered bibliography suggest some clinical discoveries characteristic of this entity. The histogenesis of these neoplasias are examined and made up to date and the usefulness of the new medication to control check the tumor-like progress is emphasized.

Hierarchical analysis of genetic structure in Spanish donkey breeds using microsatellite markers

The hierarchical population structure of five, native-Spanish donkey breeds (Andaluza, Catalana, Mallorquina, Encartaciones and Zamorano-Leonesa) has been studied using F-statistics. In addition, nine Moroccan asses and 24 Merens breed horses were included in the analysis. Data came from 15 DNA microsatellites. The analysis shows that Spanish donkeys are substructured at both hierarchical levels studied, among breeds and within breeds (between subpopulations). In the whole population, the deficit of heterozygotes was estimated to be about 21%. The fixation indices corresponding to differences between breeds, subpopulations within breeds, and within subpopulations were estimated to be 6.4%, 3.5% and 3.0%, respectively. The dendrogram obtained shows that the Andaluza and the Moroccan ass form a separate cluster from the northern Spanish breeds (Catalana, Encartaciones, Mallorquina and Zamorana-Leonesa). These groupings coincide with those obtained from historical and archaeological data.

Multiple cell cycle regulator alterations in Richter's transformation of chronic lymphocytic leukemia

To investigate the role of the cell cycle regulators p21(Waf1), p27(Kip1), retinoblastoma (Rb), and cyclin D1 in Richter's transformation of chronic lymphocytic leukemia (CLL), we analyzed 19 CLL and eight Richter's syndrome (RS) tumors, previously characterized for p53 and ARF/INK4a abnormalities. p21(Waf1)immunohistochemical expression was negative in 12 of 15 CLL (80%), whereas it was moderate or strong in three of seven RS (43%). p21(Waf1) gene was in germline configuration in all the tumors analyzed. Four immunohistochemical patterns of p53 and p21(Waf1) expression were observed: (1) p53-/p21- in 10 of 15 CLL (67%), but only in two of six RS (33%); (2) p53+/p21+ in three CLL (20%) and two RS (33%); (3) p53-/p21+ in one RS; and (4) p53++/p21- in two CLL and one RS. Two p53+/p21+ CLL evolved into RS. p53 mutations clustered around the p53++/p21- (two CLL and one RS) and p53-/p21- (one CLL and one RS) tumors. While the majority of CLL displayed strong p27 immunoreactivity, RS tumors were constantly p27-negative. p27(Kip1) gene was in germline configuration in all the tumors analyzed. Most CLL cases were negative for Rb expression. In contrast, all RS exhibited strong Rb expression. Cyclin D1 overexpression was only detected in one CLL evolving into RS and one RS. In conclusion, a p53+/p21- immunohistochemical pattern is shown exclusively by p53-mutated CLL/RS. Additionally, our results suggest a possible implication of moderate/strong p21(Waf1) expression, loss of p27 expression, and cyclin D1 overexpression in the Richter's transformation of CLL.

Longitudinal study of periodontal condition in students of the Dental School the University of Buenos Aires Argentina

The aim of the present study was to describe, clinically and radiographically, the gingivoperiodontal condition of students (young adults) entering the Dental School and reassess it 2 years later. Four hundred and seventy-five students, 147 male and 328 female (mean: 19.66 years) were studied (Initial examination: IE); two years later, 240 students 76 male and 164 female were reevaluated (Final examination: FE). The clinical examination include Plaque Index (P1I), Gingival Index (GI), Bleeding on Probing (BOP), Probing Pocket Depth (PPD), and Attachment Level (AL). Alveolar bone level was measured on bite wing radiographs. At the IE, 46.5% of the sites had no visual signs of inflammation and 65.3% did not bleed on probing, however 91% of the students had at least one site with BOP. (Prevalence). Of the total sites probed 99.47% had crevices between 1 to 4 mm. 92% had AL between 0 to 1 mm. And only 7.9% had AL > 1 mm. 49.6% of the students had at least one site with AL > 1 mm. Prevalence of alveolar bones loss > 2 mm. was 2.95% and in no case measurements exceeded 3 mm. Distal of teeth 16 and 36 showed the highest P1I, GI, PPD and AL, therefore these teeth showed the highest risk of pathology in the population studied. In the final examination 70.5% of the sites had GI 0 and 73% did not bleed on probing. 90.4% of the students had at least one site with BOP. No statistically significant difference in PPD nor in AL was found between IE and FE. In this population of young adults prevalence of gingivitis was high but severity was low. Prevalence of loss of attachment was near 50% but only 7.9% of the sites had AL > 1 mm. After studying dentistry for two years the prevalence of gingivitis was similar but the severity was lower. Periodontal condition was not substantially modified.

Comparative activity of linezolid and other new agents against methicillin-resistant Staphylococcus aureus and teicoplanin-intermediate coagulase-negative staphylococci

The activity of linezolid was determined against 225 recently isolated methicillin-resistant Staphylococcus aureus (MRSA) and 20 methicillin-resistant coagulase-negative staphylococci (CoNS) with decreased levels of susceptibility to teicoplanin. Linezolid activity was compared with other new agents (quinupristin-dalfopristin, trovafloxacin, moxifloxacin, levofloxacin and telithromycin) and six other antimicrobials (erythromycin, clindamycin, gentamicin, vancomycin, teicoplanin and rifampicin). The in vitro activity of linezolid was similar to that of vancomycin. Linezolid inhibited all MRSA strains at between 0.1 and 2 mg/L and all CoNS strains tested at between 0.2 and 0.5 mg/L. These results suggest that linezolid would be useful for the treatment of infections involving these organisms.

Eosinophilic gastroenteritis: our recent experience: one-year experience of atypical onset of an uncommon disease

Eosinophilic gastroenteritis is an unusual entity that is rarely found in daily clinical practise. Its aetiology is unknown and diagnosis can be made microscopically with evidence of massive eosinophilic infiltration in patients with chronic gastrointestinal symptoms, excluding entities that may cause such findings (parasitic infestation, medical therapy, inflammatory bowel disease, and so on). Allergic processes are usually associated and these normally respond well to steroids. We present our last year's experience of four women with eosinophilic gastroenteritis with an extraordinary atypical clinical onset. Two of the women presented with an acute abdomen and two with isolated colonic involvement. The management of acute abdomen avoiding surgery and a complete response with azathioprine are the outstanding variables that make our recent cases of special interest. Demographic variables were similar to others reported from our medium, with the exception of a higher incidence of women. Our cases suggest the wide spectrum of clinical presentations and show the high suspicion index needed for a diagnosis that is made by pathologists.

Bioaccumulation of palladium, platinum and rhodium from urban particulates and sediments by the freshwater isopod Asellus aquaticus

The three-way catalytic converters introduced to oxidize and reduce gaseous automobile emissions represent a source of platinum group elements (PGEs), in particular platinum, palladium and rhodium, to the urban environment. Abrasion of automobile exhausts leads to an increase of the concentration of PGEs in environmental matrices such as vegetation, soil and water bodies. The bioaccumulation of Pd, Pt and Rh by the freshwater isopod Asellus aquaticus was studied in natural ecosystems and under laboratory conditions. Owing to the low concentration level (ng g(-1)) of PGEs in the animals studied. analyses were performed with a quadrupole inductively coupled plasma mass spectrometry (ICP-MS) and hafnium, copper, yttrium, rubidium, strontium and lead were monitored for spectral interference correction. Asellus aquaticus collected in an urban river showed a content (mean +/- s) of 155.4 +/- 73.4, 38.0 +/- 34.6, and 17.9 +/- 12.2 ng g(-1) (dry weight) for Pd, Pt and Rh, respectively. The exposure of Asellus aquaticus to PGE standard solutions for a period of 24h give bioaccumulation factors of Bf: 150, 85, and 7 for Pd, Pt and Rh, respectively. Exposure of Asellus aquaticus to environmental samples for different exposure periods demonstrated that PGE bioaccumulation is time dependent. and shows a higher accumulation for the materials with a higher PGE content. While all three elements have the same uptake rate for exposure to catalyst materials, for exposure to environmental materials they havc a different uptake rate which can be attributed to transformations of the PGE species in the environment.

Alzheimer's disease and the cystatin C gene polymorphism: an association study

Cystatin C is an amyloidogenic protein that colocalizes with beta-amyloid (Abeta) within arteriolar walls in Alzheimer disease (AD) brains. Recently, a coding polymorphism in the cystatin C gene (CST3) has been claimed to confer risk for the development of late-onset AD. In the present work we have tested the frequencies of CST3-A and CST3-G alleles and used chi-square and logistic regression analyses to assess the association among the CST3 polymorphism, apolipoprotein E4 (APOE4), and AD in a series of 159 AD patients and 155 controls. The CST3-A allele was seen to be an accumulation risk factor for early-onset AD. Furthermore, a synergistic association among the CST3-A allele, APOE4 and AD was found in AD patients whose ages were between 60 and 74 years.

Improved cardiac function in patients with obstructive jaundice after internal biliary drainage: hemodynamic and hormonal assessment

OBJECTIVE

To investigate myocardial function in patients with obstructive jaundice before and after internal biliary drainage.

SUMMARY BACKGROUND DATA

Increased plasma levels of atrial natriuretic peptide (ANP) have been found in patients with biliary obstruction.

METHODS

Thirteen patients with newly diagnosed obstructive jaundice and no previous heart, lung, or renal disease were studied using a Swan-Ganz catheter. Hemodynamic measurements were taken before and 4 days after internal biliary drainage. Levels of ANP and brain natriuretic peptide (BNP) were obtained and liver function tests were also determined.

RESULTS

Plasma levels of ANP and BNP were increased twofold to fourfold in the basal state and declined after biliary drainage. Independent variables predicting left ventricular systolic work were total bilirubin concentrations, duration of jaundice, and BNP. In addition, bilirubin concentrations correlated with pulmonary vascular resistance, mean arterial pulmonary pressure, and right ventricular systolic work. Internal biliary drainage resulted in an improvement in left ventricular systolic work. A correlation was found between decreasing ANP concentrations and increasing cardiac output.

CONCLUSIONS

Increased plasma levels of natriuretic peptides in patients with obstructive jaundice may reflect a subclinical myocardial dysfunction correlating with the degree of jaundice. After internal biliary drainage, there is a measurable improvement of cardiac function.

[Carcinoid syndrome: report of a case with heart involvement and primary ovarian tumor]

A patient with a primary ovarian carcinoid tumor with extensive carcinoid heart disease, without hepatic metastases is presents. Literature was revisited, emphasizing that carcinoid heart disease secondary to an ovarian tumor is quite rare. Surgical indications relative to this patient are discussed.

Cadmium-induced changes in the growth and oxidative metabolism of pea plants

The effect of growing pea (Pisum sativum L.) plants with CdCl(2) (0-50 microM) on different plant physiological parameters and antioxidative enzymes of leaves was studied in order to know the possible involvement of this metal in the generation of oxidative stress. In roots and leaves of pea plants Cd produced a significant inhibition of growth as well as a reduction in the transpiration and photosynthesis rate, chlorophyll content of leaves, and an alteration in the nutrient status in both roots and leaves. The ultrastructural analysis of leaves from plants grown with 50 microM CdCl(2), showed cell disturbances characterized by an increase of mesophyll cell size, and a reduction of intercellular spaces, as well as severe disturbances in chloroplast structure. Alterations in the activated oxygen metabolism of pea plants were also detected, as evidenced by an increase in lipid peroxidation and carbonyl-groups content, as well as a decrease in catalase, SOD and, to a lesser extent, guaiacol peroxidase activities. Glutathione reductase activity did not show significant changes as a result of Cd treatment. A strong reduction of chloroplastic and cytosolic Cu,Zn-SODs by Cd was found, and to a lesser extent of Fe-SOD, while Mn-SOD was only affected by the highest Cd concentrations. Catalase isoenzymes responded differentially, the most acidic isoforms being the most sensitive to Cd treatment. Results obtained suggest that growth of pea plants with CdCl(2) can induce a concentration-dependent oxidative stress situation in leaves, characterized by an accumulation of lipid peroxides and oxidized proteins as a result of the inhibition of the antioxidant systems. These results, together with the ultrastructural data, point to a possible induction of leaf senescence by cadmium.

[Safety and efficacy of an early deambulation protocol after PTCA with an angio-seal device]

INTRODUCTION

In order to assess the efficacy and safety of an early deambulation (1-2 h) protocol after coronary angioplasty using the Angio-seal collagen plug, we analyzed a consecutive series of patients treated with this device versus a reference group treated with mechanical compression.

PATIENTS AND METHODS

Two hundred and seven coronary angioplasty patients were included from February to August 2000. Ninety-eight were treated with mechanical compression and one hundred and nine with the Angio-seal collagen plug. All patients were followed at discharge and fifteen days after surgery.

RESULTS

Eighty percent of the patients receiving the Angio-seal device achieved immediate hemostasis (< 1 min). In patients with mechanical compression hemostasis was achieved within 30 min in 68.3%, whereas 25.5% of patients required more than 40 min. First deambulation in the Angio-seal group was achieved within 2 h in 94.5% of the patients. The incidence of major complications was low in both groups (1 case in the Angio-seal group and 2 in the C-clamp group) without statistically significant differences. The Angio-seal group showed a lower incidence of overall vascular complications as compared to the C-clamp group (4.6% vs. 14.3%; p = 0.02).

CONCLUSION

Following our protocol, an early deambulation strategy after coronary angioplasty with the use of the Angio-seal collagen plug was feasible, safe and efficacious.

Chemical mechanism of beta-xylosidase from Trichoderma reesei QM 9414: pH-dependence of kinetic parameters

The variation of kinetic parameters of beta-xylosidase from Trichoderma reesei QM 9414 with pH was used to elucidate the chemical mechanism of the p-nitrophenyl beta-D-xylopyranoside hydrolysis. The pH-dependence of V and V/K(m) showed that a group on the enzyme with a pK value of 3.20 must be unprotonated and a group with a pK value of 5.20 must be protonated for activity and both are involved in catalysis. Solvent-perturbation studies indicated that these groups are neutral acid type. Temperature dependence of kinetic parameters suggested the stickiness of the substrate at lower temperatures than the optimum and the calculated ionization enthalpies pointed to carboxyl groups as responsible for both pKs. Chemical modification with triethyloxonium tetrafluoroborate and protection with the substrate studies demonstrated essential carboxyl groups on the enzyme. Profiles of pK(i) for D-gluconic acid lactone indicated that a group with a pK value of 3.45 must be protonated for binding and it has been assigned to the carboxyl group of D-gluconic acid formed by lactone ring breakdown in solution.

Melatonin versus vitamin E as protective treatment against oxidative stress after extra-hepatic bile duct ligation in rats

The aims of the present study were first to compare the effects of melatonin and vitamin E on the cholestasis syndrome and their protective effect on liver injury, and second, to evaluate the activity of antioxidant enzymes after treatment with these antioxidant drugs. Cholestasis was achieved in adult male Wistar rats by double ligature and section of the extra-hepatic biliary duct. Hepatic and plasma oxidative stress markers were evaluated by changes in the amount of lipid peroxides, measured as malondialdehyde (MDA) and reduced glutathione (GSH) in plasma and homogenates of hepatic tissue. Serum bilirubin, alkaline phosphatase (AP), and gamma-glutamyl-transpeptidase (GGT) were used to evaluate the severity of cholestasis, and serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were used to evaluate the hepatic injury. Both vitamin E and melatonin were administrated 1 day before and 7 days after bile duct ligation. Acute ligation of the bile duct was accompanied by a significant increased in MDA and a decrease in GSH levels in both plasma and liver, as well as a significant reduction in antioxidant enzymes activities. The overall analysis of both treatments showed that melatonin (500 microg/kg daily) offered significantly better protection against cholestasis and a superior protective effect on hepatic injury than did vitamin E (15 mg/kg daily). Although vitamin E treatment resulted in a reduction of parameters of oxidative stress, the results were significantly better after a much lower daily dose of melatonin. Moreover, melatonin treatment was associated with a significant recovery of antioxidative enzymes. In conclusion, the present paper demonstrates a correlation between the intensity of biliary tract obstruction and increased free radical generation, as well as a direct correlation between the level of oxidative stress and the biochemical markers of liver injury. Melatonin (at a much lower dose than vitamin E) was much more efficient than vitamin E in reducing the negative parameters of cholestasis, the degree of oxidative stress and provided a significantly greater hepatoprotective effect against the liver injury secondary to the acute ligation of the biliary duct.

In vitro activities of MK-0826 and 16 other antimicrobials against Bacteroides fragilis group strains

The activity of MK-0826, a new carbapenem, against 309 Bacteroides fragilis group strains was investigated and compared with that of 11 other beta-lactam and 5 non-beta-lactam agents. MK-0826 showed excellent activity (MICs ranged from < or =0.06 to 4 microg/ml). The new carbapenem may be useful in the treatment of mixed anaerobic infections involving B. fragilis group strains.

Allogenic stem cell transplantation as salvage therapy for patients relapsing after autologous transplantation: experience from a single institution

The prognosis of patients relapsing after an autologous transplant (autoSCT) is very poor. Allogenic stem cell transplantation (alloSCT) offers the possibility of curing some of these patients, at the cost, however, of a high transplant related mortality (TRM). The aim of this study was to analyze the outcome of 14 consecutive patients with hematologic malignancies, from a single institution, who underwent alloSCT for progressive disease after autoSCT. Patients had relapsed at a median of 11.5 months (range 2-72) after autoSCT and they underwent alloSCT at a median of 25.5 months (range 7-73) from the first transplant. Ten patients received HLA-identical related peripheral blood progenitor cells, three patients underwent matched-unrelated donor marrow transplants, and one patient received a mismatched related transplant. Conditioning regimens consisted of total body irradiation plus cyclophosphamide (n=5) or melphalan (n=1), or high-dose combination chemotherapy (n=8). Cyclosporin A and methotrexate were administered as graft-versus-host disease (GVHD) prophylaxis. Eight patients (57%) developed grade II-IV acute GVHD. All evaluable patients (n=6) presented extensive chronic GVHD. Overall survival at 1 year was 16% (median 3.5 months, 95% CI 0.7-10.3). Ten patients (71%) died from transplant related complications at a median of 3.5 months (range 0.7-11). Only one patient died of recurrent disease. Three patients remain alive and in complete remission at the time of this report (4, 20 and 20 months, respectively). In conclusion, alloSCT offers the possibility of a sustained control of the disease in some patients who relapse after an autoSCT. However, the procedure is associated with a high transplant-related mortality. Better results might be obtained by carefully selecting patients and by reducing the intensity of the preparative regimen.

The CD4 T cell-deficient mouse mutation nackt (nkt) involves a deletion in the cathepsin L (CtsI) gene

We recently reported a novel autosomal recessive mouse mutation designated nackt (nkt). Homozygous mutant mice have diffuse alopecia and a marked reduction in the proportion of CD4+ T cells in the thymus and peripheral lymphoid tissues. Here we show that the CD4 T-cell deficiency is due to a defect in the thymic microenvironment rather than the hematopoietic compartment. Furthermore, we identified the molecular basis of the mutant phenotype by demonstrating that the nkt mutation represents a 118-bp deletion of the cathepsin L (Ctsl) gene which is required for degradation of the invariant chain, a critical chaperone for major histocompatibility complex class II molecules. This finding explains the similarities in skin and immune defects observed in nkt/nkt and Ctsl -/- mice. The data reported here provide further in vivo evidence that the lysosomal cysteine protease cathepsin L plays a critical role in CD4+ T-cell selection in the thymus.