Endothelial Dysfunction and Cardiovascular Risk in Obstructive Sleep Apnea: A Review Article

Obstructive sleep apnea (OSA) is a respiratory condition during sleep caused by repeated pauses in breathing due to upper airway obstruction. It is estimated that OSA affects 30% of the population, but only 10% are well diagnosed due to the absence of a well-defined symptomatology and poor screening tools for early diagnosis. OSA is associated to an endothelial dysfunction inducing several biological responses such as hypoxia, hypercapnia and oxidative stress, among others. OSA also triggers respiratory, nervous, metabolic, humoral and immunity system activations that increase the possibility of suffering a cardiovascular (CV) disease. In this review, we expose different studies that show the relationship between OSA and endothelial dysfunction and its association with CV pathologies like hypertension, and we define the most well-known treatments and their limitations. Additionally, we describe the potential future directions in OSA research, and we report clinical features such as endothelial progenitor cell alterations that could act as biomarkers for the development of new diagnostic tools and target therapies.

Integrating ecotoxicity and chemical approaches to compare the effects of ZnO nanoparticles, ZnO bulk, and ZnCl2 on plants and microorganisms in a natural soil

This work compared the toxicity of ZnO nanoparticles (ZnO-NPs), ZnO bulk, and ZnCl2 on microbial activity (C and N transformations and dehydrogenase and phosphatase activities) and their uptake and toxic effects (emergence, root elongation, and shoot growth) on three plant species namely wheat, radish, and vetch in a natural soil at 1000 mg Zn kg(-1). Additionally, plants were also tested at 250 mg Zn kg(-1). The effects of the chemical species on Zn extractability in soil were studied by performing single and sequential extractions. ZnCl2-1000 presented the highest toxicity for both taxonomic groups. For microorganisms, ZnO-NPs demonstrated adverse effects on all measured parameters, except on N transformations. The effects of both ZnO forms were similar. For plants, ZnO-NPs affected the growth of more plant species than ZnO bulk, although the effects were small in all cases. Regarding accumulation, the total Zn amounts were higher in plants exposed to ZnO-NP than those exposed to ZnO bulk, except for vetch shoots. The soil sequential extraction revealed that the Zn concentration in the most labile forms (water soluble (WS) and exchangeable (EX)) was similar in soil treated with ZnO (NP and bulk) and lower than that of ZnCl2-treated soil, indicating the higher availability of the ionic forms. The strong correlations obtained between WS-Zn fraction and the Zn concentrations in the roots, shoots, and the effects on shoot weight show the suitability of this soil extraction method for predicting bioavailable Zn soil for the three plant species when it was added as ZnO-NPs, ZnO bulk, or ZnCl2. In this work, the hazard associated with the ZnO-NPs was similar to ZnO bulk in most cases.

Toxicity of ZnO nanoparticles, ZnO bulk, and ZnCl₂ on earthworms in a spiked natural soil and toxicological effects of leachates on aquatic organisms

The present study assessed the uptake and toxicity of ZnO nanoparticles (NPs), ZnO bulk, and ZnCl₂ salt in earthworms in spiked agricultural soils. In addition, the toxicity of aqueous extracts to Daphnia magna and Chlorella vulgaris was analyzed to determine the risk of these soils to the aquatic compartment. We then investigated the distribution of Zn in soil fractions to interpret the nature of toxicity. Neither mortality nor differences in earthworm body weight were observed compared with the control. The most sensitive end point was reproduction. ZnCl₂ was notably toxic in eliminating the production of cocoons. The effects induced by ZnO-NPs and bulk ZnO on fecundity were similar and lower than those of the salt. In contrast to ZnO bulk, ZnO-NPs adversely affected fertility. The internal concentrations of Zn in earthworms in the NP group were greater than those in the salt and bulk groups, although bioconcentration factors were consistently <1. No relationship was found between toxicity and internal Zn amounts in earthworms. The results from the sequential extraction of soil showed that ZnCl₂ displayed the highest availability compared with both ZnO. Zn distribution was consistent with the greatest toxicity showed by the salt but not with Zn body concentrations. The soil extracts from both ZnO-NPs and bulk ZnO did not show effects on aquatic organisms (Daphnia and algae) after short-term exposure. However, ZnCl₂ extracts (total and 0.45-μm filtered) were toxic to Daphnia.

Behavior of zinc from six organic fertilizers applied to a navy bean crop grown in a calcareous soil

The objective of this study was to compare the mobility, leaching, availability, and relative effectiveness of Zn from Zn-polyhydroxyphenylcarboxilate (Zn-PHP), Zn-HEDTA (Zn-N-2-hydroxyethyl-ethylenediaminetriacetate), Zn-EDDHSA [Zn-ethylenediamine-di-(2-hydroxy-5-sulfophenylacetate)], Zn-EDTA (Zn-ethylenediaminetetraacetate), Zn-S,S-EDDS (Zn-ethylenediaminedisuccinate), and Zn-EDTA-HEDTA sources by applying different Zn rates (5 and 10 mg kg(-1)) to a calcareous soil under greenhouse conditions. A lysimeter experiment was carried out for 60 days and using navy bean (Phaseolus vulgaris L.) as an indicator plant. The Zn available to the plant and easily leachable Zn were determined in soil by different single extractions, while the distribution of Zn in the soil was assessed by sequential speciation. The utilization of applied Zn by the navy bean was greatest when the Zn treatments were Zn-EDTA, Zn-EDTA-HEDTA, Zn-HEDTA, and Zn-EDDHSA. Both total Zn in the plants and soluble Zn in the plant dry matter (extracted with 1 mM 2-morpholino-ethanesulfonic acid) were positive and significantly correlated with the following: the amounts of Zn extracted with the three single extractions used to estimate soil available Zn and the amounts of Zn in the water soluble plus exchangeable and organically complexed fractions. The Zn-HEDTA, Zn-EDDHSA, Zn-EDTA-HEDTA, Zn-S,S-EDDS, and Zn-EDTA sources significantly increased the mobility of micronutrients through the soil with respect to the control and Zn-PHP source. The maximum Zn concentration obtained in the leachate fractions was 65 mg L(-1) (13% of Zn applied) for the Zn-S,S-EDDS chelate applied at a rate of 10 mg Zn kg(-1) soil. In the course of the crop, the soil pH + pe parameter increased significantly with experimental time.

Review article: colorectal cancer surveillance in ulcerative colitis - what should we be doing?

Different societies have published guidelines for colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While it would seem that most gastroenterologists and endoscopists agree with these guidelines, different studies have shown that in clinical practice, the concept of dysplasia is not fully understood, and therefore, the guidelines are not always followed. According to some studies, the reason why gastroenterologists do not follow the recommendations is inadequate education. The main advance in recent years in this subject is in endoscopic diagnosis of dysplasia. The magnification and chromoendoscopy allow targeted biopsies to be taken. Some studies indicate that nontargeted biopsies are not useful in ruling out dysplasia. It is also important to realize that most dysplasia is visible in conventional colonoscopy. In colonoscopy, it is not only significant to detect dysplasia-associated lesions or masses; the endoscopist should also be trained to detect, in the course of conventional exploration, subtle changes in colour or in mucosal surfaces that imply dysplasia. Adherence to guidelines had been extensively assessed in other disease conditions (asthma, hypertension, etc.). According to our knowledge there are no such data regarding CRC surveillance in UC. Some barriers that may affect physicians include: (i) knowledge (lack of awareness or lack of familiarity); (ii) attitudes (lack of agreement, lack of self-efficacy, lack of outcome expectancy, or the inertia of previous practice) and (iii) behaviour (external barriers). In conclusion, we need new guidelines for CRC surveillance in UC, which must take into account the advances in risk factors of dysplasia and new technologies to study colon dysplasia.

[Implantation of a hospital registry of hereditary nonpolyposis colorectal cancer]

INTRODUCTION

Identification of patients with hereditary nonpolyposis colorectal cancer (HNPCC) can allow colorectal cancer (CRC) prevention through colonoscopy and polypectomies. The purpose of this study was to report the clinical characteristics of HNPCC families in our registry.

PATIENTS AND METHOD

HNPCC was identified using the Amsterdam criteria. Familial clustering of CRC and extracolonic cancers were investigated in families. Individuals at risk were offered annual colonoscopy, starting from the age of 25 years.

RESULTS

Twelve HNPCC families were identified. There were 46 cases of CRC in 38 patients. The mean age at diagnosis of CRC was 45.4 +/- 12.7 years (range 25-73 years). In patients with documented disease, right-sided tumors predominated. Eleven patients with extracolonic cancer were identified (six tumors located in the endometrium). Of 43 at-risk individuals, 29 accepted surveillance.

CONCLUSIONS

Our data confirm the importance of the family history in identifying HNPCC. This study confirms previously described characteristics in HNPCC, namely, early age at onset of CRC, right-sided predominance, multiple synchronous and metachronous neoplasms, and increased extracolonic cancers. This is the first study of clinical data in a Spanish HNPCC registry.

Prevalence of HFE C282Y and H63D in Jewish populations and clinical implications of H63D homozygosity

The frequencies of C282Y and H63D mutations of the HFE gene vary between different populations. A previous study showed an unexpectedly high H63D frequency in Chuetas (a population of Jewish descent). The present study addressed the question of the distribution of these mutations in Jewish populations from different origins and studied the possible causes of the high H63D frequency in Chuetas. Moreover, to improve the understanding of the controversial relationship between H63D homozygosity and iron overload, a group of patients with altered iron metabolism were studied. The high frequency of H63D mutation in Chuetas is not due to a high prevalence of this mutation in Sephardic Jews. Jewish populations have low C282Y and moderate H63D frequencies, suggesting slight gene flow from their surrounding populations. In accordance with historical and demographic data, genetic drift is the most probable cause for the singular H63D frequency in Chuetas. Clinically, this study of H63D homozygotes supports the conclusion that this genotype must be taken into account, because it confers an increased risk of iron overload and therefore genetic susceptibility to developing hereditary hemochromatosis or to aggravating other diseases.

Granulocyteaphaeresis in steroid-dependent inflammatory bowel disease: a prospective, open, pilot study

BACKGROUND

Uncontrolled studies suggest that granulocyteaphaeresis might be useful in the management of active ulcerative colitis.

AIM

To assess the efficacy of granulocyteaphaeresis treatment in active steroid-dependent inflammatory bowel disease.

METHODS

We conducted a multicentre, prospective, open, pilot study in patients with steroid-dependent inflammatory bowel disease. All patients were started on 60 mg/day of prednisone; after 1 week, a five-session programme of granulocyteaphaeresis (once per week) was started. The steroid dose was tapered weekly if there was clinical improvement. Remission was defined as an inactive clinical activity index together with complete withdrawal of steroids at week 6. The patients were followed up for at least 6 months or until disease relapse.

RESULTS

Twenty-six patients (14 ulcerative colitis, 12 Crohn's disease) were included. More than a half had been previously treated with immunomodulators. Remission was achieved in 62 and 70% of ulcerative colitis and Crohn's disease, respectively. During a median follow-up of 12.6 months, six of eight ulcerative colitis patients maintained their clinical remission; however, only one Crohn's disease patient remained in remission after the first 6 months of follow-up.

CONCLUSIONS

Granulocyteaphaeresis is a safe treatment option in inflammatory bowel disease. A five-session programme of granulocyteaphaeresis seems to be efficient in the treatment of steroid-dependent ulcerative colitis, but not in Crohn's disease.

[Lactose malabsorption in ulcerative colitis. A case-control study]

BACKGROUND

The role of lactose malabsorption in ulcerative colitis is controversial. The aim of this study was to compare the prevalence of lactose malabsorption in a group of ulcerative colitis patients and a control group and to modify lactose consumption in view of the results.

METHODS

Lactose malabsorption was studied using the hydrogen breath test in 52 patients with ulcerative colitis and 34 controls after ingestion of 25 g of lactose. A questionnaire on ingestion of milk products was also administered.

RESULTS

Of the 52 patients with ulcerative colitis, 13 (25%) presented lactose malabsorption compared with 11 of the 34 (32%) controls (p = 0.45). Twenty-four patients (46%) had been advised to completely eliminate lactose from their diets. Twenty-seven of the 39 patients without malabsorption had reduced or eliminated lactose consumption after being diagnosed with ulcerative colitis.

CONCLUSIONS

No significant differences in the prevalence of lactose malabsorption was found between patients with ulcerative colitis and controls. We believe that systematic elimination of lactose from the diets of these patients is erroneous. In our environment, we recommend the hydrogen breath test only in patients with symptoms of lactose intolerance.

In hereditary hemochromatosis, red cell apheresis removes excess iron twice as fast as manual whole blood phlebotomy

The current treatment of hereditary hemochromatosis (HH) consists of performing periodic manual whole blood phlebotomies. Erythroapheresis (EPH) is considered to be an alternative procedure if the classic treatment is contra-indicated. A prospective study of 13 consecutive cases of HH were included in a periodic EPH program with the aim of assessing the efficacy, feasibility, and tolerability of EPH in the treatment of HH by induction and maintenance. Iron depletion (ferritin <20 microg/l) was achieved in all patients after a mean of 6.7 +/- 2.9 months of treatment and a mean of 13.5 +/- 7.2 EPH sessions. The procedure was well tolerated and there were no complications. After a follow-up period of 10.5 +/- 6.6 months, only four patients have required further maintenance sessions beyond 6 months after completing the induction therapy. The efficacy, speed, tolerability, and more favorable schedule of an EPH program facilitate treatment of HH.

[Endoscopic management of foreign bodies in the esophagus. Results of a retrospective series of 501 cases]

We present the results of a retrospective study of endoscopic management (with flexible endoscopy) in 501 patients admitted for suspected ingestion of a foreign body between 1977 and 1997. The mean age of the patients was 55.73 19.38. Foreign bodies were found in the esophagus in 322 patients (64.3%) and endoscopic removal was successful in 307 (95.35%). More experienced endoscopists, with more than 45 cases, had a higher success rate (98.1%) than did less experienced endoscopists (87.9%) (p < 0.01). The most frequent type of foreign body in our series was meat bolus (32.8%). Underlying disease was found in 38.9%, and peptic stenosis was the most frequent. The only severe complication found was esophageal perforation in one patient (0.3%). Emergency flexible endoscopy is the most effective method for managing patients admitted for suspected ingestion of a foreign body and for the removal of foreign bodies located in the esophagus.

[Osteomatous jaw lesions in familial adenomatous polyposis]

The first aim of this study is to assess the frequency of osteomatous jaw lesions in patients with a diagnosis of familial adenomatous polyposis (FAP), and a group of FAP-relatives from the FAP registry of Majorca (Balearic Islands, Spain). The second aim is to study the predictive significance of osteomatous jaw lesions in families with FAP. The study included forty-two people. Twenty-five patients and seventeen relatives. All individuals underwent pantomography. Osteomatous jaw lesions were diagnosed in 68% of FAP-patients, and 6% of FAP-relatives. The difference was statistically significant (p < 0.001). The sensitivity was 68%, the specificity 94% and positive predictive value 94%. This frequency of osteomatous jaw lesions agree with previous studies of FAP-patients (57-82%), but differ from these of the previous studies of FAP-relatives (16-18%). The available method detect APC (adenomatous polyposis coli) gene mutations in 48-82% of FAP families. In the families without detected mutation, non-informative study or non-available study, the screening is based in seriated sigmoidoscopy and study of the extraintestinals lesions of the FAP syndrome. The frequency of osteomatous jaw lesions in FAP-patients is greater than the observed in FAP-relatives (p < 0.001). Osteomas in families with FAP are of predictive significance.

Zinc transformations in acidic soil and zinc efficiency on maize by adding six organic zinc complexes

Experiments under laboratory and greenhouse conditions were conducted to study the response of maize (Zea mays L.) to Zn fertilizer applications (Zn-phenolate, Zn-EDDHA, Zn-EDTA, Zn-lignosulfonate, Zn-polyflavonoid, and Zn-heptagluconate) in an Aquic Haploxeralf soil. The application of Zn complexes significantly increased Zn uptake by the plant compared with that in the control soil. The highest enhancements were obtained in soil treated with Zn-EDTA, Zn-lignosulfonate, and Zn-EDDHA. The highest percentages of Zn taken up by the plants occurred when 20 mg x kg(-1) Zn was applied as Zn-EDTA fertilizer and 10 mg x kg(-1) as Zn-lignosulfonate fertilizer. In the greenhouse experiment, Zn speciation in soil after harvesting showed that almost all Zn was found in the residual fraction followed by metal in the water-soluble plus exchangeable fraction and metal bound to organic matter. The most effective fertilizers maintaining Zn in the most labile fractions were Zn-phenolate, Zn-EDTA, and Zn-lignosulfonate. Conversely, in the incubation experiment, only a small percentage of Zn was found in the water-soluble plus exchangeable fraction and no differences in the Zn distribution were observed between the different fertilizer treatments. The micronutrient content in maize was positively correlated with the water-soluble plus exchangeable Zn as well as with the available Zn determined by the diethylenetriaminepentaacetic acid and Mehlich-3 methods, in the greenhouse experiment. Results of this study showed that the incubation experiment in acidic soil is not a suitable tool to establish the different effectiveness of Zn chelates in plants.

Distribution of HFE C282Y and H63D mutations in the Balearic Islands (NE Spain)

The HFE gene contains two main missense mutations: C282Y and H63D. Individuals with these mutations carry a risk of developing hereditary haemochromatosis (HH). The common form of this disease is due to homozygosity for the C282Y mutation. Population studies have shown the variation of the prevalence of these mutations in different countries and ethnic groups. The purposes of this current study were to determine the prevalence of the C282Y and H63D mutations in the Balearic Islands and the genotypic characterization of patients diagnosed with HH, as well as those with iron overload and liver diseases. A total of 1330 Balearic chromosomes were analyzed. The results showed that the populations of the Balearic Islands were not homogeneous. No C282Y carriers were observed in a group of descendants of Majorcan Jews (Chuetas) and the frequency was very low in Minorca (1.2%) in comparison with the other islands of Majorca (4.7%) and Ibiza (6.5%). The carrier frequency of the H63D mutation was similar in the three islands and very high (43.1%) in the descendants of Majorcan Jews. The study of patients was carried out in 129 individuals. The homozygous C282Y genotype was the principal one involved in hereditary haemochromatosis (90%), whereas the other HH patients were C282Y/H63D compound heterozygous and H63D homozygous.

[Tropical chronic pancreatitis in a young patient]

Tropical chronic pancreatitis is a form of idiopathic chronic pancreatitis that has not previously been described in Spain. Typically it is related to dietary factors and malnutrition, although genetic factors may also play a significant role in the development of the disease. We report a case of chronic tropical pancreatitis in a 27-year-old woman from the Dominican Republic domiciled in Spain since 1992. The patient was admitted to our hospital for acute pancreatitis that fulfilled the diagnostic criteria (clinical and radiological) for chronic tropical pancreatitis. This case has led us to review this uncommon entity. Because of the increasing number of immigrants from tropical countries, chronic tropical pancreatitis will probably need to be taken into account in the differential diagnosis of chronic pancreatitis in our patients.

Stabilization of blood homocysteine in an epidemiological setting

The major problem in the determination of homocysteine (Hcy), which is thought to be a risk factor in colorectal cancer, is the rise in its concentration if blood is not centrifuged immediately after collection. We assess the interference of 3-deazaadenosine (which inhibits conversion of S-adenosylhomocysteine into Hcy within the erythrocyte), using the fluorescence polarization immunoassay (FPIA) assay, the stabilizing effect of 3-deazaadenosine and the impact of temperature on Hcy stabilization. To assess interference of 3-deazaadenosine, 12 blood samples were extracted; two aliquots were obtained from each and one of them was added 3-deazaadenosine (50 micromol/l). To assess the stabilizing value of 3-deazaadenosine, as well as the effect of temperature, two blood samples were extracted from 24 volunteers. One of the tubes was immediately placed on ice and centrifuged (reference concentration). To the second tube was immediately added 3-deazaadenosine (50 micromol/l), producing six aliquots, three of which were kept at room temperature (25 degrees C) for 1, 4 and 6 hours, the other three kept at 37 degrees C. The mean values (standard deviation) obtained for methodological interference were: 7.32 (3.58) micromol/l without stabilizer, and 7.11 (3.61) micromol/l with stabilizer. There were no statistically significant differences (P = 0.104) and intraclass correlation coefficient was 0.989, suggesting no methodological interference. We did not find any significant differences regarding our reference value in the samples kept at room temperature during the interval studied. A high Pearson correlation coefficient was obtained. Nevertheless, in those samples kept at 37 degrees C, a slight increase was observed in the 4-hour period (P = 0.009). The addition of 3-deazaadenosine may avoid problems in the critical pre-analytical phase in the Hcy measurement. There is no interference with the FPIA assay, nor any dilution effect, and new reference values are not necessary.

Mobility and leachability of zinc in two soils treated with six organic zinc complexes

A study of soil columns was conducted to evaluate Zn movement potential in two reconstructed soil profiles. Zn-phenolate, Zn-EDDHA, Zn-EDTA, Zn-lignosulfonate, Zn-polyflavonoid, and Zn-heptagluconate were applied in the upper zone of the column. The different physicochemical properties of the two soils and the micronutrient source may influence Zn leaching, the distribution of Zn among soil fractions, and the Zn available to the plant in the depth of the layers. In Aquic Haploxeralf soil, the application of six fertilizers produced little migration and very small leaching of Zn in the soil profiles. In Calcic Haploxeralf soil, Zn-EDTA migrated and was distributed throughout the soil columns. This Zn chelate produces a loss of Zn by leaching, which was 36% of the added Zn. In the latter soil, Zn leached very little with the other five fertilizer treatments. The same as for these organic Zn complexes, the retention of added Zn indicated the potential of metal accumulation in the A(p) horizons of the two soil profiles. A large portion of applied Zn was available to plants [diethylenetriaminepentaacetic acid (DTPA) and Mehlich-3 extractable Zn] in the depths reached by the different commercial formulations. The relationship between the two methods was highly significant (Mehlich-3-Zn = 1.25 + 1.13 DTPA-Zn, R(2) = 99.19%). When Zn was added as Zn-EDTA, the amounts of the most labile fractions (water-soluble plus exchangeable and organically complexed Zn) increased throughout the entire profile column in comparison with the control columns, although in the B(t) horizon of the Aquic Haploxeralf soil they increased only slightly.

Influence of thermal treatment on sequential extraction and leaching behaviour of trace metals in a contaminated sewage sludge

The losses of weight and organic matter of a sludge caused by thermal treatments at 180 degrees C, 300 degrees C and 400 degrees C were determined in order to assess how the possibilities of sludge use were influenced. The sludge heated at 180 degrees C lost small amounts of weight and organic matter (9.8%) but the losses from the two other treatments were large enough (92.2% and 99.9% in organic matter) to preclude the use of the sludges as organic amendments. The concentration and potential lability and leachability of Cr, Cu, Fe, Mn, Ni, Pb and Zn in the native sludge and in the thermal-treated sludge samples were studied by means of a five-step chemical fractionation method and a column experiment. As a consequence of heating, the trace metals were more strongly fixed in the treated sludges, as could be seen by the decrease with temperature of the ratio between the sum of the first two sequential-extracted fractions and the residual fraction. The leaching results showed that, for the native sludge, the quantities of studied metals leached were larger than for the sludge heated to 180 degrees C. The order of leachability of metals was the same in both cases, and the same equation could be used to calculate the quantities of metals leached. The amounts of metals leached correlated significantly with the first extracted fraction (exchangeable metals) and an equation could be used to calculate the quantities leached, as a function of that fraction.

Prevalence of the C282Y mutation for haemochromatosis on the Island of Majorca

The C282Y mutation of the HFE gene has been reported to be present in most of the patients with hereditary haemochromatosis (HH) of Northern European ancestry. HH affects approximately 1/300 individuals, but it is not evenly distributed in the different European countries. In the present study, polymerase chain reaction (PCR) and restriction-enzyme digestion were used to analyse the frequency of the most important mutation in haemochromatosis (C282Y) in subjects from Majorca (Balearic Islands, Spain) and patients with haemochromatosis. The results were compared with other studies from Spain and Europe. A total of 420 Majorcan chromosomes were analysed and the C282Y mutation was observed at a frequency of 2.62%+/-0.8 (11 heterozygotes: eight men and three women). In the group of hereditary haemochromatosis probands, 13 out of 14 were homozygous for the C282Y mutation. In the distribution of the C282Y mutation, a north-west to south-east cline was detected, supporting the Celtic origin of this mutation.

Secretory granules of endocrine and chief cells of human stomach mucosa contain leptin

BACKGROUND

Leptin plays an important role in the control of food intake and body weight homeostasis. In humans, leptin is produced by adipocytes, placental cells and secretory cells of the mammary epithelium. Recently, it has been reported that stomach glands produce leptin in rats.

OBJECTIVE

To test the expression of leptin protein in human stomach and localize, by immunocytochemistry, the specific cell type producing leptin.

DESIGN

Endoscopic stomach biopsies of six patients were used to investigate leptin production in the fundic epithelium using reverse transcription polymerase chain reaction (RT-PCR) of RNA. Leptin protein was detected by immunoblot analysis and localized by immunohistochemistry and ultrastructural immunocytochemistry (immunogold method).

RESULTS

Human gastric epithelium expresses leptin mRNA and leptin protein. The cells in the lower half of the stomach glands were immunoreactive for leptin. Ultrastructural immunocytochemistry showed leptin immunoreactivity in the pepsinogen granules of chief cells, but the granules of a specific endocrine cell type in the basal portion of the glands were also positive.

CONCLUSIONS

Our results suggest that gastric leptin could function in the short-term system to control feeding behaviour and is probably secreted in the stomach lumen by chief cells and into the stomach circulation by a special type of endocrine cell.

Combined percutaneous-endoscopic pancreatic pseudocyst drainage--a new technique

Surgical drainage has been the traditional approach to treating pancreatic pseudocysts. Percutaneous and endoscopic treatment of pancreatic pseudocyst were recently suggested as an alternative to surgery. In order to avoid the difficulties that can be observed in some patients in the percutaneous or endoscopic management of pancreatic pseudocysts we have used a combined procedure. We have treated by the "rendezvous" technique two patients suffering from pancreatic fistula complicating pancreatic pseudocysts. A percutaneous-endoscopic approach was used to place an internal stent between the pseudocyst and the duodenum. We have applied the same combined approach to the main pancreatic duct that is usual for bile duct obstruction without noticeable complications. Although application of this technique will be very limited, we advocate in the future the combined approach to treating pancreatic pseudocyst when there is a fistula between the fluid collection and pancreatic duct, and the downstream main pancreatic duct is obstructed, preventing use of the transpapillary approach.

[Epidemiological study on the incidence of inflammatory bowel disease in 4 Spanish areas. Spanish Group on the Epidemiological Study of Inflammatory Bowel Disease]

BACKGROUND

The incidence of inflammatory bowel disease (IBD) shows marked geographical variations. The aim of this study was to determine and compare the incidence of IBD in four Spanish areas: Sabadell (Northeast), Vigo (Northwest), Mallorca island and Motril (South).

PATIENTS AND METHODS

Prospective survey based on inception cohorts over a two-years period (1 October 1991 to September 1993). Subjects were the patients resident in these areas and diagnosed of IBD according to a standard protocol for case ascertainment and definition.

RESULTS

Altogether 328 cases were identified, of whom 191 were diagnosed as ulcerative colitis (UC), 135 as Crohn's disease (CD) and 2 as indeterminate colitis. The overall adjusted incidence rate per 100,000 persons between ages 15-64 years of UC and CD were respectively 9.8 and 5.2 in Sabadell, 7.7 and 5.0 in Vigo, 7.8 and 5.8 in Mallorca and 4.3 and 6.5 in Motril. The Incidence rate ratio showed no significant differences for either conditions among these areas. The global adjusted incidence rate of UC in Spanish areas (8.0; IC 95%: 6.3-9.7) was significantly lower to that of Northern European countries while that of CD (5.5; IC 95%: 4.1-6.9) was between that of Northern and Southern Europe with no significant differences.

CONCLUSIONS

The incidence of IBD did not show differences among the Spanish areas, and rates are between 2 and 6 times higher than those previously reported. The incidence of UC is significantly lower than that observed in the North of Europe, while for CD the incidence is between that of Northern and Southern Europe.

[Celiac disease of the adult following orthotopic liver transplantation. Description of a case]

A case of celiac disease of the adult is herein described in a patient with a history of orthotopic liver transplantation because of cirrhosis due to hepatitis C virus. The patient presented with a decrease in the levels of cyclosporinemia, diarrhea and an increase in transaminases. This is an infrequent form of presentation leading to differential diagnosis with a complication related to the liver disease.

[Prevalence of monosymptomatic celiac disease in patients with iron deficiency anemia]

A prospective study of the prevalence of monosymptomatic celiac disease presented as ferropenic anemia in patients admitted for study such complication of was carried out. All the patients were evaluated by gastroscopy and biopsy of the distal duodenal segment, regardless of endoscopic appearance. Patients presenting an endoscopic lesion clearly suggestive as the origin of the chronic bleeding were excluded from the study. The prevalence of celiac disease, the only manifestation of which was ferropenic anemia, was 3.3% in this series. What is important to note in this study is the importance of duodenal biopsy in the study of ferropenic anemia, with the aim of avoiding diagnostic delay of a possible monosymptomatic celiac disease as the cause of the anemia.

Ki-ras mutation modifies the protective effect of dietary monounsaturated fat and calcium on sporadic colorectal cancer

The geographic differences in the incidence of colorectal cancer have been mostly attributed to variations in diet. The diversity of the Mediterranean diet and the heterogeneity of acquired genetic alterations in colorectal cancer sets the stage for investigating the possible association between dietary factors and mutations in tumor genes known to play a role in the pathogenesis of these neoplasms. With this purpose, we have studied the Ki-ras gene in 108 colorectal cancers using archival tissue and epidemiological data from our previous case-control study. Mutations in exon 1 of the Ki-ras gene were detected by a PCR-single strand conformation polymorphism approach. A polychotomous logistic regression model was used to assess the significance of observed differences between wild-type and mutated tumors with respect to population controls in the different categories of nutrient consumption. Multivariate density models were used to adjust the correlation between nutrients and total energy. Our studies show that high consumption of monounsaturated fats, mostly derived from olive oil, is associated with a statistically significant decrease in the risk of cancer with wild-type Ki-ras genotype but not of Ki-ras mutated cancers. Conversely, we find that high calcium intake is associated with a decreased risk of Ki-ras mutated tumors but not of wild-type tumors. Tumor genotyping can reveal epidemiological associations that are weak or unapparent when cases-control studies are not stratified by tumor genotype.

Frequency of congenital hypertrophy of the retinal pigment epithelium in familial adenomatous polyposis

Congenital hypertrophy of the retinal pigment epithelium is a recognized clinical marker in familial adenomatous polyposis as an expression of the altered gene in this autosomal dominant disease. Ocular lesions could be discovered years before the development of intestinal polyposis. We studied 29 diagnosed patients, 38 relatives (first degree) of familial adenomatous polyposis kindreds and 26 controls (general population). Number, size and bilaterality of pigmented lesions were analysed in order to separate members affected and non affected by intestinal polyposis in familial adenomatous polyposis kindreds. Three of 26 families (23%) had patients with polyposis and normal fundus. Bilaterality and more than 4 lesions improved specificity or sensibility of the fundus examination. However, the best efficacy of the test was obtained with large lesions (sensibility 0.82 and specificity 0.97).

Two different dosages of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective, randomized, multicenter study

Cefotaxime (CTX) is considered one of the first-choice antibiotics in the therapy of spontaneous bacterial peritonitis (SBP) in cirrhosis. Because CTX is largely metabolized in the liver, this drug may also be effective in SBP by administering lower doses than those habitually used. To investigate this possibility, a prospective, randomized, multicenter study was performed to compare the therapeutic efficacy of two different dosages of CTX in 143 patients with SBP: 71 (group I) were allocated to receive a high dose (2 g every 6 hours, which is one of the most frequently recommended doses in this infection), and 72 (group II) were allocated to receive a low dose (2 g every 12 hours). At inclusion, both groups were similar in relation to clinical and laboratory data, with the exception of a higher incidence of positive ascitic fluid culture in group I than in group II (59% vs. 40%; P = .029). The rate of infection resolution was similar for both groups (77% vs. 79%). Hospital survival was also similar in both groups (69% vs. 79%). No difference was observed between patients with positive or negative ascitic fluid cultures with regard to infection resolution and patient survival. The duration of antibiotic therapy was similar in both groups (9.0 +/- 3.3 days in group I vs. 8.8 +/- 3.1 days in group II). In a subset of 13 patients from group I and 11 patients from group II CTX levels were determined in serum (peak and trough) and ascitic fluid (concomitantly with trough serum). Peak serum levels were similar in patients from both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Energy consumption in patients with Crohn's disease. An evolutionary study during hospitalization]

In Crohn's disease, weight loss and malnutrition are very frequently occurring problems. One explanation of these findings could be an increased energy expenditure. Eleven patients were studied, of which six were women and five were men, during a hospital stay for an active episode of Crohn's disease. In three patients the small intestine was affected, in five the colon, and in the last three both the ileum and the colon were affected. Van Hees' activity index on admittance was 196 +/- 52 (132-265). The energy expenditure at rest (ECR) on admittance, was 11% higher than that found in the normal population (p: n.s.). The energy expenditure decreased weekly, in a statistically significant way, during hospitalization. No significant relationship was found between the Van Hees activity index and any of the parameters used to evaluate the energy needs. Those patients whose body weight was less than 90% of the ideal body weight, presented pathologically elevated energy needs when the energy expenditure was expressed in kcal/kg (p = 0.003). Fever was the only analyzed parameter which showed a significant correlation with the changes in energy expenditure: measured by the oxygen consumption index (p = 0.003) and by the percentage of REE (p = 0.006).