Prognostic Factors of Death in 151 Adults With Hemophagocytic Syndrome: Etiopathogenically Driven Analysis

Objective

To characterize the etiologies and clinical features at diagnosis of patients with hemophagocytic lymphohistiocytosis (HLH) and correlate these baseline features with survival using an etiopathogenically guided multivariable model.

Patients and Methods

The Spanish Group of Autoimmune Diseases HLH Study Group, formed in 2013, is aimed at collecting adult patients with HLH diagnosed in internal medicine departments between January 3, 2013, and October 28, 2017.

Results

The cohort consisted of 151 patients (91 men; mean age, 51.4 years). After a mean follow-up of 17 months (range, 1-142 months), 80 patients died. Time-to-event analyses for death identified a worse survival curve for patients with neoplasia (P<.001), mixed microbiological infections (P=.02), and more than 1 infection (P=.01) and glucocorticoid monotherapy (P=.02). According to univariate analyses, platelets of less than 100,000/mm³ (hazard ratio [HR], 3.39; 95% CI, 1.37-8.40), leukopenia (HR, 1.81; 95% CI, 1.01-3.23), severe hyponatremia (HR, 1.61; 95% CI, 1.02-2.54), disseminated intravascular coagulation (HR, 1.87; 95% CI, 1.05-3.34), bacterial infection (HR, 1.99; 95% CI, 1.09-3.63), mixed microbiological infections (HR, 3.42; 95% CI, 1.38-8.46), and 2 or more infectious triggers (HR, 2.95; 95% CI, 1.43-6.08) were significantly associated with death. In contrast, peripheral adenopathies (HR, 0.63; 95% CI, 0.40-0.98) and the immunosuppressive drug/intravenous immunoglobulin/biological therapies (HR, 0.44; 95% CI, 0.20-0.96) were protective against all-cause mortality. Multivariable Cox proportional hazards regression analysis identified 2 or more infectious triggers (HR, 3.14; 95% CI, 1.28-7.68) as the only variable independently associated with death.

Conclusion

The mortality rate of adult patients diagnosed with HLH exceeds 50%. Infection with more than 1 microbiological agent was the only independent variable associated with mortality irrespective of the underlying disease, epidemiological profile, clinical presentation, and therapeutic management.

Xanthogranulomatous Cholecystitis Associated with Gallbladder Adenocarinoma. A Clinicopathologic Study. of 5 Cases

The simultaneous presence of xanthogranulomatous cholecystitis and adenocarcinoma of the gallbladder has rarely been reported. A review of 53 cases of gallbladder adenocarcinoma in a 15-year period revealed 5 cases in which a concomitant diffuse xanthogranulomatous disease was observed. Clinical and pathologic features of these cases are commented and the diagnostic importance stressed. Both inflammatory and neoplastic components were closely mixed in 3 cases, thus making a prompt diagnosis difficult. Etiologic factors implicated in the development of both entities are considered.

[Prebiotics: concept, properties and beneficial effects]

Prebiotics are non-digestible food ingredients (oligosaccharides) that reach the colon and are used as substrate by microorganisms producing energy, metabolites and micronutrients used for the host; in addition they also stimulate the selective growth of certain beneficial species (mainly bifidobacteria and lactobacilli) in the intestinal microbiota. In this article, a multidisciplinary approach to understand the concept of prebiotic carbohydrates, their properties and beneficial effects in humans has been carried out. Definitions of prebiotics, reported by relevant international organizations and researchers, are described. A comprehensive description of accepted prebiotics having strong scientific evidence of their beneficial properties in humans (inulin-type fructans, FOS, GOS, lactulose and human milk oligosaccharides) is reported. Emerging prebiotics and those which are in the early stages of study have also included in this study. Taken into account that the chemical structure greatly influences carbohydrates prebiotic properties, the analytical techniques used for their analysis and characterization are discussed. In vitro and in vivo models used to evaluate the gastrointestinal digestion, absorption resistance and fermentability in the colon of prebiotics as well as major criteria to design robust intervention trials in humans are described. Finally, a comprehensive summary of the beneficial effects of prebiotics for health at systemic and intestinal levels is reported. The research effort on prebiotics has been intensive in last decades and has demonstrated that a multidisciplinary approach is necessary in order to claim their health benefits.

Redox potential of cecum content of growing pigs and its relation with pH and VFA concentration

Digestive microflora is partly responsible for physiological gut conditions. Measurements of redox potential (Eh) and pH of digesta may give a basis for understanding microbial activity and dynamics of fermentation. However, few studies have assessed the Eh of the gastrointestinal tract of pigs. Twenty-four pigs of 30 kg BW were slaughtered to measure Eh and pH of cecum content in situ and to obtain samples of ileum, cecum, and colon contents for VFA determinations. Pigs had previously been fed with a nonmedicated starter feed for 5 wk. Measurements of Eh and pH were recorded first at 2 min and then at 5-min intervals for 35 min to estimate kinetics and the delay to reach stabilization of the Eh value. Cecum Eh rapidly decreased (P < 0.001) from -115 to -180 mV after 15 min of insertion of the electrodes and then slowly decreased until -185 mV at 35 min. Cecal pH started at 5.74 and decreased (P < 0.01) slowly afterwards until 5.53 after 35 min. The Eh value after stabilization was negatively correlated (r = -0.64; P < 0.001) with final pH. Acetic, propionic, and butyric acids accounted for 58.7, 24.0, and 12.8%, respectively, of total VFA production of cecum content. The VFA production of ileal content was lower (P < 0.001) when compared to cecum or colon (50.8, 142.1, and 130.8 μmol/g, respectively) and a higher proportion of formic and lactic acids was detected (32.3 and 27.0%, respectively). Proportions of acetic and propionic acids were negatively (r = -0.53; P < 0.01) and positively (r = 0.66; P < 0.001) correlated with Eh, respectively. In conclusion, Eh measured after stabilization seemed to be a meaningful predictor of hindgut fermentative activity.

Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.

Integument Mycobiota of Wild European Hedgehogs (Erinaceus europaeus) from Catalonia, Spain

There are some reports about the risk of manipulating wild hedgehogs since they can be reservoirs of potential zoonotic agents like dermatophytes. The aim of this study was to describe the integument mycobiota, with special attention to dermatophytes of wild European hedgehogs. Samples from spines and fur were cultured separately in Sabouraud dextrose agar (SDA) with antibiotic and dermatophyte test medium (DTM) plates. Nineteen different fungal genera were isolated from 91 cultures of 102 hedgehogs. The most prevalent genera were Cladosporium (79.1%), Penicillium (74.7%), Alternaria (64.8%), and Rhizopus (63.7%). A lower prevalence of Aspergillus (P = 0,035; χ² = 8,633) and Arthrinium (P = 0,043; χ² = 8,173) was isolated during the spring time and higher frequencies of Fusarium (P = 0,015; χ² = 10,533) during the autumn. The prevalence of Acremonium was significantly higher in young animals (70%, 26/37) than in adults (30%, 11/37) (P = 0,019; χ² = 5,915). Moreover, the majority of the saprophytic species that grew at the SDA culture were also detected at the DTM. Finally, no cases of ringworm were diagnosed and no dermatophytes spp. were isolated. Concluding, this study provides the first description of fungal mycobiota of the integument of wild European hedgehogs in Spain, showing a large number of saprophytic species and the absence of dermatophytes.

Antifungal activity of extracts of Rosmarinus officinalis and Thymus vulgaris against Aspergillus flavus and A. ochraceus

The antifungal activity of ethanolic extracts of Rosmarinus officinalis and Thymus vulgaris were tested against strains of Aspergillus flavus and A. ochraceus, since these two species are common contaminants of cereals and grains and are able to produce and accumulate mycotoxins. The methodology used is based on measuring the inhibition halos produced by discs impregnated with the extracts and establishing their Minimum Inhibitory Concentration (MIC) as well as the Minimum Fungicide Concentration (MFC). The results obtained suggest that the assayed extracts affect the proper development of A. flavus and A. ochraceus; leading to a lower MIC (1200 ppm) and MFC (2400 ppm) for T. vulgaris extract against A. ochraceus than against A. flavus. The results show, that the extracts of Rosmarinus officinalis and Thymus vulgaris used at low concentrations could have significant potential for the biological control of fungi in foodstuffs.

Mycobiota and concentration of ochratoxin A in concentrated poultry feed from Venezuela

The main objective of this study was to evaluate the frequency distribution of mycobiota and the concentration of Ochratoxin A (OTA) in 50 samples from one company of commercial brand poultry feed produced in Venezuela. The concentration of OTA in the samples analyzed was determined using the competitive ELISA method. The most frequently isolated genera of moulds were Aspergillus (36%) and Penicillium (20%). Of these genera, the most frequently isolated species were Aspergillus flavus, Aspergillus terreus and Penicillium citrinum. Ochratoxigenic species such as Eurotium herbariorum, Aspergillus niger, Aspergillus ochraceus and Aspergillus glaucus, were also found with lower frequency. Rhodotorula mucilaginosa was the only yeast isolated. 94% of the samples presented contamination by OTA in a range between 2.558 and 31.978 microg kg(-1) feed and 42% of them presented OTA levels from 10 up to 20 microg kg(-1). The findings of this investigation show that 84% of the samples of concentrated feed for meat poultry surpass the maximum permitted limit for OTA of 5 microg kg(-1), established in the majority of countries in which regulations are placed.

Effect of plant extract supplementation on Escherichia coli O157:H7 and Salmonella carcass isolation in young Holstein bulls fed a high-concentrate diet

Ninety Holstein bulls were used in a complete randomized design to study the effect of a blend of plant extract (PE) supplementation on jejunum, cecum, and rectum microbiota (Escherichia coli and lactic acid bacteria [LAB]) and hide and carcass contamination (identification of E. coli O157:H7 and Salmonella). Three treatments--control (CTR), monensin (MON), and PE--were tested. Bulls were offered straw and concentrate ad libitum during 108 d. In the cecum, the percentage of LAB counts below 5 log CFU/ml was greater (P < 0.01) in MON (68.1%) than in CTR (34.6%) and PE (28.0%) treatments. On hide, Salmonella was detected (P < 0.05) in CTR (13.3%) and MON (10.0%) treatments, in contrast to PE (0%) treatment. In bulls fed high-concentrate diets supplemented with PE, no increase of carcass E. coli O157:H7 and Salmonella identification was observed.

Influence of Brine Concentration, Brine Temperature, and Presalting on Early Gas Defects in Raw Milk Pasta Filata Cheese

Thirty-one 3.8-kg blocks of Ragusano cheese were made on each of 6 d starting with a different batch of raw milk on each day. On d 1, 3, and 5, cheeses were not presalted and on d 2, 4, and 6, all cheeses were presalted. Before brine salting, one of the 31 blocks of cheese was selected at random for analysis (i.e., at d 0). The remaining 30 blocks were randomly divided into 2 batches of 15 blocks each, one group was placed in 18% brine, and the other group was placed in saturated brine. For the 15 blocks within each of the 2 brine concentrations, 5 blocks each were placed in brine tanks at 12, 15, and 18 degrees C. Cheese blocks were sampled immediately before brine salting (d 0) and after 1, 4, 8, 16, and 24 d of brine salting. Presalting the curd with 2% added salt before stretching reduced the coliform count in the cheese by 1.41 log and resulted in a major reduction in early gas formation. Across all treatments in the present study, the average reduction in gas formation due to presalting was 75%. Reducing brine temperature had the second largest impact on reducing gas production, but did not reduce the coliform count in the cheese. Reducing brine temperature from 18 to 12 degrees C made a larger reduction in early gas formation in cheeses that were not presalted (from 6.8 to 1.8% gas holes, respectively) than in cheeses that were presalted (from 1.9 to 0.5% gas holes, respectively). To achieve the same absolute level of gas production in the nonpre-salted cheese as was achieved in presalted cheese in combination with 18 degrees C brine, the brine temperature for the nonpresalted cheese had to be lowered from 18 to 12 degrees C. Reducing brine concentration, although effective at increasing the rate of salt penetration into the block, did not have any impact on coliform count and had minimal impact on reducing gas production. The condition where reducing brine concentration was able to make a reduction in gas production was for cheeses that were not presalted and brined at 18 degrees C. Presalting is a very simple and practical approach to reducing the problem of early gas formation in combination with strategies to improve milk quality and cheese making conditions. Further work is needed to understand the impact of different levels of presalting on death of coliforms and gas production in the cheese.

Enzymatic activity of micro-organisms isolated from cork wine stoppers

The production of enzymes by micro-organisms which are found on vegetal substrates is important due to their ability to decompose cellulose, lignin and other components, which guarantee the integrity of the vegetal cell. The objective of this study was to determine the enzymatic activity of filamentous fungi, yeasts and bacteria, isolated from natural cork stoppers for bottles of still and sparkling wines. Suspensions of fungal conidia, yeasts and bacterial cells of micro-organisms were established in concentrations of 10(6) CFU/ml. The enzymatic activity of these micro-organisms was evaluated by means of the API ZYM system, with which it was possible to determine and semi-quantify nineteen enzymatic activities simultaneously. The enzymes produced by all of the species were esterase (C1), esterase lipase and naphthol-AS-BI-phosphohydrolase. The micro-organisms with the greatest enzymatic activity were Monilia sitophila, Alternaria alternata, Aspergillus niger and Aeromonas sp.

Effect of the raw extracts of Arthrinium strains (Hyphomycetes, Dematiaceae) on the growth of some deleterious fungi in poultry feed

In previous work the authors have shown that some species of the Arthrinium genus are characterized by being able to produce secondary metabolites with antibiotic activity. The aim of this study was to evaluate the effect of raw extracts of the growth of three different Arthrinium strains against Aspergillus flavus, Aspergillus nidulans, Fusarium moniliforme and Penicillium purpurogenum when they were present in poultry feed. The results showed that the extracts reduced the growth of Aspergillus flavus and Fusarium moniliforme but could not inhibit the development of Aspergillus nidulans. Only the raw extract of A. aureum inhibited the growth of Penicillium purpurogenum.

[Retinal hemorrhages following phacotrabeculectomy. Differential diagnosis]

PURPOSE

We report a case of a patient who underwent uneventful facotrabeculectomy. Right after surgery patient she complained of very poor vision, showing hemorrhage spots scattered throughout the retina. Differential diagnosis is studied.

CONCLUSION

An ocular decompression retinopathy should be the first diagnosis; however clinical details and diagnosis tests suggest the ocular ischemic syndrome as the reason of the problem.

Evaluation of methods for the microbiological control of natural corks for sparkling wine bottles

The various parameters proposed in Norm 0.20/95 of Catalunya (Spain) for the microbiological analysis of natural corks for sparkling wines were evaluated. The best results were obtained through the use of 1/4 Ringer's solution or saline for rinsing with an agitation time of 30 min, and an agitation speed of 150-200 rpm. Tryptone soya agar (TSA) and Sabouraud dextrose agar (SDA) were used as a culture medium for the bacteria and fungi, respectively, and a cultivation time of 48 h and incubation temperatures of 37 +/- 2 degrees C for bacteria and 28 degrees C for yeast and filamentous fungi.

Effect of ultraviolet light irradiation and nitrosoguanidine on viability of 46 strains of Arthrinium and their antibiotic production

The ability of strains of the Arthrinium genus to inhibit microbial development has been previously described. In the present work different periods of mutagenic treatment using ultraviolet light, and of nitrosoguanidine treatment, on strains of Arthrinium were investigated. With nitrosoguanidine treatment the survival rate ranged from 2.17 to 8.78%. Mutant strains were only obtained with a higher antibiotic production in comparison with the wild-strain, when the mutagenic agent was UV light.

Intraocular pressure as a risk factor for visual field loss in pseudoexfoliative and in primary open-angle glaucoma

OBJECTIVE

To analyze the relationship between intraocular pressure (IOP) and visual field loss in patients with primary open-angle glaucoma (POAG) and in those with pseudoexfoliative glaucoma (PEXG).

DESIGN

A cross-sectional, observational study.

PARTICIPANTS

Thirty-one patients with PEXG and 31 patients with POAG that was newly diagnosed were included in this study.

MAIN OUTCOME MEASURES

The authors recorded the untreated IOP and the amount of the visual field loss, at presentation, in both study groups.

RESULTS

The authors found a significant relationship between IOP and visual field mean deviation (MD) index (P = 0.0001, r = 0.68) in PEXG but not in POAG eyes (P = 0.7).

CONCLUSION

The authors found that untreated IOP levels can explain the amount of visual field loss, as measured by the MD index, much better in patients with PEXG than in comparable patients with POAG. Thus, vulnerability of the optic nerve head to increased IOP appears to be different in these two diagnostic categories.

Viscoelastic-injecting cystotome

This continuous curvilinear capsulorhexis (CCC) technique is for use in complicated surgical cases such as when the anterior chamber is shallow, the red reflex is not good, or eye movements are present. This technique is easier and safer in such cases because it uses a cystotome connected to a viscoelastic syringe. First, the anterior chamber is filled with viscoelastic material using a conventional cannula. The cannula is replaced with a bent needle (or cystotome), and the CCC is performed in the usual way. This instrument allows the surgeon to inject small amounts of viscoelastic material exactly where and when it is needed. The anterior chamber remains deep while the CCC is performed, and the anterior capsule tear is done in a more controlled fashion.

[Human immunodeficiency virus and resistance]

It has been demonstrated that following prolonged treatment with reverse transcriptase inhibitors, especially with nucleoside analogs, resistant viral strains appear that show mutations in the nucleotides of the gene that codifies reverse transcriptase. These mutations cause changes in amino acids, which gradually increases resistance. In this study we evaluated the applicability af the LiPA HIV-1 RT test in determining the presence of mutations in this gene that can lead to resistance to antiretroviral treatments.Twenty-one samples were studied without previous knowledge of the antiviral treatments that the patients had received. No mutations in the HIV-1 stains from untreated patients were found. In the other patients who had undergone various treatment regimens, the results obtained With the LiPA HIV-1 RT made in possible to retrospectively identify the different nucleoside analogs they had been treated with. The most frequently found mutations were those that lead to a certain degree of resistance to AZT, followed by those related to resistance to ddl, which in effect in this order were the drugs used in the treatment of the patients. However, the LiPA HIV-1 RT test has certain limitations. It can only detect mutations that can be recognized by its sequences. As such, including sequences that would make it possible to study the possible genotypic variations in the gene that codifies the protease of HIV-1 would be helpful, given the importance of the protease inhibitors in clinical practice. In any case, direct sequencing continues to be standard method as it allows us to obtain full information on the genes that need to be studied.

Ocular hypotensive effect of pilocarpine before and after argon laser trabeculoplasty

PURPOSE

The purpose of this study was to compare the hypotensive response of human glaucomatous eyes to 1% pilocarpine solution before and after argon laser trabeculoplasty.

METHODS

We designed a prospective, 'repeated measures' study comparing the ocular hypotensive effect of acutely administered 1% pilocarpine solution in 30 medically uncontrolled glaucomatous eyes, before and after argon laser trabeculoplasty.

RESULTS

The pilocarpine-induced IOP decrease was 3.6 +/- 0.59 mmHg before argon laser trabeculoplasty, and 1.8 +/- 0.53 mmHg after laser therapy. In both instances, the pilocarpine hypotensive effect was significantly correlated with pretreatment IOP (p = 0.02, r = 0.41 before argon laser trabeculoplasty, and p = 0.003, r = 0.52 after argon laser trabeculoplasty). We built a 'repeated measurements ANCOVA' model, and found no statistically significant difference between the pilocarpine IOP lowering effect before and after argon laser trabeculoplasty (p = 0.4).

CONCLUSION

Argon laser trabeculoplasty does not modify the IOP lowering effect of 1% pilocarpine solution.

Influence of the culture medium on the inhibitory activity of Arthrinium strains

Modifications in the antibiotic capacity of Arthrinium strains when they were developed in culture media of various compositions were studied. The culture media used were 2% malt extract agar, Czapek-Dox agar, Sabouraud dextrose agar, oatmeal agar, Yoshimura's medium, mixed medium of salts, modified phytone agar, malt extract-yeast extract agar, potato dextrose agar, and Wickerham's medium. The inhibition values were compared with those obtained when the strains were developed in Wickerham's medium. The media which enhanced the production of inhibitory substances were potato dextrose agar and 2% malt extract agar.

Increased susceptibility of microcytic red blood cells to in vitro oxidative stress

Oxidative damage to erythrocytes in thalassaemia has been related to generation of free radicals by an excess of denaturated alpha- or beta-globin chains, intracellular iron overload and low concentration of normal haemoglobin (HGB). Two good indicators of such oxidative damage are the high red blood cell (RBC) malonyldialdehyde (MDA) production detected following exogenous oxidant stress and the decrease of pyrimidine 5'-nucleotidase (P5N), the most sensitive enzyme to SH-group damage in vivo. Conflicting data, however, have so far accumulated in the literature concerning differences in oxidative damage between the different forms of thalassaemia and iron deficiency anaemia (IDA). In the present study, oxidative susceptibility, as defined by the production of MDA in vitro and antioxidant capacity, as measured by the activity of RBC glutathione peroxidase (GPx), superoxide dismutase (SOD) and by reduced glutathione (GSH), have been studied in microcytic RBCs from patients with beta-thalassaemia trait, Spanish (delta beta) zero-thalassaemia heterozygotes (delta beta-thalassaemia trait) and iron deficiency anaemia (IDA). The results are consistent with the existence of significant differences in the severity and pattern of oxidative stress susceptibility between beta-thalassaemia trait (increased MDA production and higher SOD and GPx activities) and the other two forms of microcytosis (delta beta thalassaemia trait and IDA). Furthermore, the finding of normal P5' N activity in delta beta thalassaemia trait, gives further support to the less intense peroxidative environment of RBCs in this form of thalassaemia when compared to beta-thalassaemia trait, characterized by acquired RBC P5' N deficiency due to oxidative damage.

Chemical microanalysis of hyphae and conidia from Arthrinium aureum

Analysis of the chemical composition of hyphae, conidia and chlamydospores of Arthrinium aureum enabled all sample constituents of > 23 kD molecular weight to be detected. Sulphur, chlorine, potassium and calcium were present in the hyphae and condia of A. aureum, and sulphur, potassium and calcium in the chlamydospores.

[Infectious external otitis: etiology in the Terrassa region, culture methods, and considerations on otomycosis]

The etiology of infections of the outer ear was studied in the area of Terrassa (Barcelona) over a six-year period (1987-1992). A total of 1419 samples of ear discharge were processed. Traditional culture media were used to isolate the microorganisms as well as a modified culture medium prepared by us (APA). Usual methods were used to identify the microorganisms. The results show Pseudomonas aeruginosa to be the most frequently isolated microorganism. 76.5% of the otitis studied were unimicrobial and the presence of moulds or yeast was noted in 6.9% of samples. Otomycosis (5.9%) is one of the major pathological processes of the outer ear, and Aspergillus niger is the prime causal agent.

[Anatomopathologic changes in the testis following prolonged treatment with LHRH agonists. Experimental study in rats]

Presentation of a study conducted on 20 male Wistar rats treated for 3 months with Leuprolide (LHRH agonist). Analysis of pathophysiological testicular changes resulting from the treatment and extent of recovery at 3 months of therapy discontinuation, relating those changes to testosterone plasma levels in peripheral blood. Serum testosterone fell to 1.17 +/- 0.30 ng/ml in the treated group, shifting to figures overlapping with normal values within 3 months of discontinuing treatment. Such decreased testosterone levels translate into significant testicular histological damage. Three months after interruption of treatment there is nearly complete recovery of such damage, with just around 10% tubules without spermatozoa, with unchanged germinal line. We conclude that the marked suppression in testosterone levels caused by LHRH agonists translates into a significant degeneration of the seminiferous tubule, which appears to be reversible 3 months after treatment discontinuation.

[Role of testosterone in the testicular microcirculatory changes produced in the rat by the administration of high doses of human chorionic gonadotrophin]

A study was performed in 20 male Wistar rats weighing 250-300 gm; 10 comprised the control group and the other 10 were treated with 5 mg/day of cyproterone acetate which was given with the meal for 2 months. The rat testicular microcirculation was studied by laser Doppler flowmetry. Similarly, the testicular interstitial fluid volume and plasma testosterone in peripheral blood were determined. Within each of the two groups, 5 were studied without any pharmacologic stimulation and 5 at 4 hours following the administration of 100 IU subcutaneous HCG. The rats treated with cyproterone acetate had very low levels of serum testosterone (1.254 +/- 0.667) versus the control group (3.686 +/- 0.705), the difference being statistically significant (p < 0.05). Following administration of HCG, the microcirculation changes and the interstitial fluid were the same as those of the control group despite the blockade of the androgenic receptors by cyproterone acetate. The increase in testosterone levels therefore does not appear to mediate the testicular microcirculation changes produced by HCG.

[Diagnostic value of aspiration cytology with ERCP]

ERCP is of great value in diagnosing malignant pathology of the biliopancreatic duct system. However, the ERCP endoscopic characteristics in malignant stenosis often lack specificity and are difficult to differentiate from those of chronic pancreatitis. In these cases histological confirmation is essential to diagnosis. With the aim of increasing the diagnostic possibilities of ERCP in pancreatic cancer--particularly when associated with chronic pancreatitis--we performed aspiration cytology of pancreatic juice obtained via endoscopic cannulation of the main pancreatic duct using ERCP in 102 patients with suspected periampullar pathology, chronic pancreatitis and/or pancreatic cancer. The diagnostic sensitivity of cytology for pancreatic malignancy was 33.3%, versus 60% for cancer of Vater's papilla. Specificity was 100% in both cancers. We observed no false positive results or complications. On combining both techniques, i.e., ERCP and cytology of the pancreatic juice, sensitivity increased to 100% for pancreatic malignancy, 77.7% for chronic pancreatitis (characteristic ERCP radiographic images and absence of neoplastic cells) and 100% in the case of ampullomas. Difficulties in the differential diagnosis between advanced chronic pancreatitis and pancreatic cancer persist with ERCP alone. In such cases aspiration cytology may secure a definitive diagnosis--particularly when neoplastic cells are demonstrated (Class IV).

Effects of Ca2+ channel antagonists in guinea-pig normal and skinned gall bladder

CaCl2 (0.01-50 mM, in K(+)-depolarized tissues), KCl (0.1-100 mM) and acetylcholine (1 nM-10 mM) produced concentration-dependent contractions of guinea-pig isolated gall bladder. Nifedipine (1-100 microM), verapamil (1-100 microM), diltiazem (1-100 microM), cinnarizine (1-100 microM), and flunarizine (1-100 microM) each produced a concentration-related inhibition of the log concentration-effect curve for CaCl2. The rank order of potencies of these antagonists, measured as the IC50 against Ca2+ (50 mM)-induced contraction of depolarized gall bladder, was diltiazem (0.25 microM) > or = verapamil (0.8 microM) approximately nifedipine (1.2 microM) >> cinnarizine (25 microM) approximately flunarizine (80 microM). Verapamil and diltiazem depressed KCl-induced contraction with an effectiveness and potency similar to those displayed against CaCl2 but nifedipine, cinnarizine and flunarizine were less effective against contractions in response to KCl compared to CaCl2. Verapamil and diltiazem, but not the other Ca2+ channel antagonists tested, had a specific inhibitory effect on the contractions due to KCl when compared to acetylcholine-induced contractions. Cinnarizine (10-100 microM) and flunarizine (10-100 microM), but not the other antagonists tested, depressed Ca2+ (20 microM)-evoked contraction of skinned guinea-pig gall bladder preparations. It is concluded that distinct differences exist between the Ca2+ channel antagonists examined. The action of nifedipine, verapamil and diltiazem is restricted to the plasmalemma whereas cinnarizine and flunarizine also act on the intracellular contractile apparatus.

[Testicular microcirculation in rats measured with laser-Doppler flowmetry]

Study carried out in 50 male Wistar rats distributed into 5 groups: baseline and at 2, 4, 8 and 24 hours after subcutaneous injection of Human Chorionic Gonadotropin, 100 IU. It was observed that testicular microcirculatory flow shows a rhythmical fluctuating pattern (5-10 fluctuations per minute), which becomes continuous at 4 hours but recovers at 24 hours. At the same time, there is an increased volume of testicular interstitial fluid that peaks at 8 hours, and returns to baseline levels at 24 hours. Serum testosterone values increase with HCG injection, reaching a peak at 4 hours (25.9 mg/ml), to return to nearly baseline levels at 24 hours (5.04 mg/ml). Disappearance of the rhythmical microcirculatory pattern, and the increase of interstitial fluid volume do not appear to be mediated by testosterone, since the raise in hormone levels, occurred after HCG administration, preceded the observed microcirculatory changes.

Pathological lesions following an experimental intoxication with aflatoxin B1 in broiler chickens

A follow-up of chickens dosed orally over 21 days with 0.2 and 3 micrograms of aflatoxin B1 (AFB1) g-1 of bodyweight daily and their subsequent recovery 10 days after withdrawal of contaminated food was conducted. Vacuolation of liver cells during the initial days of the intoxication and cellular depletion in the follicle medulla of the bursa of Fabricius were the lesions which appeared first and persisted during the recovery phase in both groups of intoxicated animals. The intensity of these lesions and their persistence was related to the dose of aflatoxin ingested. A significant reduction in the bodyweight and absolute weights of liver, bursa of Fabricius spleen and thyroid was observed in the higher dose group.

Ultrastructure of the concentric membrane system in Arthrinium aureum

An ultrastructural study was performed on Arthrinium aureum. The fungi were treated with glutaraldehyde and osmium tetroxide fixation. The hypha and conidia has a concentric membrane system which consisted of multiple membranes of a myelinoid appearance, and continued to the conidia and hypha plasma membrane. The fungi were also treated with periodic acid-alkaline bismuth (PABi) staining after glutaraldehyde and osmium tetroxide fixation. PABi positive materials were found on the marginal glycogen granules, the concentric membrane system and the conidia plasma membrane.

Gastric juice and analysis of basal and stimulated secretion following treatment with rice-bran oil

In determining whether rice-bran oil (RBO) has antisecretory activity, we induced stress ulcers in 20 Wistar rats (10 controls; 10 animals given 0.2 ml/day RBO orally for 4 days prior to ulcer induction). In turn, we analyzed gastric juice for histamine, pepsin, H+ concentration ([H+]) and output volume. A second, complementary study was made of basal and stimulated gastric secretion through continuous "in vivo" recording of output. Secretion was stimulated with increasing doses of histamine, betanechol and pentagastrin. Ninety-four rats were used (47 controls and 47 rats given 0.2 ml/day RBO orally for 4 days prior to gastric output evaluation). The results were evaluated by the Student t-test. Ulcer index in the RBO-treated rats was significantly lower than among the controls (p less than 0.01), as also reflected by a significantly greater decrease in [H+] among the RBO-treated rats (p less than 0.05). However, no significant differences were observed for the remaining parameters. Continuous recording of basal gastric output showed a significant decrease in [H+] among the RBO-treated rats (p less than 0.01). Following histamine stimulation, [H+] was likewise significantly lower among the RBO-treated rats than in the controls. However, no significant differences were observed following stimulation with either betanechol or pentagastrin. RBO contains a high percentage of unsaturated fats; the latter act as precursors in the synthesis of arachidonic acid, which in turn is the essential precursor of prostaglandins--established inhibitors of gastric secretion. RBO also contains antioxidants such as alpha-tocopherol, which may likewise stimulate the synthesis of prostaglandins. RBO likely acts by increasing prostaglandin output, thus interfering with gastric HCl production.

[Complicated hepatic hydatid cyst and acute pancreatitis. Value of ERCP and treatment with endoscopic sphincterotomy]

We present the case of a 29 year-old cholecystectomized woman with hepatic hydatid cysts who was admitted for acute pancreatitis. Echography and abdominal CAT revealed three thydatid cysts-the one in the right liver lobe being complicated-as well as pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed the suspected diagnosis of intrabiliary hydatid cyst rupture. An endoscopic sphincterotomy was performed, posterior evolution being asymptomatic, thus permitting the postponing of surgery.

Fungal density in the sands of the Mediterranean coast beaches

The fungal density of one hundred and forty-eight samples of sands obtained from forty-two Spanish Mediterranean littoral beaches are investigated. The CFU/g number ranged from 15 and 76 x 10(5). The most commonly isolated genera were: Penicillium, Cladosporium, Aspergillus, Acremonium, Alternaria, Fusarium. The keratinophilic capacity of all the isolated fungal strains was also determined.

Orbital metastasis, by transitional cell carcinoma of the bladder

We report a new case of a patient with transitional cell carcinoma of the urinary bladder and a solitary metastasis to the orbita. A review of the literature shows two cases described previously. This case is interesting for the clinical features and evolution.

Effects of zinc sulphate on gastric mucosal blood flow and gastric emptying of the rat

Zinc sulphate (50 mg kg-1 p.o.) did not modify basal gastric mucosal blood flow, as measured by [3H]aniline clearance, but inhibited its reduction by noradrenaline (3.5 micrograms kg-1 min-1). Zinc sulphate also influenced gastric emptying of phenol red but its effects depended upon the dose; 30 mg kg-1 caused no variation whereas 80 mg kg-1 induced a significant delay. The nature of both actions is discussed and their implications in the development and prevention of gastric ulceration have been analysed.

Experimental dermatophytoses produced by E. floccosum in guinea pigs

Experimental dermatophytoses were tested in guinea pigs by 17 strains of genus Epidermophyton. Only three strains of E. floccosum produced lesions. These lesions were detected 5-7 d after inoculation, and no crust formation or alopecia was observed. These lesions were also studied using microbiological and histopathological techniques. No infection occurred after cutaneous application of E. floccosum var. nigricans and E. stockdaleae.

Further observations on the keratinolytic activity of strains of the genus Epidermophyton

The ability of 17 strains of Epidermophyton to perforate hair in vitro using the Ajello & Georg's test procedure and a modification of Lu's method has been studied. Following the Ajello & Georg's test procedure only E. stockdaleae perforated hair. Sporadically some strains of E. floccosum perforated horse hair. We noted as well unusual perforations originated from inside to outside of the hair. By the other technique, all strains, excepting E. floccosum var. nigricans in child hair, perforated hair. E. floccosum showed these perforations later than E. stockdaleae.