Impact of climate change-related environmental factors on the allergens production and the epidemiology and severity of allergic pathologies

BACKGROUND

Allergic disease affects up to 40% of the global adult population, a proportion that is increasing with environmental changes related to global warming.

METHODS

We undertook a systematic review of the literature to identify and evaluate the current evidence of the impact of climate change-related environmental factors on the allergen production and the epidemiology and severity of allergic pathologies. PECO criteria were established and guided the literature searches of the PubMed and Cochrane databases (Jan 1, 2016 to Dec 31, 2021). Study outcomes were categorized and grouped to facilitate data synthesis. Outcomes were classified as significant (statistical significance <0.05), non-significant (p>0.05) or undetermined (p value not reported). Study quality was assessed using MMAT analysis.

RESULTS

Of 195 studies, 40 were considered relevant and 9 of them provided data to be included in the data quantitative synthesis. Environmental factors, including the presence of pollutants, temperature, and drought, influenced the type, volume, and timing of exposure to local aeroallergens. The most relevant environmental factor was the presence of environmental pollutants, of which tropospheric ozone was the most frequently associated to changes in allergen production, prevalence, and severity of allergic disease. Also, several publications demonstrated the impact of environmental factors on the healthcare burden.

CONCLUSIONS

Climate-change related environmental factors increased allergic disease in terms of prevalence, severity, and healthcare burden due to alterations in allergen exposure (volume and type) with the presence of pollutants such as ozone being the most commonly reported driver of such increase.

SuperCam Calibration Targets: Design and Development

SuperCam is a highly integrated remote-sensing instrumental suite for NASA's Mars 2020 mission. It consists of a co-aligned combination of Laser-Induced Breakdown Spectroscopy (LIBS), Time-Resolved Raman and Luminescence (TRR/L), Visible and Infrared Spectroscopy (VISIR), together with sound recording (MIC) and high-magnification imaging techniques (RMI). They provide information on the mineralogy, geochemistry and mineral context around the Perseverance Rover. The calibration of this complex suite is a major challenge. Not only does each technique require its own standards or references, their combination also introduces new requirements to obtain optimal scientific output. Elemental composition, molecular vibrational features, fluorescence, morphology and texture provide a full picture of the sample with spectral information that needs to be co-aligned, correlated, and individually calibrated. The resulting hardware includes different kinds of targets, each one covering different needs of the instrument. Standards for imaging calibration, geological samples for mineral identification and chemometric calculations or spectral references to calibrate and evaluate the health of the instrument, are all included in the SuperCam Calibration Target (SCCT). The system also includes a specifically designed assembly in which the samples are mounted. This hardware allows the targets to survive the harsh environmental conditions of the launch, cruise, landing and operation on Mars during the whole mission. Here we summarize the design, development, integration, verification and functional testing of the SCCT. This work includes some key results obtained to verify the scientific outcome of the SuperCam system.

CA 549 and SP2 in postoperative breast cancer patients. Comparison with CA 15.3, CEA and TPA

The levels of CA 549 and SP2 were measured in 430 subjects: 100 healthy blood donors, 130 patients with benign diseases and 200 postoperative breast cancer patients. In the latter group, the serum levels of CA 15.3, CEA and TPA were also measured. The Kolmogorov-Smirnov, Mann Whitney and McNemar tests were used for statistical analysis. The upper normal limits were established on the basis of the values obtained in the healthy blood donors group, the benign diseases group and R.O.C. analysis of the breast cancer group. They were: CA 549 = 13 U/ml, SP2 = 14 U/ml, CA 15.3 = 35 U/ml, CEA = 5 ng/ml and TPA = 110 U/ml. The sensitivity, specificity and accuracy in the breast cancer group were, respectively: CA 549 = 78.1%, 97.1% and 88%; SP2 = 21.9%, 90.4% and 57.5%; CEA = 66.7%, 95.2% and 81.5%; CA 15.3 = 80.2%, 98.1% and 89.5%, and TPA = 73.9%, 78.8% and 76.5%. Statistical analysis showed significant differences only between CA 15.3, the marker which gave the best results, and SP2 (p<0.001). There were no significant differences with the association of two or three tumor markers.

ABCG2/BCRP gene expression is related to epithelial-mesenchymal transition inducer genes in a papillary thyroid carcinoma cell line (TPC-1)

Tumor malignancy is associated with the epithelial-mesenchymal transition (EMT) process and resistance to chemotherapy. However, little is known about the relationship between the EMT and the multidrug-resistance gene in thyroid tumor progression. We investigated whether the expression of the ABCG2/BCRP gene is associated with ZEB1 and other EMT inducer genes involved in tumor dedifferentiation. We established a subpopulation of cells that express the ABCG2/BCRP gene derived from the thyroid papillary carcinoma cell line (TPC-1), the so-called TPC-1 MITO-resistant subline. The most relevant findings in these TPC-1 selected cells were a statistically significant upregulation of ZEB1 and TWIST1 (35- and 15-fold change respectively), no changes in the relative expression of vimentin and SNAIL1, and no expression of E-cadherin. The TPC-1 MITO-resistant subline displayed a faster migration and greater invasive ability than parental cells in correlation with a significant upregulation of the survivin (BIRC5) gene (twofold change, P<0.05). The knockdown of ZEB1 promoted nuclear re-expression of E-cadherin, reduced expression of vimentin, N-cadherin, and BIRC5 genes, and reduced cell migration (P<0.05). Analysis of human thyroid carcinoma showed a slight overexpression of the ABCG2/BCRP at stages I and II (P<0.01), and a higher overexpression at stages III and IV (P<0.01). SNAIL1, TWIST1, and ZEB1 genes showed higher expression at stages III and IV than at stages I and II. E- and N-cadherin genes were upregulated at stages I and II of the disease (ninefold and tenfold change, respectively, P<0.01) but downregulated at stages III and IV (fourfold lower, P<0.01). These results could be a promising starting point for further study of the role of the ABCG2/BCRP gene in the progression of thyroid tumor.

Movement disorders in ischemic stroke: clinical study of 22 patients

Movement disorders (bemichorea-hemiballismus, hemidystonia and isolated tremor) are an uncommon clinical manifestation in ischemic stroke (IS), and their anatomical basis is poorly understood. We analyzed the clinical and neuroimaging characteristics of 22 consecutive patients who bad movement disorders associated with cerebral infarction (MDCI), studied at four institutions over 8 years. In one institution (from the La Alianza-Central Hospital of Barcelona Stroke Registry) nine patients with MDCI were identified among 1099 consecutive first ever stroke patients (0.8%) (908 with IS, 1%). Fifteen out of 22 patients (68%) had hemichorea-hemiballismus, five (23%) hemidystonia and two (9%) isolated tremor. MDCI were more often left sided (n = 15, 68%), being bilateral in one patient (4.5%). A lesion was found on neuroimaging (CT and/or MRI) in 15 patients (68%), in the territory of the posterior cerebral artery (n = 8) and middle cerebral artery (six deep and one superficial). The most commonly involved structure was the thalamus (n = 8, 36.5%). IS subtypes were; presumed lacunar infarcts in 14 patients (64%), atherothrombotic infarcts in two patients (9%), cardioembolic infarcts in two patients (9%) and infarcts of unknown etiology in four patients (18%). Hemichorea-hemiballismus was the most common type of MDCI in our study, usually being the result of a thalamic infarction. The thalamus was the most frequently damaged structure underlying all types of MDCI. There was a striking propensity of MDCI which resulted from nondominant deep hemispheric small vessel infarctions.

First Report of Crenate Broomrape (Orobanche crenata) on White Lupine (Lupinus albus) Growing in Alkaline Soils in Spain and Egypt

Crenate broomrape (Orobanche crenata Forsk.) is a parasitic weed known to threaten legume crops since antiquity. It is mainly restricted to the Mediterranean Basin, Southern Europe, and the Middle East where it is an important pest in grain and forage legumes and in some apiaceous crops such as carrot and celery (1). White lupines are cultivated in acid soils, which usually are free of O. crenata infestations. However, breeders are attempting to develop white lupine cultivars adapted to alkaline soils (2). We report here findings of O. crenata infection in field trials of this new lupine germplasm in alkaline soils in experimental farms with a known history of faba bean cultivation and heavy infestation of O. crenata in Kafr El-Sheikh, Egypt and Córdoba, Spain in the spring of 2009. Symptoms were typical of O. crenata infection with reduced growth and emergence of typical O. crenata nonbranched spikes close to the lupine plants. Infection was confirmed by digging up the plants to verify the attachment of the broomrape plant to the lupine. O. crenata plants growing on lupines were fully fertile, producing viable seeds. Plant morphology was typical of O. crenata (1). Voucher specimens were deposited at the Herbarium of the Botanic Department of the University of Córdoba. To our knowledge, this is the first report of O. crenata infecting lupine and is relevant because the expected introduction of alkaline-tolerant lupine cultivars will extend its area of cultivation into fields heavily infested with Orobanche. O. crenata is highly polymorphic and could easily adapt to, recognize, and infect this new host. Development of lupine-adapted O. crenata populations should be monitored because it could represent a major constraint on lupine introduction into alkaline soils. References: (1) D. M. Joel et al. Biology and Management of Weedy Root Parasites. Page 267 in: Horticultural Reviews. Vol. 33. John Wiley and Sons, Inc. Hoboken, NJ, 2007. (2) M. Vishnyakova and A. Mikic, White lupin (Lupinus albus L.) landraces and the breeding for tolerance to alkaline soil reaction. Page 142 in: Second GL-TTP Workshop: Integrating Legume Science and Crop Breeding. Novi Sad, Serbia, 2008.

[Genetic and environmental factors that may influence in the senile form of Alzheimer's disease: nested case control studies]

INTRODUCTION

We identify the genetic and environmental factors associated to Alzheimer's disease (AD) in a population aged 80 years or greater.

POPULATION STUDIED

subjects who participated in the COGMANLLEU study on prevalence of cognitive deterioration in Manlleu (Osona, Central Catalonia).

DESIGN

nested case control studies. The subjects who were diagnosed of AD (cases) in phases 2 of said study were paired 1:1 by age and gender with control subjects who were selected from among those who had no suspicion of cognitive deterioration and who had been examined in phase 1 of the study. The participating subjects (cases and controls) and their family or caregivers were interviewed. This included psychometric tests, physical examination, biological measurements, cranial computed tomography scan and determination of ApoE genotype.

RESULTS

Age is the principal factor associated to AD: risk of getting the disease is six time greater among those over 85 years (odds ratio [OR]: 6.54; 95% confidence interval [CI]: 2.05-20.81; p<0.05). Other factors associated of AD were female gender (OR: 3.17; 95 % CI: 0.80-12.50) and having been exposed to general anesthesia (OR: 3.22; 95 % CI: 1.03-10.09; p < 0.05). Arterial hypertension (AHT) presented a negative association (OR: 0.37; 95% CI: 0.10-1.31; p<0.05). An association was also observed between AD and the presence of ApoE4 allele so that the likelihood of ApoE4 in subjects with AD was three times greater than in the control group (OR: 3.44; 95% CI: 0.67-17.62).

CONCLUSIONS

The results agree with the hypothesis that senile AD is a complex, multifactorial disease in which different genetic and environmental factors play a part, among which having received general anesthesia has a role that can be considered in future research.

[Prevalence of cognitive deterioration in people over 80-years-old: COGMANLLEU study]

INTRODUCTION

We want to detect the prevalence of cognitive prevalence deterioration in the elderly population of 80-years-old or older, their grade of deterioration and the causal pathogenic entity.

DESIGN

a cross-sectional population study, including a first phase of screening and a second one of diagnosis confirmation.

STUDY SUBJECTS

a total of 877 elderly people of 80-years-old or older belonging to the basic health care area of Manlleu (Osona, Catalonia midlands). In the first phase, relatives and/or caregivers were interviewed, and the participating subjects underwent a set of tests. Those who obtained 24 points or less on the Mini-Mental State Examination (MMSE) and/or an equal Global Deterioration Scale (GDS) or over 3 were admitted to the second phase. During the second phase, a general and a neurological examination were performed, along with blood tests, cranial computed tomography scan and a neuropsychological study. DSM-IV criteria were used for dementia diagnosis, NINCDS-ADRA criteria for Alzheimer's disease (AD) and NINCS-AIREN for vascular dementia.

RESULTS

Half of the people over 80-years-old had cognitive deterioration. One-fourth had dementia. A total of 70.3% of these dementias corresponded to AD (47.2% AD without vascular lesions and 23.1% AD with vascular lesions) and 12% corresponded to vascular dementia. The percentage of other degenerative dementias was 17.6%. Age and gender were observed to be associated to dementia.

CONCLUSIONS

The prevalence of dementia in the COGMANLLEU study is similar to other European studies. AE is the most frequent dementia.

Using robotic systems in order to determine biomechanical properties of soft tissues

Biomechanical properties of soft tissue are important not only during computer simulation for medical training but also for systems where tissue deformation must be estimated in real-time, for example, Robot Assisted Surgery. The purpose of this paper is to describe some biomechanical tests consisting in the measurement of contact forces and deformations in tissue phantoms and porcine soft tissues (liver, brain, stomach and intestine). During the measurements two different procedures were applied. First, we have used a 5DOF micromanipulator instrumented with a spherical probe and a 6-axis force/torque ATI sensor. In the second procedure instead of the micromanipulator a Stäubli RX60 robot was used to apply the force over the samples. During this last test a high noise-signal relationship was detected and in order to improve the accuracy of the experiments some results were obtained using a Stäubli TX40 robot. Major accuracy in research in the field of soft tissue could be reached using standard procedures. Robotic systems allow precise movements to carry on biomechanical tests, and also permit a wide range of tasks to be implemented.

Linkage relationships between prolamin genes located on chromosome 1Hch in Hordeum chilense

The endosperm storage proteins of Hordeum chilense Roem. et Schult., a species used in the synthesis of the amphiploid tritordeum (x Tritordeum Ascherson et Graebner), have a great effect on the gluten strength of this amphiploid. We have analysed electrophoretically the heredity of these proteins, which are synthesised by genes located on chromosome 1H(ch), and detected up to five loci in a cross between two lines of H. chilense. These loci present a certain homology with loci synthesising the same proteins in wheat. The genetic distances between these loci were calculated.

Free amino acids and biogenic amines in red and white muscle of tuna stored in controlled atmospheres

This paper analyses the presence of and changes in free amino acids and biogenic amines in red and white muscle of bigeye tuna during storage in controlled atmospheres with 2 gas mixes containing different concentrations of CO(2) and O(2). Levels of amines were generally higher in white than in red muscle, with the exception of putrescine and spermidine. Levels of biogenic amines increased (p<0.05) throughout storage, commencing later in red than in white muscle. A correlation between the amino acid histidine and the biogenic amine histamine was observed, but only in white muscle. Only in the case of tryptophan did white and red muscle differ (p<0.05) in terms of essential free amino acid content. They also differed in anserine content. Concentrations of the non-essential FAAs glutamic acid, glycine and alanine were higher in red than in white muscle. The effectiveness of the atmospheres was reflected in the evolution of both biogenic amines and FAAs. Gas mix 1, containing a higher concentration of CO(2), was the more effective.

Search for partial resistance to leaf rust in a collection of ancient Spanish wheats

A collection of 917 accessions of Spanish durum and bread wheat was screened for resistance to leaf rust (Puccinia triticina) under field conditions at three locations. Resistance levels ranged from very low to very high, high susceptibility being most frequent. Relative disease severity (referred to the most susceptible accession = 100%) was lower than 20% in about 6% of the accessions in each location. In the collection most of the lines (84%) displayed a susceptible infection type. A final selection of seven accessions (one of them durum) displaying low severity level in the field and high infection type in a growth chamber was chosen for further studies. High levels of partial resistant with longer latency period and high percentage of early aborted colonies without necrosis were found. They might be used in breeding programmes.

Sensory, chemical and bacteriological changes during storage of iced squid (Todaropsis eblanae)

AIMS

To relate sensory shelf-life of iced whole and gutted squid to bacterial growth and chemical changes.

METHODS AND RESULTS

Cooked mantles from whole and gutted individuals were rejected after 10 and 12 days of storage, respectively, due to ammoniacal off-odours. Rate of production of both ammonia and trimethylamine was highest in the whole lot. Agmatine, which was only present in trace amounts in freshly-caught squid, increased rapidly in both lots. The main microflora at the time of sensory rejection of iced whole squid included Gram-negative, motile and non-fermentative rods, which were psychrophilic and had a requirement for NaCl. 16S rDNA sequence analyses identified the strains as belonging to the genus Pseudoalteromonas. Shewanella putrefaciens, Pseudoalteromonas sp. and Pseudomonas sp. dominated in spoiled gutted squid. Identification of strains from the stomach and digestive gland of recently-captured squid showed that the main flora consisted of Photobacterium phosphoreum.

CONCLUSIONS

Spoilage of iced squid is likely to result from a combination of autolytic and bacterial changes. Agmatine seems to be an excellent freshness indicator. Photobacterium phosphoreum may contribute to spoilage through activity in the digestive gland, followed by diffusion of volatile compounds and amines to the mantle.

SIGNIFICANCE AND IMPACT OF THE STUDY

Due to the psychrophilic nature of P. phosphoreum and Pseudoalteromonas sp., spread-plating and low temperature incubation are recommended for bacteriological evaluation of iced squid.

Preservation of shelf life of pota and octopus in chilled storage under controlled atmospheres

Whole ungutted pota and octopus were stored in bulk in stainless steel refrigerated containers under controlled atmospheres. In order to evaluate the effectiveness of this treatment, physicochemical tests (pH, trimethylamine nitrogen, total volatile basic nitrogen, 2-thiobarbituric acid) and sensory assessments (inspection) were done. For both pota and octopus, the control lot had the highest physicochemical values and the lowest sensory values, and of the two assayed atmospheres, the 60/15/25% atmosphere (CO2/O2/N2) had the best physicochemical results. pH, trimethylamine nitrogen, and total volatile basic nitrogen levels were lower (P < or = 0.05) in octopus than in pota, and the inspection results were significantly (P < or = 0.05) higher. However, the octopus had a higher 2-thiobarbituric acid index than the pota. Therefore, the application of controlled atmospheres on these cephalopods during chilled bulk storage considerably increases their shelf life.

Formation of biogenic amines in bulk-stored chilled hake (Merluccius merluccius L.) packed under atmospheres

The production of biogenic amines in the lots of whole hake stored bulk under a controlled or modified atmosphere for 12 days with the gas mixture 40% CO2:40% O2:20% N2 and after packing in trays under a modified atmosphere in the same mixture of gases or with air was studied. Results indicated a close relation between the development of trimethylamine nitrogen (TMA-N) and the sensory parameters gill appearance and odor but not with the general appearance of the skin and eyes. These results were related to changes observed in the concentration of gases (CO2 and O2) during storage containers and trays. The lot of bulk-stored whole hake in controlled atmospheres for 12 days with the gas mixture 40% CO2:40% O2:20% N2 and then packed in trays with the same atmosphere exhibited TMA-N levels below the 12.5 mg/100 g limit designated by the legislation in force (Directive 91/143/EU) on day 31 of storage when the sensory parameters general appearance and skin and gill color were not rejected. Histamine and tyramine levels were less than 1 mg/kg, putrescine levels were approximately 7 mg/kg, and cadaverine and agmatine levels were 33.91 and 20.33 mg/100 g, respectively.

Growth and metabolic activity of Shewanella putrefaciens maintained under different CO2 and O2 concentrations

Growth, trimethylamine (TMA), off-odour and biogenic amine production by a strain of Shewanella putrefaciens isolated from spoiled hake (Merlucius merluccius L.) and cultured in a model system, were tested under four different gas compositions (60% CO2/40% O2, 60% CO2/15% O2/25% N2, 40% CO2/60% O2, 40% CO2/40% O2/20% N2) and under air. After 3 weeks of incubation, the control (air) batch showed the highest microbial counts (> 9 log cfu/ml) and TMA concentrations (45 mg N-TMA/100 ml), and strong putrid off-odours were detected from day 15. High amounts of putrescine and cadaverine were produced in this batch, but histamine increased only slightly. Batches under controlled atmospheres showed reduced growth, TMA, off-odour and biogenic amine production. The 40% CO2/60% O2 mixture had the strongest inhibitory effect on bacterial growth, while the 60% CO2/15% O2/25% N2 mixture was less effective. Putrescine and histamine production was lowest in S. putrefaciens under the 40% CO2/60% O2 mixture. However, the level of histamine in S. putrefaciens was higher under 40% CO2/40% O2/20% N2 than when the bacteria was incubated in air. Under the gas mixtures, there was a similar decrease in the production of cadaverine and agmatine by S. putrefaciens, irrespective of the gas concentrations. The production of 2-phenylethylamine appeared to be inhibited under any atmospheric condition.

The use erythrocyte glutathione as a predictive marker for malignant melanoma

BACKGROUND

Glutathione (GSH) may provide defense against reactive oxygen species (ROS) generated by ultraviolet radiation. Furthermore, some authors have demonstrated a relationship between the GSH of peripheral blood erythrocytes (GSHe) and resistance to chemotherapy.

PATIENTS & METHODS

To observe the influence of GSH on the genesis and evolution of Malignant Melanoma (MM), we assessed the concentration of GSH in erythrocytes (GSHe) in MM patients (n = 566) and controls (n = 164) by the method of Beutler (1963).

RESULTS

No differences were found between the two groups (5.94 +/- 1.61 cases vs 6.08 +/- 1.49 mmol/gr Hb, controls; p > 0.05). Fifty seven patients with poor evolution (disease-free survival < 2 years) had higher GSH levels than the remaining patients (6.35 +/- 1.83 vs 5.83 +/- 1.62 mmol/g Hb; p < 0.01). GSHe increased significantly after antineoplastic therapy (4.75 +/- 1.26 vs 7.73 +/- 1.39 mmoVg Hb; p < 0.001), thus indicating a possible role in chemoresistance. 2

CONCLUSIONS

GSHe is not related to the risk of developing MM. GSHe may be related to the evolution of MM, being higher in patients who suffer relapse or metastasis. GSHe increases significantly during cytostatic treatment.

Isolation and partial characterization of two types of muscle collagen in some cephalopods

Collagen from muscle of volador (Illex coindetii), pota (Toradopsis eblanae), and white octopus (Eledone cirrhosa) was characterized in terms of anatomical location, sex, and maturity. Collagen content was higher in arms than in mantle in all three species; there were also significant differences in octopus depending on the age of the individual. Concerning sex, the largest differences in the amount of collagen were found in relation to total protein content. In volador and pota, collagen solubility was higher in the mantle than in the arms, and in the case of pota there were also sex-related differences. In octopus males, solubility was higher in the arms. Two types of collagen, I and V, were identified as the principal constituents in all three species and at both anatomical locations (mantle and arms). The electrophoretic mobility of the alpha2 chain differed in the two types of collagen, but the amino acid compositions of the collagen were similar in the mantle and arms in all three species examined.

Evaluation of neuronal loss, astrocytosis and abnormalities of cytoskeletal components of large motor neurons in the human anterior horn in aging

In order to identify possible morphological changes which occur in the anterior horn of normal individuals during aging, 40 controls with no neurological disease were studied. Brain and spinal cord tissue was processed according to a brain banking protocol. Controls were grouped according to age in 10 year intervals. Serial sections (20 microm) of formalin fixed, paraffin-embedded tissue were obtained, from each cervical, thoracic and lumbar spinal cord segment. Every 5th section (until 2 mm) was stained with haematoxylin and eosin and the numbers of motor neurons in the anterior horn counted at x400 magnification. Descriptive statistical analysis was performed using the SPSS program. Parallel sections (5 microm) of the same spinal segments were immunostained with a panel of antibodies including glial fibrillary acidic protein (GFAP), tau, ubiquitin and two phosphorylated neurofilaments subunits. Significant neuronal loss with aging was found by regression line analysis where three equations were used to calculate the number of motor neurons by age in each spinal segment. In 24/40 cases spheroids were observed and they were more numerous in the lumbar segment. GFAP staining revealed a distinctive cellular pattern in the anterior horn of oldest cases. Large and intensely stained astrocytes were seen in the anterior horn of cases aged over 75 years. The number of astrocytes increased progressively with age up to 70 years. Some of the changes observed in the present study may be the result of a selective vulnerability of large motor neurons to aging which could play an important role in the progression of MND. Most of these changes may also have similar pathophysiological mechanisms.

Extraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for treatment of malignant melanoma

BACKGROUND

Current treatment of malignant melanoma of the leg includes ilioinguinal lymphadenectomy (IIL). Standard open IIL (open IIL) includes sectioning of the inguinal ligament to gain access to the iliac nodes. Extraperitoneal laparoscopic IIL (lap IIL) is a feasible, less aggressive approach. It can be combined with standard superficial lymphadenectomy for treatment of malignant melanoma.

DESIGN

Comparative, prospective, nonrandomized series.

SETTING

Tertiary care center.

PATIENTS

Twelve consecutive, unselected patients with malignant melanoma treated with lap IIL (group 1) were compared with 10 consecutive, unselected patients with malignant melanoma on whom open IIL was performed (group 2).

INTERVENTIONS

Standard open IIL and laparoscopic extraperitoneal iliac lymphadenectomy (lap IIL) plus superficial groin lymphadenectomy.

MAIN OUTCOME MEASURES

Operative time, intraoperative complications, requirements of analgesia, total volume of lymphatic drainage, number of lymph nodes retrieved, immediate morbidity, hospital stay, and long-term morbidity were evaluated.

RESULTS

Operative time was significantly longer for the lap IIL group (group 1) than for the open IIL group (group 2) (177+/-44 vs 140+/-18 minutes, respectively; P<.05), but no patients in group 1 needed conversion to open surgery or developed related complications. Overall lymphatic drainage was significantly lower in group 1 than in group 2 (615+/-518 mL vs 1393+/-793 mL, repectively; P<.01). The number of doses of analgesics (13+/-8 vs 31+/-22, P<.03) and length of postoperative stay (7.3+/-3.3 vs 13+/-5 days, P<.006) were also significantly lower in the laparoscopic group. The overall number of lymph nodes retrieved was similar in both groups (10.2+/-4.6 vs 10+/-3, P=.9). One patient developed a groin hernia of 6 m after open IIL.

CONCLUSIONS

Laparoscopically assisted IIL offers a less aggressive approach than open IIL and entails less pain and a shorter hospital stay, as we observed in 2 groups with similar oncological results (mainly, a similar number of lymph nodes retrieved) who were treated with one procedure or the other. Further research should be done to confirm these preliminary advantages in a prospective randomized trial with long-term follow-up.

Surgery in Spain

The Iberian Peninsula-the southwestern point of Europe, between the Mediterranean Sea and the Atlantic Ocean-was visited and settled in ancient times by a variety of peoples. Phoenicians, Carthaginians, Celts, Greeks, Romans, Visigoths, and Arabs all left their mark on the peninsula, and their cultures blended together to found, among other things, a rich tradition in medicine and surgery. During the Renaissance, the fluid exchange of technical skills and knowledge with the rest of Europe and the emergence of universities ensured the development of a high level of medical expertise. Today, surgery in Spain is at the forefront of innovations in the field.

Immunohistochemical study of alpha, mu and pi class glutathione S transferase expression in malignant melanoma. MMM Group. Multidisciplinary Malignant Melanoma Group

Human pi, mu and alpha class glutathione S transferases (GST) have been localized immunohistologically in normal skin, naevi and melanoma. Pi GSTs were found principally in the stratum basalis and, to a lesser extent, in the superficial layers. Normal melanocytes showed strong nuclear and cytoplasmatic staining. Distribution of GST mu in the epidermis showed that only the stratum basale, where melanocytes are located, stained well but with weak nuclear staining. Normal melanocytes were also well stained. The alpha GSTs were relatively abundant in the upper strata and to a lesser extent, in the basal layers. The absence of nuclear staining gives these cells a target appearance. Normal melanocytes showed strong cytoplasmatic staining. The pi GSTs seem to be most persistently and strongly expressed in malignant melanoma (MM), but mu GSTs are also found, whereas the alpha GSTs were only occasionally present. The finding of the GST mu in the melanocytes of the basal layer raises new questions regarding the role of GST mu in these cells because of the inherent risk of MM in individuals with a congenital deficiency of this isoenzyme. The role of GSTs in the resistance of cells to chemotherapy is also discussed.

Acute phase is the only significantly reduced component of the injury response after laparoscopic cholecystectomy

The objective demonstration of improved postoperative recovery suggests that the surgical injury response induced by the laparoscopic approach is less intensive than that after open surgery. Twenty-five patients diagnosed as having noncomplicated gallstones were studied prospectively. They were operated by laparoscopy (group I, n = 12) or open surgery (group II, n = 13). Analgesia requirements (p < 0.026) and postoperative stay (p < 0.001) were significantly less in group 1. Cholecystectomy performed by either technical options induced a significant increase over basal values of glucose, lactate, white blood cell count, prolactin, ACTH, cortisol, interleukin 6, C-reactive protein, and PCO2. Both surgical procedures induced a significant reduction of total proteins, albumin, prealbumin, free fatty acids hemoglobin, hematocrit, and pH. There were no differences between the levels of growth hormone, insulin, glucagon, or PO2 during any of the periods studied. Comparison of the results of the two cholecystectomy techniques showed that laparoscopic cholecystectomy induced a significantly less intensive acute-phase response (area under the curve) of interleukin 6 (17 +/- 17 versus 47 +/- 26 pg/ml x hr x 10(2); p < 0.003), C-reactive protein (16 +/- 12 versus 35 +/-16 mg/dl x hr x 10; p < 0.004), and prealbumin (16 +/- 2.7 versus 13.8 +/- 2.3 mg/dl x hr x 10(2); p < 0.05). The surgical injury response after laparoscopic cholecystectomy is similar to that after open cholecystectomy, but the aeute-phase response component is less intense. This finding may be a consequence of the reduced size of the operative wound with laparoscopic cholecystectomy.

Synaptophysin in spinal anterior horn in aging and ALS: an immunohistological study

Aged-related spinal cord changes such as neuronal loss have been related to the degree of clinical severity of amyotrophic lateral sclerosis (ALS); morphological data on synapses are, however, wanting. Variations in synaptophysin (Sph) expression in aging and ALS were thus studied at the level of lower motor neurons in 40 controls with non-neurological diseases and 11 cases of ALS. Control sections of formalin fixed paraffin embedded cervical (C7/8), thoracic (T10) and lumbar spinal cord (L5) and C6, C7, C8 and L5 of ALS cases were stained with haematoxylin and eosin, luxol fast blue (LFB), and immunostained with a mouse monoclonal antibody against Sph. The neuropil of the anterior horn (AH) in all control cases demonstrated Sph positivity. A dot-like pattern of positivity of presynaptic terminals on soma of motor neurons and fine immunoreactivity along neuronal processes were observed. A significant reduction of Sph immunostaining was observed in the neuropil with increasing age and 3 different somatic patterns were seen: a- well preserved Sph reactivity around the soma and the proximal dendrites of histologically normal neurons; b- few chromatolytic neurons showing large numbers of dot-like presynaptic terminals around the cell body and in a "fused" pattern; c- intense, diffuse, and homogeneous reactivity of some neurons. Attenuation of Sph reactivity in the AH neuropil, to its complete loss, was observed in all ALS cases. In addition to patterns a-c, two additional microscopic findings were noted in ALS: d- chromatolytic neurons showing complete absence of Sph reactivity; e- absence of Sph reactivity around the soma and the proximal dendrites of histologically normal surviving neurons. Our findings demonstrate that there is a decrease in Sph immunostaining with aging, thus suggesting an alteration in dendritic networks of the AH with aging. Changes in the pattern of Sph immunoreactivity in cell bodies may represent synaptic plasticity and/or degeneration. Reinnervation may also be a possible mechanism as a response to neuronal loss in oldest control cases. Sph reactivity results may thus lend support to the presence of superimposed aging components in ALS cases which may give an insight into explaining the increasing severity of the disease which is encountered with advancing age.

Phenotype of glutathione S-transferase Mu (GSTM1) and susceptibility to malignant melanoma. MMM group. Multidisciplinary Malignant Melanoma Group

The isoenzyme Mu of glutathione S-transferase (GSTM1) is dominantly inherited, and the prevalence of this isoenzyme in the population is about 60%. The lack of GSTM1 has been linked with cancer risk. The frequency of the phenotypes of this isoenzyme in melanoma (MM) patients (n = 197) is reported here. A significantly higher proportion of individuals in the control group (n = 147) had measurable GSTM1 than MM patients (59.1% vs 42%, P = 0.002); there was a higher proportion of positive phenotypes in general among women than among men. Odds ratio analysis indicated that individuals with this polymorphic variant have an approximately 2-fold risk of developing these cancers. GSTM1 phenotype distribution depends on age, smoking habit and tumour pathology. A group of MM patients with dysplastic naevi was also studied.

[Is there a relationship between cholelithiasis and colorectal cancer?]

PROBLEM

The pathogenesis of colorectal cancer must be perceived as a complex interaction between the genetic make-up of the individual and the environment. Recent publications stress the association between colorectal carcinoma and cholelithiasis.

OBJECTIVE

A retrospective study was set up to compare the presence of cholelithiasis/cholecystectomy in patients with colorectal carcinoma vs gastric carcinoma.

PATIENTS

In 481 patients with colorectal carcinoma, and in another group of 126 patients with gastric carcinoma, the incidence of prior cholelithiasis/cholecystectomy was investigated.

RESULTS

In the colorectal carcinoma cases a personal history the cholelithiasis was observed more often than cholecystectomy, 88 vs 8 (P < 0.001) patients, and cholelithiasis was more commonly observed in cases of right-sided colonic cancer, than in cancer of the left colon and rectum. In the group with gastric carcinoma the cholelithiasis incidence was 5.6 percent.

CONCLUSIONS

These findings suggest that a relationship was found more often between colorectal cancer and cholelithiasis, that with cholecystectomy.

Selective adverse reactions to diflunisal

BACKGROUND AND OBJECTIVE

Diflunisal is a difluorophenyl derivative of salicylic acid. We report two patients who presented immediate adverse reactions to diflunisal (Dolobid) that consisted of generalized urticaria and chest tightness.

METHODS

Diflunisal was conjugated to human serum albumin in order to perform in vivo and in vitro tests (skin prick and intradermal tests, leukocyte histamine release, and RAST). The patients were challenged following a single-blind, placebo-controlled oral procedure with diflunisal and other nonsteroidal antiinflammatory drugs.

RESULTS

Skin tests with diflunisal were negative as were leukocyte histamine release tests and RAST in both patients. They tolerated therapeutic doses of aspirin, salsalate, salicylamide, lysine acetylsalicylate, acetaminophen, dipyrone, and propyfenazone. The oral provocation with diflunisal elicited an immediate response at the cumulative dose of 400 mg in both patients.

CONCLUSION

These are two exceptional cases of selective adverse reactions to diflunisal with good tolerance to other salicylates and nonsteroidal antiinflammatory drugs. Thus, the inhibition of cyclooxygenase does not seem to be the mechanism involved. The pathogenic mechanism implicated in the reaction remains unclear, both idiosyncratic and immunologic mechanisms could explain our patients' adverse responses.

Laparoscopic splenectomy: technical aspects and preliminary results

The success of laparoscopic cholecystectomy has prompted the application of laparoscopic techniques to other abdominal procedures. Laparoscopic splenectomy poses certain specific difficulties for the control of the vascular pedicle, handling and mobilisation of a parenchymatous organ and the retrieval of the specimen. The aim of this paper is to present a technique for laparoscopic splenectomy.

MATERIAL AND METHODS

Between February and October, 1993 we attempted laparoscopic splenectomy (LS) in 7 patients. Splenectomy was indicated in 5 patients for treatment of an idiopathic thrombocytopenic purpura and in two patients for treatment of hereditary microspherocytosis. One patient had concomitant cholelithiasis.

RESULTS

LS was completed in 6 and converted in one patient to an open procedure due to blood from the splenic bed obscuring vision. Laparoscopic cholecystectomy and splenectomy were performed simultaneously in the patient with cholelithiasis. Three patients required transfusion of two packed cell units. In one patient, the bag broke during extraction of the spleen, and a minilaparotomy was required to remove the spleen. In one patient an accessory spleen was removed. Oral intake was started the next morning. Two patients developed pulmonary atelectasis. Analgesia requirements ranged between 2 and 10 doses, and postoperative stay ranged between 4-8 days.

CONCLUSION

LS is technically feasible, and offers the functional and aesthetic advantages of laparoscopic surgery.

Laparoscopic resection of a retroperitoneal cystic lymphangioma

The success of laparoscopic cholecystectomy has expanded the scope of laparoscopic procedures and resection of retroperitoneal organs and selected cystic intraadominal masses have been performed by minimally invasive surgical techniques. We report the case of a 45-year-old that presented a retroperitoneal cystic lymphangioma that was successfully excised by a laparoscopic approach. Laparoscopic surgical techniques should be considered for treatment of selected cystic lesions of intrabdominal or retroperitioneal origin.

Type II hereditary angioedema: presentation and follow-up of three cases

Three cases with a family history of type II hereditary angioedema (HAE) are presented, together with their progress following treatment with stanozolol. The development of patients with this drug was satisfactory in clinical terms, as it gave rise to virtually no side effects or angioedema episodes. Only patient 3 showed an elevation of hepatic enzyme (SGOT, SGPT) levels in serum, 2 months after starting treatment. C4 values of patient 2 attained sporadic normalization in the first five months of treatment, while the values corresponding to the other two patients remained below normal at all times. The activity of C1 inhibitor (C1-INH) remained below normal in all three cases. In patient 3, it was observed that circulating immunocomplex (CIC) monitoring was, together with clinical progress, a useful method for controlling HAE activity.

Detection of inflammation/infection with human polyclonal immunoglobulin G labelled with 99Tcm

Radiolabelled human polyclonal immunoglobulin G (IgG) has been successful in identifying inflammatory/infectious processes in human and animal models. We studied 71 patients with suspicion of inflammation of varied origin and location (44 of musculoskeletal location and 27 other) using 99Tcm. IgG images correctly identified 21/22 inflammatory sites of musculoskeletal origin and only 4/14 sites of soft-tissue location. Five false negative studies corresponded to granulomatous processes, three of them tuberculosis. Four false positive studies were obtained in the musculoskeletal group corresponding to three synovial tumours and a Charcot joint. No false positive results were seen in the soft tissue group. 99Tcm-IgG performs well in the identification of bone-joint lesions and rules out non-inflammatory conditions (with the important exception of tumours). The role of 99Tcm-IgG in soft-tissue inflammatory sites, especially in highly vascular organs is inferior, with a high yield of false negative studies. Granulomatous lesions probably represent situations of low or absent IgG uptake.

Erythromycin ototoxicity in liver transplant patients

We report on three liver transplant patients who developed erythromycin-related ototoxicity. This complication has been described in renal transplant patients and in patients with liver dysfunction, but to our knowledge it has not yet been reported in liver transplant patients. The influence of hepatic dysfunction, common renal failure, and the interaction between cyclosporin and erythromycin in the development of erythromycin ototoxicity are discussed.

[Subcutaneous venous reservoirs: comparative study of their efficacy in patients with AIDS versus oncology and hematology patients]

BACKGROUND

Chronic venous access may constitute a serious problem in some patients and the subcutaneous venous reservoirs have demonstrated to be a useful alternative. AIDS patients require intense pharmacologic treatment, thus the use of subcutaneous venous reservoirs may be specially useful. However, the prevalence of septic type complications following placement of the subcutaneous venous reservoirs in these patients is particularly high.

AIMS

To know the efficacy of subcutaneous venous reservoirs in the AIDS population and compare the results in a non AIDS population.

METHODS

All the subcutaneous venous reservoirs placed between January 1990 and December 1992 were prospectively studied with two groups being established: Group I: patients with positive serology for HIV and who achieved criteria of AIDS requiring placement of a subcutaneous venous reservoirs. Group II: All the remaining patients in whom a subcutaneous venous reservoirs was placed during the same period of time.

RESULTS

The incidence of infection was higher in group I (AIDS) with respect to group II (0.1 versus 0.014 infections/100 catheters/day, p < 0.01) and the non septic complications were higher in group II (3.6% versus 12.7%, p < 0.0004). The catheters were most frequently used in group I with respect to group II (12.7 +/- 7.1 versus 3.3 +/- 4.9 punctures/month) but the period was use longer in group II (13.7 +/- 9.2 versus 4.3 +/- 3.1 months, p < 0.0001).

CONCLUSIONS

The population of AIDS patients may benefit greatly from the systematic use of subcutaneous venous reservoir due to their clinical and therapeutic characteristics. Nonetheless greater risk of infection may occur in these patients because of the greater need for punctures with respect to the other indications for placement of these catheters.