[Pulmonary diffusion of carbon monoxide in 2 clinical situations: bronchial asthma and diabetes mellitus]

OBJECTIVE

The aim of our work has been the study and comparison of diffusion capacity of CO (DLCO) in two different clinical situations: bronchial asthma and diabetes mellitus.

METHOD

We have studied 16 control subjects, 38 patients with bronchial asthma and 65 patients with diabetes mellitus. We performed CO pulmonary diffusion tests by single breath method to determine two components: membrane diffusion factor (Dm) and pulmonary capillary blood volume (Vc).

RESULTS

We have found a positive correlation of FEV1 with Dm. The bronchial asthma group had a lower FEV1 and FEF25-75% and an increase in DLCO, Dm and Vc, with respect to the control group. The diabetes mellitus group presented a decrease in CVF, FEV1, DLCO and Vc, with respect to the control group. The bronchial asthma group showed a lower ratio of Dm/Vc than the control and diabetes groups.

CONCLUSIONS

The bronchial asthma patients have an increase in CO pulmonary diffusion, membrane diffusion factor and pulmonary capillary volume. However, the diabetes mellitus patients present a decrease in CO pulmonary diffusion mainly due to pulmonary capillary volume.

External iliac vein thrombosis after renal transplantation: treatment by thrombolysis and stent placement: a case report

We present a patient with iliac vein stenosis and thrombosis, which occurred 2 weeks after renal transplantation and were secondary to a perivascular hematic collection. The vein stenosis was identified by color Doppler ultrasonography and venography. Computed tomography demonstrated a perivascular collection. One week later, control venography identified iliac vein thrombosis. The patient underwent pharmacological thrombolysis with local infusion of urokinase for 4 hr, percutaneous transluminal angioplasty, and percutaneous installation of a metallic stent (Wallstent), with immediate favorable results. The patient remains in stable condition at 2 years after the procedure.

EBV-positive non-Hodgkin's lymphoma developing after phenytoin therapy

We report the first case of Epstein Barr virus (EBV) positive non-Hodgkin's lymphoma occurring 20 years after continuous phenytoin therapy for idiopathic epilepsy. This malignant lymphoproliferative disease was preceded by an phenytoin-associated benign reactive lymphadenopathy. Serological findings suggested a chronic active EBV infection. Immunohistochemistry showed that neoplastic cells expressed B antigens (CD20, lambda) and the bcl-2 protein. The presence of EBV-encoded latent membrane protein 1 (LMP 1) was also expressed on neoplastic cells. Cytotoxic chemotherapy (CHOP) reversed the non-Hodgkin's lymphoma.

[The rapid specific characterization of clinical isolates of the genus Mycobacterium by the polymerase chain reaction and restriction enzyme analysis]

BACKGROUND

Typing at species level of Mycobacterium is usually performed by microbiological and biochemical methods that require a long time and/or sufficient amount of bacteria. Molecular biology can avoid these problems using different techniques.

METHODS

A colony growth of the following mycobacteria has been analyzed: M. tuberculosis, M. kansasii, M. avium, M. intracellulare, M. gordonae, M. phlei, M. aurum, M. fortuitum, M. flavescens, M. marinum, M. xenopi, M. nonchromogenicum, M. terrae and M. chelonei. Strains were grown in Löwenstein-Jensen medium. DNA was obtained by proteolytic digestion and fenol extraction. The 16S rRNA gen was amplified by polymerase chain reaction (PCR) and the amplification was digested by HaeIII, HpaII, RsaI and AluI restriction enzymes. Restriction fragment patterns were analyzed by agarose gel electrophoresis and UV transillumination.

RESULTS

The combination of the patterns obtained with HpaII and RsaI was sufficient to generate 13 different combined ones. The patterns of M. intracellulare and M. avium were the same.

CONCLUSIONS

PCR and restriction enzyme analysis is an useful method for typing at species level of clinical isolates of mycobacteria.

Arnold-Chiari malformation associated with sleep apnea and central dysregulation of arterial pressure

The natural history of symptomatic adult type I Arnold-Chiari (ACM1) malformation is variable. Patients with this condition frequently develop corticospinal and sensory deficits, together with cerebellar signs and lower cranial nerve palsies in various combinations. In the present report we describe a patient with ACM1 in whom sleep apnea together with disturbances in the central regulation of arterial pressure were a major component of the symptomatology. These paroxysmal blood pressure changes has not been previously reported. The decompression of our patient's medulla, which contains the primary respiratory centers and baroreceptors, resulted in a marked improvement and indicate that the origin may have been on a central basis.

Effect of clonidine on glucose, insulin and glucagon responses to a protein meal in type 2 diabetics

The authors investigated the effects of clonidine (alpha-2 stimulating agent) on blood glucose, insulin and glucagon levels in order to assess the alpha-adrenergic regulation of endocrine pancreatic secretion. Ten hypertensive female subjects affected with type 2 diabetes were studied; each subject was given a protein meal (boiled beef 200 g); blood samples were taken at -30, 0, 30, 60, 90 and 120 min; after this test each subject was treated for 4 days with clonidine (0.150 mg, 3 times/day per os); at the 5th day the protein meal was repeated under the same conditions except for the added administration of clonidine. Plasma glucose, insulin and glucagon were estimated. The administration of a protein meal caused a significant increase of blood glucose (peak at 60 min), insulin (peak at 90 min) and glucagon (peak at 90 min) levels; the association of clonidine caused an increase of blood glucose (single values and total areas) without changes of insulin and glucagon levels, when compared to those obtained before clonidine treatment. In conclusion, the association of clonidine to a protein meal caused impaired glucose tolerance presumably due to a direct glycogenolytic effect, occurring in the liver on account of an alpha-2 receptor stimulation, insulin and glucagon not being involved in this phenomenon.

Effect of alpha-1-blockade by prazosin on blood sugar, insulin and glucagon levels in normals and non-insulin dependent diabetics

The AA. studied the glycometabolic activity of prazosin, a hypotensive drug with an adrenergic blocking activity of alpha-1-selective type. Twenty-two moderately hypertensive subjects were studied. Their ages ranged from 37 to 57 years; 10 of the patients had non-insulin dependent diabetes mellitus. After overnight fasting every patient underwent an oral glucose test (g 100) at 09:00. Blood samples were withdrawn at 0, 30, 60, 90 and 120 minutes. Each patient was then given in randomized and double-blind fashion placebo or prazosin (4 mg, 2 pills of Minipress Pfizer per day) for the following 7 days; then another glucose load was administered. Glucose (enzymatic method), insulin and glucagon (RIA method) were measured in each blood sample. In non diabetic subjects glucose levels (60, 90, 120 min and total area) after oral glucose and prazosin were statistically higher (p less than 0.05, p less than 0.01, p less than 0.05) than after glucose only. No significant difference between the two curves was observed in the diabetic group. IRI levels in normal subjects were statistically higher after 120 min and in the total area, while no evident changes were noted in the diabetic group. The glucagon curve seen after oral glucose was not modified by prazosin in either group.

Effect of metformin on blood glucose, insulin and C-peptide responses to glucagon in non-insulin dependent diabetics

Since the C-peptide Radioimmuno active/Immuno Reactive Insulin (CPR/IRI) molar ratio is considered as an index of insulin hepatic extraction and tissue receptor binding, the AA. investigated the effects of metformin on this index after glucagon infusion in non-insulin dependent diabetics. Fourteen lean subjects (aged 48 to 67 years, mean 54 +/- 7) with non-insulin dependent diabetes were studied. At 9.00 a.m. each subject after overnight fasting, underwent glucagon infusion (1 mg i.v. diluted in 250 ml of saline, infused at a rate of 8.3 gamma/min for 2 hours); blood specimen were obtained at --15, 0, 30, 60, 90, 120 min. This test was repeated after a five-day treatment with metformin (1.5 g per os). For each sample plasma glucose by glucose oxidase method, plasma insulin and C-peptide by Radio Immuno Assay (RIA) method were determined. After treatment with metformin the hyperglycemia induced by glucagon was not influenced; nevertheless insulin and C-peptide plasma levels showed an evident reduction while CPR/IRI molar ratio was unchanged. The AA. suppose an indirect effect of metformin upon beta cells, namely a less pancreatic insulin requirement, mediated by an improvement of glucose utilization.

[Effect of metformin on plasma lipoprotein lipase]

The action of metformin with respect to in vitro turbidimetric clarification of a glyceridic system (lipostrate) has been studied in a group of metabolically healthy subjects. It is observed that biguanide associated with 3GS, heparinoid with known structure and costant liposemec activity, significantly accentuates clarifying activity whereas biguanide alone leads to only a slight increase in the clarification index, at least 5 times less than that induced by 3GS. Results are discussed. These agree with some recent experiments on the catabolic and antiatherogenic effect in vivo of biguanide on the VLDL and LDL, fostering their conversion into high density lipoproteins.

Ratio between the amplitude of sensory evoked potentials at the wrist in both hands of left-handed subjects

Maximum sensory conduction velocity, duration and amplitude of the sensory evoked potentials at the wrist on stimulating digits 1, 2, 3 and 5, were determined bilaterally in 21 left-handed subjects with an age range from 6 to 47 years. The amplitude of the sensory evoked potential at the wrist was larger in the right hand. This asymmetry is the reverse of the one previously observed in right-handed infants and adults. It could be physiological and suggests a difference in density of sensory innervation between the two hands. Asymmetry of sensory innervation can be helpful in the study of hand dominance.