Use of CT-scan in pediatric patients with thoraco-abdominal trauma: experience at a latin-american trauma facility

INTRODUCTION

CT-scan is the method of choice for major trauma assessment. However, it significantly increases radiation exposure in the pediatric population. The objective of this study was to analyze differences in clinical outcomes according to the preoperative use of CT-scan.

MATERIALS AND METHODS

A retrospective observational study of pediatric patients admitted for trauma and requiring surgery was carried out. Patients were classified according to the previous use of CT-scan. ICU stay, re-admissions, and deaths were assessed.

RESULTS

From 2011 to 2017, 737 patients under 18 years of age with external lesions were treated, 174 of whom required surgery. 48 patients (27.6%) underwent CT-scan prior to the procedure (Group 1), while the remaining 126 patients (72.4%) were directly scheduled for surgery (Group 2). Penetrating trauma occurred in 81% of patients, the proportion being significantly higher in Group 2 (p= 0.001). Median age was 15 years (interquartile range: 12-17), with no differences between groups. No significant differences were found in terms of hemodynamic instability at admission between groups (p= 0.596). At surgery, 3 out of 48 patients (6.3%) had no evident lesion. No significant differences were found in terms of re-admissions (p= 0.476), mortality (0.994), and ICU stay (0.466).

CONCLUSION

The use of CT-scan as a diagnostic tool in pediatric trauma does not reduce mortality, ICU stay, or number of re-admissions. The use of tools such as ultrasound examination and simple X-ray should be protocolized to avoid unnecessary exposure to higher radiation doses. Prospective studies confirming this hypothesis are required.

Effectiveness and safety of ertapenem used in hospital-at-home units: data from Spanish Outpatient Parenteral Antimicrobial Therapy Registry

AIM

To evaluate the effectiveness and safety of ertapenem in patients hospitalized at home.

PATIENTS & METHODS

Retrospective analysis of data from Spanish Outpatient Parenteral Antimicrobial Therapy (OPAT) registry.

RESULTS

Data from 1428 patients (median age 70 years; 5.4% institutionalized) and 1547 infectious processes (24% self-administration) were analyzed. Clinical cure or improvement was achieved in 93.8% of cases. Rate of related readmissions was 4.2%, of clinically important complications -3.9%, and of adverse drug reactions -3.2%. High comorbidity burden, contagion in nursing home and certain types of infection were associated with worse prognosis. Self-administration was effective and safe, except in case of nursing home-acquired infections.

CONCLUSION

Ertapenem OPAT was effective and safe. Caregivers in nursing homes should be better trained in OPAT-related procedures.

Post-acquisition data processing for the screening of transformation products of different organic contaminants. Two-year monitoring of river water using LC-ESI-QTOF-MS and GCxGC-EI-TOF-MS

This study describes a comprehensive strategy for detecting and elucidating the chemical structures of expected and unexpected transformation products (TPs) from chemicals found in river water and effluent wastewater samples, using liquid chromatography coupled to electrospray ionization quadrupole-time-of-flight mass spectrometer (LC-ESI-QTOF-MS), with post-acquisition data processing and an automated search using an in-house database. The efficacy of the mass defect filtering (MDF) approach to screen metabolites from common biotransformation pathways was tested, and it was shown to be sufficiently sensitive and applicable for detecting metabolites in environmental samples. Four omeprazole metabolites and two venlafaxine metabolites were identified in river water samples. This paper reports the analytical results obtained during 2 years of monitoring, carried out at eight sampling points along the Henares River (Spain). Multiresidue monitoring, for targeted analysis, includes a group of 122 chemicals, amongst which are pharmaceuticals, personal care products, pesticides and PAHs. For this purpose, two analytical methods were used based on direct injection with a LC-ESI-QTOF-MS system and stir bar sorptive extraction (SBSE) with bi-dimensional gas chromatography coupled with a time-of-flight spectrometer (GCxGC-EI-TOF-MS).

Deep subsurface sulfate reduction and methanogenesis in the Iberian Pyrite Belt revealed through geochemistry and molecular biomarkers

The Iberian Pyrite Belt (IPB, southwest of Spain), the largest known massive sulfide deposit, fuels a rich chemolithotrophic microbial community in the Río Tinto area. However, the geomicrobiology of its deep subsurface is still unexplored. Herein, we report on the geochemistry and prokaryotic diversity in the subsurface (down to a depth of 166 m) of the Iberian Pyritic belt using an array of geochemical and complementary molecular ecology techniques. Using an antibody microarray, we detected polymeric biomarkers (lipoteichoic acids and peptidoglycan) from Gram-positive bacteria throughout the borehole. DNA microarray hybridization confirmed the presence of members of methane oxidizers, sulfate-reducers, metal and sulfur oxidizers, and methanogenic Euryarchaeota. DNA sequences from denitrifying and hydrogenotrophic bacteria were also identified. FISH hybridization revealed live bacterial clusters associated with microniches on mineral surfaces. These results, together with measures of the geochemical parameters in the borehole, allowed us to create a preliminary scheme of the biogeochemical processes that could be operating in the deep subsurface of the Iberian Pyrite Belt, including microbial metabolisms such as sulfate reduction, methanogenesis and anaerobic methane oxidation.

Sinonasal involvement in systemic vasculitides and cocaine-induced midline destructive lesions: Diagnostic controversies

Multiple systemic diseases produce various clinical manifestations in the sinonasal area. They usually appear as difficult-to-diagnose disease processes with slow, atypical clinical courses. The aim of this study was to evaluate the sinonasal manifestations of systemic vasculitides, highlighting key points for diagnosis and differential diagnosis with other pathological entities, especially cocaine-induced midline destructive lesions (CIMDL). A retrospective study was performed of 10 patients treated in our hospital during the last 5 years with an initial diagnosis of systemic vasculitides with sinonasal involvement: eight patients with granulomatosis with polyangiitis (GPA; new nomenclature for Wegener granulomatosis) and two patients with Churg-Strauss syndrome (CSS). The study variables were clinical presentation, nasal endoscopy results, maxillofacial scan results, nasal biopsy results, erythrocyte sedimentation rate, and autoimmune antibody levels. The definitive diagnosis was GPA in six (60%) patients, CSS in two (20%) patients, and CIMDL in two (20%) patients. Nasal symptoms were similar in all patients, but nasal polyps were present in only one patient with CSS. Systemic manifestations were absent in patients with CIMDL. Likewise, peripheral eosinophilia was observed only in the two patients with CSS. Specific positive biopsy specimens were obtained in six patients (all six patients with GPA, one with CSS, and one with CIMDL). Antineutrophil cytoplasmic antibodies (ANCA) were positive in all patients with GPA (proteinase 3 antigen in five patients and myeloperoxidase in one patient), and perinuclear ANCA was positive in one patient with CIMDL; however, this patient showed an undefined pattern. Finally, the response to treatment was adequate in all patients excluding those with CIMDL. GPA and CIMDL syndromes pose a difficult differential diagnosis because they have common clinical, serological, and histological presentations. Negative histological results do not exclude the diagnosis of sinonasal vasculitides. The absence of systemic manifestations and the lack of response to treatment will lead to the confirmation of CIMDL syndrome in a cocaine user. Otolaryngologists play an important role in the early and differential diagnosis of these diseases.

Investigation of Galaxolide degradation products generated under oxidative and irradiation processes by liquid chromatography/hybrid quadrupole time-of-flight mass spectrometry and comprehensive two-dimensional gas chromatography/time-of-flight mass spectrometry

RATIONALE

Polycyclic musks have become a concern due to their bioaccumulation potential and ecotoxicological effects. The HHCB transformation product (TP) (1,3,4,6,7,8-hexahydro-4,6,6,7,8,8-hexamethyl-cyclopenta[γ]-2-benzopyran; HHCB-lactone) is the most stable intermediate generated and it is frequently detected in river waters. The aim of this work was the identification of relevant TPs generated from UV irradiation and ozone treatments.

METHODS

Identification of HHCB TPs was carried out by liquid chromatography/hybrid quadrupole time-of-flight mass spectrometry (LC/ESI-QTOF-MS) and two-dimensional gas chromatography/electron impact time-of-flight mass spectrometry (GC×GC-EI-TOF-MS). With LC/ESI-QTOF-MS, TPs were characterized by means of mass accuracy in both full-scan and MS/MS modes through information-dependent acquisition (IDA) and direct injection on-column. With stir bar sorptive extraction (SBSE)-GC×GC-EI-TOF-MS, identification was based on the enhanced separation capacity and screening of unknowns through the acquisition of full-range mass spectra.

RESULTS

The effectiveness of these complementary techniques allowed a detailed evaluation of the main TPs. Eighteen TPs were elucidated based on mass accuracy, in both full-scan and MS/MS modes using LC/ESI-QTOF-MS with mass errors below 5 ppm and 10 ppm (mostly), respectively. Most of the TPs had not been analytically identified in previous studies. Separation of the enantiomeric species (R) and (S) of HHCB-lactone, and the identification of other relevant TPs, was performed using SBSE-GC×GC-EI-TOF-MS.

CONCLUSIONS

LC/ESI-QTOF-MS and GC×GC-EI-TOF-MS analysis provides the best alternative for TP identification of chemicals of concern, which have a wide range of polarities and isobaric compounds. A prediction of PBT (persistence, bioaccumulation and toxicity) using the PBT Profiler program suggested a classification of 'very persistent' and 'very toxic' for most of the TPs identified.

Mortality and hospital stay related to coagulase-negative Staphylococci bacteremia in non-critical patients

OBJECTIVES

To describe the morbidity and mortality related to coagulase-negative Staphylococci (CNS) bacteremia in non-critical patients.

METHODS

Prospective, matched case-control study nested in a cohort. Patients with CNS bacteremia and no other isolate in blood cultures during their admission were defined as cases. Each case was matched by age, sex and area of hospitalization to one control. A 30-day follow-up was performed. Mortality and hospital stay were defined as endpoints.

RESULTS

105 cases and 105 controls were included. All cases carried intravascular catheters at the time of inclusion. Cases presented higher mortality compared to controls (14.3% vs. 4.8%), although this association was not independent in a multivariate analysis (p = 0.11). CNS bacteremia was independently associated with longer hospital stay (mean 12 vs. 8.5 days, p = 0.008). Moreover, when patients with CNS bacteremia were specifically analyzed, the persistence of fever (p = 0.005) and inappropriate empirical treatment (p = 0.04) were independently related to mortality.

CONCLUSION

We did not observe increased mortality attributable to CNS bacteremia, although it was associated with longer hospitalizations. Early appropriate empirical antibiotic therapy pending blood culture results might improve the outcome of patients with CNS bacteremia. Close follow-up is recommended if fever persists beyond 72 h.

Comparative genomic analysis reveals novel facts about Leptospirillum spp. cytochromes

Chemolithoautotrophic acidophilic bacteria, which belong to the genus Leptospirillum, can only grow with Fe(II) as electron donor and oxygen as an electron acceptor. Members of this genus play an important role in bioleaching sulfide ores. We used nearly complete genome sequences of Leptospirillum ferrooxidans (group I), Leptospirillum rubarum, Leptospirillum '5-way CG' (group II) and Leptospirillum ferrodiazotrophum (group III) to identify cytochromes that are likely involved in electron transfer chain(s). The results show the presence of genes encoding a number of c-type cytochromes (18-20 genes were identified in each species), as well as bd and cbb₃ oxidases. Genes encoding cbb₃ oxidase are clustered, with predicted genes involved in cbb₃ maturation proteins. Duplication of cbb₃ encoding genes (ccoNO) was detected in all four genomes. Interestingly, these micro-organisms also contain genes that potentially encode bc₁ and b₆f-like complexes organized into two putative operon structures. To date, the Leptospirillum genus includes the only organisms reported to have genes coding for two different bc complexes. This study provides detailed insights into the components of electron transfer chains of Leptospirillum spp., revealing their conservation among leptospirilla groups and suggesting that there may be a single common pathway for electron transport between Fe(II) and oxygen.

Rapid automated screening, identification and quantification of organic micro-contaminants and their main transformation products in wastewater and river waters using liquid chromatography-quadrupole-time-of-flight mass spectrometry with an accurate-mass database

In this study we have developed and evaluated an analytical method for a rapid automated screening and confirmation of a large number of organic micro-contaminants (almost 400) and also the quantification of the positive findings in water samples of different types (surface and wastewaters) using liquid chromatography-electrospray quadrupole-time-of-flight mass spectrometry (LC-QTOFMS) based on the use of an accurate-mass database. The created database includes data not only on the accurate masses of the target ions but also on the characteristic in-source fragment ions, isotopic pattern and retention time data. This customized database was linked to commercially available software which extracted all the potential compounds of interest from the LC-QTOFMS raw data of each sample and matched them against the database to search for targeted compounds in the sample. The detailed fragmentation information has also been used as a powerful tool for the automatic identification of unknown compounds and/or transformation products with similar structures to those of known organic contaminants included in the database. The database can be continually enlarged. To confirm identification of compounds which have no fragment ions (or fragments with low intensity/relative abundance) from in-source CID fragmentation or isomers which are not distinguished within full single mass spectra, a "Targeted MS/MS" method is developed. Thereafter, these compounds can be further analyzed using the collision energy (CE) in QTOF-MS/MS mode. Linearity and limits of detection were studied. Method detection limits (MDLs) in effluent wastewater and river waters were, in most cases, lowers or equal to 5 and 2 ng/L, respectively. Only 15 compounds had MDLs between 5 and 50 ng/L in effluent wastewater matrix. We obtained a linearity of the calibration curves over two orders of magnitude. The method has been applied to real samples and the results obtained reveal that most of the pharmaceutically active compounds contained in the created database were present in the water samples with concentrations in the range of ng/L and μg/L levels and in most of the samples between 2 and 15 pesticides of the 300 contained in the database were also detected. In addition to the compounds included in the database, some degradation products were found, thus revealing the method as a useful tool for the analysis of organic micro-contaminants in waters.

Efficacy and safety of rituximab in adult patients with idiopathic relapsing or refractory thrombotic thrombocytopenic purpura: results of a Spanish multicenter study

BACKGROUND

Between 30% and 60% of patients with thrombotic thrombocytopenic purpura (TTP) relapse and mortality remains at 15-20%. Limited clinical data suggest that the administration of anti-CD20 antibody (rituximab) may be useful in preventing acute refractory and chronic relapsing TTP.

DESIGN AND METHODS

We studied the clinical response to rituximab in 24 adult patients (median age 42 years, range 24-72 years) from 15 Spanish centers with an acute refractory (14 patients) or acute relapsing (10 patients) episode of idiopathic TTP. On admission, every patient received daily plasma exchange (PE). Rituximab was administered at a dose of 375 mg/m(2) weekly for a median of 13 days (range 0-57 days) after starting PE for a median of 4 doses (range 1-8 doses).

RESULTS

No severe acute or delayed toxicity was observed in the patients treated with rituximab. Three (12.5%) patients died because of TTP-related causes. The remaining 21 (87.5%) patients achieved complete remission in a median of 21 days (range 2-35 days) after initiating rituximab. After a median follow-up of 30 months (range 7.5-74 months), 18 patients are in remission and 3 patients have relapsed at 7, 29, and 29 months.

CONCLUSIONS

Rituximab appears to be a safe, effective therapy and has a high response rate for the treatment of acute refractory or relapsing idiopathic TTP in adult patients.

Photodegradation study of three dipyrone metabolites in various water systems: identification and toxicity of their photodegradation products

The photochemical behaviour of three relevant metabolites of the analgesic and antipyretic drug dipyrone, 4-methylaminoantipyrine (4-MAA), 4-formylaminoantipyrine (4-FAA) and 4-acetylaminoantipyrine (4-AAA), was evaluated under simulated solar irradiation (Suntest system). For 4-MAA, different aqueous solutions (synthetic seawater, freshwater and Milli-Q water) as well as different operational conditions were compared. According to the experimental results, 4-MAA resulted as being an easily degraded molecule by direct photolysis, with half-life times (t1/2) ranging from 0.12 to 0.58 h, depending on the irradiation conditions. Faster degradation was observed in synthetic waters, suggesting that the photolysis was influenced by the salt composition of the waters. However, no effect on the degradation rate was observed by the presence of natural photosensitizers (dissolved organic matter, nitrate ions). 4-FAA and 4-AAA showed slower photodegradation kinetics, with t1/2 of 24 and 28 h, respectively. A study of photoproduct identification was carried out by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-time-of-flight mass spectrometry (LC-TOF-MS) (ESI positive mode), which allowed us to propose a tentative photodegradation pathway for 4-MAA and the identification of persistent by-products in all the cases. Finally, the application of an acute toxicity test (Daphnia magna) showed an increase in toxicity during the photolytic process, a consequence of the formation of toxic photoproducts.

The -250G/A polymorphism in the hepatic lipase gene promoter influences the postprandial lipemic response in healthy men

BACKGROUND AND AIM

The -250G/A promoter polymorphism of the hepatic lipase gene has been associated with changes in the activity of the enzyme. We investigated whether this polymorphism modifies the postprandial response of triacylglycerol-rich lipoproteins (TRL) in young normolipemic males.

METHODS AND RESULTS

Fifty-one healthy apolipoprotein (apo) E3/E3 male volunteers (30 G/G and 21 carriers of the A allele) underwent a vitamin A fat-loading test and blood samples were drawn every hour until the 6th, and every 2h and 30 min until the 11th. Total plasma cholesterol and triacylglycerols (TG), as well as cholesterol, TG and retinyl palmitate (RP) in TRL, isolated by ultracentrifugation, were determined. Carriers of the A allele showed a higher response (P=0.008), a higher area under the curve (AUC; P=0.022) and a lower RP peak time (P=0.029) in small TRL during the postprandial response, as well as a lower peak time in total plasma TG levels (P=0.034) and large TRL-TG (P=0.033) than subjects who were homozygous for the G allele.

CONCLUSION

Our data indicate that the presence of the A allele in the -250G/A promoter polymorphism of the hepatic lipase gene is associated with a higher postprandial lipemic response.

Evaluation of ozone-based treatment processes for wastewater containing microcontaminants using LC-QTRAP-MS and LC-TOF/MS

This article describes the development of an enhanced liquid chromatography-mass spectrometry (LC-MS) method for the analysis of a selected group of 57 organic contaminants in wastewater. This group comprises 39 pharmaceuticals belonging to different therapeutical classes and 10 of their most frequent metabolites. Six pesticides and two disinfectants were also included. The LC-MS method was developed using a hybrid quadrupole/linear ion trap (Q TRAP) analyzer operating in selected reaction monitoring (SRM) mode (in both positive and negative electrospray ionization) in combination with a time-of flight (TOF) mass analyser. The application of both techniques provided very good results in terms of accurate quantification and unequivocal identification. Quantification was based on the use of a linearly accelerating (LINAC) high-pressure collision cell, which enable the analysis of a high number of compounds with enough acquisition data points for an optimal peak definition in SRM. Unequivocal identification was provided by the acquisition of at least two SRM transitions and by obtaining accurate mass measurements of the identified compounds with errors lower than 2 ppm. As an alternative for compounds where a second transition cannot be detected by Q-Trap-MS, the application of survey scans in enhanced product ion (EPI) was evaluated. The analytical performance of the method was evaluated in effluent wastewater samples. Linearity of response over three orders of magnitude was demonstrated (R2>0.99 for most compounds). Matrix effects resulting in suppression of the response were frequently observed, between 2-50% for most of compounds, except 4-DAA and 4-AA, which exhibit higher values (68%). Signal enhancement was also detected in 16 compounds. Method limits of detection (LOD) were between 0.1-50 ng L(-1). Finally, the methodology was successfully applied to the evaluation of the efficiency of two ozone-based treatments applied to the effluent from the secondary clarifier of a municipal wastewater treatment facility. Preliminary results are presented demonstrating that ozonation of wastewaters degrade pharmaceuticals with a high efficiency. Removals higher than 90% were reached for most of target analytes.

Successive positive contrast in one-way avoidance behavior with Roman low-avoidance rats

The inbred Roman High- (RHA-I) and Roman Low-Avoidance (RLA-I) rats, psychogenetically selected for rapid (RHA-I) vs. extremely poor (RLA-I) acquisition of two-way active avoidance, exhibit a lower or a higher level of fearfulness, respectively, that can be observed in many laboratory anxiety models. The present study analyzed the performance of female RLA-I and RHA-I rats in a successive positive contrast situation induced during one-way avoidance learning. Three groups of RLA-I and three of RHA-I rats (1-30, 30-30 and 1-1 groups, the numbers stand for the time spent in the safe compartment during the first and second phase of training) were trained to avoid an electric foot-shock administered in a "danger" compartment, by running from this compartment to a "safe" one. Only RLA-I rats showed a significant positive contrast effect, in such a way that the reinforcement increase from the lower (1 s spent in safety) to the higher reward (30 s) led to a response enhancement, surpassing the performance of rats trained with the low (1-1 s) or the high (30-30 s) reward from the beginning of training. The results are discussed in the context of an opponent process theory based upon the interaction between the motivational strength of fear and the incentive value of relief taking place during one-way avoidance learning.

Pilot survey monitoring pharmaceuticals and related compounds in a sewage treatment plant located on the Mediterranean coast

A one-year monitoring study was performed to evaluate the occurrence, persistence and fate of a group of 14 organic compounds in a sewage treatment plant (STP) located in the south of Spain. These results are part of a more extensive study, financed by the Spanish Ministry of Research with the aim to evaluate the traceability of new pollutants on the Mediterranean coast and to determine the removal efficiency of sewage treatment plants (STP) for these pollutants. The compounds which have been analyzed include pharmaceuticals of various therapeutic categories (ibuprofen, acetaminophen, dipyrone, diclofenac, carbamazepine and codeine), pesticides (chlorfenvinfos and permethrin), caffeine, triclosan, bisphenol A and three of their more relevant metabolites (1,7-dimethylxanthine, carbamazepine 10,11-epoxide and 2,7/2,8-dichlorodibenzo-p-dioxin). An SPE/GC-MS multi-residue analytical method was developed and validated to facilitate simultaneous determination of these compounds in both influent and effluent wastewater. The method provided mean recoveries higher than 75%, with the exception of 2,7/2,8-dichlorodibenzo-p-dioxin, dipyrone and permethrin which exhibited recoveries lower than 22%. The overall variability of the method was below 14%. The method detection limit (LOD) was between 1 and 100 ng l(-1) and precision, which was calculated as relative standard deviation (RSD), ranged from 1.8% to 11.2%. The application of the proposed method has allowed the identification of all the target compounds at mean concentrations which ranged from 0.12 to 134 microg l(-1) in the influent and from 0.09 to 18.0 microg l(-1) in the effluent. The removal efficiencies of the STP for these compounds varied from 20% (carbamazepine) to 99% (acetaminophen), but in all cases resulted insufficient in order to avoid their presence in treated water and subsequently in the environment.

Skin tests with native, depigmented and glutaraldehyde polymerized allergen extracts

INTRODUCTION

Dose-response skin prick tests are an important tool to standardise allergen extracts and to evaluate changes in skin test response as a consequence of allergen modifications.

OBJECTIVES

To evaluate in vivo and in vitro characteristics of 3 different types of extracts of Phleumpratense, Olea europaea, Parietaria judaica and Dermatophagoides pteronyssinus.

MATERIAL AND METHODS

Three types of extracts were used: native unmodified extracts (N), depigmented extracts (DP) (extracts subjected to a mild acid treatment under controlled conditions and dialysis), and a depigmented glutaraldehyde polymerised extract (DPP). Adult patients were skin tested in duplicate with the 3 types of extracts. The dose-response relationship between the geometric mean of the wheal areas and the allergen concentrations was calculated for each patient using regression line analysis. The amount of freeze-dried allergen preparation needed to produce the same wheal size as histamine was calculated in each patient (individual 10 HEP) and for each of the 3 types of extracts. In vitro analysis consisted of major allergen determinations and specific IgE and IgG inhibitions.

RESULTS

The respective 10 HEP values for N, DP and DPP preparations were 0.20 mg, 0.15 and 2.11 for D. pteronyssinus. For P. pratense, these values were 0.02 mg, 0.02 and 0.99; for O. europaea 0.15, 0.44 and 4.9; and for P. judaica 0.01, 0.008 and 1.78 mg.

CONCLUSIONS

The polymerised depigmented extracts are significantly less allergenic than the corresponding native and depigmented extracts. This could provide a greater safety margin for the administration of higher doses of immunotherapy in a shorter period of time.

Comparative study of analytical methods involving gas chromatography–mass spectrometry after derivatization and gas chromatography–tandem mass spectrometry for the determination of selected endocrine disrupting compounds in wastewaters

Two GC-MS methods, based on the application of N,O-bis(trimethylsilyl)trifluoroacetamide-derivatization-GC-MS (selected-ion monitoring) and GC-MS-MS without derivatization, respectively, were optimised and applied to the determination of a group of five selected endocrine disrupting compounds (EDCs) in wastewaters. Both methods included solid-phase extraction with Oasis HLB cartridges allowing an enrichment factor for wastewater samples of 100-fold. The investigated EDCs were estrone, 17beta-estradiol, 17alpha-ethynylestradiol, 4-tert-octylphenol and bisphenol A. Results obtained from the validation studies yielded comparable results in both cases. Recoveries in spiked wastewaters at 50 ng/l were higher than 90% for all the compounds, except for 4-tert-octylphenol (75%). Repeatability and reproducibility were adequate, varying from 1.6 to 14%, except for estrone which reproducibility was 28% when the derivatization-GC-MS method was applied. Limits of detection calculated ranged from 2.5 to 27.5 ng/l with differences between both methods from 1.1 (estrone) to 10.4 (bisphenol A) times. Both methods were successfully applied to the analysis of the target compounds in sewage treatment plant influents and effluents. Traces of bisphenol A, 4-tert-octylphenol, estrone and 17beta-estradiol were detected at concentration levels ranging from 13.3 to 1105.2 ng/l.

Tissue factor expression is decreased in monocytes obtained from blood during Mediterranean or high carbohydrate diets

BACKGROUND

Mediterranean and high carbohydrate diets play a dominant role in the prevention of atherosclerosis as a result of their lipid lowering effect. However, diets can also have a protective effect in other ways, such as modulating tissue factor expression in circulating monocytes.

METHODS AND RESULTS

Forty-one subjects participated in this randomised crossover study consisting of three dietary periods: a saturated fat enriched diet (SFA), a low fat and high carbohydrate diet (CHO), and a Mediterranean diet. Plasma levels of total cholesterol, triglycerides, low density lipoprotein (LDL-C) and high density lipoprotein (HDL-C) were determined at the end of each dietary period, as was the expression of tissue factor (TF) in circulating monocytes isolated from blood samples. Total cholesterol, LDL-C, HDL-C and TF expression were lower after the Mediterranean and high carbohydrate diets than after the SFA diet, and there was a positive correlation between LDL-C levels and monocyte TF expression.

CONCLUSIONS

High carbohydrate and Mediterranean diets reduce the expression of TF in circulating monocytes.

Enumeration of Clostridium perfringens spores in groundwater samples: comparison of six culture media

In order to investigate the ability of Fluorocult-supplemented TSC agar (TSCF (Fluorocult supplemented TSC-agar): prepared from Tryptose Sulfite Cycloserine Agar Base (Merck), D-cycloserine (Fluka Chemika, USA), and fluorocult TSC-Agar supplement (Merck)) for detecting spores of Clostridium perfringens in water, we analyzed groundwater samples, pretreated by heating to 80 degrees C/5 min, using this fluorogenic medium together with five other media: mCP agar (Panreac; Cultimed), TSC agar (Merck, Germany), TSN agar (Merck), and SPS agar (BBL, USA) by the membrane filtration technique, and Wilson-Blair agar (WB) following the still-in-force Spanish official method. Variance analysis of the data obtained shows statistically significant differences in the counts obtained between media employed in this work. The C. perfringens spore counts on mCP agar were significantly lower (P<0.05) than the corresponding values of TSC, TSCF, SPS, and WB media. No statistically significant differences were found between C. perfringens spore counts on TSCF compared with those of other methods used. On the other hand, the identification of typical and atypical colonies isolated from all media demonstrated that fluorogenic TSC agar was the most specific medium for C. perfringens spore recovery in groundwater samples. Additionally, the results obtained indicate that mCP agar, which is the reference method in the European Union, is not suitable medium for recovering C. perfringens spores from groundwater samples.

[Bacteriological techniques for the design and identification of Mycobacterium tuberculosis]

This review summarizes the classic bacteriologic techniques used to diagnose M. tuberculosis and others mycobacterial infection. This methodology involves special methods such as staining, recovery in culture media and identification by phenotypic and biochemical characteristics. New methods for rapid diagnosis are been developed and the laboratories should be alert in order to incorporated them in their routine.

[Descriptive analysis of patients admitted to hospital for acute cerebrovascular disease]

INTRODUCTION

Acute cerebrovascular disease (ACVA) makes up a high proportion of the neurological patients admitted to hospital, but we do not know the exact figures in our setting. We consider that it would be useful if the use of health-care resources for attending these patients was to be evaluated and studied by the neurologists who direct them.

OBJECTIVE

To analyze a predetermined series of variables related to strokes in our setting. Patients and methods. We made a descriptive analysis by means of a questionnaire, recording variables related to the admission to the neurology department of patients with probable ACVA, at 100 days and with further evaluation 6 months later.

RESULTS

We recorded 107 cases with ACVA confirmed in 101 of 104 patients with averages of: 70.54 years, average admission 13.53 days and intrahospital mortality 5.8%. The most common neurological findings were paralysis and speech disorder. The proportion of ischaemic stroke as compared with haemorrhagic stroke was 87.5% to 12.5%. The prevalence of usual risk factors was: arterial hypertension, diabetes and cardiopathy. The percentage of patients given rehabilitation treatment during their admission was 41.34%. A proportion, 37.2%, of the patients were referred to Hospital San Rafael for convalescence and treatment. The average time before evaluation by a neurologist was 30.23 hours. Eleven of 86 patients who answered a weekly questionnaire died (12.8%) and 54/86 had no rehabilitation treatment during the week (62.8%).

CONCLUSIONS

We found no differences in the epidemiological characteristics as compared with other studies. The excessive lapse of time before attending the emergency department was striking, as was the delay in receiving neurological attention since there was no emergency neurologist available and fewer haemorrhagic strokes since there was no neurosurgical service available. There was little use of salicylates as a platelet anti-aggregrant agent on discharge from hospital, little rehabilitation treatment six months after the stroke, and twice as much mortality as when the patients were in hospital. We consider that a more detailed and extensive analysis would be fully justified in our setting, preferably with more people interested in the early and late treatment of ACVA taking part and prolonged follow-up of these patients.

Evaluation of Coli-ID and MUG Plus media for recovering Escherichia coli and other coliform bacteria from groundwater samples

Several chromogenic media for detecting coliform bacteria in water are commercially available including Coli ID medium (ID) (bioMérieux) and MUG Plus cefsulodin agar (MP) (Laboratorios Microkit, S.L.). Since little is known about the performance of these media, we have evaluated their usefulness for recovering Escherichia coli and other coliform organisms in groundwaters used for direct human consumption. Variance analysis of obtained data showed that no statistically significant differences in counts of E. coli and other coliforms on ID and MP media compared with reference methods. However, the evaluation of sensitivity and recovery efficiency of both media showed that the two chromogenic media were more sensitive and significantly more efficient (P = < 0.05) than reference medium for detecting coliforms in groundwater. However, the identification of 400 typical and atypical colonies isolated from ID and MP media demonstrated a higher specificity when using ID for coliforms and E. coli. In summary, the two chromogenic media evaluated could be used as alternative methods to reference media for detecting and recovering coliform bacteria in groundwater samples. MP agar was more sensitive and efficient than ID agar whereas the latter was more specific and selective.

Evaluation of fluorogenic TSC agar for recovering Clostridium perfringens in groundwater samples

Clostridium perfringens is widely recognised as a reliable water pollution indicator. Since several media can be employed for the membrane filtration enumeration of this microorganism, the main aim of this work was to investigate the ability of fluorocult-supplemented TSC-agar (Merck) for recovering Cl. perfringens from public springs used for direct human consumption. Cl. perfringens recovery was also performed on mCP agar (Cultimed) according to Directive 98/83 as well as on TSC-Agar (Merck), TSN-Agar (Merck) and SPS-Agar (BBL) media. Variance analysis of data obtained showed no statistically significant differences in the counts obtained among all media employed in this work. However, the Cl. perfringens recovery efficiencies with TSC and fluorogenic TSC agars were significantly greater (P = < 0.05) than the corresponding values of mCP and TSN media. On the other hand, the identification of typical and atypical colonies isolated from all media demonstrated that fluorogenic TSC agar was the most specific medium for Cl. perfringens recovery in groundwater samples (85.3% of typical colonies and 82.8% of atypical colonies confirmed). In summary, the membrane filtration technique with fluorogenic TSC agar showed the best performance characteristics of all the media tested as judged by their recovery efficiency and specificity in these water samples.

Utility of fluorine-18-fluorodeoxyglucose positron emission tomography in differentiated thyroid carcinoma with negative radioiodine scans and elevated serum thyroglobulin levels

BACKGROUND

This study aimed to determine the role of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in the follow-up of patients who underwent total thyroidectomy and iodine-131 ((131)I) ablation therapy for differentiated thyroid cancer and presented increased thyroglobulin levels with negative (131)I and thallium-201 ((201)Tl) scans.

METHODS

Two patients with follicular carcinoma and eight with papillary tumors underwent total thyroidectomy and (131)I therapy until the (131)I scan was negative. (131)I and (201)Tl scans were performed with negative results in all cases, while serum thyroglobulin measurements were all positive with negative thyroglobulin autoantibodies. One week after the (131)I scans, all the patients underwent FDG-PET whole-body scans.

RESULTS

The FDG-PET scan detected in 4 patients, a single focal increase of FDG uptake in one lymph node metastasis (subsequently confirmed histologically); in 1 patient, multiple pathological focal uptakes in brain, neck, and chest; and in 1 patient, two mild focal uptakes in the mediastinum, close to the tracheal branch. In 2 other patients, pathological FDG uptakes in cervical spine and mediastinum were not confirmed by other imaging techniques, and in the 2 remaining patients the scan results were inconclusive. The sensitivity of FDG-PET whole-body scan for detecting metastatic thyroid cancer was 60%.

CONCLUSIONS

This study indicates that the FDG-PET whole-body scan is a useful tool in the follow-up of patients with differentiated thyroid cancer, negative (131)I and (201)Tl scans and elevated serum thyroglobulin levels. The FDG-PET scan detects metastatic disease in 60% of patients with differentiated thyroid cancer, enabling surgical therapy to be performed on accessible lesions.

GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms

BACKGROUND

Frequent attendance in general practice increases workload and affects doctor-patient relationships. It is a complex phenomenon, but patients' psychological problems appear to be important.

AIM

To assess whether frequent attendance is more likely to be associated with depressive symptoms than with physical health problems.

METHOD

The study was carried out in two general practices: one in Liverpool and one in Granada. Subjects comprised 127 frequent attenders (FAs) plus 175 matched controls, stratified by age and sex. Measures included demographic factors, Beck Depression Inventory (BDI), self-reported health, and current health problems classified by ICHPPC-2 criteria.

RESULTS

Seventy-five (59%) FAs had a BDI score > or = 13, compared with 9 (5%) controls (odds ratio [OR] = 26.6, 95% confidence interval [CI] = 12.4 to 56.8, P < 0.001). A total of 136 (78%) controls reported their health to be good or excellent, compared with 40 (31%) FAs (OR = 7.6, 95% CI = 4.5 to 12.7, P < 0.001). Respiratory problems were present in 50 (39%) FAs and 47 (27%) controls (chi 2 = 6.992, P < 0.03). Depression rates were similar in Liverpool and Granada, although Liverpool subjects were less likely to report good health. On logistic regression, BDI status was the major predictor of frequent attendance (OR = 17.18, 95% CI = 7.54 to 39.01). Self-reported ill health (OR = 2.67, 95% CI = 1.40 to 5.10) and respiratory problems (OR = 2.20, 95% CI = 1.11 to 4.37) were also associated with frequent attendance.

CONCLUSION

Depressive symptoms were the major predictor of frequent attendance in this study. Clinical and research activity should therefore concentrate on the identification and management of psychological problems among FAs in general practice.

Spontaneous changes in ventricular tachycardia cycle length and their relation to earliest sites of epicardial activation in a canine model

BACKGROUND

The purpose of this study was to examine the spontaneous changes in cycle length during episodes of sustained monomorphic (MVT) and polymorphic (PVT) ventricular tachycardias and to relate these changes with the earliest epicardial activation site of the beat.

METHODS

Isochronal activation maps were obtained from 127 unipolar electrograms recorded from the surface of both ventricles with a sock electrode array in 24 open chest anesthetized dogs. After atrioventricular block, the left anterior descending coronary artery was occluded for 60 min under ventricular pacing (140/min), followed by reperfusion. In 7 dogs the left stellate ganglion was stimulated 5 min after reperfusion.

RESULTS

In 7 MVTs (reperfusion) and 4 PVTs (sympathetic stimulation), cycle length changes showed an initial acceleration, reaching a minimum cycle length and then decelerating before termination. Isochronal maps showed radial spread from earliest activation, without conduction block. Cycle length (481 +/- 80 msec) in MVT had beat to beat variations of 15 +/- 17 msec corresponding to small shifts in sites of the earliest activation, clustered along the border of the ischemic myocardium. In PVTs the cycle length (352 +/- 90 msec, p < 0.01) had a variability of 62 +/- 23 msec, corresponding to wide changes in the sites of earliest activation in right and left ventricles. Linear regression analysis showed a strong and significant correlation between cycle length variability and the number of electrodes with the earliest activation (r = 0.77, p < 0.0001).

CONCLUSION

In these models of monomorphic and polymorphic ventricular tachycardias, cycle length variability showed a significant correlation with the number of electrodes with the earliest activation. MVTs showed concentrated origins with regular cycle length, whereas PVTs showed dispersed origins with irregular cycle length. These results suggest that the earliest epicardial activation site of the beat could be a factor in determining the dynamics in the cycle length.

The Body Attitude Test: validation of the Spanish version

A Spanish version of the Body Attitude Test (BAT) is presented. It was validated with 165 eating disorder patients (79 anorexia nervosa, 86 bulimia nervosa) and 220 schoolgirls from the general population. Factor analysis allowed the extraction of four factors, as in the original questionnaire, but with different item loadings on each. Taken together, these four factors accounted for 67.1% of the variance. The alpha reliability coefficient was 0.92 in both groups. The test-retest reliability with a one-week interval was 0.91 in a subgroup of 34 eating disorder patients and in a subgroup of 43 girls from the general population. The difference between the mean scores of the girls from the general population and the anorexics on one hand and the bulimics on the other was highly significant (p < 0.0001). On the basis of the discriminant validity study, the use of a cut-off point of 41--which gives a sensitivity of 75.1% and a specificity of 72.7%--is recommended.

mraW, an essential gene at the dcw cluster of Escherichia coli codes for a cytoplasmic protein with methyltransferase activity

Three new open reading frames, mraZ, mraW and mraR (also called ftsL), were revealed by DNA sequencing immediately upstream of gene pbpB in the dcw cluster of Escherichia coli. We have found that mraW and mraZ are active genes, coding for two proteins with relative molecular masses of 34 800 and 17 300, respectively. MraW is a cytoplasmic protein that under overproduction condition is also loosely bound to the membrane. Soluble MraW was purified up to 90% by a single high performance electrophoresis (HPEC) step from an extract of an overproducing strain. The protein exhibits a S-adenosyl-dependent methyltransferase activity on membrane-located substrates.

Discrimination between monomorphic and polymorphic ventricular tachycardia using cycle length variability measured by wavelet transform analysis

The objective of this study was to assess the capability of wavelet transform (WT) analysis to differentiate between monomorphic (MVTs) and polymorphic ventricular tachycardias (PVTs) in a canine model and to relate these results to epicardial isochronal maps on a beat-by-beat basis. Unipolar electrograms were simultaneously recorded from the surface of both ventricles with a 127-lead sock electrode array in 24 open-chest anesthetized dogs. The sampling frequency was 500 Hz. Atrioventricular block was induced by formaldehyde injection into the atrioventricular node. The left anterior descending coronary artery was occluded for 60 minutes under ventricular pacing (140 stimuli/min) followed by reperfusion. Ventricular tachycardias were obtained during reperfusion and during left stellate ganglion stimulation. After visual selection, a total of 97 segments of 2,048 samples (4.096 seconds) were extracted and classified as 67 MVTs and 30 PVTs. A parameter based on the cycle length variability was defined in the second scale of the WT decomposition, normalized by its mean value. Similar assessment of cycle length variability was performed based on the detection of the point of most rapid change in potential with a negative slope in excess of -0.5 mV/ms in each individual electrogram to test the accuracy of the results obtained with the WT parameter. The WT parameter correctly identified 97% MVT and 83.3% PVT segments, for an overall accuracy of 92.8%. Beat-by-beat epicardial maps of MVT displayed a cluster of sites of initial activation close to the reperfusion area, while the sites of breakthrough from beats during PVT were much more dispersed over both ventricles. A strong and significant correlation was found between the number of electrodes with the earliest epicardial activation and the WT parameter (r = .78, P < .0001). To test the accuracy of the results obtained, a comparison was performed between the WT parameter (0.082 +/- 0.007) and the cycle length variability, estimated as the normalized standard deviation of the intervals between individual electrograms (0.076 +/- 0.006). No significant differences were shown (P = .0022), and a strong linear correlation was found between both measurements (Pearson correlation coefficient, .966). It is concluded that WT analysis discriminated accurately between MVT and PVT, and a quantitative relation was found with the spatial dispersion of sites of earliest epicardial activation. The WT results strongly correlated with those obtained by another method of estimating cycle length variability. Methodologically, the strength of the WT lies in the complementary information that could be extracted from the processing of electrograms to enhance the detection/discrimination of different types of arrhythmias.

Ectopic potassium uptake in trk1 trk2 mutants of Saccharomyces cerevisiae correlates with a highly hyperpolarized membrane potential

Null trk1 trk2 mutants of Saccharomyces cerevisiae exhibit a low-affinity uptake of K+ and Rb+. We show that this low-affinity Rb+ uptake is mediated by several independent transporters, and that trk1Delta cells and especially trk1Delta trk2Delta cells are highly hyperpolarized. Differences in the membrane potentials were assessed for sensitivity to hygromycin B and by flow cytometric analyses of cellular DiOC6(3) fluorescence. On the basis of the latter analyses, it is proposed that Trk1p and Trk2p are involved in the control of the membrane potential, preventing excessive hyperpolarizations. K+ starvation and nitrogen starvation hyperpolarize both TRK1 TRK2 and trk1Delta trk2Delta cells, thus suggesting that other proteins, in addition to Trk1p and Trk2p, participate in the control of the membrane potential. The HAK1 K+ transporter from Schwanniomyces occidentalis suppresses the K+-defective transport of trk1Delta trk2Delta cells but not the high hyperpolarization, and the HKT1 K+ transporter from wheat suppresses both defects, in the presence of Na+. We discuss the mechanism involved in the control of the membrane potential by Trk1p and Trk2p and the causal relationship between the high membrane potential (negative inside) of trk1Delta trk2Delta cells and its ectopic transport of alkali cations.

[The postantibiotic effect of amoxicillin/clavulanic acid on Streptococcus pneumoniae strains of different serotypes and penicillin sensitivity]

Amoxicillin and clavulanic acid, combined in a 4:1 ratio, caused a significant (longer than 0.5 hours) postantibiotic effect (PAE) for the S. pneumoniae stains tested. These strains were from a different serotype (3, 6 and 9) and also had different susceptibility to penicillin. The duration of the PAE depended both on the strain and the amoxicillin/clavulanic acid concentration used. It is significant that for the serotype 9 strain, which was both penicillin and amoxicillin resistant, the duration of the PAE was between 1.5 and 2.2 hours. These results agree with those observed by other authors as to the effectiveness of amoxicillin/clavulanic acid against S.pneumoniae.

[Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients]

The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses.

RESULTS

There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.

The effect of ovariectomy on depressed contractions to phenylephrine and KCl and increased relaxation to acetylcholine in isolated aortic rings of female compared to male rabbits

1. Differences in vascular responses to phenylephrine, acetylcholine (ACh) and potassium chloride (KCl) were studied in rabbit aorta from female and male rabbits, in the absence and presence of an inhibitor of nitric oxide (NO) production, NG-nitro-L-arginine methyl ester (L-NAME, 100 microM). 2. Phenylephrine and KCl-induced contractions, were significantly reduced in amplitude (P < 0.01) in the rings from female rabbits compared to those from male rabbits. 3. ACh-induced relaxation was greater (P < 0.01) in aortic rings from females than from males. 4. Incubation of the rings with L-NAME abolished the phenylephrine-induced contraction differences between rings from male and female rabbits. 5. Ovariectomy eliminated the differences in vascular responses to phenylephrine, KCl and ACh of aortic rings from the female rabbits. 6. Both basal and ACh-stimulated release of nitrites from aortic rings was greater (P < 0.01) in vascular tissue from female than male rabbits. 7. These results indicate that differences in vascular reactivity in aortic rings from male and female rabbits may be associated with a higher release of NO, resulting in an increased vasodilator response in the female rabbits.

Therapeutic effects of CDP-choline in Alzheimer's disease. Cognition, brain mapping, cerebrovascular hemodynamics, and immune factors

CDP-choline was given to patients with Alzheimer's disease (AD) at a daily dose of 1000 mg/day p.o. for one month. This compound slightly improved mental performance, tended to reduce theta activity in fronto-temporal regions, increasing alpha power in occipital areas, and enhanced cerebrovascular perfusion by increasing blood flow velocity and reducing pulsatility and resistance indexes. In addition, CDP-choline diminished histamine and interleukin-1 levels in blood and serum, respectively, and increased plasma TNF.

The capacity to transport potassium influences sodium tolerance in Saccharomyces cerevisiae

The capacity to transport potassium and to discriminate between the different alkali cations has been found to affect sodium tolerance in Saccharomyces cerevisiae. Mutants with a defective capacity to transport K+ were more sensitive to high concentrations of Na+ because they accumulated more Na+ and less K+ than wild-type cells which showed high discrimination between K+ and Na+.

[Cytogenetic alterations found by chromosome analysis and fish technique in two patients with variant chronic lymphocytic leukemia]

Chromosomal studies in CLL have yielded poorer results than in other blood diseases because of the low mitotic index of the B cells. The FISH technique is a very useful tool for trisomy 12 detection in interphase nuclei in CLL, although this method cannot be a substitutive for conventional cytogenetics. The FISH technique was applied in two cases of CLL by means of satellite DNA probing specific for chromosome 12 according to the Oncor S 1370-CF kit protocol. Trisomy 12 was detected, along with other chromosomal abnormalities secondary to this trisomy. Both patients had lymphocyte counts lower than 5.0 x 10(9)/L and their peripheral blood immunophenotype showed 58% lymphocytes with lambda sIg of medium density, co-expressing CD5 and unable to form rosettes with mouse red-cells. Patient no. 1 was 46,XY/47,XY + 12/47,XY + 12,5q-, and patient no. 2 was 46,XX/47,XX + 12,14q-. The presence of secondary anomalies could explain the special clinico-haematological picture, characterised by low lymphocytosis and presence of irregular nuclei in mature lymphocytes, along with the lack of CD23 expression and rosette formation with mouse red-cells. FISH technique combined with chromosome analysis may prove a useful means for diagnosing and recognising variants or specific entities within low-grade lymphoproliferative syndromes.

Brain mapping activity and mental performance after chronic treatment with CDP-choline in Alzheimer's disease

CDP-choline participates in brain phospholipid metabolism and acts as an endogenous intermediate in a biosynthetic pathway incorporating free choline into phosphatidylcholine and choline plasmalogens in several tissues, including the central nervous system (CNS). In patients with chronic cerebrovascular disorders, CDP-choline reduces the slow delta frequencies and increases alpha activity in spectral electroencephalogram analysis. We have studied the effect of CDP-choline (cytidine-S-diphosphate-choline; 1000 mg/day x 30 days, p.o.) on brain electrical activity mapping and mental performance in 19 Alzheimer's disease (AD) patients (10 males/9 females; age: 66.21 +/- 1.48 years; Mini-Mental State Examination (MMSE): 26.55 +/- 1.22, Spanish version max. score 35). EEG was registered from 19 electrodes placed according to the 10-20 system and digitalized online. Artefact-free 2-s periods were visually selected, submitted to a frequency analysis and averaged across periods. CDP-choline significantly decreased spectral amplitude in the theta band in F4, F8, and T4 electrodes, and did not modify relative power parameters in any of the frequency bands (delta, theta, alpha, beta) as compared to basal recordings. In patients with late-onset AD (LOAD; N = 6; age: 73.5 +/- 1.34 years; MMSE: 28.75 +/- 2.33), CDP-choline tended to increase relative alpha power in O1 and O2 electrodes. No changes were found in early-onset AD patients (EOAD; N = 13; age: 62.85 +/- 1.21 years; MMSE: 25.54 +/- 1.4). We detected a significant improvement in mental performance after 1 month of treatment with CDP-choline in patients with early-onset AD in whom brain electrical activity data correlated with cognitive parameters. It is likely that the bioelectrical changes induced by CDP-choline in AD are the result of its immunogenic and/or neurotrophic activity in the vicinity of the vascular microenvironment.

Effects of CDP-choline on cognition and cerebral hemodynamics in patients with Alzheimer's disease

CDP-choline (cytidine-5-diphosphate-choline) is an acetylcholine precursor frequently used in cerebrovascular disorders and psychoorganic syndromes. Furthermore, several authors have demonstrated the positive effects of CDP-choline on cognitive disorders and memory deficits. In the present study, the effects of CDP-choline (1000 mg/day, p.o. for 1 month) on cognition, evaluated by the Mini-Mental State Examination (MMSE) of Folstein et al., and on blood flow velocities, measured by transcranial Doppler ultrasonography (TCD), were investigated in patients with Alzheimer's disease: (AD, n = 20, age: 66.75 +/- 6.73 years, range: 57-78 yr). Cognitive function was measured by means of the MMSE in basal conditions (A) and after 1 month of treatment with CDP-choline (C). TCD measures were taken through the temporal window for right (MCA-R) and left (MCA-L) middle cerebral arteries with a 2 MHz pulsed transducer using a TC-2000S in basal conditions (A), 1 h after the administration of CDP-choline (B) and after 1 month of treatment with CDP-choline (C). MMSE scores were significantly increased (p < 0.005) in patients with early-onset Alzheimer's disease (EOAD) after CDP-choline treatment. Moreover, the orientation subtest significantly increased in the global group of AD patients (p < 0.01) and in EOAD patients (p < 0.02). Significant differences (p < 0.05) were also found in MCA-Land MCA-R measures between recordings. These results suggest that CDP-choline influences cognitive and cerebrovascular function in Alzheimer's disease, probably through a mechanism linked to an immunogenic and/or neurotrophic effect at the microvascular niche.(ABSTRACT TRUNCATED AT 250 WORDS)

Transcranial Doppler ultrasonography in senile dementia: neuropsychological correlations

Blood flow velocities were measured in right and left middle cerebral arteries (MCAs) and in basilar artery (BA) on rest conditions by transcranial Doppler ultrasonography in three groups of patients: a) Alzheimer's disease patients (AD, N = 12, age = 63.5 +/- 6.6 years), b) patients with multi-infarct dementia (MID, N = 12, age = 72.8 +/- 9.0 years), and c) control subjects (CS, N = 12, age = 57.20 +/- 7.5 years). TCD measures were taken through the temporal window for MCA recordings, and transforaminal approach for BA recordings, with a 2 MHz ultrasonic probe using a TC-2000S (EME). A significantly (p < 0.05) decrease in TCD measures was found in right and left MCA and BA of dementia patients with respect to controls. Data analysis included a significant correlation between blood flow velocities and Hachinski scores (p < 0.016) in multi-infarct dementia patients. These results appear to show a general hypoperfusion pattern in the brain of senile dementia patients.

[Transesophageal echocardiography in the study of intracardiac thrombosis, tumors and vegetations]

Of 200 consecutive patients, studied with transesophageal echocardiography the findings were analyzed with respect to the presence of thrombi, tumors or vegetations. Thrombus formation was detected in 18 patients; their location and associated pathology are described. Tumors were present in 9 cases and in 10 patients endocarditis in native or prosthetic valves. The information obtained by transesophageal echocardiography was compared with transthoracic echocardiographic data. Transoesophageal echocardiography was demonstrated to be more sensitive, especially in the detection of intracavitary masses in the posterior structures of the heart.

[Personality and emesis in the patient treated with antineoplastic chemotherapy]

A sample of twenty cancer patients following chemotherapy realize MMPI questionnaire, and another one for valuation of emetic and anticipatory phenomena in relation to said therapy. The authors came to the conclusion that 36.8% of the sample had anticipatory nausea and vomiting, 63.6% anticipatory dysphoria, and 66% emetic incidents after chemotherapy. The conclusion, through comparison of personality variables, is that all patients showed neuroticism and depression scales increased, in relation to healthy population. Depression variable increased especially in patients that didn't present anticipatory nausea and vomiting. Likewise, patients with anticipatory symptoms or emetic incidents after chemotherapy present an increased social introversion variable.

[Enteritis caused by Campylobacter fetus in Navarre]

C. fetus ss jejuni was demonstrated in stool samples from 17 patients, among 605 studied, using the selective media of Skirrow. 13 of them were children, 11 two years' old or younger, and 4 were adult patients. The frequency of isolation of C. fetus ss jejuni in stool cultures has been greater than the isolation of Y. enterocolitica serotype 3, S. sonnei and E. coli, and has been only superated by the isolation of microorganisms belonging to the generus Salmonella.