[Consideration regarding 20 antireflux laparoscopic operations for hiatal hernia]

AIM

To evaluate the clinical, therapeutical and evolutive aspects of the patients with hiatal hernia with laparoscopical approach.

MATERIALS AND METHODS

Retrospective analysis of 20 patients diagnosed with hiatal hernia and operated, laparoscopical, between 13.01.1999-10.04.2002.

RESULTS

At 18 cases (90%), were sliding hiatal hernia and at 2 cases (10%), were paraesophageal hiatal hernia. There were performed laparoscopical: 1 (5%) Dor anterior hemi-fundoplication, 4 (20%) Rosetti fundoplication, 3 (15%) Toupet posterior hemi-fundoplication and 11 (55%) Nissen fundoplication. For the dissection, the ultrasound scissors (Ultra-Shears) was used and for the suture of the both diaphragmatic crus and the wrap, the Endo-Stitch. There were reported 1 (5%) optional conversion and 3 cases (15%) with bleeding solved by clipping and hemostatic suture. No postoperative complications, deaths intra and postoperative were reported. The average duration of the intervention decreased in time, due to the experience, from 180 to 60 minutes, but in accordance with the complexity of the procedure (Nissen-Toupet-Dor). At 2 (10%) cases with Nissen fundoplication was reported a transitory dysphagia, which was remitted between 1-2 months. We noticed a decreasing of the duration of hospitalisation for the antireflux laparoscopical interventions, compared with the classic methodes.

CONCLUSIONS

There is a tendency of the laparoscopical approach of hiatal hernia to come the standard in the GERD, due to his minimal invasive character, significantly reducing costs and good postoperative results.

Analysis of risk factors for acute cutaneous graft-versus-host disease after allogeneic stem cell transplantation

BACKGROUND

Although skin is typically the first site of involvement of acute graft-versus-host disease (GVHD), most standard recommended staging and grading criteria allow enrolment of patients with involvement of GVHD target organs other than the skin in studies analysing risk factors for acute GVHD after stem cell transplantation (SCT).

OBJECTIVES

To determine the risk factors for developing histologically confirmed acute cutaneous GVHD in patients who underwent allogeneic SCT for different haematological disorders.

METHODS

This retrospective study was based on review of clinical files and databases from 300 consecutive patients with several haematological disorders who received allogeneic SCT between 1 January 1984 and 31 December 1999 at Hospital Universitario de la Princesa, Madrid, Spain. Variables evaluated included diagnosis of haematological disorder, age and gender (donor and recipient), HLA matching, female donor to male recipient, donor and recipient viral serology (cytomegalovirus), conditioning regimen, GVHD prophylaxis, blood counts at day of engraftment, mortality, cause of death, and survival at 100 days, 5 years and 10 years following SCT.

RESULTS

In multivariate analysis, risk factors for acute cutaneous GVHD were type of haematological disease (P = 0.006), HLA disparity (P = 0.006), number of transplants per patient (P = 0.017), conditioning regimen (P = 0.001), and GVHD prophylaxis (P = 0.025). Survival rates did not differ significantly for cases and controls.

CONCLUSIONS

Risk factors for acute cutaneous GVHD were a diagnosis of chronic myeloid leukaemia, HLA disparity, receipt of more than one SCT, conditioning regimens including total body irradiation, and GVHD prophylaxis regimens other than ciclosporin plus methotrexate. Other common risk factors for acute GVHD without specific target organ involvement showed no significant association with the risk for developing acute GVHD affecting the skin as primary target organ.

[Adverse reactions to vaccines]

Adverse reactions to vaccines are highly varied, ranging from mild local reactions to fatal outcomes. In the last few years many adverse reactions have been attributed to vaccines, often without justification. In agreement with the World Health Organization, these reactions can be classified as follows, depending on the cause: vaccination-induced reactions (due to an effect of the vaccine itself or to an idiosyncrasy); reactions due to errors in storage, manipulation and/or administration; and coincidental reactions (no causal relationship with the vaccine). Hypersensitivity reactions fall into six categories, depending on the causative agent: reactions due to some component of the infectious agent or one of its products; reactions due to adjuvants: aluminium hydroxide; reactions due to stabilizers: gelatin; reactions due to preservatives: thiomersal; reactions due to antibiotics: neomycin; and reactions due to a biological culture medium: chicken embryo cells. Allergic children should not be excluded from the normal vaccine calendar. Immunologically, allergic individuals are more susceptible to infection and to microbial and viral diseases, which often play an aggravating role. Rubella, whooping cough, and influenza usually exacerbate respiratory allergies. Non-vaccination carries a marked risk of contracting serious diseases such as poliomyelitis, tetanus, and diphtheria, etc. In a not too distant future, the techniques of genetic recombination and monoclonal antibody production will allow the creation of vaccines from organisms that cannot be cultivated in the laboratory or that produce small quantities of antigen. These techniques will also lead to identification of the antigens with the greatest immunogenic power and, consequently, to extremely pure vaccines. The adverse reactions to vaccines referred to our service account for between 0.59 % and 1.27 % of first visits in the last three years. We recorded a total of 48 adverse reactions to vaccines. Of these, 44 were attributed to the tetanus vaccine (92 %), 2 to the measles-mumps-rubella vaccine (4 %) and 2 to the meningitis A and C vaccine (4 %). Clinical features consisted of urticaria (11 cases), urticaria with angioedema (7 cases), pseudo-shock (5 cases), fever and urticaria (4 cases), local reactions (4 cases), persistent crying with exanthema (3 cases), giant local reactions with angioedema of the limb (3 cases), anaphylaxis (3 cases), fever > 39.5 C (2 cases), bronchospasm (1 case), and severe atopic dermatitis (1 case).A regimen of hyposensitization to tetanus toxoid was required in 20 patients (45 %); in three, this could not be completed due to generalized urticaria but all the patients presented protective titers with diluted vaccine.

[Laparoscopic choledochoscopy]

AIM

Of this study was to evaluate the treatment of common bile duct stones (CBDS) by laparoscopic choledochoscopy.

MATERIAL AND METHOD

Between 1997-2002, 9 patients (with age between 42-75 years) were treated laparoscopic for CBDS: 8 cases with choledocholithiasis; 1 case with pancreatic neoplasm. Laparoscopic choledochoscopy was performed in 7 cases (84.4%). We used the choledochoscope Pentax of 5 mm diameter and with work canal.

RESULTS

We performed the CBD exploration with: transcystic approach-1 case; choledochotomy-6 cases. The CBD diameter was between 1.2-1.5 cm. The bile duct stones diameter were between 0.5-1.5 cm. We performed with successfully the laparoscopic choledochoscopy exploration and extraction of CBD stones to all patients. External biliary drainage (transcystic duct and with Kehr-tube) were done systematically. The major complication (choleperitoneum) occurred in 2 cases (28.5%). The occurrence of residual ductal stones was 0.

CONCLUSION

The laparoscopic treatment of choledocholithiasis is feasible, safe and efficient.

Liquid chromatographic/mass spectrometric determination of desmedipham and phenmedipham and their metabolites in soil

A simple method is described for the simultaneous determination of residues of 2 carbamate herbicides (phenmedipham and desmedipham) and related metabolites (m-aminophenol, aniline, and m-toluidine) in soil. The analytes are extracted from spiked soils with methanol. The solvent/soil suspension is centrifuged, and the supernatant is directly injected, without any further cleanup, into a reversed-phase liquid chromatography/mass spectrometry apparatus equipped with a TurbolonSpray interface. The method was tested on 5 soils having different physicochemical properties. Recoveries from the soil types, spiked over the range of 50-200 ppb, were essentially quantitative for each analyte. The detection limits of the method are < or = 25 ng/g.

Circadian rhythmicity of whole-blood glutathione in healthy subjects

OBJECTIVES

Physiologic rhythms of antioxidants have been the subject of considerable interest in recent years. Physiologically, it is known that 24-h variability in whole-blood glutathione (GSH) could depend on various factors, such as meal composition, protein dietary content, meal-related hormonal modifications, and stress. Experiments were conducted to determine if the circadian variations previously observed in hepatic concentrations of reduced glutathione in animals also occurred in healthy volunteers.

METHODS

The circadian periodicity of whole-blood glutathione was explored. All parameters were measured enzymatically at 4-h intervals over a 24-h period.

RESULTS

Circadian rhythms were not found. The rhythms peak for glutathione content occurred at 9 h with a small peak at 21 h. The nadir occurred at 17 h and 1 h.

CONCLUSION

These data show that despite this wide distribution of glutathione throughout the day we could not find any significant intertime variability.

Mechanism of the ultrasonic activation of micellar drug delivery

The mechanism of the ultrasonic enhancement of the uptake of cytotoxic drugs, doxorubicin (DOX) and ruboxyl (Rb) by HL-60 cells from Pluronic micelles was studied. DOX and Rb sorption from either PBS or micellar Pluronic solutions is described by Langmuir-type isotherms characteristic of substrates with limited number of sorption centers. The sorption limits for Rb from PBS and Pluronic were considerably higher than those for DOX, presumably due to much higher Rb partitioning into cell membranes. The overall number of drug sorption centers for both drugs decreased in the presence of Pluronic implying the effect of Pluronic on the DNA conformation, which was confirmed by the electron paramagnetic resonance (EPR) experiments using Rb as a spin probe. Ultrasound increased drug uptake by the cells from PBS and Pluronic solutions. The fluorescence microscopy and flow cytometry experiments using fluorescently-labeled Pluronic showed that ultrasound enhanced both the intracellular uptake of Pluronic micelles and Pluronic trafficking into cell nuclei. A scheme is suggested that describes various equilibria controlling drug/cell interactions and effect of ultrasound on these equilibria. Under the action of ultrasound, the equilibrium between the micellar-encapsulated and free drug is shifted in the direction of free drug due to micelle perturbation; the equilibrium between extracellular and internalized drug is shifted to the intracellular drug due to the ultrasound-induced cellular changes that enhance the accessibility of various cellular structures to drug. An important advantage offered by ultrasound is that the same degree of the intracellular drug uptake may be achieved at a substantially lower drug concentration in the incubation medium.

Practical implications of nutritional support during continuous renal replacement therapy

Continuous blood membrane interactions during continuous renal replacement therapy cause bioincompatibility and low grade inflammatory reactions with potentially adverse consequences on protein metabolism and immunocompetence. In designing a nutritional program for patients receiving this treatment, these adverse metabolic effects, especially the loss of nutritional substrates, must be considered. This review provides a practical overview of nutritional support in acute renal failure, including assessment techniques, determination of nutrient needs, and appropriate intervention for patient support.

Acoustic activation of drug delivery from polymeric micelles: effect of pulsed ultrasound

The effect of a continuous wave (CW) and pulsed 20-kHz ultrasound on the Doxorubicin (DOX) uptake by HL-60 cells from the phosphate buffered saline solution (PBS) and Pluronic micellar solutions was studied. Both CW and pulsed ultrasound enhanced DOX uptake from PBS and Pluronic micelles. The main factor that effected drug uptake was ultrasound power density; however, with increasing power, the enhanced drug uptake was accompanied by the extensive cell sonolysis. For PBS, no significant effect of duration of the ultrasound pulse or inter-pulse interval on the drug uptake was observed. For Pluronic micelles, the uptake increased with increasing pulse duration in the range 0.1-2 s, overall sonication time being the same. For 2-s pulses, the uptake was close to that under CW ultrasound. There was no significant effect of the duration of the inter-pulse interval on the drug uptake from Pluronic micelles. The data on the effect of pulse duration on drug uptake suggest that the characteristic times of drug release from micelles and drug uptake by the cells are comparable. The results point to two independent mechanisms controlling acoustic activation of drug uptake from Pluronic micelles. Both mechanisms work in concert. The first one is related to the acoustically-triggered drug release from micelles that results in higher concentration of the free drug in the incubation medium. The second mechanism is based on the perturbation of cell membranes that results in the increased uptake of the micellar-encapsulated drug. The intracellular uptake of Pluronic micelles was confirmed by fluorescence microscopy.

[Mechanical suture in colorectal surgery]

THE OBJECT

Of this work was the study of using, as well as the utility of the mechanical sutures in colorectal surgery; because of the special caution needed to be taken for any colonic or rectal suture, more than any other digestive segment. The frequency of the postoperative fistulas after the suture and anastomosis is higher at this level and so it increases the period and costs of the hospitalization.

MATERIAL AND METHOD

We studied the possibilities of performing and evolution of 64 mechanical sutures for 19 patients, with colorectal pathology, hospitalized in our department from july 1999 to december 2000.

RESULTS

We performed 64 mechanical sutures, as followed: 47 in open surgery and 17 in laparoscopic. From all these, 56 was bowel sutures, 8 of them were vascular (in laparoscopic, for cutting the most important vascular pedicles). We did 18 anastomosis: 15 in open and 3 in laparoscopic surgery. It was 2 postoperative fistulas from all 56 intestinal sutures (3.57%). We haven't any intra or postoperative bleeding from the vascular anastomosis. It was 3 intraoperative bleeding from the intestinal anastomosis, and only 1 case of postoperative bleeding (5.26% of the cases: 1.56% of all mechanical sutures). In only one case, the mechanical suture couldn't be initially done, but it succeeded after the removing of the segment of the bowel involved.

CONCLUSIONS

Mechanical sutures offers a high level of safety to the colorectal anastomosis. It provides a very good vascularization to the anastomosis and decreases the time needed for performing the suture or anastomosis, versus manual sature. Also, for the patients with rectal ampular neoplasm, it creates the possibility of anal sphincter preservation by making a low colorectal anastomoses--which is difficult by manual suture.

Molecular cloning of newt prolactin (PRL) cDNA: effect of temperature on PRL mRNA expression

A partial prolactin (PRL) cDNA was specifically PCR amplified from a cDNA library constructed from pituitary mRNAs of the newt (Cynops pyrrhogaster) and cloned into plasmid vectors. One clone thus obtained contained a 739-bp insert encoding the C-terminal amino acid sequence of the mature hormone molecule. Using this clone as a probe, the full-length newt PRL cDNA was screened from the cDNA library. The PRL cDNA clone thus obtained consisted of 1024 bp encoding the entire sequence of the mature PRL molecule in addition to its signal peptide. The amino acid sequence of newt PRL deduced from its nucleotide sequence showed higher homologies with those PRL sequences of tetrapod animals than with those of teleosts. Northern blot analysis revealed the newt PRL mRNA size to be approximately 1 kb. In situ hybridization using the newt PRL cDNA as a probe revealed that the pituitary region expressing PRL mRNA corresponded to that immunoreactive with antiserum against PRL. PRL mRNA levels in the pituitary of newts subjected to room and low temperatures were determined by Northern analysis employing the PRL cDNA as a probe. PRL mRNA levels were significantly higher in the pituitaries of newts subjected to 10 degrees than in those of newts kept at 23 degrees. Likewise, immunoassayable plasma PRL levels were higher in animals subjected to 10 degrees than in those kept at 23 degrees.

[Color Doppler and ultrasound-guided prostate biopsy in the diagnosis of prostatic neoplasm]

The diagnosis of prostate neoplasm is still limited today by the variable power of prediction of the three main surveys used: prostate-specific antigen (PSA), digito rectal exploration (DRE) and ultrasound transrectal (TRUS). The study aimed to estimate the benefits and the diagnostic impact of the color Doppler ultrasonography on the diagnosis of prostate neoplasm through biopsies targeted on areas with abnormal flow. With this purpose, 222 biopsies performed on 71 patients between 1997 and 1999 were considered, which led to a diagnosis of neoplasm in 36 patients. Of the 84 biopsies that revealed prostate adenocarcinoma, 74 (64.3%) were correlated to hypoechoic lesions with abnormal flow signals while 41 (35.6%) showed a benign pathology (prostatitis or benign prostatic hyperplasia) (p < 0.0011). In five patients (13%) who did not present any evident lesions at a first transrectal ultrasound, the diagnosis of neoplasm was made only through biopsies targeted on areas with abnormal flow. Therefore, the color Doppler exam can be used during prostate ultrasonography either to consolidate the diagnosis or to give a useful target in case of isoechoic lesions.

[Intraoperative ultrasonography during laparoscopic surgery]

AIM

Of this study is the introduction and the results evaluation of laparoscopic ultrasonography performed.

MATERIAL AND METHOD

We realize a prospective study about laparoscopic ultrasonography performed in 37 cases with laparoscopic surgical treatment. The Aloka SSD 2000 mobile scanner is used. This system make possible the use of an linear-array transducer, with mechanical flexibility and availability of Doppler analysis. Most frequently we used intraoperative ultrasonography in laparoscopic cholecystectomy as an alternative for cholangiography to exclude CBD pathology. Because of various surgical pathology with laparoscopic approach, the laparoscopic ultrasonography utilization range was vastly.

RESULTS

In all the cases we could performed the laparoscopic ultrasonography. In 6 of 27 cases with laparoscopic cholecystectomy we found pathological disorders of bile ducts. CBD with diameter found between 5-12 mm. We properly saw the distal segment of CBD in 23 cases (89.2%), and common hepatic duct in 26 cases (97.3%). The quality of visualization was very good in 21 cases (83.8%) and moderate in 6 cases (16.2%). We easy identify CBD stones and we successfully used Doppler color mode in differentiating vascular from non-vascular from non-vascular structures. Laparoscopic ultrasonography performed in a case with left colon cancer excluded liver metastasis and lymph nodes metastasis.

CONCLUSIONS

1. Laparoscopic ultrasonography combines the advantages of diagnostic laparoscopy and intraoperative contact ultrasonography; 2. Laparoscopic ultrasonography is a simple and very efficient intraoperative examination procedure; 3. Laparoscopic ultrasonography is the technique to choose in CBD intraoperative exploration; 4. Laparoscopic ultrasonography improve abdominal malignancy exploration, thus modifying therapeutic decisions; 5. Color Doppler mode guides the surgeon's steps in difficult directions.

[Mechanical suture in classic and laparoscopic general surgery]

AIM

Of this working is the study of employment the mechanical suture in general surgery classic and laparoscopic.

MATERIAL AND METHOD

We analysed the possibility of accomplishment and postoperatory evolution of 104 mechanical sutures performed in 24 patients, with diverse surgery pathology, operated in Department of General Surgery, between January 1999 and January 2000.

RESULTS

Mechanical sutures allowed us to minimize the duration of surgical interventions and to perform some difficult anastomotic assembles (sometimes including creation of organ substitute). We had only two postoperatory fistulas and two postoperatory haemorrhages from anastomotic area (both cases because of bad closing of clips, through tissue excess between anvil and cartridge of the stapler).

CONCLUSIONS

There are certain advantages in using mechanical sutures (versus manual sutures) consisting in decreasing of time period, both in operation itself and in hospitalization, despite their high level cost.

Protein domain interfaces: characterization and comparison with oligomeric protein interfaces

The physical and chemical properties of domain-domain interactions have been analysed in two-domain proteins selected from the protein classification, CATH. The two-domain structures were divided into those derived from (i) monomeric proteins, or (ii) oligomeric or complexed proteins. The size, polarity, hydrogen bonding and packing of the intra-chain domain interface were calculated for both sets of two-domain structures. The results were compared with inter-chain interface parameters from permanent and non-obligate protein-protein complexes. In general, the intra-chain domain and inter-chain interfaces were remarkably similar. Many of the intra-chain interface properties are intermediate between those calculated for permanent and non-obligate inter-chain complexes. Residue interface propensities were also found to be very similar, with hydrophobic residues playing a major role, together with positively charged arginine residues. In addition, the residue composition of the domain interfaces were found to be more comparable with domain surfaces than domain cores. The implications of these results for domain swapping and protein folding are discussed.

Solitary fibrous tumor of the meninges

Intracranial fibrous tumors are unusual growths that occur almost exclusively in young individuals. Most of these lesions are intra-axial, however, on extremely rare occasions they arise from the leptomeninges and compress the adjacent brain. The authors report the case of a benign solitary fibrous tumor of the meninges in a 14-year-old girl who presented with a 5-month history of generalized headaches. NMR imaging displayed a left parietal mass, which mimicked a meningioma.

Use of the amplification refractory mutation system (ARMS) in the study of HbS in predynastic Egyptian remains

We conducted a molecular investigation of the presence of sicklemia in six predynastic Egyptian mummies (about 3200 BC) from the Anthropological and Ethnographic Museum of Turin. Previous studies of these remains showed the presence of severe anemia, while histological preparations of mummified tissues revealed hemolytic disorders. DNA was extracted from dental samples with a silica-gel method specific for ancient DNA. A modification of the polymerase chain reaction (PCR), called amplification refractory mutation system (ARMS) was then applied. ARMS is based on specific priming of the PCR and it permits diagnosis of single nucleotide mutations. In this method, amplification can occur only in the presence of the specific mutation being studied. The amplified DNA was analyzed by electrophoresis. In samples of three individuals, there was a band at the level of the HbS mutated fragment, indicating that they were affected by sicklemia. On the basis of our results, we discuss the possible uses of new molecular investigation systems in paleopathological diagnoses of genetic diseases and viral, bacterial and fungal infections.

Immunological investigation of malaria and new perspectives in paleopathological studies

We applied a paleoimmunological investigation, using an immunoenzymatic assay revealing trophozoite derived Plasmodium falciparum histidine rich protein-2 antigen (PfHRP-2). The investigation was carried out on skin, muscle and bone samples. We examined predynastic egyptian mummies (3200 B.C.) from Gebelen, belonging to the Marro's Collection of the Anthropological and Ethnographic Museum of Turin, to assay the presence of malaria. The results obtained suggest an incidence of malaria of about 40% in the mummies of Gebelen group. Data are compatible with other observations effected on populations living in similar ecological conditions of malarial areas.

Parietaria allergy in children

Parietaria, a grassy plant belonging to the Urticaceae family which is commonly found in urban environments, tends to grow on fences, walls and soils with a high content in nitrogen. Since 1983 the Xarxa Aerobiologica de Catalunya (Catalonian Aerobiological Network) has been using Hirst and Court sensors to monitor the daily concentrations of its pollen with respect to the weather conditions (wind, rain, temperature) in various sites in Catalonia and the Balearic Islands. This pollen is present practically all year round in our area, mainly during cold, rainy and seaside areas. Studies at a pediatric level are scarce and this is why we reviewed our data in this field. The study included a total of 12,650 case histories of first time attendances to our Pediatric Allergology Unit; 449 children showed sensitivity to Parietal pollen. Exclusive sensitivity to Parietaria in this age group of 1 and 15 years olds tended to be very low. However, we observed that after initial preferential sensitization to domestic allergens, Parietal pollen became the most frequent cause of sensitivity as the patients grew older. Although rhinoconjunctival manifestations predominate, at least at a pediatric level, the implication of Parietal pollen as a cause of bronchial asthma cannot be ignored.

Sampling biases in a marital study on severe major depression

A comparison was carried out between participants and refusers to participate in a 2-year prospective follow-up study of major depression. 88 consecutively admitted patients of the Psychiatric University Hospital Heidelberg had been addressed. All of them fulfilled both the ICD-9 criteria for Endogenous Depression and the DSM-III-R criteria for Major Depression according to SCID. 38 patients declined participation. Participants and refusers were compared with regard to 56 items of psychopathological symptomatology, socio-demographic data, quality of marital relationship, and personality features. The information about these items was taken systematically from the medical records both of participants and refusers. For some items methods of content analysis were applied to the case histories. Only few differences between participants and refusers were found. Women and more severely ill patients were less willing to accept participation. The degree of marital problems did not differentiate between consenters and refusers.

Allergy to pine nuts in children

BACKGROUND

Allergy to nuts is a common and well-known disease. Despite the fact that pine nut is a widely eaten food, only nine cases have been described in literature.

OBJECTIVE

To describe four paediatric patients suffering from allergy reaction on ingestion of pine nuts and compare them with cases described in literature, taking into account clinical symptoms, epidemiological and diagnostic methods.

METHODS

The immuno-allergic study was carried out with skin tests (prick tests) using a commercial and native extract, and specific IgE serum test. An oral provocation test was performed in one case.

RESULTS

Ages ranged from 12 months to 6 years. All patients had a personal history of atopy. Symptoms on ingesting pine nut were severe systemic reactions in three cases. Two of the children had allergic reactions to other nuts. In all cases, both the skin test and the specific IgE serum test were positive. The oral provocation was positive in the case for which it was performed.

CONCLUSIONS

A typical clinical reaction of immediate hypersensitivity to this nut took place in all four children. The skin tests and in vitro studies confirm an IgE-mediated response. We currently have a commercial prick test for pine nut for the diagnosis, which has proven its sensitivity and specificity. In our region, due to the large consumption, the rate of allergic reactions to pine nuts would probably be greater and earlier on in life than in other areas.

The carboxy-terminus of I kappaB alpha determines susceptibility to degradation by the catalytic core of the proteasome

The Rel/NF-kappaB family of transcription factors controls the expression of a wide variety of genes that are implicated in immune and inflammatory responses and cellular proliferation. Disregulation of NF-kappaB is associated with cellular transformation and the maintenance of a high anti-apoptotic threshold in transformed cells. NF-kappaB activity is in turn regulated by its sequestration in the cytoplasm by the inhibitor I kappaB. I kappaB alpha, the most abundant and well-characterized member of the I kappaB multiprotein family, is rapidly degraded in response to multiple physiologic stimuli. In the present study we show that not only the amino-terminus, but also the carboxy-terminus of I kappaB alpha contain transferable signals that must be simultaneously present in an unrelated protein to render it susceptible to activation-induced, proteasome-mediated degradation. We show here that I kappaB alpha amino-terminal modifications occur independently of the carboxy-terminus. Moreover, we present evidence indicating a critical role for the carboxy-terminal region in facilitating proteolysis by the catalytic core of the proteasome. When incubated with 20S proteasome extracted from rat liver, I kappaB alpha was quickly degraded while a deletion mutant lacking the carboxy-terminus was resistant to proteolysis. Likewise, chimeric proteins of beta-galactosidase with the I kappaB alpha carboxy-terminus were degraded in vitro independently of the presence of the I kappaB alpha amino-terminus, whereas chimeric proteins lacking the I kappaB alpha carboxy-terminus were stable. Our results identify the carboxy-terminus of I kappaB alpha as a domain critical for degradation through interaction with an as yet unidentified component of the proteasome.

Electrophysiology and pharmacology of outward potassium currents in semicircular canal hair cells of toadfish, Opsanus tau

Outward currents from hair cells from the horizontal semicircular canal (HSCC) of the toadfish were investigated using whole cell patch clamp methods. Two classes of hair cells are found. One class (approx. 10% of cells) showed only a non-inactivating current (IKCa) which was blocked by 2 mM TEA. A second class had both inactivating and non-inactivating currents. The former (IA) was blocked by 4-AP (1 mM) and the latter (IKCa) by TEA (2-20 mM) . While the majority of the cells expressed both these outward currents, due to IA inactivation both currents are functionally present in the same cell only between -60 and -40 mV. At more depolarized membrane potentials, IA was inactivated, suggesting that a single hair cell may have two distinct signalling modes, one dominated by IA at more hyperpolarized membrane potentials and the other by IKCa at depolarized values where ICa is beginning to grow, increasing both amplitude and activation rate of IKCa. The switch between modes will be determined by the amplitude and frequency characteristics of the stimulus and possibly also by actions of efferent transmitters. In current clamp mode, 10% of the HSCC hair cells showed high Q and high frequency resonance, from 44 to 360 Hz at 12 degrees C. These cells expressed only one outward calcium dependent, non-inactivating, TEA sensitive current, characteristic of IKCa. A suggested role for high frequency resonance is as positive feedback to produce a high frequency updating of the stereociliary compliance to most faithfully transduce angular acceleration.

[Ebastine : treatment of perennial rhinitis in the child]

Ebastine is H1 receptor antagonist, powerful and selective for histamine. Its efficacy has been evaluated in control of symptoms of persistent rhinitis, appearance of secondary effects and tolerance of the drug, in 30 children who were suffering from persistent rhinitis, of which the diagnosis included:- clinical history, skin tests (prick test) nasal and conjunctival provocation tests, total and specific IgE. All the children had treatment for 30 days. The parameters followed were:- clinical score, skin tests, nasal and conjunctival provocations and evaluation of secondary effects, of the start and 10 days after the end of treatment. The results obtained were a disappearance or reduction of the weals from histamine and specific antigens, disappearance or reduction of the response in nasal and conjunctival provocation with carbachol or specific antigens, clear clinical improvement in 22 patients, in 2 small improvement and no response in 6 patients. We conclude that Ebastine improved the clinical symptoms in persistent rhinitis, the skin test is inhibited and sensitivity of the shock organ is reduced. No secondary effects were seen on the Central Nervous System (SNC) and the tolerance of the drug was very good.

Correlations between the clinical picture and the intentionality in schizophrenic and schizoaffective patients

The results are presented of catamnestic research on 24 patients with the diagnosis of schizophrenia at the first clinical episode confirmed according to the ICD-10 criteria. The clinical picture rated with the Positive and Negative Symptoms Scale (Kay, Fiszbein and Opler, 1987) and with the BPRS, was correlated with the intentionality, which was rated with the InSka (IntentionalitätsSkala; Mundt, 1985). The transformation of the phenomenal significance into a numeric value enables the use of mathematical methods for the search of interactions inside the schizophrenic phenomenon. We found the following significant tendencies: (1) the negative syndrome score correlates with the residual intentionality; (2) the negative syndrome score correlates with the premorbid intentionality; (3) the clinical thought disturbance correlates with the premorbid speech content intentional profile.

A randomized study of mitoxantrone plus cytarabine versus daunomycin plus cytarabine in the treatment of previously untreated adult patients with acute nonlymphocytic leukemia

Between May 1985 and November 1988, 143 adult patients with previously untreated acute nonlymphocytic leukemia were randomized to receive mitoxantrone and cytarabine (MTT+Ara-C) or daunomycin and cytarabine (DNM+Ara-C) in order to compare the efficacy and acute and chronic toxicities. Therapy consisted of 3 days of MTT 12 mg/m2/i.v. or DNM 45 mg/m2/i.v.; both groups received Ara-C 100 mg/m2 daily by continuous infusion (CI) for 7 days. Those who failed to achieve a complete remission after one induction course received a second induction course for 2 and 5 days at the same doses. All the patients who achieved complete remission received two consolidations of 2 days of MTT or DNM and 5 days of Ara-C in CI at the same dose as for induction. Of the 72 patients on MTT+Ara-C, 38 (53%) achieved complete remission, compared with 29 (43%) of 67 treated with DNM+Ara-C. Three and 5 patients had partial remission, 7 and 18 failed to respond, 24 and 15 died in the first 21 days of induction, of those treated with MTT+Ara-C or DNM+Ara-C, respectively (p = 0.34). Median duration of complete remission and survival was 185 and 103 days or 165 and 160 days, respectively (p = 0.85). More early deaths were observed with MTT+Ara-C due to greater myelosuppression, and a higher incidence of failure with DNM+Ara-C. No significant differences between treatment groups were observed in 21 categories of adverse events. The results demonstrate similar incidence of complete response, length of duration of complete remission, overall survival, and toxicity with MTT+Ara-C and DNM+Ara-C.

Ultrastructural analysis of the cavernous and dorsal penile nerves in experimental diabetes

The present study was designed to investigate whether experimental diabetes determines structural changes in peripheral nerves involved in reflexogenic erection, namely the cavernous and the dorsal nerve of the penis. Myelinated axons were examined in the dorsal nerve of the penis from rats with streptozotocin-induced diabetes (3- and 6-month duration). Morphometric analysis disclosed a significant decrease of myelinated fibre size most likely due to a progressive axonal atrophy. In addition, morphological analysis revealed diffuse accumulation of glycogen within axons, lipid droplets in Schwann cells and pronounced sequestration of axoplasm by adaxonal Schwann cell processes. These signs were particularly prominent in 6-month-diabetic rats. Myelinated and unmyelinated axons of the cavernous nerve were analysed in 6-month-diabetic animals. No substantial ultrastructural abnormalities were found in the cavernous nerves. These results suggest that in experimental diabetes regionally specific structural changes occur in neuronal pathways subserving erectile function.

[Value of local cerebral hypoperfusion in the diagnosis of frontal syndromes. Importance in medical expert assessment of head injuries]

The importance of the symptoms linked to a frontal disorder in the intellectual and behavioral sequelas of severe cranial trauma, is now measured carefully because these troubles are one of the most important obstacle to the social and professional come-back. The handicap linked to a disorder of the frontal lobe is not well known in all its neurological, mental and sociological dimensions because the diagnosis is not easy. To help to this diagnosis, the study of cerebral blood flow with SPECT is usefull in medical practice. We present here 4 clinical cases of post-trauma frontal syndrome not easy to measure. With a measure of cerebral blood flow with SPECT, it was observed a decrease of frontal blood flow, that allowed to link the neuropsychological symptom to a frontal lobe disorder. It seems that in these conditions the post-trauma frontal syndrome is not so uncommon.

Depression and partial epilepsy: relevance of laterality of the epileptic focus

In a prospective study of 50 epileptic patients (20 with a left hemisphere epileptic focus, 20 with a right one and 10 with a cryptogenic generalized epilepsy), the authors show that depression as appreciated by the H.A.R.D. score, is more frequent and severe in partial epilepsy in males, and when the epileptic focus is localized on left hemisphere. This association is related to the duration of epilepsy, the number of seizures, but not to age or medication status. Vulnerability of left hemisphere to depression is analysed, and neuro-chemical mechanisms are discussed.

Effect of streptozotocin-induced diabetes on electrically evoked erection in the rat

This study was designed to investigate whether experimental diabetes in rats could functionally affect reflexogenic erection. Erection was elicited by means of electrical stimulation of the dorsal nerves of the penis and recorded as intracorporeal pressure. Rats were examined 1, 3 and 6 months after diabetes induction by streptozotocin. Three and 6 month diabetes caused a significant decrease of latency for erection and a slower phase of detumescence when compared to age-matched controls. In addition, a trend for a lower developed intracorporeal pressure was present in the 6 month diabetes group. Our results indicate that experimental diabetes is associated with alterations of reflexogenic erection.

[REM-sleep behavior disorder and olivo-ponto-cerebellar atrophy: a case report]

The authors report the observation of REM-sleep behavior disorder in a patient also suffering from an olivo-ponto-cerebellar atrophy. They discuss the place of this sleep disorder among the parasomnias, its pathophysiological basis and its features similar to those of the somnambulism. Only a polysomnography study can help to make the diagnosis.

Mustard allergy. Two anaphylactic reactions to ingestion of mustard sauce

Two cases of anaphylactic reactions set off by the ingestion of a small amount of mustard sauce are described. Mediation by specific IgE to mustard was determined by skin prick tests and radioimmunoassay, which suggested a type I hypersensitivity mechanism. Despite the antigenic potency of mustard, a spice that is consumed frequently, very few cases of hypersensitivity from ingestion have been described.

[Effects of callosotomy in the treatment of intractable epilepsies in children on psychiatric disorders]

Two children, 13 and 14 years old, presented an intractable epilepsy of Lennox-Gastaut. In front of dangerous tonic and atonic epileptic crisis, a corpus callosotomy was performed. Corpus callosotomy is becoming a more widely used procedure in the treatment of intractable epilepsy as Lennox-Gastaut syndrome, or frontal epilepsy. However, there have been very few series that have reported results in children. It is not a complete but a partial, callosal section including approximately the anterior two thirds of the callosum. After this surgery the two children improved dramatically because the dangerous tonic and atonic crisis disappeared. Secondly we observed improvement of pre-surgical psychiatric troubles, that is a data not developed in the literature. Before surgery, the two children had a frontal syndrome with hyperkinesia, distractibility, aggressiveness, alexithymia, loss of the program of ideas. During the two months after the section of the anterior two thirds of the corpus callosum, we observed a progressive improvement of the frontal syndrome, with possibility to learn new praxies. The intellectual quotient was not altered and associative functions, depending of the posterior third of the corpus callosum were spared. Anti-epileptic medications were not stopped. We think that the improvement of the frontal syndrome is due to reduction of seizures. Therefore, we insist on the interest of the section of the anterior two thirds of the corpus callosum as treatment of tonic and atonic seizures but also as treatment of psychiatric symptoms depending of a frontal syndrome.

Synthesis and anthelmintic activity of carbamates derived from imidazo[2,1-b][1,3,4]thiadiazole and imidazo[2,1-b]thiazole

The anthelmintic activity of 25 compounds, most of them carbamates, was determined. The in vitro results are interesting and show that an aromatic azapentalene can replace the benzimidazole ring without loss of its biological properties. The in vivo results, however, show that the compounds are devoid of practical interest.

Asthma trough to Parietaria in pediatrics

We selected 183 patients with asthma, rhinitis and/or conjunctivitis. They responded positively to Parietaria Judaica skin prick-tests. In the first test 91 were positive. Of those 11 were monosensitive and 80 polysensitive. In the follow-up tests 92 were positive, of which 5 were monosensitive and 87 polysensitive. There were 54 cases of rhinitis, of which 23 developed asthma. Of 129 asthma cases, 90 developed asthma with rhinitis. The main seasons are Spring and Autumn and activity declines during winter. 18.57% are perennial. IgE was greater in the re-examination of the polysensitive cases. The monosensative cases confirmed the clinical symptoms most characteristic of rhinitis syndrome, 16.893% and asthma with rhinitis, 49.18%.

Chronic erosive arthritis associated with an unusual intestinal bypass

We describe an unusual intestinal bypass arthritis in a 37-year-old man. The intestinal bypass was unusual because the intestinal blind loop was entirely composed of colon. The arthritis was first a typical bypass arthritis but later resembled rheumatoid arthritis. In spite of this resemblance, all rheumatic symptoms disappeared after jejunocaecal reanastomosis.