Obstructive sleep apnea syndrome analysis in children by decreases in the amplitude fluctuations of pulse photoplethysmography: role of recording duration and heart rate variability

Heart rate variability (HRV) during Decreases in the Amplitude fluctuations of Pulse Photopletysmography signal events (DAP) is studied. The DAP duration and the time span of the polysomnography (PSG) recording under study are also considered for identification of Obstructive Sleep Apnea events in children. Oxygen desaturation is used as reference. The study involves recordings of 21 children. Periods of time associated with a drop in SaO2 of 3% from baseline during at least 5% of the time were labeled as pathologic. DAP events were detected using an automatic detector, HRV signal processing using the Smooth Pseudo Wigner-Ville Distribution was carried out in order to obtain several time and frequency HRV indexes. T-test was used to analyze differences between groups. The results show discrimination power between groups that increases as the duration of the time period under analysis, becomes shorter, and so more tune to the apneic episodes. Also HRV increase the discrimination power helping in discriminating DAP event non related to apnea.

Study of the relationship between pulse photoplethysmography amplitude decrease events and sleep apneas in children

In this work, a method to analyse the effects of an apnea on the pulse photoplethysmography signal (PPG) is proposed. Therefore, an apnea detector based on respiratory signals has been developed and a decreases in amplitude of PPG (DAP) detector developed in a previous study was used. The apnea detector was tested using real signals. S and +PV of the detector were 95.3% and 94.4%, respectively. For each of the apneic events, we analyzed the presence of DAP in a window previous to the apnea event and another during/following the apnea. An increase of about 15% in DAP events in the window during/following the apnea with respect to the previous to apnea window is produced. These results shows an association between apneic events and DAP events, which indicates that DAP events provide useful information in sleep research and PPG signals might be useful in the diagnosis of OSAS.

Detection of obstructive sleep apnea in children using decreases in the amplitude fluctuations of PPG signal and HRV

An analysis of the HRV during decreases in the amplitude fluctuations of PPG (DAP) events, and their utility in OSAS screening is presented. The overall data set used in the study includes the polysomnographic records of 21 children. DAP events were automatically detected by an algorithm based on the envelope attenuations of the PPG. DAP events were classified as apneic or non apneic by a linear discriminant analysis. The features used by the linear discriminant come from the temporal and spectral parameters of the heart rate obtained by Smooth Pseudo Wigner Ville Distribution. Two indexes were defined: the number of DAP events per hour ratio r(DAP) and the number of apneic DAP events per hour ratio r(DAP)(alpha). Results show a 12% increase in accuracy for r(DAP)(alpha) with respect to r(DAP) in classifying 1 hour polysomnographic segments, reaching values of 72.7% and 80% for sensitivity and specificity, respectively. As for subject classification, the improvement in accuracy is 6.7% obtaining values of 87.5% and 71.4% for sensitivity and specificity respectively. These results suggest that the combination of DAP and HRV could be an alternative for sleep apnea screening with the added benefit of low cost and simplicity.

Traqueotomía percutánea por dilatación: nuestra experiencia

Percutaneous dilation Tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our hospital, we recently adopted the use of the PDT in intensive care unit patients.

OBJECTIVE

The objective [corrected] of this investigation is to characterize and quantify the rate of complications for PDT.

MATERIALS AND METHODS

A prospective study of 60 PDT performed at different intesive care units, betweem September 2002 to July 2003.

RESULTS

The intraoperative time for PDT was 8 minutes. Complications included 6 cases of mild intraoperative hemorrhage, 1 case of moderate intraoperative hemorrhage, 4 cases of mild postoperative hemorrhage and 1 case of subcutaneous emphysema.

CONCLUSIONS

PDT is a good alternative to surgical tracheotomy and should be added to the otolaryngologists armamentarium of surgical airway procedures.

[Bilateral vocal cords paresis following iodine therapy]

We present a case of a 33 year old man who underwent a thyroidectomy due to papillary thyroid carcinoma, with a reversible paresis of both vocal cords after radioiodine therapy. The patient had no previous lesion in laryngeal nerves. Paralysis of the vocal cords is a rare complication of the 131I administration and generally occurs more frequently when there is already some type of lesion in the recurrent laryngeal nerves. The paper reviews the literature on this type of complications.

The Trauma Symptom Checklist for Young Children (TSCYC): reliability and association with abuse exposure in a multi-site study

OBJECTIVE

The Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item caretaker-report measure of children's trauma- and abuse-related symptomatology. It contains two reporter validity scales and eight clinical scales [Post-traumatic Stress-Intrusion (PTS-I), Post-traumatic Stress-Avoidance (PTS-AV), Post-traumatic Stress-Arousal (PTS-AR), Post-traumatic Stress-Total (PTS-TOT), Sexual Concerns (SC), Dissociation (DIS), Anxiety (ANX), Depression (DEP), and Anger/Aggression (ANG)], as well as an item assessing hours per week of caretaker contact with the child. This paper introduces the TSCYC and describes its psychometric properties in a multisite validity study.

METHOD

A total of 219 TSCYCs administered by six clinician/researchers across the United States were analyzed for scale reliability and association with several types of childhood maltreatment.

RESULTS

The TSCYC clinical scales have good reliability and are associated with exposure to childhood sexual abuse, physical abuse, and witnessing domestic violence. The PTS-I, PTS-AV, PTS-AR, and PTS-TOT scales were most predictive, followed by SC in the case of sexual abuse and DIS in the case of physical abuse. There were a small number of age, sex, and race effects on TSCYC scores.

CONCLUSIONS

The TSCYC appears to have reasonable psychometric characteristics, and correlates as expected with various types of trauma exposure. Subject to continued validation and the development of general population norms, its use as a clinical measure is supported.

Value of the serum alpha-L-fucosidase activity in the diagnosis of colorectal cancer

OBJECTIVES

The purpose of this study was to assess the value of the serum levels of alpha-L-fucosidase activity in the diagnosis of patients with colorectal cancer.

METHODS

Using a fluorometric method we analyzed the alpha-L-fucosidase activity in preoperative sera from 137 colorectal cancer patients and in sera from 232 donors.

RESULTS

The enzymatic activity of alpha-L-fucosidase was significantly lower (p <0.001) in patients (4.8+/-3.09 U/ml) than in donors (10.5+/-5.46 U/ml). Using the ROC curve, the ideal cut-off for the diagnostic value of alpha-L-fucosidase activity was determined to be 5.6 U/ml. The diagnostic efficiency for colorectal cancer of alpha-L-fucosidase activity was higher than that observed for carcinoembryonic antigen (cut-off 5.0 ng/ml), especially for tumors at an early stage.

CONCLUSIONS

Our results suggest that preoperative serum alpha-L-fucosidase activity may be used as a cheap and easy complementary test, in addition to standard clinical procedures routinely used for the diagnosis of colorectal cancer.

Seroprevalence of HIV and HTLV in a representative sample of the Spanish population

HIV and HTLV seroprevalence was determined by means of unlinked anonymous testing of 2144 sera, originally obtained from primary care patients by representative sampling of the Spanish population aged 15-39 years in 1996. HIV-1 seroprevalence was 4.3 per 1000 population in the 15-39 years age group [95% confidence interval (CI), 1.5-10.7] and 5.6 per 1000 (95% CI, 1.8-15.3) in the 20-39 years age group. Seroprevalence proved higher in males and urban residents. No antibodies to HIV-2 and HTLV-I were detected in any of the sera studied. However, presence of antibodies to HTLV-II was confirmed in one serum sample, while HTLV seroreactivity, though detected in another, could not be typed. The two HTLV-positive results equated to a seroprevalence of 1.9 per 1000 in the 20-39 years age group (95% CI, 0.3-8.6). HIV-I seroprevalence was consistent with previous estimates yielded by back-calculation. The level of HTLV seroprevalence found suggests endemicity.

Differential nuclear and cytoplasmic expression of PTEN in normal thyroid tissue, and benign and malignant epithelial thyroid tumors

Germline mutations in PTEN (MMAC1/TEP1) are found in patients with Cowden syndrome, a familial cancer syndrome which is characterized by a high risk of breast and thyroid neoplasia. Although somatic intragenic PTEN mutations have rarely been found in benign and malignant sporadic thyroid tumors, loss of heterozygosity (LOH) has been reported in up to one fourth of follicular thyroid adenomas (FAs) and carcinomas. In this study, we examined PTEN expression in 139 sporadic nonmedullary thyroid tumors (55 FA, 27 follicular thyroid carcinomas, 35 papillary thyroid carcinomas, and 22 undifferentiated thyroid carcinomas) using immunohistochemistry and correlated this to the results of LOH studies. Normal follicular thyroid cells showed a strong to moderate nuclear or nuclear membrane signal although the cytoplasmic staining was less strong. In FAs the neoplastic nuclei had less intense PTEN staining, although the cytoplasmic PTEN-staining intensity did not differ significantly from that observed in normal follicular cells. In thyroid carcinomas as a group, nuclear PTEN immunostaining was mostly weak in comparison with normal thyroid follicular cells and FAs. The cytoplasmic staining was more intense than the nuclear staining in 35 to 49% of carcinomas, depending on the histological type. Among 81 informative tumors assessed for LOH, there seemed to be an associative trend between decreased nuclear and cytoplasmic staining and 10q23 LOH (P = 0.003, P = 0.008, respectively). These data support a role for PTEN in the pathogenesis of follicular thyroid tumors.

Morphologic and biochemical changes in male rat lung after surgical and pharmacological castration

The morphology of the rat lung was studied by light microscopy in different situations: after surgical and pharmacological castration and after administration of testosterone to the castrated rat to determine if the androgen is required to maintain the normal morphology of the lung. We also determined the effect of flutamide on the phospholipid composition of both the surfactant and microsomes of the lung. Rats were separated into five groups: I - control non-castrated rats, II - castrated rats sacrificed 21 days after castration, III - castrated rats that received testosterone daily from day 2 to day 21 after castration, IV - castrated rats that received testosterone from day 15 to day 21 after castration, and V - control rats injected with flutamide for 7 days. The amount of different phospholipids in the surfactant and microsomes of the lung was measured in group I and V rats. At the light microscopy level, the surgical and pharmacological castration provoked alterations in the morphology of the lung, similar to that observed in human lung emphysema. The compositions of surfactant and microsomes of the lung were similar to those previously reported by us for the surgically castrated rats. These results indicate that androgens are necessary for the normal morphology as well as for some metabolic aspects of the lung.

PTEN suppresses breast cancer cell growth by phosphatase activity-dependent G1 arrest followed by cell death

PTEN/MMAC1/TEP1, a tumor suppressor gene, is frequently mutated in a variety of human cancers. Germ-line mutations of phosphatase and tensin homolog, deleted on chromosome ten (PTEN) are found in two inherited hamartoma tumor syndromes: Cowden syndrome, which has a high risk of breast, thyroid, and other cancers; and Bannayan-Zonana syndrome, a related disorder. PTEN encodes a phosphatase that recognizes both protein substrates and phosphatidylinositol-3,4,5-triphosphate. The lipid phosphatase activity of PTEN seems to be important for growth suppression through inhibition of the phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway. We established clones with stable PTEN expression controlled by a tetracycline-inducible system to examine the consequences of increased levels of wild-type and mutant PTEN expression in a well-characterized breast cancer line, MCF-7. When we overexpressed PTEN in MCF-7, growth suppression was observed, but only if PTEN phosphatase activity is preserved. The initial growth suppression was attributable to G1 cell cycle arrest, whereas subsequent growth suppression was attributable to a combination of G1 arrest and cell death. Of note, the decrease in Akt phosphorylation preceded the onset-of suppression of cell growth. Treatment of MCF-7 cells with wortmannin, a PI3K inhibitor, caused cell growth inhibition in a way similar to the effects of overexpression of PTEN in this cell. In general, the inverse correlation between PTEN protein level and Akt phosphorylation was found in a panel of breast cancer cell lines. Therefore, PTEN appears to suppress breast cancer growth through down-regulating PI3K signaling, which leads to the blockage of cell cycle progression and the induction of cell death, in a sequential manner.

The Clock Drawing Test: utility for dementia detection in multiethnic elders

BACKGROUND

Disproportionate increases in dementia morbidity in ethnic minorities challenge established screening methodologies because of language and culture barriers, varying access to health services, and a relative paucity of cross-cultural data validating their use. Simple screening techniques adapted to a range of health and social service settings would accelerate dementia detection and social and health services planning for demented minority elders.

METHODS

The effectiveness of the Clock Drawing Test (CDT) for dementia detection was compared with that of the Mini-Mental State Examination (MMSE) and the Cognitive Abilities Screening Instrument (CASI) in community-dwelling elders of diverse linguistic, ethnic, and educational backgrounds. Subjects (N = 295) were tested at home in their native languages (English, n = 141; another language, n = 154). An informant-based clinical dementia history and functional severity index derived from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) protocols were used to classify subjects as probably demented (n = 170), and probably not demented (n = 125).

RESULTS

All tests were significantly affected by education (p < .001) but not by primary language (p > .05). Sensitivities and specificities for probable dementia were 82% and 92%, respectively, for the CDT; 92% and 92% for the MMSE; and 93% and 97% for the CASI for subjects completing each test. However, in poorly educated non-English speakers, the CDT detected demented subjects with higher sensitivity than the two longer instruments (sensitivity and specificity 85% and 94% for the CDT, 46% and 100% for the MMSE, and 75% and 95% for the CASI). Moreover less information was lost due to noncompletion of the CDT than the MMSE or CASI (severe dementia or refusal: CDT 8%, MMSE 12%, and CASI 16%).

CONCLUSIONS

Overall, the CDT may be as effective as the MMSE or CASI as a first-level dementia screen for clinical use in multiethnic, multilingual samples of older adults. Its brevity (1-5 minutes), minimal language requirements, high acceptability, and lack of dependence on specialized testing materials are well adapted for screening of non-English-speaking elderly persons in settings where bilingual interpreters are not readily available and screening time is at a premium.

Self-mutilation in clinical and general population samples: prevalence, correlates, and functions

Self-mutilation, examined in samples of the general population, clinical groups, and self-identified self-mutilators, was reported by 4% of the general and 21% of the clinical sample, and was equally prevalent among males and females. Results suggest that such behavior is used to decrease dissociation, emotional distress, and posttraumatic symptoms. Childhood sexual abuse was associated with self-mutilation in both clinical and nonclinical samples.

Antagonism of peripheral 5-HT4 receptors reduces visceral and cutaneous pain in mice, and induces visceral analgesia after simultaneous inactivation of 5-HT3 receptors

The role of 5-HT4 receptors on cutaneous and visceral pain remains largely unexplored. The objective of this study was to establish the activity profile of SDZ 205-557, a 5-HT4 antagonist, on cutaneous (hotplate) and visceral (writhing) models of pain, after peripheral administration. Since SDZ 205-557 possesses some affinity for 5-HT3 receptors at high doses, nociceptive effects of a 1:1 combination of SDZ 205-557 and MDL 72222, a 5-HT3 antagonist, were also evaluated. Drugs were injected 30 min before tests (0, 0.001, 0.01, 0.1 or 1 mg/kg IP). A hypoalgesic effect of SDZ 205-557 on cutaneous pain was found at 0.1 and 1 mg/kg doses, as revealed through an enhanced nociceptive threshold in rats placed on the hotplate. This effect was likely mediated through inactivation of peripheral 5-HT4 receptors. After the 1:1 combination, the hypoalgesic effect disappeared, which indicates that simultaneous inactivation of 5-HT3 and 5-HT4 receptors antagonized peripherally 5-HT4-mediated hypoalgesia by an unknown mechanism. SDZ 205-557 also induced hypoalgesia in the writhing test over the entire dose range tested, and visceral hypoalgesia turned out to be analgesia after 1:1 combination. In summary, findings of the present study imply that: i) antagonism of 5-HT4 receptors mediates antinociception in enteric viscera and, to a lesser extent, in cutaneous terminals, and ii) dual inactivation of both 5-HT4 and 5-HT3 receptors induces visceral analgesia, a fact which might have clinical importance.

Nontraumatic lower extremity amputations in diabetic and non-diabetic subjects in Madrid, Spain

The purpose of this study was to determine the incidence of non-traumatic lower extremity amputations (LEAs) in diabetic and non-diabetic subjects in Madrid, Spain, and their direct cost. All patients who underwent LEAs between the 1st of January 1994 and the 31st of December 1996, and who had lived in area 7 of the city (569,307 inhabitants) for at least the last 6 months, were identified through operating theatre records cross-checked with Vascular Surgery Department discharge records. In addition, the direct cost of LEAs per year was estimated, taking into account the length of the hospital stay, the period of rehabilitation in the outpatient clinic after discharge, and the use of artificial limbs and their maintenance. The incidence of LEAs was 1.6 (95% CI: 1.1-2.2) per 10(5) non-diabetic subjects and 46.1 (95% CI: 34.5-57.6) per 10(5) diabetic patients. Relative risk was 28. Total direct costs associated with LEAs per year were US$ 56,131 in the diabetic population and US$ 30,765 in the non-diabetic population. Thus, potential cost savings associated with excess amputations in the diabetic population was estimated at US$ 541,353 per year of US$ 94,736 per 10(5) inhabitants. It is concluded that the incidence of LEAs in both diabetic and non-diabetic populations in area 7 is the lowest reported in European countries. The potential cost savings per 10(5) inhabitants and per year is estimated at US$ 94,736.

Effects of 'crack' cocaine on pulmonary alveolar permeability

BACKGROUND

Lung clearance of 99mTc-labeled diethylenetriamine pentaacetate (DTPA) is a sensitive test of altered alveolar epithelial permeability that has been found to be increased in smokers of tobacco, as well as a small number of healthy smokers of crack cocaine, suggesting the possibility of subclinical crack-related lung injury.

STUDY OBJECTIVE

To evaluate further whether habitual smoking of cocaine alone alters alveolar permeability, whether crack smoking adds to or potentiates the effects of tobacco and/or marijuana, and whether experimental cocaine smoking acutely alters DTPA lung clearance.

DESIGN

Observational cohort study (habitual cocaine smoking) and single-blind crossover study (experimental cocaine administration).

SUBJECTS

Fourteen habitual smokers of cocaine alone (CS), 19 smokers of cocaine and tobacco (CTS), 3 smokers of cocaine and marijuana, 12 smokers of cocaine, tobacco, and marijuana (CMTS), and 5 smokers of marijuana plus tobacco (MTS). Results obtained in the crack-smoking subjects were compared with data previously obtained in 10 nonsmokers (NS), 9 smokers of tobacco alone (TS), 10 smokers of marijuana alone (MS), and 4 additional MTS.

METHODS

Subjects underwent measurements of DTPA radioaerosol lung clearance after refraining from marijuana and/or cocaine for > 12 h and from tobacco for >2 h. Ten of the 48 crack users were tested on two days 1 to 2 weeks apart within 2 h of experimental smoking of three physiologically active or inactive doses (total 98.8+/-15.5 or 8.5+/-2.5 mg, respectively) of cocaine base. Lung clearance half-times (T1/2) were computed from time-activity curves for each lung.

RESULTS

T1/2 values for each lung in CS and MS were comparable to those of NS, while TS, MTS, CTS, and CMTS had significantly shorter clearance rates than NS (p<0.01; three-way analysis of variance). No additive or interactive effects on T1/2 were noted among tobacco, cocaine, and/or marijuana. No acute effect of experimental cocaine smoking on T1/2 was noted.

CONCLUSION

Whereas regular smoking of tobacco alone or with other substances increases alveolar epithelial permeability, habitual smoking of cocaine and/or marijuana has no measurable effect on alveolar permeability in the absence of tobacco nor any additive effect to that of tobacco alone.

Single restraint stress sensitizes acute chewing movements induced by haloperidol, but not if the 5-HT1A agonist 8-OH-DPAT is given prior to stress

The objective of this study was two-fold: (i) to analyze behavioral sensitization to haloperidol 2 weeks after single restraint stress, and (ii) to establish the effects of 8-OH-DPAT treatment prior to stress on sensitized behavioral responses. Overall behavior was analyzed and not only catalepsy, but also sedation (immobility), grooming, exploration and vacuous chewing movements were evaluated. Results indicated that single restraint stress induced a long-lasting sensitization of acute vacuous chewing movements induced by haloperidol (0.25, 0.5 mg/kg i.p.). Interestingly, this behavioral sensitization was prevented by 8-OH-DPAT (0.35 mg/kg s.c.) prior to stress. Finally, haloperidol-induced sedation was not disrupted by either restraint stress or 8-OH-DPAT treatment.

[Diarrhea, rectorrhagia and colonic ulceration following the ingestion of NSAIDs]

The lower digestive tract, in contrast to the gastroduodenal tract, is infrequently affected by non-steroidal antiinflammatory drugs (NSAID), and rarely referred to in medical literature. We report the case of a 40-year-old man who presented with bloody diarrhea following treatment with NSAID. The fiber gastroscopy was normal. The fiber colonoscopy showed elongated aphthous ulcers with fibrin in the sigmoid colon. Others studies were normal. After withdrawal of NSAID, the patient returned to normal, as did the fiber colonoscopy. The treatment with NSAID has been linked with ulcerative lesions in the lower digestive tract, perforation, bloody lesions, perforation of diverticuli, reactivation of quiescent colitis and stenosis. In spite of this, doubts persist about the frequency of presentation, high risk doses and its pathophysiological mechanism, which probably involves blocking the cyclooxigenase system and the formation of the leukotrienes and free oxygen radicals. Taking into consideration the above factors, more care should be taken in investigating colonic involvement in patients who present with gastrointestinal bleeding following treatment with NSAID.

[Tracheal rupture in a patient with head and thoracic injuries]

A 49-year-old patient presented with cranioencephalic injuries including subdural hematoma and severe mass effect, facial and thoracic injuries with bilateral rib fractures but no parenchymatous lesions or extrapulmonary air. After surgical evacuation of the subdural hematoma, the patient entered the intensive care unit. Twenty-four hours later the patient pulled out the tubes, which were reinserted after signs of respiratory failure appeared. A series of clinical and radiological signs then followed, namely subcutaneous cervicothoracic emphysema, mediastinitis accompanied by hyperinsufflated balloon tamponade (pressures < 28 cmH2O). Tracheal rupture was suspected, but fibrebronchoscopy through the trachea revealed no damage. Surgical exploration 72 hours after admission confirmed high tracheal rupture near the pars membranacea. The damage was sutured, but sepsis with severe respiratory distress and mediastinitis led to death.

Acute and chronic effects of marijuana smoking on pulmonary alveolar permeability

Pulmonary clearance of technetium (99mTc)-labeled diethylene triamine pentaacetate (DTPA), a sensitive test of alveolar epithelial permeability, was measured twice in 34 healthy subjects, including 10 control nonsmokers (NS), 10 habitual smokers of marijuana alone (MS) (> or = 10 joints/wk), 9 regular smokers of tobacco alone (TS) (> or = 15 cigarettes/day) and 4 habitual smokers of both marijuana and tobacco (MTS). In smokers, the first study was performed after > or = 12 hrs of abstinence from smoking to assess chronic effects of marijuana and/or tobacco smoking on alveolar permeability; the second study was performed within 15 min of smoking to assess possible acute effects. TS exhibited abnormally rapid 99mTc-DTPA clearance after > or = 12 hours of abstinence, indicating an increase in pulmonary epithelial permeability, consistent with chronic tobacco-induced lung injury. MS showed a more modest and less consistent chronic effect than TS on 99mTc-DTPA clearance, suggesting a more variable and smaller degree of marijuana-induced lung injury. No acute effect of tobacco or marijuana smoking on 99mTc-DTPA clearance was apparent. Concomitant habitual smoking of marijuana and tobacco had no additive effect on alveolar permeability.

Effect of a community-based Aedes aegypti control programme on mosquito larval production sites in El Progreso, Honduras

This paper describes the results of a trial to assess the efficacy in reducing the density of larval production sites of utilizing community involvement in the planning and implementation of an Aedes aegypti control programme, in a dengue-endemic city in Honduras. In addition to a substantial increase in knowledge about dengue transmission and prevention, a relative reduction in Ae. aegypti larval infestation indices was found in those city neighbourhoods where community involvement was utilized compared with their untreated counterparts. Several methods of improving the impact of this type of programme are discussed.

[Clinical efficacy and tolerance to acarbose in the treatment of non-insulin-dependent diabetic patients]

BACKGROUND

Acarbose is a pseudotetrasacaride which reversibly and competitively inhibits the intestinal alpha-glycosidases leading to a decrease in the increase of postprandial glycemia.

METHODS

A multicentric double-blind clinical trial (8 centers), controlled versus placebo, crossover and randomized was carried out in 90 non insulin dependent diabetic patients under treatment with diet or with diet and sulphonilureas. During the first three months of the trial the patients received placebo or acarbose randomly. Following one months of wash-out with placebo the patients received the inverse medication for 3 more months. During the first month of each phase the patients received 3 x 50 mg/day of acarbose or placebo and the following 2 months 3 x 100 mg/day.

RESULTS

Upon comparison of the two treatments significant statistical differences were observed in HbA1 (p = 0.0115) and in postprandial glycemia (p = 0.0001). There were differences, although not significant, in the levels of triglycerides, cholesterol, fasting glycemia, and postprandial insulinemia. Episodes of hypoglycemia appeared in 12 patients and 57 patients referred undesirable gastrointestinal effects.

CONCLUSIONS

The results of this trial indicate that acarbose may be useful in the treatment of non insulindependent diabetic patients since it significantly reduces the amount of postprandial glycemia and HbA1.

[Palliative care in cancer patients. Frequency and priority of symptoms]

BACKGROUND

The presence of multiple symptoms is very frequent in patients with advanced cancer disease. In this situation in which cure is not a realistic aim, the goal is to achieve symptom control and to give support to the patient and family. This study was designed to identify the most common and priority symptoms in patients with advanced cancer.

METHODS

Patients were given a questionnaire with a list of symptoms and were asked to underline those they presented, and also number those they considered most distressful from 1-3. Physicians and nurse independently answered the same questionnaire.

RESULTS

Asthenia was the most frequent symptom (patient evaluation 84%, nurse 82% and doctor 93%). Psychopathological disturbances showed a high prevalence. Regarding patient evaluation, dry mouth was the third symptom in frequency (73%), but it was detected by nurses in 39% and by physicians in 16%. Priority symptoms for the three groups were pain, asthenia, anorexia and anxiety. Pain was controlled in 19/22 patients (86%), while psychopathological symptoms were only controlled in 7/19 patients (27%).

CONCLUSIONS

In order to optimize treatment patient participation is mandatory. An interdisciplinary team (physicians, nurses, social workers, and psychologists) is necessary to take care of these patients.

Effects of chronic treatment with ethanol and withdrawal of ethanol on levels of dopamine, 3,4-dihydroxyphenylacetic acid and homovanillic acid in the striatum of the rat. Influence of benzodiazepines, barbiturate and somatostatin

Administration of ethanol for 40 days, at 10.53 +/- 0.25 g/kg/day did not modify levels of dopamine (DA) or 3,4-dihydroxyphenylacetic acid (DOPAC) in the striatum of the rat; however, the concentration of homovanillic acid (HVA) and the ratio of turnover were increased in a statistically significant way (P < 0.05). Twenty-four hours after withdrawal of ethanol appears as the central time of the ethanol-induced abstinence syndrome, showing noticeable decreases in levels of DA (P < 0.05) and DOPAC (P < 0.05), with respect to control and chronically ethanol-treated groups. The concentrations of DA, DOPAC and HVA and ratio of turnover values showed a tendency to return to control normal levels of 48 hr after ethanol withdrawal, although the differences still showed statistical significance (P < 0.05). The intraperitoneal injection of saline, the water soluble benzodiazepine midazolam, the barbiturate thiopental and somatostatin, in single doses, resulted in a noticeable increase in levels of DA, DOPAC and HVA and ratio of turnover values. The intraperitoneal injection of midazolam produced statistically significant decreases in levels of DOPAC and ratio of turnover values (P < 0.01) in rats 48 hr after withdrawal of ethanol, with respect to control and chronically ethanol-treated animals, in contrast to the absence of changes produced when injecting thiopental or somatostatin.

[Effect of acarbose on glycemia and pancreatic hormone secretion induced by usual meals in Spain]

Acarbose is a pseudotetrasaccharide of bacterial origin which, in a competitive and reversible way, inhibits intestinal alphaglycosidase. Following such mechanism of action, carbohydrates are not split to monosaccharides and, therefore, cannot be absorbed as easily as in normal conditions. Controlled clinical trials have shown the therapeutic usefulness of Acarbose in the treatment of mon-insulin dependent as well as insulin dependent Diabetes, specially in reducing postprandial hyperglycemia and glycosylated hemoglobin levels. The objective of this study was to evaluate the effect of Acarbose when it is used in a diet with a time-schedule and calorie distribution typical of a Spanish environment. A cross-over simple-blind study design was followed, in which 8 healthy volunteers, with ages between 23 and 29 years, took at 8:30 a.m. a 530 Kcal breakfast (18% of the daily total), at 13:30 p.m. a 1.400 Kcal lunch (40%), and at 21:00 p.m. a 1.070 Kcal dinner (36%). Before each of the meals 100 mg of Acarbose (or placebo, following a randomized distribution) were administered, and blood samples were drawn-10, 0, 30, 60, 90, 120, 150 and 180 minutes, in which glucose levels, insulin, pancreatic polypeptide and glucagon were determined. When Acarbose was administered statistically significant differences in glycemia and insulin postprandial figures were observed. It is concluded that when Acarbose is administered at a 100 mg dose (t.i.d.) together with a diet with a typically spanish calorie distribution and time-schedule, it produces a significant lowering in the postprandial glucose and insulin raises.(ABSTRACT TRUNCATED AT 250 WORDS)

Recurrent dislocation of the elbow

Twelve cases of recurrent dislocation of the elbow have been studied with special reference to the cause of instability, the operative findings and the results of treatment. We consider the major cause to be insufficiency of the posterolateral capsule and ligaments, and therefore the best treatment is a posterolateral capsulorraphy.

Cellular immunity abnormalities in patients with recurrent Bell's palsy

Recurrent Bell's palsy is a rare form of facial paralysis. To investigate the role which cellular immunity plays in the aetiology of recurrent Bell's palsy, we evaluated a series of such patients using a laboratory test specially formulated to test the cellular immune system. We measured T-lymphocyte and T-lymphocyte subsets in the peripheral blood of 10 recurrent Bell's palsy patients and in 30 healthy volunteers. T-lymphocytes and T-lymphocyte subsets were reduced significantly in the patients, but the T-helper: T-cytotoxic ratio was normal. Cellular immunity abnormalities were therefore found in the peripheral blood of patients with recurrent Bell's palsy, supporting the concept that this is an immunomediated demyelinating disease.

Micromamíferos (Insectivora, Rodentia y Lagomorpha) del nuevo yacimiento villafranquiense de Casablanca B (Almenara. provincia de Castellón)

Se describe la fauna de micromamíferos del nuevo yacimiento kárstico de Casablanca B (prov. de Castellón) que es la siguiente: Crocidura sp., Eliomys aff, intermedius, Mimomys cappettai, Stephanomys balcellsi, Castillomys crusafonti ssp, Apodemus jeanteti y Prolagus cf, calpensis. La edad de esta asociación faunística es el Plioceno terminal (Villafranquiense medio) y puede situarse en la unidad MN17.

Succulence and CAM relationships in Aeonium genus

The CAM has been tested in six species of the Aeonium genus by studying the diurnal fluctuation of organic acids, pH and night fixation of CO2. The existence of a mesophyll structure able to support this metabolism has been shown as well as a congruent periodicity in the pool of cell starch.We have calculated the S, ES and Sm indices in the six species. A series of regression equations of different grades and types were calculated and shown to have correlation coefficients statistically significant. This allows us to confirm the suitability of the Sm index as a rapid test to establish the CAM as postulated by former authors.

A cluster-analytically derived typology: feasible alternative to clinical diagnostic classification of children?

Despite numerous studies of the relationships among symptoms manifested by children and adolescents, there have been few systematic attempts to group individuals on the basis of the syndromes identified. In the course of a treatment evaluation project requiring classification of both child patients and untreated controls, the present study was conducted to determine whether replicable types of children and adolescents could be identified by the cluster analysis of their IJR Behavior Checklist profiles. One clinical sample (N = 185) and two mixed clinical and normal subsamples (Ns of 358 and 373) were cluster-analyzed separately. Seven types that replicated across at least two subsamples were identified: (1) High Assets, Flat Symptom Profile; (2) Sociopathic, Academic Problems; (3) Moderate Assets, Egocentric, Incontinent; (4) Insecure, Somaticizing, Underachieving; (5) Aggressive, Overreactive; (6) Schizoid, Withdrawn, Anxious, Bizarre; and (7) Diffuse, Mixed Pathology. The issue posed by the title of the article was explored in the light of the findings.