[Renal transplantation with positive crossmatch]

INTRODUCTION

Lymphocytotoxic antibodies reduce the expectancy of renal transplantation due to the increased risk of a positive crossmatch.

MATERIAL AND METHODS

We analyzed the evolution of eight kidney transplants performed in our unit in presence of a positive crossmatch with historical T and/or B lymphocyte positive crossmatches.

RESULTS

Mean panel reactivity was 76,6 +/- 25,7% (r: 22-100%), been higher than 75% in six patients. Six patients were recipients of a second or third transplant. Immunosuppression consisted of quadruple therapy including induction with thymoglobuline. Five patients had delayed graft function, and one had primary non-function of the graft. One patient lost her graft due to chronic allograft nephropathy in the second year postransplantation. Six patients maintained a good renal function (serum creatinine 1,2 +/- 0,5 mg/dl, proteinuria 0,20 +/- 0,34 g/day).

CONCLUSION

Renal transplantation in presence of a positive cross-match with historical serum and T lymphocytes and/or B lymphocytes, was followed by a satisfactory graft survival.

Kinetic study of the thermoluminescence of KMgF3:LaF3 compounds employing the general one trap model

The parameters characterising the trap centres involved in the thermoluminescence of KMgF3:LaF3 compounds have been found by deconvolving the glow curve with the General One Trap model (GOT). For the fitting procedure the Levenberg-Marquardt method has been employed. Tm-T(stop) measurements along with initial rise measurements were performed in order to estimate the number of peaks the glow curve is made up of, and the corresponding activation energies. Instead of the Runge-Kutta method, a novel algorithm has been employed to integrate the differential equation of the GOT model, which reduces the computational time nearly 30 times with respect to the former when the glow curve is recorded with a lineal heating rate profile. The strong computational time reduction makes feasible a large number of runs with different guess values. An interesting result is that the concentration of disconnected deep traps is much less than the concentration of trap centres.

[Fungal peritonitis episodes in a peritoneal dialysis centre during a 10-year period: a report of 11 cases]

Fungal peritonitis is a rare cause of peritonitis, but it is associated to poorer prognosis and higher mortality than bacterial peritonitis. Until now, predisposing factors and treatment have not been well established. We retrospectively reviewed all the cases of fungal peritonitis diagnosed for ten years in 218 patients undergoing continuous ambulatory peritoneal dialysis. In all we detected 11 episodes of fungal peritonitis in 11 patients, that means the 4% of continuous ambulatory peritoneal dialysis peritonitis. All the cases of fungal peritonitis were caused by Candida species. As a result of fungal peritonitis 36% of the patients died, 55% had to change to long-term hemodialysis because of failure in peritoneal dialysis technique. Only one case (9%) managed to continue peritoneal dialysis. The factors associated with the development of fungal peritonitis were: the presence of antibiotic use within 1 month before fungal peritonitis, patient older than 70 years old, low levels in albumine plasmatic and long permanence in continuous ambulatory peritoneal dialysis. The treatment consisted in intraperitoneal fluconazol combined with oral 5-flucytosine for 4 to 6 weeks. In the two last cases we associated intravenous caspofungine too. Given that no improvement was seen within 72 hours of treatment, the catheter must be removed in all the cases.

[Post-transplant diabetes mellitus associated with acute hepatitis C virus infection in a renal transplant recipient]

There are some controversial reports about the pathogenic role of hepatitis C virus infection on diabetes mellitus in renal graft recipients. We report a case of a renal transplanted who developed diabetes mellitus post-transplantation during an acute hepatitis C virus infection. We discuss the multifactorial etiology of post-transplant diabetes mellitus, and the possible interaction between tacrolimus and an acute virus C infection on its pathogenesis.

Inhibition of leukocyte functions by the alkaloid isaindigotone from Isatis indigotica and some new synthetic derivatives

The alkaloid isaindigotone (1a) and seven derivatives have been synthesized to study their influence on several leukocyte functions and the generation of inflammatory mediators. Isaindigotone (1a) was found to be a scavenger of superoxide generated either by the hypoxanthine/xanthine oxidase system or stimulated human neutrophils. Isaindigotone (1a) and its acetylated derivative (1b) also inhibited 5-lipoxygenase activity and leukotriene B(4) production in these cells, whereas none of the compounds affected degranulation. In RAW 264.7 macrophages stimulated with lipopolysaccharide, synthetic derivatives exerted higher inhibitory effects on prostaglandin E(2) (PGE(2)) and nitric oxide (NO) generation when compared with (1a). The presence of an acetoxyl group at C-4' favors the inhibition of NO and PGE(2) production, whereas the fluoro substituent at C-4' or the absence of substituents on the aromatic ring of the benzylidene unit improves the inhibition of PGE(2). Thus, this series of compounds can attenuate the production of mediators relevant to the inflammatory response.

Solid-phase synthesis and inhibitory effects of some pyrido[1,2-c]pyrimidine derivatives on leukocyte formations and experimental inflammation

A number of pyrido[1,2-c]pyrimidines bearing a nitrogen, oxygen, or sulfur functionality at C-1 were synthesized on solid-phase using the iminophosphorane methodology and tested for their effects on leukocyte functions in vitro and antiinflammatory activity. Compound 5c was found to be a strong scavenger of superoxide anion and an inhibitor of chemiluminescence induced by 12-O-tetradecanoylphorbol 13-acetate in human neutrophils. These pyrido[1,2-c]pyrimidines inhibited the generation of PGE(2) by COX-2 in RAW 264.7 macrophages stimulated with lipopolysaccharide. Compounds 7, 5f, 6, and 8 inhibited enzyme activity, whereas the remaining compounds also acted on the induction phase. In addition, 5a-f, 6, and 7 administered p.o. at a dose of 20 mg/kg showed antiinflammatory activity in the carrageenan mouse paw edema model, where they inhibited PGE(2) levels in inflamed paws without affecting the content of this eicosanoid in stomachs. Inhibition of PGE(2) production and superoxide scavenging may participate in the mechanism of the antiinflammatory action of these pyrido[1,2-c]pyrimidine derivatives.

Mutant p53 forms a complex with Sp1 on HIV-LTR DNA

Many mutants of p53 activate HIV-LTR driven transcription and promote HIV replication. The region of the HIV-LTR containing Sp1-binding sites is important for this effect. In this study we test the hypothesis that mutant p53 interacts with DNA-bound Sp1 and in this way can increase transcription from Sp1-dependent promoters. We have used the breast cancer cell line MDA-MB-468 that expresses endogenous mutant p53(His273) as our source of p53 protein. First, we demonstrated that this mutant p53 participates in activating transcription from the HIV-LTR by showing that HIV-LTR-directed transcription in MDA-MB-468 cells is inhibited in a dominant-negative manner by p53(Val135). Using HIV-LTR DNA affinity chromatography, we detected coelution of p53(His273) and Sp1. We also demonstrated that this mutant p53 binds sequence specifically to the super consensus sequence (SCS) and that Sp1 coeluted with p53(His273) from a column containing this site. These data indicate that p53(His273) can associate with DNA-bound Sp1 suggesting that activated HIV-LTR transcription associated with mutant p53 occurs through a DNA driven multi-protein complex.

Milk production and composition in captive Iberian red deer (Cervus elaphus hispanicus): effect of birth date

This study describes milk production and milk composition of Iberian red deer (Cervus elaphus hispanicus) females (hinds) and the effect of calving date and BW change of hinds by milking over 34 wk. All hinds produced milk throughout the 34-wk study period, well over the standard lactation period. Total milk yield was 224.1 +/- 21.1 L, and daily production was 0.91 +/- 0.06 L. Milk yield decreased with lactation stage (P = 0.01) and the later a calf was born (P = 0.008), and it was greater in posterior quarters (P < 0.05). Milk yield was unaffected (P > 0.10) by side position or milking order of the udder. Milk production did not correlate with hind BW (P > 0.1). Hinds lost 4.4% BW during lactation (P < 0.001); losses increased the later a calf was born (P = 0.012). Iberian red deer milk had 11.5% fat, 7.6% protein, 5.9% lactose, and 26.7% DM. Stage of lactation affected fat (P < 0.001), protein (P = 0.002), DM (P < 0.001), and protein:fat ratio (P < 0.001), but not lactose (P > 0.1). These constituents became concentrated as lactation proceeded, and protein was substituted by fat. Calving date had a similar concentrating effect on fat (P < 0.001) and DM (P < 0.001), whereas it decreased lactose (P = 0.015) and protein (P = 0.002), thus producing a substitution of protein by fat (ratio of protein to fat, P < 0.001). Milking order of quarters or their position had no effect on milk composition (P > 0.10). Results suggest that milk production and milk energetic quality might increase by advancing calving date in red deer hinds.

[Exactness of mortality statistics by external and natural causes of death with medico-legal intervention in Catalonia, 1996]

OBJECTIVE

Deaths due to external and natural causes with forensic intervention require medical-legal autopsy. In order to be included in the mortality statistics the results are reported in the statistical document MNP52. The accuracy of cause of death depends on the characteristics of the document, the point at which it is completed (after the death or after the autopsy) and the person that completes it. The objective is to determine the accuracy of external and natural causes of death with forensic intervention, reported in the official statistical documents by a medical-legal autopsy report of these deaths occurred in Catalonia in 1996.

METHODS

Two samplings were undertaken--one for natural causes and another for external causes--that were stratified by sex and judicial district. The information sources were the Mortality Register of Catalonia for the statistical documents and the criminal courts for the medical-legal autopsy, toxicological and pathological reports. We calculated the index of agreement, the sensitivity or detection rate (DR) and the positive predictive value of confirmation rate (CR), and their respective 95% confidence intervals.

RESULTS

The index of agreement was 72.3% (IC 95%: 68.7-75.9). The DR for external causes groups was 65.9% (60.6-71.2) and the CR was 69% (63.6-71.2). For natural causes the DR was 79.4% (74.7-84.2) and the CR was 75.5% (70.7-80.5).

CONCLUSION

In deaths with forensic intervention, the official statistical documents do not correctly report external causes of death, and statistics for natural causes of death approach acceptable levels of accuracy. The results are mainly due to deficits in reporting and certifying these causes in the official statistics.

Cocaine abusers show a blunted response to alcohol intoxication in limbic brain regions

Cocaine and alcohol are frequently used simultaneously and this combination is associated with enhanced toxicity. We recently showed that active cocaine abusers have a markedly enhanced sensitivity to benzodiazepines. Because both benzodiazepines and alcohol facilitate GABAergic neurotransmission we questioned whether cocaine abusers would also have an enhanced sensitivity to alcohol that could contribute to the toxicity. In this study we compared the effects of alcohol (0.75 g/kg) on regional brain glucose metabolism between cocaine abusers (n = 9) and controls (n = 10) using PET and FDG. Alcohol significantly decreased whole brain metabolism and this effect was greater in controls (26+/-6%) than in abusers (17+/-10%) even though they had equivalent levels of alcohol in plasma. Analysis of the regional measures showed that cocaine abusers had a blunted response to alcohol in limbic regions, cingulate gyrus, medial frontal and orbitofrontal cortices.

CONCLUSIONS

The blunted response to alcohol in cocaine abusers contrasts with their enhanced sensitivity to benzodiazepines suggesting that targets other than GABA-benzodiazepine receptors are involved in the blunted sensitivity to alcohol and that the toxicity from combined cocaine-alcohol use is not due to an enhanced sensitivity to alcohol in cocaine abusers. The blunted response to alcohol in limbic regions and in cortical regions connected to limbic areas could result from a decreased sensitivity of reward circuits in cocaine abusers.

Spectroscopic imaging of the uptake kinetics of human brain ethanol

Previous measurements of the ratio of brain to venous blood alcohol have ranged from 21-100%, depending on the experimental model, pulse sequence, and the concentration reference used. The goal of this study was to evaluate the uptake kinetics and visibility of brain ethanol in comparison to venous blood levels using a pulse sequence that minimizes uncertainties due to differences in J-modulation, T(1), and T(2) between ethanol and the concentration standard. This was achieved using a short TE (24 msec) spin echo sequence with a semiselective refocusing pulse to minimize J-modulation losses of the ethanol. Brain ethanol levels were measured with 10-min time resolution using a 16 x 16 spectroscopic imaging matrix with nominal voxels of 1.44 cc. During the course of the study, the brain/blood alcohol ratio declined from a value of 1.54 +/- 0.74 at 35 min after drinking to a final value of 0.93 +/- 0.16 at 85 min postdrinking. Magn Reson Med 42:1019-1026, 1999.

Analysis of p53 and mdm2 proteins in malignant fibrous histiocytoma in absence of gene alteration: prognostic significance

TP53 and MDM2 genes and their protein expression were evaluated in frozen and paraffin-embedded tissue from 27 patients with malignant fibrous histiocytoma to elucidate the relationship between them, their implication in tumor progression mechanisms and their possible diagnostic-prognostic value in malignant fibrous histiocytoma. Single-strand conformation polymorphism analysis and direct sequencing of polymerase chain reaction-amplified DNA were used to establish two TP53 mutations (7.4%): a point mutation and a 63-bp duplication. Amplification of the MDM2 gene was observed in two tumors (7.4%) by means of Southern-blot analysis, one of them also carrying the TP53 point mutation. Immunohistochemical and Western-blot techniques were used to study nuclear accumulation of p53 and mdm2 proteins: 11 cases (40.7%) with p53 protein expression and thirteen cases (48.1%) with mdm2 protein expression were detected. We confirmed overexpression of mdm2 protein in eight of ten cases (80%) with p53 protein expression without TP53 gene mutation. Statistical analysis shows that simultaneous co-expression of p53 and mdm2 in malignant fibrous histiocytoma is significantly correlated with survival in absence of gene alteration in contrast to the lack of statistical correlation with survival of p53 protein expression alone.

[Cognitive stimulation workshops in old age: preliminary experience]

OBJECTIVE

To test the utility of cognitive stimulation in a group of healthy older people.

DESIGN

A pilot study in 11 healthy women from Conchali council. All of them were evaluated before and after stimulation using Minimental State Examination of Folstein (MM), Memory Wechsler Scale (MW) and Geriatric Depression Scale (GDS).

PARTICIPANTS

Were selected from a group of regularly participants in center for seniors, aged 60 years or more (mean 66.6 years old), able to read and write (mean scholarship 5.3 years).

INTERVENTION

16 workshop of 90 minutes, twice a week during 2 months. They had motivation pantomime plays, memory activities and so on.

RESULTS

Wilcoxon signed rank pre and post workshop for MM was -2.633 (p = 0.008), for MW was -2.938 (p = 0.003) and for GDS was -2.943 (p = 0.03).

CONCLUSIONS

Cognitive stimulation could be useful in older people. It is necessary to increase the sample.

Guanidinium-based potentiometric SO2 gas sensor

An SO2 gas sensor was developed by using a hydrogen sulfite-selective electrode positioned behind a gas-permeable membrane (GPM). The hydrogen sulfite-selective electrode was prepared by incorporating a multicyclic guanidinium ionophore in a plasticized poly(vinyl chloride) membrane. This gas sensor presents important advantages over the conventional Severinghaus-type SO2 gas sensor that contains a pH electrode immersed in an internal solution behind the GPM. The Severinghaus gas sensor suffers interferences from weak acids that can cross the GPM as gases and change the pH of the internal solution. In contrast, in the proposed sensor, the excellent selectivity of the HSO3- electrode and the ability of the GPM to discriminate gaseous from nongaseous species combine to generate the most selective potentiometric SO2 gas sensor reported to date.

[Tick-borne recurrent fever. Description of 5 cases]

BACKGROUND

Tick-borne relapsing fever (FRGT) is a worldwide zoonosis. The disease is caused by spirochetes of the genus Borrelia, and is transmitted to man by ticks of the genus Ornithodoros (O. erraticus in Spain).

METHODS

5 FRTG cases attended in our hospital in a 2 years period are described. Diagnosis was established in all cases by demonstration of borreliae in peripheral blood. Three Borrelia strains were isolated from blood of 3 of our patients and they are maintained by passages through mice.

RESULTS

High fever, tachycardia and headache were noted in all cases accompanied in 2 of them by hepatosplenomegaly. Three of the patients complained of arthromyalgias or lumbar myalgia. Treatment with doxycicline was curative in all of them.

CONCLUSIONS

FRGT incidence in our country is probably underestimated due to the low suspicion of the disease and the specificity of the clinical symptoms. The isolement of the causative Borrelia strain will allow the development of more specific serological tests necessary to establish the prevalence of this disease as well to assess its implication in chronic diseases, as is observed in other borreliosis (i.e. Lyme disease), that might be missed at this moment.