[Pulmonary nocardiosis: presentation of 3 clinical cases]

INTRODUCTION

Nocardiosis is an infectious disease that frequently involves to the respiratory tract. Nocardia asteroides is the predominant human pathogen. Nocardiosis is difficult to diagnose and that's why its incidence is not well established.

CASES

Three cases diagnosed in a Pneumology Section are reported. None of them was affected by AIDS and all of them were initially diagnosed from bronchopneumonia. Empirical antibiotherapy was initiated and because of the unsatisfactory progress, bronchoscopy was performed in all cases and in one case a transthoracic puncture was made. Nocardia spp. was then isolated and this let to began with a specific treatment. All the patients progress satisfactorily in their respiratory infection.

DISCUSSION

Although there are usually factors that predispose to nocardiosis, it can also occur in absence of these, as it happened in one of report patients. The clinical and radiological manifestations are not, in many cases enough to reach the diagnosis. Thus germ isolation is very important, and invasive procedures are often essential to obtain a quality samples to cultivate. Sulfonamides were considered drugs of choice, but nowadays, many authors propose trimethoprim-sulfamethoxazole. Imipenem, amikacin have also proved to be effective.

[Drainage of loculated and/or multiloculated pleural effusions using a small caliber catheter and urokinase (pleuro-fibrinolysis)]

The main causes of pleural fluid drainage failure are known to be the formation of fibrin septa, increased viscosity in pleural fluid and inappropriate placement of chest tubes. Reports also tell us that such problems can be solved by using ultrasound as a guide for tube placement and by infusing intrapleural fibrinolytic agents to prevent the formation of septa and reduce the viscosity of pleural fluid. To assess our experience, the role and efficacy of administering intercavitary urokinase (UK) through a small caliber catheter (SCC) implanted with ultrasound guidance as part of the treatment for pleural effusions (PE) that are multiloculated and/or loculated. Fifty multiloculated and/or loculated PE were drained through a pig-tail type SCC between 8.2 and 10 F caliber inserted with ultrasound guidance. The criteria for prescribing the procedure were as follows: PE of any etiology with ultrasound confirmation of fibrin septa and/or multiloculation and absence of contraindication off UK administration. UK was given at a dose of 100,000 i.u. every two hours until disappearance of PE. Before and after treatment the levels of D-dimer were measured in order to monitor pleural fibrinolytic activity. The SCC was properly placed in all patients. UK administration was 366,000 i.u. and time the SCC were in place was 4.7 days. All PEs were initially drained completely. We examined the patients 30 days later, finding that PE had recurred in 2 (4%), resolution was complete and without sequelae in 8 (16%), nearly complete but with slight pleural thickening in 32 (64%) and partial with pleural opacities larger than 2 mm in 8 (16%). Use of SCC and UK (pleural fibrinolysis) is a moderately invasive procedure that is effective and well tolerated and that shortens drainage time, prevents sequelae and is relatively inexpensive for the treatment of PE with fibrin septation and/or multiloculation.

Lymphocyte subpopulations and catecholamines; daytime variations and relationships

The diurnal variations and their possible relations with endogenous catecholamines have been studied in 16 apparently healthy subjects (8 women and 8 men, between 22-35 years of age). A butterfly cannula was inserted into the flexure vein of the elbow at 8 h and at 20 h, a blood sample being taken after three 15-minute intervals. Leukocytes, lymphocytes, monocytes, and granulocytes were quantified in a cell counter while lymphocyte subpopulations were determined with flow cytometry in cells labelled with specific monoclonal antibodies. Plasma catecholamine concentrations were measured by high-pressure liquid chromatography. Significant differences for leukocyte circulating levels were found, as well as for all subpopulations measured at different times of day, save NK cells and monocytes. A statistically significant correlation was also found both between leukocytes, all subpopulations and epinephrine save B lymphocytes and NK cells, and between total lymphocytes, T lymphocytes, CD4, CD4/45RA+ subtypes and norepinephrine. In conclusion, diurnal rhythms were proved to exist in leukocyte and lymphocyte subpopulations; the significant correlation between these cells and catecholamine plasma levels suggests the presence of a possible mechanism that connects the cellular immunity with determined hormones.

Non-Hodgkin's lymphoma after liver transplantation: response to chemotherapy

An increased incidence of lymphoproliferative disorders in immunosuppressed organ transplant recipients has long been recognised. Lymphoproliferative disorders occur in 2% of orthotopic liver transplant patients. Different therapies have been used, but the optimal treatment remains unknown. Relatively little information is available on experience with cytotoxic chemotherapy. Three children who developed Burkitt-like, non-Hodgkin's lymphomas after liver transplantation are described. The disease failed to regress after initial management, which included a reduction in immunosuppression. With cytotoxic chemotherapy all three achieved complete remission, which continued 36+, 35+, and 16+ months after diagnosis. Results suggest that in selected cases chemotherapy can be safe in late-onset lymphomas appearing after solid organ transplantation.

Prenatally diagnosed de novo apparently balanced complex chromosome rearrangements: two new cases and review of the literature

Complex chromosome rearrangements (CCR) are rare structural rearrangements. Currently six cases of prenatally diagnosed balanced de novo CCR have been described. We present two new cases of prenatally ascertained balanced de novo CCR. In the first case, an amniocentesis revealed a balanced de novo three-way CCR involving chromosomes 5, 6, and 11 with a pericentric inversion of chromosome 5 [four breaks]. In the second case, a balanced de novo rearrangement was identified by amniocentesis which involved a reciprocal translocation between chromosomes 3 and 8 and a CCR involving chromosomes 6, 7, and 18 [six breaks]. The use of whole chromosome painting helped elucidate the nature of these rearrangements. A review of the postnatally ascertained cases suggests that most patients have congenital anomalies, minor anomalies, and/or developmental delay/mental retardation. In addition, there appears to be a relationship between the number of chromosome breaks and the extent of phenotypic effects. The paucity of information regarding prenatally diagnosed CCR and the bias of ascertainment of postnatal CCR cases poses a problem in counseling families.

Ipsapirone, a 5-HT1A agonist, suppresses REM sleep equally in unmedicated depressed patients and normal controls

To determine whether ipsapirone, a 5-HT1A agonist, differentially suppresses REM sleep in depressed patients compared with normal controls, we administered placebo, ipsapirone 10 mg, or ipsapirone 20 mg in a double-blind, random order before bedtime in 18 unmedicated patients with depression and 16 age-matched, gender-matched normal controls. Compared to placebo, ipsapirone affected REM sleep measures equally in depressed patients and controls as follows: (1) increased REM latency; (2) reduced total REM percent, REM time, and REM density; and (3) delayed the onset of REM sleep. In addition, ipsapirone had similar effects in patients and controls in other sleep measures: (1) reduced total sleep time; (2) delayed sleep onset time; and (3) increased sleep latency, stage 1%, stage 2%, the amount of stage 3 & 4 sleep in the first non-REM period, and wake time after sleep onset. The study does not support the hypothesis that downregulated 5-HT1A receptors mediate the pathophysiology or sleep disturbances of depression, although further studies are needed as these patients did not differ from controls in baseline sleep measures.

Immune phenotype and cytotoxic activity of lymphocytes from human term decidua against trophoblast

Flow cytometric data were used to compare the phenotype of term decidual lymphocytes and peripheral blood lymphocytes. Unlike peripheral blood lymphocytes, a significant percentage of CD3+, CD4+, CD8+ and CD16+ term decidual lymphocyte populations expressed the CD69 activation marker. The relative proportions of CD38 in CD3+, CD4+ and CD8+ populations were more than twice as large in term decidual lymphocytes as in peripheral blood lymphocytes. As reported for early decidual lymphocytes, the expression of CD38 and CD69 by term decidual lymphocytes suggests that these cells are also regionally activated. However, term decidual lymphocytes showed no spontaneous cytotoxicity against normal trophoblast or its tumoral counterpart, JEG cells. After stimulation with interleukin-2, these lymphocytes became cytotoxic, as did peripheral blood lymphocytes. The relevance of this latter result to the immune control of the physiological and pathological invasion of the decidua by the trophoblast is discussed.

[Daily defined doses of parkinsonian drugs in Alcoi]

BACKGROUND

Some authors have suggested that the use of DDD (defined daily doses) of L-dopa may be useful as an indicator of the frequency of Parkinson's disease.

AIM

To determine the measurement for L-dopa and selegiline in Alcoi.

MATERIAL AND METHODS

We have obtained the intakes for L-dopa and selegiline between January and December, 1990 and we have calculated the DDD/1,000 inhab/day.

RESULTS

During the study period, we have found that the mean intakes were 18,000.969 mg and 53,800 mg for L-dopa and selegiline, respectively. And so, the L-dopa intake in Alcoi was 0.60 DDD/ 1,000 inh, and the selegiline intake was 0.21 DDD/1,000 inh.

DISCUSSION

Comparing the other data of the literature, specially in scandinavian countries, the obtained intake for L-dopa was low, and that could indicate that the frequency of the disease in Alcoi was lower.

Cultured human decidual stromal cells express antigens associated with hematopoietic cells

Although decidual stromal cells (DSC) have classically been considered to play a nutritional role during pregnancy, several reports have demonstrated that they can also exert different immune activities. Furthermore, some authors have occasionally found antigens on DSC normally expressed by immune cells. In this study, we isolated and cultured 12 human DSC lines and studied them with immunocytochemistry and flow cytometry using monoclonal antibodies against antigens associated with hematopoietic cells. Decidual stromal cells exhibited a constant phenotype: they were CALLA (CD10)-positive and DR-positive, although the expression of CD45, the leukocyte common antigen, was found to be very weak or negative. We also detected myelomonocytic antigens CD11b (CR3), CD13, CD16 (Fc gamma RIII) and CD36, although DSC lacked CD14, CD15 and CD33. B cell antigens CD20, CD21 (CR3), CD23 (Fc epsilon RII) and CD24 were expressed. DRC-1, an antigen detected on follicular dendritic cells (FDC), was also observed on DSC. When these cells were cultured in the presence of progesterone, they expressed desmin and prolactin (PRL), findings that confirmed their identity as DSC. The phenotype described, together with the immune activities reportedly carried out by DSC, suggest that DSC may play a role in the maternal-fetal immune relationship.

Constitutive secretion of interleukin-6 by human decidual stromal cells in culture. Regulatory effect of progesterone

PROBLEM

Although several studies have demonstrated that decidual stromal cells (DSC) can secrete cytokines in culture, none of these studies documented the purity of the cultures. Since other cells of the decidua, such as macrophages and epithelial cells, also produce cytokines, it is important to ensure purity of the culture so that cytokine production can be ascribed with confidence to DSC.

METHOD

DSC from early human pregnancies were highly purified and maintained in culture. Basal secretion by these cells of IL-6, together with other cytokines considered critical for pregnancy (IL-1 beta, TNF alpha and IFN gamma), was measured with immunological techniques.

RESULTS

We found that DSC in culture produce insignificant quantities of IL-1 beta, TNF alpha and IFN gamma, but appreciable amounts of IL-6. The production of this later cytokine was, however, inhibited by the effect of progesterone.

CONCLUSIONS

Basal production of IL-6 by DSC may be involved in physiological functions at the maternal-fetal interface. Nevertheless, the secretion of this cytokine is regulated by progesterone, probably to prevent excessive production of this cytokine from triggering an inflammatory response that might compromise pregnancy.

Orthotopic transplantation for total anomalous pulmonary venous connection associated with complex congenital heart disease

BACKGROUND

When total anomalous pulmonary venous connection is associated with other complex cardiac malformations, early and late postsurgical morbidity and mortality are excessive.

METHODS

In an attempt to modify this outcome, twelve children (4 days to 6.8 years of age) with total anomalous pulmonary venous connection and various congenital cardiac defects were treated with orthotopic heart transplantation. Associated cardiac diagnoses included the following: hypoplastic left heart syndrome (n = 2), unbalanced atrioventricular canal with pulmonary atresia (n = 2), and single ventricle with severe pulmonary stenosis (n = 3) or atresia (n = 5). Two patients had situs inversus, and two had dextrocardia with situs ambiguous. Eight patients had asplenia and one had polysplenia. Palliative pretransplantation procedures in five patients included the following: systemic to pulmonary artery shunt (n = 5), atrioventricular valve annuloplasty (n = 1) and classical Glenn shunt (n = 1). The donor left atrium was anastomosed directly to a common pulmonary venous pool in nine patients; whereas three children required complex reconstruction to baffle the pulmonary venous flow to the donor left atrium.

RESULTS

There was one operative death related to an oversized heart and vena caval thrombosis. Follow-up ranged from 16 months to 4.5 years (average 3 years). In two patients (18%) pulmonary venous obstruction developed 3 and 4 months after transplantation. Reoperation to relieve the obstruction was successful in one patient. The second patient underwent three such reoperations and died of sepsis 10 months after orthotopic heart transplantation.

CONCLUSION

Orthotopic transplantation is a viable option for children with complex total anomalous pulmonary venous connection that precludes a biventricular repair. Transplantation may improve the dismal prognosis of those children, but it does not eliminate the potential for late pulmonary venous obstruction.

Relationship of blood rheology to lipoprotein profile during normal pregnancies and those with intrauterine growth retardation

AIMS

The effects on fetal growth of hyperlipidaemia in pregnancy are not well understood at present. In this study the different lipid fractions in normal pregnancies and pregnancies complicated by intrauterine growth retardation (IUGR) were determined and related to changes in plasma and serum viscosity.

METHODS

Two groups of pregnant women were studied. Group 1 consisted of 35 healthy pregnant women aged between 21 and 38 years with no previous pathology and a normal pregnancy to term. Group 1 patients were studied at four periods defined at the start of the study: (1) < or = 17 weeks; (2) 18-24 weeks; (3) 25-32 weeks, (4) > or = 33 weeks. Group 2 consisted of 24 pregnant women aged between 16 and 34 years with ultrasound diagnosed IUGR confirmed after birth. Plasma lipids and plasma and serum viscosity were measured.

RESULTS

Plasma triglycerides, low density lipoprotein cholesterol, and total cholesterol increased progressively throughout pregnancy, with significantly higher values after week 25. Apolipoprotein A (ApoA) and triglyceride concentrations were significantly lower in the IUGR group than in the normal group. The HDL/ApoA ratio was greater in the IUGR group than in the control group, as was the ApoB/ApoA ratio. There were no differences in the other lipids. Plasma and serum viscosity was higher in the IUGR group than in the normal group.

CONCLUSIONS

Haemorheological modifications in the IUGR group are partly secondary to changes in high density lipoprotein metabolism and the competitive inhibition of fibrinolysis by ApoB, which is increased in pregnancies with IUGR. Changes in ApoA, and more specifically in the ApoB/ApoA ratio, could be good markers for the early detection of IUGR.

Sequential gene activation by ecdysone in Drosophila melanogaster: the hierarchical equivalence of early and early late genes

Ecdysteroids are key regulators of insect development. In Drosophila melanogaster the late larval response to ecdysone is characterised by a precise sequential activation of members of the superfamily of nuclear receptors (DHR3, DHR39, EcR, E75, E78, FTZ-F1, usp). Many of these genes are localised in the polytene chromosome puffs of the salivary gland previously classified as intermoult, early or early-late puff loci. Ashburner et al. (Ashburner, M., Chihara, C., Meltzer, P. and Richards, G. (1974) Cold Spring Harbour Symp. Quant. Biol. 38, 655–662) proposed a formal model describing interactions between ecdysone, its receptor and the early and late puffs during this ecdysone response. To integrate transcripts from the intermoult and early-late puffs into this model, we have used a micro RT-PCR assay to study their hormonal regulation using salivary gland culture protocols first used in the puffing analyses. We show that transcripts from certain early-late puffs are induced in parallel with the early transcripts and are thus hierarchically equivalent. In vivo the profile of the increase in hormone titre, the sensitivity of different promoters to hormone and the rate of transcript accumulation must contribute to the temporal differences in expression observed between these two classes.

Evaluation of phagocytic capacity with a modified flow cytometry technique

Phagocytic capacity was determined in human polymorphonuclear leukocytes with a modified flow cytometry technique. The advantages of this method include simplified sample preparation--the assay is done using whole blood--and quantification of phagocytosis with a phagocytic index obtained by comparison with controls, which obviates errors arising from non-specific adherence.

Isolation of genes differentially expressed at the downstream anastomosis of prosthetic arterial grafts with use of mRNA differential display

PURPOSE

Downstream anastomotic intimal hyperplasia in prosthetic arterial grafts remains a major cause of delayed graft failure. The new method of messenger RNA (mRNA) differential display was used to screen numerous genes to gain insight into the molecular mechanisms of intimal hyperplasia.

METHODS

Fifty-centimeter-long 8 mm expanded polytetrafluoroethylene grafts were placed in four mongrel dogs from the carotid artery to the distal abdominal aorta. At 3 months the distal anastomoses and adjacent normal aortas were harvested; a portion was taken for histologic examination, and total RNA was isolated from the remainder. Differential mRNA display was used to identify candidate cDNA clones whose expression differed in anastomotic intimal hyperplasia as compared with adjacent unaffected aorta. The clones were sequenced, and national gene databases were searched. Northern blot analysis confirmed alteration of gene expression.

RESULTS

Approximately 5000 mRNA species were screened, and 11 candidate clones were obtained. DNA sequence revealed homology of five clones to known gene sequences. Homologous genes included an interferon-gamma-induced human gene, (IGUP I-5111), alpha-1 protease inhibitor gene, human retinoblastoma susceptibility gene, and human creatine kinase gene (two clones). Northern blot analysis revealed altered gene expression in 4 of 11, nonregulation in 1 of 11, and undetectable signals in 6 of 11. Expression of the clone representing IGUP I-5111 in the segment of intimal hyperplasia was found to be decreased over threefold to only 31% +/- 16.4% SE of the level seen in normal aorta.

CONCLUSIONS

The technique of mRNA differential display has identified differences in gene expression in an in vivo model of anastomotic intimal hyperplasia. Expression of RNA with homology to an interferon-gamma-induced human gene was consistently decreased within the hyperplastic region at the downstream polytetrafluoroethylene arterial anastomosis.

[Changes in the cerebral flow velocity induced in the middle cerebral artery by acute stress studied by transcranial Doppler ultrasonography]

BACKGROUND

The behavior of brain flow on acute stress has not been previously evaluated. Transcranial Doppler ultrasonography (TD) is a bloodless method to evaluate the speed of cerebral flow in the arteries of the Willis polygon. The present study was designed to analyze the changes which occur in the same during two situations of acute stress.

METHODS

The mean speed of cerebral flow (MS) and the pulsation rate (PR) of the right and left middle cerebral artery (MCA) were measured basally and following a mental stress test (calculation) and physical stress (cold test) by TD and through the temporal window. Twenty-five healthy volunteers (18 women and 8 men) with a mean age of 27.8 +/- 7.3 years were studied.

RESULTS

In response to mental stress an increase was observed in MS in both the right MCA (10 +/- 8.6 cm/sec) and the left MCA (10.4 +/- 8.7 cm/sec) with a decrease in the MCA (0.14 +/- 0.23 in the right MCA, 0.14 +/- 0.18 cm/sec in the left MCA). In response to the cold test an increase in MS (7.3 +/- 7.5 cm/sec in the right MCA, 14.8 +/- 14.7 cm/sec in the left MCA) was also observed with a decrease in the PR (0.2 +/- 0.2 in the right MCA and 0.2 +/- 0.16 in the left MCA). No significant differences were observed in the changes induced in the right or left artery or in those induced by the mental or cold tests.

CONCLUSIONS

These results suggest that the acute stress produces an increase in cerebral flow in the arteries of the Willis polygon.

Dose-dependent effects of transdermal nicotine on early morning awakening and rapid eye movement sleep time in nonsmoking normal volunteers

The dose-dependent, acute effects of transdermal nicotine (7 and 14 mg) and placebo, applied 2 hours before bedtime, on sleep and mood were determined in 12 nonsmoking normal volunteers. Compared with placebo patch, transdermal nicotine was associated with early morning awakening and reduced total rapid eye movement (REM) sleep time and REM% in a dose-dependent fashion. On the recovery night after the administration of an active nicotine patch, REM latency and stage 2% were significantly reduced, whereas REM sleep time and REM% increased compared with the active patch. Mood and subjective recall of dreaming were not significantly affected in this study. Although one subject vomited about 10.5 hours after the 14-mg dose, reported side effects were generally mild.

Triploid partial molar pregnancy detected through maternal serum alpha-fetoprotein and HCG screening

BACKGROUND

Screening for Down syndrome using maternal serum alpha-fetoprotein (MSAFP) and hCG, with or without unconjugated estriol (E3), has become standard practice in much of the United States. When both MSAFP and hCG are elevated, the possibility of a partial molar pregnancy with fetal neural tube or abdominal-wall defect should be added to the differential diagnosis, as illustrated by this case.

CASE

A 22-year-old woman had elevated MSAFP and hCG levels on routine screening at 16 weeks' gestation. Ultrasound examination suggested a neural tube defect and a thickened placenta. Amniocentesis was performed. She very rapidly developed preeclampsia. Fluorescence in situ hybridization showed three distinct spots for the three probes tested. A triploid karyotype was confirmed with standard cytogenetic analysis. The fetus had an open neural tube defect, and placental pathology was consistent with a partial hydatidiform mole.

CONCLUSIONS

A possible partial molar pregnancy with abdominal-wall or open neural tube defect should be added to the differential diagnosis for interpreting Down syndrome screens when both MSAFP and hCG are elevated. A presumptive diagnosis of triploidy using fluorescence in situ hybridization was important in the management of this pregnancy.

Cardiovascular reflexes in Parkinson disease

We have investigated the autonomic function of 95 patients with Parkinson disease (PD) by testing their cardiovascular reflexes and compared the results with those of 53 healthy volunteers. 51.1% of the patients were on antiparkinsonian therapy. The patients showed a smaller heart rate response to deep breathing with a mean exhalation-inspiration difference of 87.73 +/- 7 (p: 0.0005), a smaller heart rate response to standing with a mean 30: 15 index of 1.18 +/- 0.25 (p: 0.01), and a smaller blood pressure rise to handgrip with a mean rise of 9.53 +/- 8.76 mmHg (p: 0.005). We found a higher percentage of patients with established sympathetic lesion (41% vs 34%) or atypical patterns of global autonomic function involvement (33% vs 26%), but the percentage of subjects with parasympathetic lesion was similar in both, patients and controls (16% vs 15%). We found no significant difference on cardiovascular performance between treated and untreated patients. The patients with autonomic impairment were older than the patients with normal autonomic function. Our findings suggest that patients with PD have a true autonomic dysfunction.

Expression of adhesion molecules by endothelial cells of early human decidua

The expression of adhesion molecules by endothelial cells (EC) of early human decidua was studied with monoclonal antibodies and the immunoperoxidase technique. Although E-selectin, INCAM-110 and VCAM-1 were poorly detected on decidual EC, ICAM-1, P-selectin and DR antigens were highly expressed by these cells, some of which showed high endothelial venule-like morphology. Our results suggest that decidual EC are activated, and are probably involved in the active recruitment of leucocytes.

Puffs and PCR: the in vivo dynamics of early gene expression during ecdysone responses in Drosophila

The steroid hormone ecdysone orchestrates insect development by regulating gene networks. In Drosophila the most detailed description of ecdysone action is the sequential activation of early and late puffs in the polytene chromosomes of the late larval salivary gland. A number of these early puffs (2B5, 74EF and 75B) contain complex transcription units (Broad-Complex, E74 and E75 respectively) encoding families of regulatory proteins which are expressed in most if not all tissues. In vitro, transcripts of the different isoforms of these early genes as well as the ecdysone receptor (EcR) present varying dose response characteristics (Karim and Thummel, 1992, EMBO J. 11, 4083–4093). We have developed an in vivo approach using a reverse transcription-polymerase chain reaction assay (RT-PCR) so as to visualise these transcripts in the RNA extracted from a single salivary gland. Using one salivary gland lobe for developmental puff staging and the sister lobe for RT-PCR, we have obtained precise developmental profiles for these transcripts and have extended our study to other tissues and stages where puffing studies were not possible. In the salivary gland we have characterised three distinct ecdysone responses. For the mid and late third larval instar responses our results confirm and extend the conclusions of the in vitro studies concerning the temporal expression of the early gene isoforms. The relatively brief prepupal response contains elements in common with each of the larval responses and all three can be explained by the profiles of the respective ecdysone peaks. Interestingly EcR transcripts respond differently during each response. The analysis of different tissues of the same animal reveals subtle differences in the timing of the ecdysone response and isoform expression and suggests that this may reflect tissue differences in the ecdysone profiles. As these molecules have homologues in vertebrates, our analysis may have general implications for the organisation of hormonal responses in vivo.

Application of flow cytometry to the study of antiphagocytic properties of Klebsiella pneumoniae capsular polysaccharide

We used flow cytometry to compare the effects of whole cells and capsular polysaccharides of Klebsiella pneumoniae on the phagocytic ability ot polymorphonuclear leukocytes. Our results showed a light decrease in phagocytic activity in the presence of capsular polysaccharides, but a marked decrease with whole cells. Our findings suggest that the resistance to phagocytosis in these microorganisms is not due exclusively to their capsule, as claimed by other authors.

Comparison of the proportions of leukocytes in early and term human decidua

The percentages of cells expressing immune markers were determined with immunohistochemistry and flow cytometry in early and term human decidua. Although we found no variation in the proportion of cells of bone marrow origin (CD45+), the percentages of T cells and CD16+ lymphocytes were significantly higher in term decidua. On the contrary, CD56+ lymphocytes, the most abundant leukocyte type in early decidua, decreased at term. These variations may reflex the immunological adaptations of decidua during pregnancy.

Holzgreve syndrome: recurrence in sibs

We report on 2 sibs with cardiac and renal abnormalities. The first had hypoplastic left heart sequence and renal hypoplasia; the second had a complex congenital heart defect, renal agenesis, and cleft lip and palate. We suggest that these cases represent the first familial examples of the Holzgreve syndrome. As such, they demonstrate the phenotypic variability seen in sibs, and may serve to further delineate the syndrome.

An image analyzer study of central serous chorioretinopathy

The angiographic characteristics of central serous chorioretinopathy (CSC) were studied by analyzing digitalized angiograms with an IMAGEnet system. We determined the type of leak, its location, and its distance from the fovea and from the center of the detachment. Round leaks were located farther from the detachment center and farther from the fovea than smokestack leaks. Detachments tended to center on the fovea regardless of the leak to fovea distance. These findings suggest that for serous detachment of the sensory retina to develop and be maintained, there must be a diffuse dysfunctional area of retinal pigment epithelium and a focal leak.

Expression of class II HLA molecules by endothelial cells of human decidua

Many authors have documented a high level of expression of class II HLA molecules by decidua. Although macrophages appear to be responsible for this, we show in this article that endothelial cells (EC) of the venules and capillaries of human decidua also strongly express class II molecules, whereas EC of chorionic villi do not. We discuss this finding in the context of the maternal-fetal immune interaction.

The cholinergic REM sleep induction test with pilocarpine in mildly depressed patients and normal controls

Previous studies suggested that depressed patients enter rapid-eye movement (REM) sleep more quickly than normal controls following the administration of muscarinic agonists such as arecoline or RS 86. We recently reported that pilocarpine, an orally active muscarinic agonist, induced REM sleep and reduced Stage 3 & 4 (Delta) sleep in young normal volunteers. In this study we present preliminary evidence that pilocarpine had similar effects on REM latency, REM percentage, and Delta (Stages 3 & 4) sleep percentage in depressed patients and controls. Pilocarpine, however, decreased stage-4 sleep in controls more than in depressed patients. Because this group of patients were only mildly depressed at the time of the study, had a high frequency of comorbid substance abuse diagnoses, and had normal electroencephalogram (EEG) sleep patterns under placebo conditions, further studies are necessary to test the hypothesis that depressed patients show hypersensitive cholinergic REM sleep induction.

Cardiovascular reflexes in patients with vascular headache

We have investigated the autonomic function of 75 patients with migraine by examining cardiovascular reflex function. The results were compared with those of 78 healthy volunteers. Measurements were made between attacks. Patients with migraine showed a smaller heart-rate response to deep breathing but a greater heart-rate response and higher blood pressure to standing when compared to controls. Migraine patients had a higher percentage of established sympathetic lesions (51% vs 17%) and severe (25% vs 5%) or atypical (24% vs 11.5%) global autonomic dysfunction. No significant differences were found among patients with migraine with aura, migraine without aura, and migraine with prolonged aura. Our findings indicate that patients with migraine have sympathetic hypofunction.

Unsuspected rheumatic heart underlying group B streptococcal endocarditis at the age of 20 months

The case is reported of a 20-month-old girl admitted to our centre for group B streptococcal endocarditis who died of complete atrioventricular block after a week of treatment. There was no history pointing to the presence of a heart disorder. Necropsy disclosed the surprising existence of a vast rheumatic carditis involving essentially the aortic and mitral valves, with bacterial superinfection of the former. The double rheumatic and infectious lesion in such a young patient with infective pseudo-aneurysms of the sinuses of Valsalva makes this an exceptional case.

Transseptal catheterization update 1992

Resurgence of the transseptal procedure in the last decade has occurred coincident with the advent of therapeutic catheterizations and in particular mitral balloon vavuloplasty. As larger numbers of these procedures have been performed, experience shows that the position of intended septal puncture varies for each anticipated procedure and need not lie at the fossa ovalis, which is frequently displaced or inaccessible. Recognizing the dynamic alterations in septal and atrial anatomy that accompany the various combinations of valvular heart disease, the experienced interventionalist will use precatheterization echo and radiological techniques to enable precise and localized transseptal puncture. Using these techniques in 597 patients for valvular heart disease, we have had no deaths and a morbidity of 1.8% with the transseptal puncture.

Epidemic dermatitis due to contact with a moth in Cozumel, Mexico

In early December 1989, an outbreak that was initially thought to be scabies was investigated among employees of tourist hotels in Cozumel, Mexico. Of 417 employees interviewed, only 19 (4.6%) met a case definition for scabies dermatitis, while 91 (21.8%) reported a nonspecific dermatitis of less than one-week's duration. Persons with nonspecific dermatitis related the onset of their dermatitis to skin contact with a moth that had been present in large numbers in November. At the time of the initial investigation in December, there were no active cases of dermatitis and the moth was no longer present. During early January 1990, numerous cases of dermatitis again began to be reported. Using a case definition for nonspecific dermatitis, a survey of Cozumel's resident population showed an attack rate of 12.1%. A case-control study revealed the only significant risk factor to be skin contact with the suspect moth (P less than 0.01), which had returned in large numbers. Six health workers volunteered to have the moth rubbed on their skin; within 5 min, five of six developed an intense pruritus followed by an erythematous rash. The moth was classified as Hylesia alinda Druce. This species has nettling hairs on its abdomen that excrete a histamine-like substance. Although this moth is normally present in small numbers in Cozumel, the passage of hurricane Gilbert killed most of its natural predators (wasps and bees), allowing its population to overgrow. No control measures were undertaken because the moth's natural predators returned that spring and dramatically reduced the moth population. No further outbreaks of dermatitis occurred.

Insect immunity: developmental and inducible activity of the Drosophila diptericin promoter

Diptericins are 9 kDa inducible antibacterial peptides initially isolated from immune haemolymph of Phormia (Diptera). Following the isolation of a Drosophila cDNA encoding a diptericin homologue, we have now cloned a genomic fragment containing the Drosophila diptericin gene. To dissect the regulation of this gene, we have transformed flies with a fusion gene in which the reporter beta-galactosidase gene is under the control of 2.2 kb upstream sequences of the diptericin gene. We show that such a fusion gene is inducible by injection of live bacteria or complete Freund's adjuvant and respects the tissue specific expression pattern of the resident diptericin gene. Our analysis reveals at least four distinct phases in the regulation of this gene: young larvae, late third instar larvae, pupae and adults. This complexity may be related to the presence in the upstream sequences of multiple copies of response elements previously characterized in genes encoding acute phase response proteins in mammals (e.g. NK-kappa B, NF-kappa B related, NF-IL6 response elements).

Treatment of thymomas. A report of 67 cases

From 1979 to 1989, 126 patients were treated for thymic tumors. Of these, 67 (53%) had thymomas occurring in 27 men and 40 women; the mean age was 46 years: 24 patients had no symptoms and myasthenia gravis was present in 21 cases. A complete resection was performed in 45 patients, associated in 22 with postoperative adjuvant treatment (radiotherapy, 2; radio- and chemotherapy, 20). Two patients had a partial resection followed by radiotherapy and chemotherapy. Twenty patients had initially only a biopsy and were treated by irradiation in 3 cases, radio- plus chemotherapy in 16, radio- plus chemotherapy and subsequent resection in 1 case. The staging was carried out according to the GETT Classification (stage I A:26; I B:6; II:12; III A:1; III B:18; IVA:4). Thymomas were found to be of predominant epithelial type in 12 cases, predominantly lymphocytic type in 9, and mixed in 46. No recurrence occurred after complete resection. The overall 10-year survival was 71.1%. A good correlation was found according to staging: 96% in stage I; 80% in stage II; 35% in stage III. Presence of myasthenia gravis did not affect the results. The best prognostic factor remains complete resection with postoperative radiotherapy to prevent recurrences. The role of adjuvant chemotherapy needs further evaluation.

Response of brain protein kinase C isozymes to ethyl oleate, an alcohol metabolite

Rat brain protein kinase C (PKC) isozymes I, II and III were stimulated by fatty acids in the absence and presence of calcium. Ethyl oleate, which by itself has no effect on PKC activity, had a potentiating effect on fatty acid-induced activation of all 3 isozymes. Potentiation was observed predominantly in the presence of calcium. Interaction of ethyl oleate with a signalling mechanism involving PKC may underlie the cognitive disturbances noted after alcohol consumption.

[Coronary angioplasty with a rotary atherotome]

Several new coronary dilatation systems, including those using laser energy, atherectomy devices and stent implantation, are being developed as alternative or complementary procedures to coronary artery balloon angioplasty. We report our initial experience performing coronary angioplasty with a new rotational atherectomy device, the transluminal extraction catheter, which simultaneously cut and aspirate fragments from the atherosclerotic plaque. The components of the whole system are a special guidewire to cross the stenosis, the atherectomy catheter and the conduction-control unit. This unit, connected when the atherectomy catheter is positioned across the lesion, produces rotation of the conical bladder located in the catheter distal tip and simultaneous aspiration of residual particles. The procedure was performed in 11 patients in whom 13 lesions were dilated. All patients were male (mean age 55 +/- 23 years, range 45-77). The reason for the angioplasty was stable angina in 2 patients and unstable angina in the remaining seven. Initial success (residual stenosis less than 50% of vessel diameter) was obtained in 10 of 13 lesions. In two, conventional balloon angioplasty was required to improve atherectomy result. The only unsuccessful procedure was in a proximal right coronary artery venous graft, in which a large dissection occurred. Patient had angina but no myocardial infarction. Pathologic examination of aspirated material revealed fibrous tissue in 12 cases and cholesterol crystals in four. We conclude, with the limitation of a preliminary study, that rotational atherectomy with the transluminal extraction catheter is a useful procedure to relief coronary stenosis of the coronary arteries.

The effects of scopolamine on sleep and mood in depressed patients with a history of alcoholism and a normal comparison group

In order to determine the effect of an anticholinergic agent on mood and sleep, scopolamine (0.4 mg IM) was administered before bedtime for three consecutive nights to 10 depressed patients (8 with a history of alcohol abuse) and 10 normal comparison subjects. The patients had a small, statistically significant antidepressant response on the second morning of treatment. Scopolamine inhibited rapid eye movement (REM) sleep and prolonged REM latency equally in depressed patients and the normal comparison group. Partial tolerance to the REM inhibiting effect of scopolamine developed between the first and third night of treatment. A REM rebound occurred during recovery nights. These results are consistent with concepts relating central cholinergic mechanisms to the control of REM sleep. Compared with controls, patients showed a greater increase in Stage 2 and Stage 2% and a lesser and increase in Delta (Stage 3 and 4) sleep % and Stage 4% on the first night of treatment. Further, well-controlled studies are needed to determine whether anticholinergic drugs possess clinically significant antidepressant effects.

Dose dependent inhibition of REM sleep in normal volunteers by biperiden, a muscarinic antagonist

We tested the effect of biperiden (2, 4, and 8 mg per os 30 min before bedtime) on the polygraphically recorded sleep of normal volunteers (n = 8). Biperiden is a cholinergic, muscarinic receptor antagonist that may preferentially block the M1 receptor subtype. Compared with placebo, biperiden significantly prolonged rapid eye movement (REM) latency and suppressed REM sleep time and REM percentage in a dose-dependent manner. These REM suppressing effects of biperiden are similar to those previously reported with scopolamine and other nonselective muscarinic receptor antagonists. Because of uncertainties about the pharmacological specificity of biperiden, further studies are needed to determine the mechanism of action and the role of M1 receptors subtypes in the regulation of REM sleep.

[Cancer incidence by municipalities in Puerto Rico]

This study consist of the trends of those malignant tumours in Puerto Rico diagnosed 1960 to 1988 that we considered more related with some environmental factors. For this purpose 160,288 cancer cases analyzed included 16,286 of squamous and basal cell carcinomas of the skin diagnosed from 1950 up to 1975 only. We have darkened in the map and mentioned below in this summary those municipalities with incidence greater than Puerto Rico's average.