Factors Influencing Length of Hospital Stay in Patients with Bacterial Pleural Effusion

BACKGROUND

Factors influencing length of hospital stay have been poorly analyzed in parapneumonic pleural effusions (PPE).

OBJECTIVES

The aim of this work is to identify the variables that determine increased hospital stay in patients with infectious pleural effusion (PE).

PATIENTS AND METHODS

We analyzed 112 patients with PE: empyema, complicated parapneumonic and non-complicated parapneumonic. Epidemiologic, biochemical, therapeutic and radiological variables were analyzed. Correlations with hospital stay were studied using the Student's t test, analysis of variance, Mann-Whitney U-test and linear regression model.

RESULTS

Among the 112 patients studied, there were 32 empyema, 50 complicated and 30 non-complicated parapneumonic cases. The median of length stay for all patients was 17 days. Longer hospitalization was required in patients with empyemic PE (p = 0.015), patients with underlying diseases (p = 0.003), those needing pleural drainage (p = 0.005) or decortication (p = 0.043) and those presenting unfavorable radiological outcome after treatment (p = 0.02). Biochemical parameters associated with longer hospital stay were elevated pleural fluid polymorphonuclear elastase (p = 0.001, r = 0.307) and lactate dehydrogenase (p = 0.001, r = 0.312). After linear regression analysis, only underlying disease, pleural drainage and pleural fluid polymorphonuclear elastase values remained in the model, explaining 23.1% of the variability of days of hospitalization.

CONCLUSIONS

The patients with PPE and empyema who required longer hospitalization were those with purulent fluid, underlying disease, surgical drainage and/or decortication, with unfavorable radiological outcome and higher pleural fluid levels of lactate dehydrogenase and polymorphonuclear elastase.

Decrease of parafollicular thyroid C-cells in experimental esophageal atresia: further evidence of a neural crest pathogenic pathway

Adriamycin-induced experimental esophageal atresia (EA) is often associated with malformations of neural crest (NC) origin, such as abnormal pharyngeal pouch derivatives like the thymus and the parathyroids. The aim of the present study was to examine whether NC-derived thyroid C-cells were abnormal in a rat model. Pregnant rats received intraperitoneally either 2 mg/kg Adriamycin (EA) or vehicle (controls) on days 8 and 9 of gestation. Fetuses were recovered on day 21, and blocks including the trachea and thyroid were fixed in formalin, coronally sectioned at 3-mum widths, and stained with standard hematoxylin and eosin until the largest area of thyroid was reached. From this point on, the 1st, 10th, and 20th slices were immunohistochemically stained with anti-calcitonin antibody. Positively-stained cells in each section of the gland were counted using a computer-assisted image analysis method, and the results were averaged. The distribution of the cells within the gland was assessed as well. Comparisons between EA and control rats were made by nonparametric tests with a significance threshold of p<0.05. The number of C-cells was dramatically reduced in EA animals compared with controls (32.4+/-36 vs. 92.3+/-60.5, p<0.001). Histology of the thyroid was similar in both groups, but the distribution of positive C-cells within the gland followed an abnormal pattern in EA rats. Adriamycin causes a pattern of NC-derived malformations, including a severe decrease in thyroid C-cells accompanied by abnormal distribution or migration patterns. These results represent further evidence of the involvement of NC organogenic control dysregulation in the pathogenesis of EA and its associated malformations. The similarities between the rat model and the clinical picture strongly support investigating other subclinical NC-derived anomalies in patients with EA.

[Prevalence of atopy in chronic fatigue syndrome]

BACKGROUND

Several hypotheses have been postulated to explain the etiopathogenesis of chronic fatigue syndrome (CFS). Among these, immunologic dysfunction has been proposed. Up to 30 % of these patients have a history of allergic disease. The aim of this study was to investigate whether allergic sensitization is higher in patients with CFS than in the general population.

METHODS

Twenty-five patients with CFS and 20 controls were evaluated. A clinical history for allergy was taken and immediate hypersensitivity tests were performed.

RESULTS

Twelve patients (48 %) and eight controls (40 %) had a family history of atopy. Personal histories of atopy were as follows: rhinoconjunctivitis: 12 patients (48 %), seven controls (35 %); asthma: five patients (20 %), two controls (10 %); food allergy: three patients (12 %); atopic dermatitis: two patients; contact dermatitis: two patients. No statistically significant differences were found between the groups in any of the variables (p > 0.05). In the CSF group, 3.4 % (15/441) of the inhalant prick tests were positive, and in the control group 3.8 % (16/420) were positive. None of the tests for hypersensitivity to food or latex were positive.

CONCLUSIONS

In our study atopy was not more prevalent in patients with CFS than in healthy controls, although the CSF group tended to report more respiratory symptoms and drug allergies.

Creation of BAC genomic resources for cocoa ( Theobroma cacao L.) for physical mapping of RGA containing BAC clones

We have constructed and validated the first cocoa ( Theobroma cacao L.) BAC library, with the aim of developing molecular resources to study the structure and evolution of the genome of this perennial crop. This library contains 36,864 clones with an average insert size of 120 kb, representing approximately ten haploid genome equivalents. It was constructed from the genotype Scavina-6 (Sca-6), a Forastero clone highly resistant to cocoa pathogens and a parent of existing mapping populations. Validation of the BAC library was carried out with a set of 13 genetically-anchored single copy and one duplicated markers. An average of nine BAC clones per probe was identified, giving an initial experimental estimation of the genome coverage represented in the library. Screening of the library with a set of resistance gene analogues (RGAs), previously mapped in cocoa and co-localizing with QTL for resistance to Phytophthora traits, confirmed at the physical level the tight clustering of RGAs in the cocoa genome and provided the first insights into the relationships between genetic and physical distances in the cocoa genome. This library represents an available BAC resource for structural genomic studies or map-based cloning of genes corresponding to important QTLs for agronomic traits such as resistance genes to major cocoa pathogens like Phytophthora spp ( palmivora and megakarya), Crinipellis perniciosa and Moniliophthora roreri.

Relation between leptin and body fat distribution in menopausal status

We examined the serum concentrations of leptin in a homogeneous group of 52 postmenopausal Mediterranean women, calculating body fat mass distribution by waist-to-hip circumference ratio (WHR) and other anthropometric measurements. Significant correlations were found between leptin and weight (r=0.59), Body Mass Index (BMI) (r=0.56), Conicity Index (CI) (r=0.49) and all circumferences measured: chest (r=0.55), waist (0.61) and hip (r=0.65), but not between leptin and WHR. Leptin levels does not seem to be influenced by fat mass distribution (android or gynoid type) while weight gain over life appears to be related with the hormone concentration when menopausal status is well established.

Rickettsia typhi infection in wild rodents from central Spain

When sera from 218 rodents captured in two provinces of central Spain were tested, by indirect immunofluorescence, for antibodies to Rickettsia typhi, 46 (21.1%) were found to be positive, at titres between 1:20 and 1:320. The seropositives included rodents of each of the five species collected: Mus musculus, Mus spretus, Apodemus sylvaticus, Rattus rattus and Rattus norvegicus. Rickettsia typhi infection appears to be common and widespread among the rodents of central Spain.

[Repercussion of age on management of neoplastic patients in an Internal Medicine Service]

AIM

To determine whether age is a factor affecting the management of patients diagnosed with neoplastic disease in an internal medicine service.

PATIENTS AND METHODS

Prospective study of 388 patients diagnosed with cancer in the internal medicine service of a large public health teaching hospital. We evaluated clinical characteristics, diagnostic procedures, types and stage of neoplasm, referral after hospital discharge and treatment. A comparative study based on age was performed between patients 65 years older and patients under this age.

RESULTS

The 388 cancer patients accounted for 12% of hospital admissions in our service. Among the total, 62% were > or = 65 years old. Constitutional syndrome, the most frequently associated symptom and the main reason for the consultation, was more common in the > or = 65-year-old group. Lung cancer was predominant in men and hematologic neoplasms in women. Patients > or = 65 were referred more frequently to internal medicine physicians, general practitioners and home palliative assistance services (p < 0.05) and they received only palliative treatment in a greater percentage of cases (50% vs. 37%, p = 0.001).

CONCLUSIONS

The incidence of neoplasms in our service was high (12%), with a considerable percentage of patients in advanced phases of the disease (83%). Age was not related to diagnostic methods nor was it determinant in the staging, but it did have repercussions on treatment; patients > or = 65 received palliative treatment alone more often than younger patients.

Protein nitration in cutaneous inflammation in the rat: essential role of inducible nitric oxide synthase and polymorphonuclear leukocytes

1: We have examined the relationship between neutrophil accumulation, NO(*) production and nitrated protein levels in zymosan-mediated inflammation in rat skin in vivo. 2: Rats were anaesthetized and cutaneous inflammation was induced by zymosan (injected intradermally, i.d.). Experiments were carried out up to 48 h, in recovery procedures as appropriate. Assays for neutrophil accumulation (measurement of myeloperoxidase), nitric oxide (assessment of NO(2)(-)/NO(3)(-)) and nitrated proteins (detected by ELISA and Western blot) were performed in skin extracts. 3: The results demonstrate a close temporal relationship between these parameters. Samples were assayed at 1, 4, 8, 24 and 48 h after i.d. injection of zymosan. The highest levels measured of each parameter (P<0.001 compared with vehicle) were found at 4-8 h, with a reduction towards basal levels by 24 h. 4: Selective depletion of circulating neutrophils with anti-neutrophil antibody abolished neutrophil accumulation and protein nitration. In addition substantially decreased NO levels were found. 5: A selective inducible nitric oxide synthase (iNOS) inhibitor, N-3-aminomethyl-benzyl-acetamidine-dihydrochloride (1400W) also significantly reduced neutrophil levels and NO production and substantially inhibited protein nitration. 6: We conclude that the neutrophil leukocyte plays an essential role in the formation of iNOS-derived NO and nitrated proteins in inflammation, in a time-dependent and reversible manner. The NO-derived iNOS also has a role in stimulating further neutrophil accumulation into skin. This suggests a close mechanistic coupling between neutrophils, NO production and protein nitration.

Physiological and performance responses to a 6-day taper in middle-distance runners: influence of training frequency

The purpose of this investigation was to examine the influence of training frequency on performance and some physiological responses during a 6-day taper. After 18 weeks of training, 9 male middle-distance runners were assigned to a high frequency taper (HFT, n = 5) or a moderate frequency taper (MFT, n = 4), consisting of training daily or resting every third day of the taper. Taper consisted of an 80% nonlinear progressive reduction in high intensity interval training. Blood samples were obtained, and 800 m performance and peak blood lactate ([La] peak ) measured before and after taper. Performance improved significantly after HFT (121.8 +/- 4.7 vs 124.2 +/- 4.9 s, p < 0.05), but not after MFT (126.6 +/- 2.8 vs 127.1 +/- 2.1 s). Neutrophils (2.89 +/- 0.68 vs 2.56 +/- 0.61 10 (3) x mm(-3)), granulocytes (3.08 +/- 0.70 vs 2.77 +/- 0.66 10 (3) x mm(-3)), haptoglobin (79.7 +/- 47.9 vs 60.7 +/- 33.6 mg x dl(-1)), total testosterone (7.39 +/- 1.67 vs 5.52 +/- 0.88 microg x l(-1)) and [La] peak (15.5 +/- 1.5 vs 14.4 +/- 2.0 mmol x l(-1)) significantly increased with taper. [La] peak correlated with performance time before taper (r = -0.76, p < 0.05), and change in [La] peak with change in serum cortisol (r = -0.75, p < 0.05) and total testosterone:cortisol ratio (r = 0.82, p < 0.01). In conclusion, training daily during a 6-day taper brought about significant performance gains, whereas resting every third day did not. High [La] peak and a hormonal milieu propitious to anabolic processes seemed to be necessary for optimum performance.

Effects of acute alcohol intoxication on pituitary-gonadal axis hormones, pituitary-adrenal axis hormones, beta-endorphin and prolactin in human adults of both sexes

- The effects of acute alcohol intoxication (AAI) on the pituitary-gonadal axis hormones, and the possible contribution of pituitary-adrenal axis hormones, beta-endorphin and prolactin to alcohol-induced dysfunction of pituitary-gonadal axis hormones were studied in adult men and women. Blood samples were drawn from adults of both sexes who arrived at the emergency department with evident behavioural symptoms of drunkenness (AAI) or from adult volunteers with nil consumption of alcohol (controls). Our results demonstrated that AAI produces a high increase in plasma prolactin, corticotropin (adrenocorticotropic hormone, ACTH), and cortisol in adults of both sexes, a decrease in luteinizing hormone levels only in men, an increase in dehydroepiandrosterone-sulphate (DHEAS) and a contradictory behaviour of testosterone according to gender, with increased plasma testosterone in women and a decrease in men. ACTH and prolactin correlated positively with cortisol, DHEAS and testosterone in women, which suggests that prolactin and ACTH could contribute to stimulated adrenal androgen production. In contrast, the decrease in testosterone and increase in beta-endorphin in men suggests that AAI could have an inhibitory effect on testicular testosterone, perhaps mediated by beta-endorphin. Our results suggest that the effect of alcohol on pituitary-gonadal axis hormones in humans could depend on the gender and degree of sexual maturity of the individual.

Pleural-fluid myeloperoxidase in complicated and noncomplicated parapneumonic pleural effusions

The diagnostic accuracy of myeloperoxidase (MPO) in pleural fluid, for differentiating between complicated and noncomplicated parapneumonic pleural effusions (PPE) evaluated prospectively. Seventy patients aged >18 yrs with PPE (36 complicated and 34 noncomplicated) were studied after admission to a tertiary referral teaching hospital. MPO concentration was measured in plasma and pleural fluid using a double-antibody competitive radioimmunoassay. The concentrations of MPO in complicated and noncomplicated PPE were compared using a Mann-Whitney U-test and multiple logistic regression models were used to predict the odds that an effusion was complicated. MPO pleural-fluid concentrations were significantly higher in complicated than in noncomplicated PPE. After excluding purulent effusions, pleural-fluid MPO was the marker that best differentiated between the two types of PPE: the area under the receiver operating characteristic curve was 0.912, the sensitivity was 87.5% and the specificity was 85.1% at a cut-point limit of 3.000 microg x L(-1). The authors concluded that the concentration of pleural-fluid myeloperoxidase helps to differentiate between nonpurulent complicated and noncomplicated parapneumonic pleural effusions.

Allozyme diversity in endemic flowering plant species of the Juan Fernandez Archipelago, Chile: ecological and historical factors with implications for conservation

The level and apportionment of allozyme diversity were determined for 29 endemic (and 1 native) species from the Juan Fernández Islands, Chile. Mean diversities at the species level (H(es) = 0.065) are low but comparable to those measured for other insular endemics in the Pacific. A high mean proportion (0.338) of species-level diversity resides among populations. Diversity statistics were compared for species in different ecological-life history trait categories and abundance classes. Species occurring in large populations and those present in scattered small populations have higher diversities than species occurring in one or two populations. Although not significant with the conservative statistical test employed, lower diversity was found in highly selfing species as compared to animal- or wind-pollinated species. The apportionment of genetic diversity within and among populations (G(ST) values) is not significantly different for any of the species categories. Of particular interest is the lack of difference between animal- and wind-pollinated species because previous analyses of large data sets showed higher differentiation between populations of animal- than wind-pollinated species. Historical factors, both ecological and phylogenetic in nature, can influence the level and apportionment of diversity within insular endemics, and thus ecological correlates of diversity seen in many continental species may not apply to endemics. The results have several conservation implications. The preservation of large populations or several small populations is important for conserving diversity within species because when species are reduced to one or two populations, allozyme diversity is sharply reduced. High mean G(ST) values for the species examined illustrate the need for conserving as many populations as possible, either in the wild or in the garden, to preserve maximal diversity within species. Effective conservation strategies require empirical knowledge of each species.

Exchange coupling in cyano-bridged homodinuclear Cu(II) and Ni(II) complexes: synthesis, structure, magnetism, and density functional theoretical study

The synthesis and structural characterization of several new cyano-bridged copper(II) and nickel(II) homodinuclear complexes is presented. The measure of magnetic properties for these complexes is complemented with a computational study of the exchange coupling for several model structures representing this family of compounds. The influence of several factors on the coupling constant has been examined, coordination position occupied by the bridging ligand, distortions of the coordination environment, and relative disposition of the cyanide ion with respect to the M-M vector. Comparison of experimental and calculated coupling constants allows for the rationalization of the most relevant features of the exchange interaction between two identical metal ions through a cyano bridge.

[Mechanical versus manual suture in the jejunal esophageal anastomosis after total gastrectomy in gastric cancer]

AIM

To compare the leakage rate of esophagojejunal anastomosis performed with stapler or hand sutures.

MATERIAL AND METHODS

We studied a series of 367 patients who underwent total gastrectomy for gastric cancer at the Instituto de Enfermedades Neoplásicas (Lima-Peru) from 1986 to 1999.

RESULTS

In 197 patients esophagojejunal anastomosis was performed with stapler and in 170 with manual sutures. There were no differences between both groups with regard to age, TNM stage, operating time and hospital stay. There were 8 anastomotic leakage (4.1%) in the stapler group and 4 (2.4%) in the hand sutures group (p> 0.05). Of these 12 cases, 2 patients (16%) died of causes directly related to the leak of the esophagojejunal anastomosis.

CONCLUSION

There were no statistical differences in the rate of leakage of the esophagojejunal anastomosis performed with stapler or hand sutures, thus both techniques should be accepted as standard procedures.

[Tumors diagnosed in 65 patients with type I neurofibromatosis]

BACKGROUND

Type 1 neurofibromatosis patients develop malignant neoplasm more frequently than general population.

PATIENTS AND METHOD

We have studied 65 patients with neurofibromatosis type 1 because we intend to know the kind of neoplasms that they have presented.

RESULTS

65 patients (48 men and 17 women) fulfilling type 1 neurofibromatosis criteria have been studied. Globally 67 tumors appeared, from which 47 (70%) were benign and 20 (30%) were malignant. Benign tumors included 25 neurofibromas, 11 central nervous system tumors and 11 extraneurological tumors. Malignant tumors accounted for 6 soft tissue sarcomas, 6 carcinomas, 3 malignant CNS tumors and 2 acute lymphoblastic leukemias.

CONCLUSION

Presentation of neoplasms is frequent in type 1 neurofibromatosis and constitutes main death and morbility cause.

Growth inhibitory activity of indapamide on vascular smooth muscle cells

Abnormal vascular smooth muscle cell proliferation has a fundamental role in the pathogenesis of vascular diseases. Indapamide is an oral diuretic antihypertensive drug effective for patients with mild or moderate essential hypertension. We now investigated the effects of indapamide on the growth of aortic vascular smooth muscle cells (A10 cell line). Indapamide inhibited cell proliferation as measured by the tetrazolium salt XTT (sodium 3'-[1-(phenylamino-carbonyl)-3,4-tetrazolium]-bis(4-methoxy-6-nitro)benzene sulfonic acid hydrate) test. The increase in cell number was significantly reduced in the presence of indapamide 10(-6) and 5 x 10(-4) M (P < 0.05 n = 3 and P < 0.01, n = 3, respectively). Serum-induced DNA synthesis, determined as the incorporation of 5-bromo-2'-deoxyuridine (BrdU), was concentration-dependently inhibited by indapamide. BrdU incorporation was 47.2+/-1.6% (10% foetal calf serum). Indapamide treatment markedly prevented BrdU incorporation (37.2+/-2.1%, 29.2+/-4.8%, 15.0+/-1.8%, 8.7+/-2.1%) indapamide 10(-6), 10(-5), 5 x 10(-5) and 5 x 10(-4) M, respectively. Cell-cycle progression was also evaluated. Flow cytometry analysis of DNA content in synchronised cells revealed blocking of the serum-inducible cell-cycle progression by indapamide. This inhibition was abolished when the drug was added 2 h after serum repletion, indicating that indapamide must act at the early events of a cell cycle to be fully effective against DNA synthesis. In addition, serum-induced intracellular Ca2+ movements and also p44/p42 mitogen-activated protein kinase (MAPK) phosphorylation were studied in the presence or absence of indapamide. Indapamide 10(-5) and 5 x 10(-5) M decreased significantly cytosolic free calcium, and the p44/p42 mitogen-activated protein kinase phosphorylation (5 x 10(-5) M) stimulated by 10% foetal calf serum. In accordance with this finding, indapamide (5 x 10(-4) M) caused a 95% to 99% decrease in the early elevation of c-fos expression as evaluated by northern blot analysis of mRNA induced after serum addition. In conclusion, our results indicate that indapamide reduces vascular smooth muscle cell proliferation by a mechanism which involves a decrease in the intracellular Ca2+ movements that might link with the mitogen-activated protein kinase (MAPK) pathway, altering cell-cycle progression.