Promoter activities in Vibrio cholerae ctx phi prophage

Comparison of cholera toxin (CT) production directed by different gene constructs and S1 nuclease mapping revealed the presence of a ctxB-specific promoter within the ctxA coding sequence. Initiation of transcription in this region occurred in wild-type El Tor and classical biotype choleragenic vibrios. We propose that transcription from the ctxB-specific promoter and a stronger ribosomal binding site on the ctxB mRNA synergistically contribute to achieve the correct (5B:1A) subunit stoichiometry. Plasmid pB, a CT promoterless vector expressing only CTB, was used to detect promoter activity by restoration of A-subunit synthesis. Promoter activity expressed in vitro and in vivo was detected upstream of the zonula occludens toxin gene, suggesting that this factor could be produced in vivo to contribute to fluid accumulation. No promoter activity was detected in vitro and in vivo upstream from the accessory cholera enterotoxin gene.

Human placental ecto-enzymes: studies on the plasma membrane anchorage and effect of inhibitors of ATP-metabolizing enzymes

The human placental microvillar membrane contains several ectoenzymes, including 5'-nucleotidase, alkaline phosphatase and ATP-diphosphohydrolase (ATP-DPH), which might be involved in the extracellular metabolism of nucleotides. The type of anchorage to the plasma membrane of the two first enzymes has been shown to be via a glycosyl-phosphatidylinositol. In the present study, using an enzymatic approach, we show that the ATP-DPH should be attached to the plasma membrane through a different type of anchorage. We were also interested in the search of compounds which could interact differentially with this enzyme to be used as a tool for studying the other two hydrolytic enzymes in the presence of ATP-DPH. Here we report several inhibitors of ecto-ATPases which seem to be a useful tool for studying these three enzymes.

Relevance of early seizures for in-hospital mortality in acute cerebrovascular disease

BACKGROUND

We studied the influence of early poststroke seizures (within the first 48 hours of onset of a first stroke or transient ischemic attack) on in-hospital mortality in 1,099 consecutive patients collected in a prospective stroke registry.

METHODS

Differences in the frequency of demographic characteristics, clinical events, and outcome between patients with and those without epileptic seizures were assessed. To determine the independent predictive value of early seizures on in-hospital mortality, variables related to vital status at discharge (alive, dead) in the univariate analysis, plus age, were studied in two multiple linear regression models. The first predictive model was based on demographic, anamnestic, and clinical variables with a total of 13 variables, and the second model was based on clinical and neuroimaging variables with a total of 16 variables.

RESULTS

A total of 27 patients (2.5%) had epileptic seizures during the first 48 hours of stroke. Advanced age, confusional syndrome, hemorrhagic stroke, large lesions, involvement of parietal and temporal lobes, and occurrence of neurologic and medical complications were significantly more frequent in seizure patients than in nonseizure patients. Overall in-hospital mortality rate was 33.3% in the seizure group and 14.2% in the nonseizure group (p = 0.02). The presence of early seizures was a significant predictive variable both in the model based on clinical variables (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.81 to 16.72) and in the model based on clinical and neuroimaging variables (OR, 6.1; 95% CI, 2.13 to 17.93).

CONCLUSIONS

Seizures at the onset of a first-ever stroke is an independent prognostic factor for in-hospital mortality. Patients with the highest risk of developing epileptic seizures-aged persons with a large hemorrhagic infarction of a parietal lobe-may be candidates to be treated prophylactically against seizures for a few days.

Perinatal delta 9-tetrahydrocannabinol exposure in rats modifies the responsiveness of midbrain dopaminergic neurons in adulthood to a variety of challenges with dopaminergic drugs

The present study has been designed to explore further the existence of a persistent, but 'silent' alteration in the adult functionality of midbrain dopaminergic neurons following perinatal cannabinoid exposure. To this end, we evaluated the responsiveness of these neurons, measured at the neurochemical or behavioral levels, to pharmacological challenges with a variety of dopaminergic drugs administered to adult male and female rats that had been exposed to delta 9-tetrahydrocannabinol (THC) or vehicle during the perinatal period. Results were as follows: In the first experiment, we tested the magnitude of motor inhibition caused by administration of dopaminergic receptor antagonists. The most interesting observation was that the administration of SCH 23390, a D1 antagonist, produced a more marked motor inhibition, reflected by a greater decrease in the ambulation measured in an open-field test, in adult animals of both sexes when they had been exposed perinatally to THC. This did not occur with the motor inhibition caused by sulpiride, a D2 antagonist. In the second experiment, we evaluated the sensitivity of midbrain dopaminergic neurons to amphetamine (AMPH), which causes, through different mechanisms, a decrease in dopamine (DA) metabolism. The most interesting observation was that adult females, when exposed perinatally to THC, exhibited a trend to lesser response to AMPH, in terms of decreasing DA metabolism, than oil-exposed females. This was observed in dopaminergic terminals reaching the limbic forebrain area, but not in those terminals reaching the striatum, and was a specific effect for THC-exposed adult females because it was not observed in THC-exposed adult males. In the third experiment, we evaluated the in vivo synthesis of DA in midbrain dopaminergic neurons by analyzing the magnitude of L-3,4-dihydroxyphenylalanine (L-DOPA) accumulation caused by the blockade of L-DOPA decarboxylase with NSD 1015. The most worthy finding was that, as occurred in the above experiment, adult females, when exposed perinatally to THC, tended to exhibit a higher ability to synthesize DA in vivo in the limbic forebrain but not in the striatum, as reflected by the increased L-DOPA accumulation observed after NSD 1015 administration. As in the above experiment, this was not seen in males. In summary, our results are consistent with the possible existence of subtle and sexually dimorphic changes in the sensitivity of midbrain dopaminergic neurons in adulthood caused by the exposure to THC during perinatal development. These silent changes could be revealed after the administration of drugs which specifically act on key processes of dopaminergic neurotransmission, such as the synthesis, reuptake and catabolism of DA and its binding to receptors.

The possible value of ascorbic acid as a prophylactic agent for urinary tract infection

The effect of ascorbic acid on urine pH was studied in spinal cord injury patients. Their urine was not colonized by urease positive microorganisms. The study was designed to compare the baseline urine pH value and the urine pH value after the administration of placebo or ascorbic acid 500 mg/6 h. The diet and medical treatment were not controlled. A significant decrease in urine pH value was not obtained. There was no clinical benefit from the use of ascorbic acid.

ATP-diphosphophydrolase activity in rat heart tissue

Extracellular nucleotides interact with specific receptors on the cell surface and are locally metabolized by ecto-nucleotidases. Biochemical characterization of the ATPase and ADPase activities detected in rat heart sarcolemma, under conditions where mitochondrial ATPase and adenylate kinase were blocked, supports our proposal that both activities correspond to a single enzyme, known as ATP-diphosphohydrolase or apyrase. The physiological function of this enzyme could be dephosphorylation of the nucleotides present in the interstitial heart compartment acting together with 5'-nucleotidase. Both hydrolytic activities have similarities in: sarcolemma localization, bivalent metal ion dependence, optimum pH, effect of several amino acid residue modifiers, competitive inhibition of nucleotide analogs, and broad nucleoside di-and triphosphate specificity. The ATPase activity could not be separated from the ADPase either through isoelectrofocusing or electrophoresis under acid conditions.

Influence of biochemical parameters of liver function on vancomycin pharmacokinetics

The influence of biochemical parameters of hepatic function on vancomycin pharmacokinetics was retrospectively evaluated in 76 adult patients (age 18 to 81 years), from biochemistry data gathered during routine therapeutic drug monitoring. All subjects had normal serum creatinine levels. Vancomycin concentrations were determined by fluorescence polarization immunoassay in 101 paired serum samples. All data for vancomycin concentration versus time were fitted to a one-compartment model using the bayesian approach. Bilirubin, transaminases (n = 101), gamma-glutamyl transferase (n = 97), alkaline phosphatase (n = 95), albumin (n = 92) and lactate dehydrogenase (n = 42) were determined. No strong correlation was seen between any of the pharmacokinetic and biochemistry parameters studied. In patients with hyperbilirubinaemia, the mean Vss and t1/2 were increased (Vss: 0.75 +/- 0.31 versus 0.92 +/- 0.42 1.kg-1, p = 0.020; t1/2 5.93 +/- 3.30 versus 7.48 +/- 4.44 hr, p = 0.049). When liver function was evaluated according to hepatic profile (normal, mildly altered and severely altered), no significant differences were observed in vancomycin pharmacokinetics among the groups. In conclusion, vancomycin pharmacokinetics are only weakly influenced by the biochemistry parameters of liver function.

ATP-diphosphohydrolase activity in rat renal microvillar membranes and vascular tissue

Ecto-nucleotidases may have a role in the regulation of purinoceptor-mediated responses. ATP-diphosphohydrolase or apyrase has been described as an ecto-nucleotidase, which is characterized by a low specificity for its substrates and bivalent cations. The aim of this work was to demonstrate the presence of apyrase as an ecto-enzyme in the rat kidney. ATPase-ADPase activities of the renal microvillar membrane preparation, which correspond to "right side out' membranes, were characterized. The detection of ATP-diphosphohydrolase in the renal vasculature was done through perfusion of isolated rat kidney. ATPase-ADPase activities of the microvillar membrane preparation and apyrase share similar kinetic properties. These include: low substrate and bivalent metal specificities and insensitivity towards inhibitors like: oligomycin, ouabain, verapamil, levamisole and Ap5A. The M(r) or native ATPase and ADPase activities was determined by the 60Co irradiation-inactivation technique being around 65 kDa for both hydrolytic activities. Immunowestern blot analysis also supports the presence of apyrase in microvilli. Perfusion of isolated rat kidney with ATP and ADP, in the presence or absence of different inhibitors or apyrase antibodies indicated the existence of this enzyme in the vascular endothelium. The identification of ATP-diphosphohydrolase as an ecto-enzyme both in microvilli and vasculature support the proposal that the enzyme may have an important role in the extracellular metabolism of nucleotides.

Comparison of the biochemical properties, regulation and function of ATP-diphosphohydrolase from human placenta and rat kidney

ATP-diphosphohydrolase (apyrase. EC 3.6.1.5) has both ATPase and ADPase activity that are stimulated by bivalent metals, with Ca2+ being the most effective. The possible physiological function of this enzyme, associated with placental and renal microvilli, is related to the extracellular metabolism of nucleotides. A comparison of the biochemical properties of human placenta and rat kidney apyrase is presented, showing similarities in Mr. bivalent metal stimulation, nucleotide nonspecificity, insensitivity towards specific ATPase inhibitors, and lack of essential sulfhydryl and aliphatic hydroxyl groups. We describe the treatment of membrane preparations from both tissues with different detergents and the isoelectric focusing of the solubilized proteins to partially purify apyrase. An ectoenzyme localization is assigned both in microvillus membranes and in the vasculature on the basis of organ perfusion experiments with nucleotides in the presence of antibodies. Placental and kidney microvillus membranes inhibited ADP-induced platelet aggregation, in agreement with an extracellular role. Initial studies on enzyme regulation suggested the existence of at least two types of modulatory proteins: an activating protein in the cytosol of both tissues, and an inhibitory protein associated with placental microsomes. Possible hormonal regulation was investigated in kidneys using in vivo estradiol treatment, but only slight changes in total apyrase activity were observed.

Circadian variation of growth hormone secretion in normal prepubertal children. Comparison to constitutional growth delay and growth hormone deficiency

When studying short slowly growing children, several investigators have found differences in spontaneous circulating growth hormone (GH) levels in some short children as compared with children of normal stature. The circadian and ultradian characteristics of GH secretion have not been considered in most of those studies. With the aim to study possible differences in rhythm characteristics of plasma GH with stature, we analyzed data from a total of 141 prepubertal children: 1) 13 GH-deficient children; 2) 36 children with short stature (up to 2 standard deviations below their peer group mean); 3) 61 children with very short stature (up to 4 standard deviations below their peer group mean); and 4) a reference group of 31 children with standard stature. Subjects were living at the hospital setting on a diurnal waking (07:30 a.m. to 10:30 p.m.), nocturnal resting routine during sampling, consuming the usual hospital diet at fixed times. GH concentrations were determined by immunoradiometric assay in plasma obtained at about 2-3 hour intervals during most of the day and at about half-hour intervals between 9:00 p.m. and 3:00 a.m. Circadian rhythm characteristics obtained by least-squares estimation were compared between groups divided according to gender and stature with a parameter test. Results show a statistically significant circadian rhythm in GH secretion for all groups studied (p<0.001 for standard, short and very short children; p=0.013 for GH-deficient children). A comparison of circadian parameters indicates similar characteristics between subjects of short, very short and standard stature. The difference in rhythm-adjusted mean and amplitude is, however, of borderline statistical [correction of statistically] significance when comparing non-deficient with GH-deficient children.

Myoblast fusion promotes the appearance of active protease nexin I on human muscle cell surfaces

Protease nexin I (PNI) is a 43- to 50-kDa glycoprotein capable of inhibiting a number of serine proteases and belongs to the serpin superfamily. PNI is identical to glia-derived nexin, a neurite outgrowth promoter by virtue of its thrombin-inhibiting activity. Of particular relevance to neuromuscular biology and pathology, PNI was the first serpin shown to be highly localized to the neuromuscular junction and it maps to precisely the same locus as autosomal recessive amyotrophic lateral sclerosis (ALSJ) at chromosome 2q33-35. In the present report, we now show that in cultures of human skeletal muscle, PNI protein is expressed only after myoblast fusion into multinuclear myotubes and is localized in patches on their surfaces. We performed complex formation experiments with labeled thrombin, another target protease for PNI, with intact human muscle cells in culture. We detected specific SDS-stable PNI/thrombin complexes in myotube extracts only, indicating that active PNI was bound to their surfaces. We studied the gene expression of PNI mRNA using a 300-bp cDNA synthesized from the published sequence of human PNI. Confirming the protein data, upregulation of PNI appears in myotubes using Northern blot analysis. The current results reinforce the hypothesis that the regulation of the balance of serine proteases and serpins, such as PNI, is involved in muscle differentiation. They also prompt us to explore PNI abnormalities in several neuromuscular diseases, including ALSJ.

Characterization of ATP-diphosphohydrolase from rat mammary gland

ATP-diphosphohydrolase (or apyrase) hydrolyses nucleoside di- and triphosphates in the presence of millimolar concentration of divalent cations. It is insensitive towards sulfhydryl and aliphatic hydroxyl-selective reagents and to specific inhibitors of ATPases. We present further evidence that ATPase and ADPase activities present in rat mammary gland correspond to apyrase. Two kinetic approaches have been employed, competition plot and chemical modification with group-selective reagents. The M(r) of these activities was determined by 60Co radiation-inactivation. The kinetic approaches employed, competition plot (which discriminate whether competitive reactions occur at the same site) and chemical modification, point to the presence of a single protein which hydrolyses ATP and ADP. The similar M(r) values of ATPase and ADPase activities also support this proposal. ATPase and ADPase activities of mammary gland show a similar sensitivity or insensitivity towards several chemical modifiers. These results suggest that this enzyme is ATP-diphosphohydrolase, also known as apyrase. The results obtained are compared with the ones obtained by us and other authors with the enzyme isolated from other sources.

[Necrotizing infections of the soft tissues]

OBJECT

In necrotizing soft tissue infections (NSTI) may be implicated skin, subcutaneous tissue, fascia and skeletal muscle, and include different clinical entities associated with high morbidity and mortality rates. Diagnosis must be early and its initial management must be common.

METHODS

A retrospective study of 24 patients diagnosed of NSTI is made. Associated factors with the development of these infections, and its treatment are analysed. It is effectuated an statistical analysis of mortality and related factors.

RESULTS

Five cases were Necrotizing Cellulitis, fourteen Necrotizing Fasciitis, three Myonecrosis, one gangrenous pyoderma and one case was a disseminated gluteus abscess. Surgical treatment was resection and debridament--in every case reaching to healthy tissue. Broad-spectrum antibiotics were always associated to surgery. E. coli and Bacteroides have been the most frequent microorganism isolated. 23 patients were operated once at least; 66 surgical interventions were made (mean: 2.86; range: 1-7). Overall mortality of this series was 29%.

CONCLUSIONS

Early and aggressive treatment are the corner stone in the management of these patients. With such therapeutic premise, in our series we had a mortality of 29%. Factors associated with a worse outcome have been advanced age, the presence of an underlying disease in the moment of developing the infection and high levels of urea at admittance.

Changes in rat brain cannabinoid binding sites after acute or chronic exposure to their endogenous agonist, anandamide, or to delta 9-tetrahydrocannabinol

A brain constituent, the N-amide derivative of arachidonic acid, termed anandamide, has been recently proposed as a possible endogenous ligand for the cannabinoid receptor. The present study has been designed to examine whether the acute or chronic exposure to anandamide affected the binding of cannabinoid receptors in specific brain areas as occurred with the exogenous cannabinoid agonist, delta 9-tetrahydrocannabinol (THC). To this end, we measured the maximum binding capacity (Bmax) and the affinity (Kd) of cannabinoid receptors, by using [3H]CP-55,940 binding assays, in membranes obtained from several brain areas of male rats acutely or chronically treated with anandamide or THC. Results were as follows. The acute administration of either anandamide or THC increased the Bmax of cannabinoid receptors in the cerebellum and, particularly, in the hippocampus. This effect was also observed after 5 days of a daily exposure to either anandamide or THC. However, whereas the increase in the Bmax after the acute treatment seems to be caused by changes in the receptor affinity (high Kd), the increase after the chronic exposure may be attributed to an increase in the density of receptors. On the contrary, the [3H]CP-55,940 binding to cannabinoid receptors in the striatum, the limbic forebrain, the mesencephalon, and the medial basal hypothalamus was not altered after the acute exposure to anandamide or THC. However, the chronic exposure to THC significantly decreased the Bmax of these receptors in the striatum and nonsignificantly in the mesencephalon. This effect was not elicited after the chronic exposure to anandamide and was not accompanied by changes in the Kd.(ABSTRACT TRUNCATED AT 250 WORDS)

The endogenous cannabinoid receptor ligand, anandamide, inhibits the motor behavior: role of nigrostriatal dopaminergic neurons

The present study has been designed to test whether the recently described endogenous ligand for the cannabinoid receptor, arachidonylethanolamide, termed anandamide, can mimic the effects produced by exogenous cannabinoids on motor behavior and to test possible neurochemical substrates for this potential effect. To this end, adult male rats were submitted to an acute i.p. injection of anandamide, delta 9-tetrahydrocannabinol (THC) or vehicle. Animals were behaviorally tested ten minutes after injection of the drug and, then, sacrificed and their brains used for dopaminergic analyses. Ambulation was not significantly affected by the treatment with either THC or anandamide, but a very pronounced increase was observed in the time spent in inactivity in rats treated with either THC or anandamide. This was accompanied by a marked decrease in the frequency of spontaneous non-ambulatory activities, such as grooming and rearing, although only the administration of THC decreased shaking behavior. The anandamide-induced decrease in grooming was dose-dependent, but the decrease in rearing was higher with the dose of 3 mg/kg than with the dose of 10 mg/kg. The administration of anandamide also caused a dose-dependent decrease in the activity of tyrosine hydroxylase and in the ratio between the number of D1 and D2 receptors in the striatum. Moreover, the administration of 3 mg/kg of anandamide significantly decreased the contents of dopamine and L-3,4-dihydroxyphenylacetic acid in the striatum although lesser and higher doses were less effective. THC only tended to decrease these parameters. No changes were seen in dopaminergic activity in the limbic forebrain after either cannabimimetics. In summary, anandamide, as well as THC, decreases motor behavior. This effect was paralleled by reduction in the activity of nigrostriatal dopaminergic neurons. However, subtle differences in the behavioral and neurochemical effects between anandamide and THC could be observed.

[Specificity of CK-MB enzyme in the diagnosis of acute myocardial infarction in the postoperative period following non-cardiac surgery]

OBJECTIVES

1) To determine plasma concentrations of creatinphosphokinase-MB (CK-MB) enzyme during non-cardiac surgery for detecting postoperative myocardial infarction or ischemia. 2) To assess the specificity of CK-MB levels for the diagnosis of acute myocardial infarction (AMI) in patients undergoing non-cardiac surgery.

PATIENTS AND METHOD

Three hundred twenty-eight patients were studied prospectively. Inclusion criteria were as follows: 1) presenting cardiac risk factors; 2) major surgery; and 3) presence of associated pathology, unrelated to cardiac pathology. All patients were given an electrocardiogram and CK-MB levels were determined every 8 hours over the first 24 hours and on the second and third days. Total CK was measured at 24 hours.

RESULTS

AMI was detected by electrocardiogram in 3.3% of the patients. ST-segment/T-wave changes were detected in 5.7% and myocardial ischemia was found in 14.7%. Mean levels of CK-MB in patients with postoperative AMI were significantly higher than in patients without AMI. Total CK levels in patients with electrocardiographic changes were not significantly different from those of other patients. Thoracic surgery produced a significant increase in total CK but no increase in CK-MB. Patients undergoing esophageal surgery presented high initial levels of CK-MB that became normal.

CONCLUSIONS

1) The CK-MB/total CK ratio is highly specific for detection AMI after surgery. 2) Type of surgery affects total CK levels. 3) Detection of high levels of MB fraction should lead to a suspicion of myocardial damage. 4) Total CK level is not a good marker of myocardial necrosis in the postoperative period.

[Mortality in the acute phase of cerebrovascular disease: the registry of La Alianza-Hospital Central of Barcelona]

BACKGROUND

Few studies have been performed on mortality from acute cerebrovascular disease (ACVD) during hospital admission, particularly in Spain.

METHODS

A prospective clinical analysis was performed in 1,356 consecutive patients with ACVD included in the Registry of Cerebrovascular Disease of the Central La Alianza-Hospital in Barcelona (1986-1992) with the aim of analyzing the causes of mortality during the acute phase of the disease and the time of hospital survival.

RESULTS

The mortality of the series was 16% (13% from cerebral infarction and 29% from cerebral hemorrhage; p < 0.0001). The causes of mortality were not neurologic in 49%, neurologic in 42% and of unknown cause in 9%. The principal causes of death were: transtentorial herniation/compression of the cerebral trunk (TH/CCT) 34%, pneumonia 14%, sepsis 14% and heart disease 11%. TH/CCT was more frequent on hemorrhage than on cerebral infarction (50% vs 27%; p < 0.001) while heart diseases were more frequent in cerebral infarction (14% vs 3%, p < 0.03). TH/CCT was the most common cause of death during the first seven days, with the pneumonia-sepsis-pulmonary thromboembolism being the most common after the third week. On the other hand, heart disease and sudden death showed homogeneous presentation with regard to frequency.

CONCLUSIONS

The causes of death during the acute phase of acute cerebrovascular disease are principally non neurologic (49%) being potentially preventable with the most frequent causes of death being from pneumonia, sepsis and pulmonary thromboembolism. Mortality of these patients may be decreased on correct diagnosis and treatment.

Phase II study of transarterial embolization in European patients with hepatocellular carcinoma: need for controlled trials

Our uncontrolled phase II study was aimed at assessing the efficacy of transarterial embolization in patients with hepatocellular carcinoma and to determine the parameters associated with a favorable response to treatment, improved survival or both. Fifty consecutive patients (25 corresponding to Okuda's stage I and 25 to stage II) with hepatocellular carcinoma (41 being multinodular or massive) were included. Transarterial embolization induced a self limited postembolization syndrome that was well tolerated. Nevertheless, three patients died shortly after the procedure because of tumor progression (two cases) or progressive liver failure. A favorable response (extensive necrosis with reduction of tumor area greater than 50%) was achieved in 81% of the cases, and this result was independently (p < 0.05) related to a preserved performance status and to a lower alpha-fetoprotein concentration. The survival of the patients at 1 and 2 yr was 65% and 38%, respectively, better than the expected survival according to a mathematical model obtained from a historical series of untreated cases (42% and 20%, respectively). Cox regression analysis disclosed that both a favorable therapeutic response and a preserved physical condition (reflected by performance status of 0 or 1) were independently associated with better survival (regression coefficient -2.248 and 0.869, respectively). These data indicate that transarterial embolization has a marked antitumoral effect in patients with inoperable hepatocellular carcinoma and that the therapeutic success is associated with improved survival. Nevertheless, because the potential benefit for survival observed in this uncontrolled study appears to be moderate, prospective controlled trials to ascertain the real usefulness of this therapeutic approach are mandatory.

[Peroperative myocardial infarction and myocardial ischemia in non cardiac surgery: prevalence and predictive factors]

BACKGROUND

The decrease in the prevalence of infarction in the population has not been accompanied by a reduction in postinfarct mortality, particularly in the population segment which does not present major symptoms of coronary disease. The aim of the present study was to determine the incidence and predictive factors of cardiac complications in patients undergoing non cardiac surgery.

METHODS

Eight hundred seventy-five patients undergoing elective surgery from May 1990-1991 had some of the following criteria: history of heart disease, major surgery, and medical risk other than cardiac. A sample of 328 patients was selected to whom an ECG an CK-MB isoenzyme test were performed on admission, every 8 h, and at the second and third days. Infarction or ischemia were diagnosed by electrocardiographic and enzymatic criteria. Minimum follow up was 72 hours.

RESULTS

IAM was diagnosed in 10 cases (3%, confidence interval 95%, 2 to 4%) and ischemia in 47 cases (14%, CI 95%, 11 to 18%). Operative mortality of cardiac origin was 4% (CI 95%, 2 to 6%). Arrhythmia not preoperatively present was detected in 11%, hemodynamic instability in 25%, and sinusal tachycardia in 21%. Other complications were: abdominal 12%, respiratory 14%, neurologic 6% and renal 4%. The appearance of cardiac complications was related with: ASA classification (p < 0.05), previous history of heart disease (p < 0.01), cardiovascular drug administration (p < 0.01) and changes in preoperative electrocardiogram (p < 0.001).

CONCLUSIONS

The present study suggests that patients with changes of the ST-T segment in the preoperative ECG should undergo examination to determine the degree of cardiac involvement. A strict peroperative hemodynamic control may reduce the prevalence of cardiac complications in those patients at high risk.

Leishmania braziliensis causing visceral leishmaniasis in a patient with human immunodeficiency virus infection, identified with the aid of the polymerase chain reaction

This study describes a male patient with human immunodeficiency virus infection, grade IV-C (oropharyngeal moniliasis and Pneumocystis carinii pneumonia), associated with visceral involvement produced by Leishmania braziliensis which was identified by deoxyribonucleic acid hybridization after the polymerase chain reaction had been performed. The patient was treated with molgramostim in association with meglumine antimonate to enhance macrophage destruction of parasites.

[Thyroid nodule disease in a previously endemic goiter area]

We conducted a 6-year study of 110 patients with thyroid nodular disease in a previously goitrogenic area. The aim of the present work was to establish its incidence, to determine if multinodular goiter and autonomous thyroid nodule have the same analytical and clinical behaviour and to verify if the iodation campaign had resulted in the development of thyrotoxicosis induced by iodine. The results demonstrated an incidence of 0.4 per 1,000 population and per year. The two modalities of thyroid nodular disease did not present any clinical and analytical differences. 58.2% of the patients had hyperthyroidism, 53.1% of which were T-4 thyrotoxicosis, 12.5% T-3 thyrotoxicosis and 34.4%, subclinical hyperthyroidism. 8.2% of the patients under study had hyperthyroidism induced by iodine (Jod Basedow), with iodide excretion values higher that 3 standard deviations with respect to the population average (> 220 micrograms/g creatinine).

[Local synthesis of immunoglobulins in neuropathies]

It is essential to know how the immune system acts in different neurological diseases, some of them non very well known or of unknown etiology at all. It was applied Reiber and Felgenhauer's formula in 56 patients with different diseases. IgA, IgM, IgG and albumin were quantified in sera and cerebrospinal fluid by simple immunodiffusion. It was observed more frequent IgG local synthesis and IgA in this sample.

[An analysis of 1000 consecutive patients with acute cerebrovascular disease. The registry of cerebrovascular disease of La Alianza-Hospital Central of Barcelona]

BACKGROUND

Registries of cerebral vascular disease (CVD) are useful in the study of the natural history of acute cerebrovascular disease (ACBD). Nonetheless there are few series which analyze the different stroke subtypes (SS) of CVD.

METHODS

A descriptive and comparative clinical analysis was performed of the different SS of CVD from the registry of CVD of the La Alianza-Central Hospital of Barcelona (Spain). A prospective study of 1,000 consecutive patients with ACVD admitted in the Neurology Department from 1986-1991 was carried out. The registry recommended by the Study Group of Cerebrovascular Diseases of the Sociedad Española de Neurología (SEN) were used and the stroke subtypes classified in agreement with the Glossary of Neurology of the SEN.

RESULTS

The mean age of the series was of 71 +/- 13 years with 537 patients being males. The frequency of the stroke subtypes in focal cerebral ischemia (FCI) was: thrombotic infarction 26%, lacunar infarction 16.9%, essential infarction 14.8%, cardioembolic infarction 12.4%, transient ischemic attacks 9% and infarction of unusual cause 3.5%. The frequency of the SS in cerebral hemorrhage (CH) was: intraparenchymatous hemorrhage 14.1%, subarachnoid hemorrhage 2.0%, subdural hematoma 1.2% and epidural hematoma 0.1%. Mortality of the series was 16.7% predominating in CH (28%) versus FCI (14%) (p < 0.00001). This was found to be greatest in cases of intraparenchymatous hemorrhage (31%) and in the cardioembolic infarction (28%) and lowest in the lacunar infarctions (0.6%).

CONCLUSIONS

The most common stroke subtypes were those of thrombotic infarctions, lacunar infarctions and intraparenchymal hemorrhages. Essential infarctions constitute 14.8% of acute cerebral vascular disease. The classification of cerebral vascular disease in its different subtypes is recommendable since this has prognostic and therapeutic implications.

[A urinary outbreak of Acinetobacter baumanii in a spinal cord injury unit]

From January 1990 to April 1992, 114 urinary strains of Acinetobacter baumanii were isolated in 57 patients with traumatic spinal cord [correction of medular] injury. The strains were characterized by having all of them the same biochemical identification, except for citrate, maltose and tryptophan-desaminase. Until December 1990, (5 strains) were resistant to all antibiotics, except to tobramicine, amikacine, cotrimoxazol and imipenem (6.3%, 33.9%, 26.7% and 0% of resistances, respectively); since January 1991, (99 strains) became resistant to all of them, except to imipenem. 39.5% of AB were isolated in pure cultures, 46% of them with pyuria. Between February 1991 and January 1992, we observed the highest number of affected patients, although without seasonal predominance. We observed as well a higher incidence among males (46 males, 11 females). 80% of them carried a permanent probe. Only 6 patients presented clinical signs directly related to AB. The environmental study could not demonstrate any source of contagion or transmission mechanism.

[Splenectomy in childhood. Review of a case load]

We review the cases of splenectomy performed in children between 1974 and 1988. During this period, we performed 24 splenectomy procedures, none of which were done as a result of injury. Most patients were between 5 to 10 years of age and had the splenectomy as a result of hemolytic disease. Antibiotic prophylaxis and anti-pneumococcic vaccination preceded splenectomy, resulting in a low morbidity and mortality. This report emphasizes the indications for splenectomy, a decrease in its frequency, variations in its etiology and the low incidence of surgical complications.

[Normal values of hemoglobin, hematocrit, blood coagulation factors, and fibrinolysis in New Zealand white rabbits]

PURPOSE

To assess the normal rates of several haematological parameters along with coagulation and fibrinolysis values.

MATERIAL AND METHODS

Male white New Zealand rabbits weighting between 1.5 and 2.5 kg. were used in variable amounts for each test (117-102). The following haematological determinations were carried out: haemoglobin, haematocrit, platelet count, and peripheral blood cell morphology. Prothrombin time, kaolin-activated partial thromboplastin time and thrombin time were assessed as well. Fibrinogen, plasminogen, prothrombin, factor V, factor X and factor XIII assays were also performed, along with tests for fibrinolytic activity and assay of fibrin and fibrinogen degradation products. All tests were compared with samples of pooled human and rabbit plasma. A statistical study was carried out including mean, mode, standard deviation, variation coefficient, confidence interval and chi square test plus Kolmogorow-Smirnoff test for normality assessment.

RESULTS

The curves attained after plotting the figures for haematocrit, haemoglobin, platelet count, kaolin-activated partial thromboplastin time, thrombin time and factors II and X approached the normal values (p > 0.05). Asymmetric curves were achieved for fibrinogen, prothrombin time and plasminogen (p < 0.005). Rabbit anti-fibrinogen serum reacted with rabbit plasma and fibrinogen, but failed to react against human samples. No fibrin and/or fibrinogen degradation products were detected and no fibrinolytic activity was observed on fibrin plate assays.

CONCLUSIONS

White New Zealand rabbits have values for haemoglobin, haematocrit and fibrinogen similar to the human ones. On the contrary, factors V, X and XIII, along with plasminogen, are in higher concentration, especially the former. Factor II is present at about half the human concentration. No fibrinolytic activity could be demonstrated with the methods used here.

Legionellae isolated from clinical and environmental samples in Spain (1983-90): monoclonal typing of Legionella pneumophila serogroup 1 isolates

Legionella isolates recovered in 21 different Spanish provinces over 8 years from both clinical (67 isolates) and environmental (181) samples, mostly from case-associated buildings, are described; 92.5% of clinical isolates were L. pneumophila serogroup 1 (SG1), only five isolates belonging to other species or serogroups: two L. pneumophila SG6, two SG8 and one L. bozemanii SG1 not clearly related with clinical infection. L. pneumophila SG1 accounted for 53.6% of isolates from the environment, followed by SG8 (27.6%), SG3 (9.4%) and SG6 (7.2%). Three isolates were labelled as SG8/10. Subtyping of L. pneumophila SG1 by the standardized panel of monoclonal antibodies revealed 90.3% of clinical and 78.3% of environmental isolates as belonging to Pontiac subgroup. Pontiac isolates were further divided into 55.3% Philadelphia 1 or Allentown 1, 21.9% Benidorm 030E and 20.4% Knoxville 1. Characterization of samples from four outbreaks in which both clinical and environmental isolates had been recovered permitted the recognition of three Philadelphia 1 or Allentown 1 and one Knoxville 1 strains as the aetiological agents.

[Surgical treatment of uretero-vaginal fistulae caused by gynecologic surgery]

The present paper is a review of 71 cases of uretero-vaginal fistulae secondary to pelvic surgery which were treated in the Urology Unit of our hospital. Surgical management of these fistula intrinsically depends on their number, location and severity. The results obtained by the different techniques were analyzed, emphasizing their merit when using the Turner-Warwick technique (uretero-cystoneostomy on psoic bladder) and any urodynamic troubles this technique can bring about when used bilaterally in patients from radical gynaecological surgery.

[The use of the determination of plasma theophylline concentrations in the hospital]

BACKGROUND

The evaluation of the determination of plasmatic concentrations of theophylline (PCT) in clinical practice is scarce. An observational study was carried out with the aim of discerning the reasons why PCT determinations are requested, the theophyllinemias obtained and the attitude of the medical staff in a hospital.

METHODS

PCT determinations obtained in 113 patients over a period of 3 months were analyzed. Information concerning treatment and daily doses of theophylline, reasons for theophylline determination, apart from those included in the request for theophyllinemia determination, clinical history and treatment sheets were collected.

RESULTS

Treatment with theophylline had been indicated in 78 patients (69%) with chronic bronchitis, and 30 (26%) with asthma. All the patients received medication in addition to theophylline. Daily dosage (SD) was 734 (260) mg and the daily doses as to body weight (SD) was 11 (4) mg/kg/day. 188 DNPT were performed, however 22 (12%) were inadequate; of the remaining 166 PCT determinations 117 (69%) had been requested with no indication of insufficient clinical response, suspicion of undesirable effects or modifying factors of the pharmacokinetics of theophylline. The mean plasmatic concentration (SD) was 11.3 (7) micrograms/ml. PCT was infratherapeutic in 74 PCT determinations (44%), therapeutic in 73 (44%) and toxic in 19 (11%). Therapeutic concentrations were obtained in only 16 (35%) of the 45 patients in whom a second PCT determination had been carried out.

CONCLUSIONS

In this study scarce individualization in the indication of treatment and the doses of theophylline administered are observed. The reason for soliciting determination of theophyllinemia and dosage adjustment in terms of plasmatic concentrations are also commented upon.

Rapid determination of beta-aminoisobutyric acid by reversed-phase high-performance liquid chromatography

For the determination of beta-aminoisobutyric acid (BAIBA) in urine samples in which the beta-alanine concentrations are higher than those of BAIBA, the resolution between these two amino acids, separated by reversed-phase liquid chromatography on an octadecylsilane column, was optimized. The chromatographic analysis included precolumn derivatization of amino acids with o-phthalaldehyde, followed by a 15-min isocratic elution and detection at 340 nm. Because of its simplicity, this method should be useful for monitoring urinary excretion of BAIBA.

Psychogenic pain and depressive disorders: an empirical study

A sample of 31 patients of both sexes suffering from psychogenic pain disorder (DSM-III) were studied in order to test if their clinical and biological features as well as their response to antidepressant treatment support the hypothesis that relates this syndrome to depressive disorders. Biological variables were basal cortisol and dexamethasone suppression test, and treatment consisted of daily administration of 100-175 mg of imipramine for a period of 5 months. Mood state was evaluated by the Hamilton scale and pain was assessed through visual analogue scales immediately before starting treatment and 3 months later. There was a low prevalence of non-suppressors (9.6%) and all patients significantly improved in mood and pain after antidepressant treatment. However, general results support both the hypothesis linking psychogenic pain to depressive disorders and its possible understanding in terms of failed adjustment processes.

Embolomycotic aneurysm of external iliac artery: producing ipsilateral hydronephrosis and venous insufficiency

We report a case of embolomycotic aneurysm of the right iliac artery secondary to bacterial endocarditis. The patient, a 33-year-old woman, presented with unilateral hydronephrosis and lower extremity edema caused by aneurysmal compression of the ipsilateral ureter and the external iliac vein. She was treated with ligation and an extraperitoneal left-external-iliac-artery to right-femoral-artery bypass using a knitted Dacron prosthesis. Since her surgery, our patient has been well except for persistence of moderate leg edema. To the best of our knowledge, we are reporting the 1st case of embolomycotic external-iliac-artery aneurysm secondary to bacterial endocarditis and resulting in hydronephrosis and venous insufficiency.

Reduced levels of uridine diphosphate glucose pyrophosphorylase activity in fetal and neonatal human and guinea pig liver

Uridine diphosphate glucose pyrophosphorylase (UDPGPP) is the first enzyme in the bilirubin conjugation pathway. A study aiming to screen for red blood cell UDPGPP deficiency in newborns with hyperbilirubinemia was carried out. No individuals with severe UDPGPP deficiency were found, however, levels of UDPGPP in premature and at term newborns were lower than in adults. These findings led to the study of UDPGPP in human fetal, neonatal and adult liver, using guinea pig tissues as a parallel control. UDPGPP activities in fetal and neonatal samples were also significantly lower than in adult ones in both species. Therefore, it is postulated that the reduced levels of UDPGPP in fetal and neonatal liver could be a factor which contributes to the pathogenesis of the physiologic jaundice in human newborns.

Persistence of elevated levels of galactosyl-alpha(1-3)galactose antibodies in sera from patients cured of visceral leishmaniasis

Using rabbit erythrocyte-derived neutral glycosphingolipids enriched for a ceramide pentasaccharide as the antigen, we detected elevated anti-galactosyl-alpha(1-3)galactose (anti-G alpha G) antibody levels in 76% of children with active visceral leishmaniasis (kala-azar [KA]) and in 42% of clinically cured patients with KA who had been treated about 5 years previously with meglumine antimonate (30 mg/kg in a series of 15 daily injections). The long-term persistence of elevated G alpha G antibodies was also found in 56% of children living in the same geographic zone who, at the time of the initial clinical examination, had fever and evident splenomegaly with hyperglobulinemia but a negative bone marrow aspirate for leishmanial bodies. Five years after antimonate treatment, these clinically cured children with presumptive KA were studied serologically. Their mean G alpha G antibody values were slightly lower than those in patients with active KA but were still abnormal. Using different biochemical and immunological approaches, we found that elevated G alpha G antibodies present in patients with KA bound specifically to glycoconjugates with an alpha(1-3)-terminal galactose residue. G alpha G antibodies were mainly distributed between immunoglobulin classes G and M in patients with active KA and in antimonate-treated patients with clinically cured KA. The possibility of the existence of remnant living parasites or the persistence of inserted G alpha G epitopes in parasitized macrophages was proposed as a mechanism to explain the long-term persistence of abnormal G alpha G antibodies in patients apparently cured of KA.