Changes in workflow to a University Pharmacy to facilitate compounding and distribution of antiseptics for use against COVID-19

This article is a report from an experience about a work developed by Farmácia Universitária at UFRJ (FU-UFRJ) during the nCov-19 pandemic period. The aim of this work was to describe its contribution in the production of antiseptic supplies used to prevent contagion by the new coronavirus. The work routine at the pharmacy has been changed to allow the implementation of local workflow during the pandemic, and to adapt the protection rules to meet the safety measures. FU-UFRJ started to manipulate two antiseptic formulations: 70% ethyl alcohol and gel alcohol, which are included in the National Form, manufacturing around 100 L of these formulations, weekly, to donate to different health units. The experience enabled the adaptation to emergency health standards, planning and meaningful guidance to pharmacists and technicians to attend clinics at university hospitals, vaccination center and UFRJ city hall, in order to facilitate the access to adequate hand hygiene to the population.

Nanovesicle-based formulations for photoprotection: a safety and efficacy approach

Vesicular nanosystems are versatile and they are able to encapsulate actives with different solubilities, such as lipophilic and hydrophilic compounds. The most well-known vesicular nanosystems are liposomes and niosomes, the last one is formed by non-ionic surfactants. In the present work, we developed photoprotective niosomes containing sunscreens (octyl methoxycinnamate, diethylamino hydroxybenzoyl hexyl benzoate and phenylbenzimidazole sulfonic acid), non-ionic surfactants, cholesterol and stearylamine (positive-charged lipid). Studies based on dynamic light scattering techniques, entrapment efficiency and morphology by transmission electron microscopy were performed to characterize the niosomes. In addition, rheology, pH, in vitro sun protection factor (SPF) efficacy and toxicity and in vivo and in vitro safety were determined for the niosome formulations F-N1 and F-N2. The mean sizes of N1 and N2 were 168 ± 5 nm and 192 ± 8 nm, respectively, and their morphologies were spherical, unilamellar and with an entrapment efficiency of more than 45% for each sunscreen. Both formulations, F-N1 and F-N2 presented characteristics of pseudoplastic non-Newtonian fluids, showing declining viscosity with increasing shear rate applied. SPF values were considered satisfactory, 34 ± 8 for formulation F-N1 and 34 ± 5 for F-N2. The formulations did not present toxicity when tested in macrophages and the pH was compatible with skin, which minimizes allergies. The in vitro safety assay showed lipophilic sunscreens greater affinity for the epidermis, since this layer contains natural lipids. In vivo safety assay suggests that the increased skin retention of N2 is directly correlated with the positive charge of stearylamine. Stable photoprotective niosomes were obtained and were shown to be promising nanostructures to be used against solar radiation.

Colorectal Adenocarcinoma: Imaging using 5-Fluoracil Nanoparticles Labeled with Technetium 99 Metastable

BACKGROUND

Adenocarcinoma of colon and rectum are one of the most common cancers worldwide, responsible for over 1,300,000 people diagnosed. Also, they are responsible for metastasis, which leads to death in less than 5 years.

METHODS

In this study, we developed, characterized, and pre-clinically tested a new nano-radiopharmaceutical for early and differential detection of adenocarcinoma of colon and rectum.

RESULTS AND CONCLUSION

Results demonstrated the specificity of the developed nanosystem and the ability to reach the tumor with very specific targeting. Also, the imaging data support the use of this nano-agent as a nanoimaging-guided-radiopharmaceutical.

Haemostatic Studies in Carbohydrate-deficient Glycoprotein Syndrome Type I

CDG syndrome (CDGS) type I is the most frequent form of a group of metabolic disorders characterised by a defect of the carbohydrate moiety of glycoproteins. A large number of plasma glycoproteins, including clotting factors and inhibitors, are decreased and stroke-like episodes have been described in about half of the reported patients. We studied blood coagulation factors, inhibitors and D-dimer plasma levels in four subjects, aged 12-23 years, with CDGS type I. Factors VIII, XI, antithrombin III activity, antigen plasma levels of antithrombin III, free protein S and protein C were decreased whereas protein C as activity was normal. In addition two patients had reduction of factors II, V, VII, IX, X reflecting the phenotypic heterogeneity associated with CDGS type I. D-dimer plasma concentrations were elevated in all subjects. The hypercoagulable state as consequence of the combined deficiencies of coagulation inhibitors could contribute to the stroke-like phenomena in CDGS type I.

The yogurt amino acid profile's variation during the shelf-life

OBJECTIVE

To analyze the yogurt amino acid profile starting from marketing through the whole shelf-life. The evaluation of the proteolytic activity of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus salivarius subsp. thermophilus, allows to deduce their vitality during the shelf-life period and within 45 days.

METHODS

Three types of full fats yogurts have been analyzed (a) natural white (b) sweet white and (c) whole fruit - in two stages: t0 (first day of shelf-life) and t1 (end of shelf-life). The proteins have been analyzed by the Kjeldahl method and the amino acid profile by HPLC.

RESULTS

In natural yogurt a significant increase of the amount of free amino acids has been observed during the period of shelf-life (97%). In the sweetened full fats and fruit yogurt, instead, there is a lower increase of respectively 33% and 39%

CONCLUSIONS

In whole milk natural yogurt, based on our data, the proteolytic activity seems to persist during the entire period of the shelf-life and this can be considered an index of bacterial survival, especially of Lactobacillus delbrueckii subsp. bulgaricus during the marketing process.

[Hemodiafiltration with endogenous reinfusion in chronic inflammation: a possible therapeutic alternative?]

The patients under maintenance haemodialysis (HD) continue to have an unacceptably excess of mortality compared to general population, that may be explained by high prevalence of inflammation that significantly influences the survival of these patients. Indeed, chronic inflammation is very common in HD and it may cause malnutrition and progression of atherosclerotic disease by several pathogenetic mechanisms triggered by pro-inflammatory cytokines. Currently no pharmacological intervention is specifically targeted the idiopathic chronic inflammation. Hemodiafiltration with endogenous reinfusion (HFR) is a dialysis technique, highly biocompatible, that combines three depurative mechanisms: diffusion, convection and absorption. The ultrafiltrate is obtained from convective section of dialyzer (convection). It is regenerated by passing through the adsorbent macro-porous synthetic resin cartridge (absorption) and then it is reinfused into the second section of the filter (diffusion). This resin cartridge is able to absorb cytokines and other uremic toxins, whereas allows to pass nutrients and antioxidants, as amino acids and vitamins, with a consequent decrement of inflammation and oxidative stress. These characteristics suggest the use of HFR in HD patients affected by overt and idiopathic chronic inflammation. In these patients, we observed that the switching from Bic-HD to HFR allowed an improvement of inflammatory as testified by a significant decrement of serum levels of CRP IL-6, IL-1 and TNF- and a significant increase of albumin and pre-albumin. Whether these favorable effects may modify the outcomes of these high-risk patients, needs to be confirmed by studies ad-hoc.

First Report of Leaf Spot Caused by Cylindrocladium pauciramosum on Dwarf Willow Myrtle in Italy

Dwarf willow myrtle (Agonis flexuosa (Willd.) Sweet) cv. Nana, an evergreen ornamental shrub belonging to the Myrtaceae, is grown in Italy as an ornamental potted plant. In November 2008, a widespread new leaf spot disease was noticed on ~80% of 5,000 6-month-old potted plants. Plants were obtained from cuttings and produced by a commercial nursery in Catania Province. Symptomatic leaves showed minute, reddish brown spots that enlarged (3 to 5 mm in diameter) and then darkened, presenting a necrotic center defined by a dark purple halo. Leaf spots were surface disinfested with 0.8% NaOCl and plated on potato dextrose agar. Twenty isolates of the fungus that was consistently isolated from the spots were selected and cultured for 8 days at 25°C on carnation leaf agar (CLA). Macroconidiophores consisted of a stipe, a penicillate arrangement of fertile branches, and stipe extension terminating in an obpyriform to ellipsoidal vesicle (6 to 10 μm in diameter). Cylindrical conidia were rounded at both ends, straight, one-septate, and ranged from 44 to 60 × 4 to 5 μm. The fungus was tentatively identified as Cylindrocladium pauciramosum based on these morphological characteristics (2). All single-conidium isolates were mated with tester strains of Calonectria pauciramosa C. L. Schoch & Crous, telomorph of C. pauciramosum, on CLA and produced fertile perithecia (4). Perithecia were solitary or in groups, orange to red-brown, subglobose to ovoid, and ranged from 280 to 400 μm long × 180 to 290 μm in diameter. Further confirmation of species was obtained by amplification and sequencing of the intergenic spacer (IGS) region of rDNA, using M13 Forward (-20) and M13 Reverse primers. On the basis of the complete IGS sequence, two primer sets (218F/218R and 106F/106R) were designed and successfully used in a nested-PCR protocol for the detection of C. pauciramosum from tissues of infected plants (3). On the basis of the combination of morphological characters, mating type, and molecular data, the isolates were identified as C. pauciramosum C.L. Schoch & Crous. One representative isolate (DISTEF-Af1) was deposited at Centraalbureau voor Schimmelcultures open fungi collection (Fungal Biodiversity Centre, Utrecht, the Netherlands; CBS 124659). Pathogenicity tests were performed by adding sterile water to CLA cultures of C. pauciramosum from a single-conidium isolate (DISTEF-Af1) and spraying the resulting spore suspension (10⁵ conidia per ml) on the leaf surface of 20 6-month-old A. flexuosa cv. Nana potted plants. The same number of plants served as noninoculated controls. Following inoculation, plants were kept in plastic bags in a growth chamber at 25 ± 1°C. All inoculated plants developed circular, brown leaf spots identical to those observed in the nursery 5 to 7 days after inoculation. Control plants remained symptomless. C. pauciramosum was always reisolated from the infected plants and identified as previously described. Leaf spotting in seedlings of A. flexuosa was previously associated with infections by C. scoparium in Australia (1). To our knowledge, this is the first record in the world of leaf spots caused by C. pauciramosum on A. flexuosa. References: (1) A. L. Bertus. Agric. Gaz. N. S. W. 87:22, 1976. (2) P. W. Crous. Taxonomy and Pathology of Cylindrocladium (Calonectria) and Allied Genera. The American Phytopathological Society, St. Paul MN, 2002. (3) F. Nigro et al. J. Plant Pathol. 88:S22, 2006. (4) G. Polizzi and P. W. Crous. Eur. J. Plant Pathol. 105:407, 1999.

Management of sodium-channel blocker poisoning: the role of hypertonic sodium salts

Sodium-channel blockers act by slowing sodium influx into myocytes through voltage gated channels. Many substances have sodium-channel blocking properties and many others show this effect when taken in overdose. Sodium-channel blocker poisoning, associated with a high death rate, is characterized by a variety of clinical presentation, depending on the pharmaceutical agent involved. Sodium bicarbonate or lactate, increasing serum pH and extracellular concentration of the ion, displace the drug from its receptor sites and can be used for the treatment of cardiac toxicity in the setting of sodium-channel blocker poisoning. In spite of this theoretical assumption, the role played by hypertonic sodium salts is not well elucidated and conflicting results have been reported. Authors review the pathophysiologic mechanisms of sodium-channel blocker poisoning and the evidences in literature concerning the efficacy of hypertonic sodium salts in the treatment of the related toxicity.

First Report of Crown Rot Caused by Cylindrocladium pauciramosum on Scarlet Honey Myrtle in Italy

Scarlet honey myrtle (Melaleuca fulgens R. Br.), native to Australia, is an evergreen colorful shrub (Myrtaceae) and grown in Italy as an ornamental plant. During November 2008, a widespread disease was noticed on ~90% of 3,000 6-month-old M. fulgens cv. Red potted plants. Plants were obtained from cuttings and produced by a commercial nursery in Catania Province. Symptomatic plants showed a crown rot and longitudinal sections of tissues revealed a brown discoloration of the basal stem. As a consequence, leaves gradually became necrotic and abscised, followed by death of the entire plant. Root rots and leaf spots were not observed. M. gibbosa, M. ericifolia, M. thymifolia, and M. elliptica, cultivated in the same nursery, did not show disease symptoms. A Cylindrocladium sp. was consistently isolated from the crown and basal stem of symptomatic plants on potato dextrose agar (1). Ten Cylindrocladium isolates obtained from infected basal stems and crowns were selected and cultured for 8 days at 25°C on carnation leaf agar (CLA). Macroconidiophores consisted of a stipe, a penicillate arrangement, and a stipe extension terminating in an obpyriform to ellipsoidal vesicle (6 to 10 μm in diameter). Cylindrical conidia were rounded at both ends, straight, 1-septate, and 42 to 60 × 4 to 5 μm. All single-conidial isolates were mated with opposite tester strains of C. pauciramosum on CLA and produced fertile perithecia (3). Perithecia were solitary or in groups, orange to red-brown, subglobose to ovoid, and 270 to 400 μm high × 180 to 290 μm in diameter. Further confirmation of species was obtained by amplification and sequencing of the intergenic spacer (IGS) region of rDNA with the M13 forward (-20) and M13 reverse primers. On the basis of the complete IGS sequence, two primer sets (218F/218R and 106F/106R) were designed and successfully used in a nested-PCR protocol for the detection of C. pauciramosum from tissues of infected plants (2). On the basis of morphological characters, mating type, and molecular data, the isolates were identified as C. pauciramosum C.L. Schoch & Crous. One representative isolate (DISTEF-MFR2; CBS 124657) was deposited at Centraalbureau voor Schimmelcultures open fungi collection (Fungal Biodiversity Centre, Utrecht, the Netherlands). Pathogenicity tests were performed by adding sterile water to CLA cultures of C. pauciramosum from a single-conidial isolate and incorporating the resulting spore suspension (10⁵ conidia per ml) on the soil surface of 20 3-month-old M. fulgens cv. Red potted plants. The same number of plants served as uninoculated controls. Following inoculation, plants were well irrigated and maintained in a growth chamber at 25 ± 1°C and 90 to 95% relative humidity. All inoculated plants developed crown rot symptoms identical to those observed in the nursery 2 months after inoculation. Control plants remained symptomless. C. pauciramosum was always reisolated from the infected plants and identified as previously described. C. pauciramosum was previously detected in Italy as being responsible for a leaf spot on M. hypericifolia (3). To our knowledge, this is the first record in the world of crown rot of scarlet honey myrtle caused by C. pauciramosum. References: (1) P. W. Crous. Taxonomy and Pathology of Cylindrocladium (Calonectria) and Allied Genera. The American Phytopathological Society, St. Paul MN, 2002. (2) F. Nigro et al. J. Plant Pathol. 88:S22, 2006. (3) G. Polizzi and P. W. Crous. Eur. J. Plant Pathol. 105:407, 1999.

Neutrophil gelatinase-associated lipocalin: a novel biomarker for the early diagnosis of acute kidney injury in the emergency department

Acute kidney injury (AKI) is a common medical problem among critical patients. In current clinical practice, AKI is diagnosed by measuring serum creatinine concentration, which is an unreliable and delayed marker of the deterioration of kidney function. Its rise occurs when a significant amount of renal function has been lost. Many are the factors able to modify physiological levels, such as age, gender, ethnicity, dietary protein intake, muscle mass or metabolism, hydration status and drugs. Definitely, creatinine, as well as blood urea nitrogen (BUN) or urine markers of kidney injury (fractional excretion of sodium, urinary concentrating ability, casts), do not directly reflect cell injury, but rather the delayed functional consequences of the damage. Due to the lack of sensitive and specific biomarkers, the identification of early stages of AKI has been impossible but, recently, neutrophil gelatinase-associated lipocalin (NGAL) is emerging as a novel biomarker of AKI from several etiologies, such as cardiac surgery, contrast nephropathy, kidney transplantation and sepsis. This protein, produced in a number of human tissues and particularly in the distal nephron, has siderophore-chelating property and acts as an iron-trasporting shuttle. NGAL increases in both serum and urine 48 hours before the rise of creatinine, and shows a strong correlation with change in creatinine concentrations. An early diagnosis of AKI allows the early institution of therapeutic measures for the protection of renal function and improves the prognosis. This possibility is particularly important in the Emergency Department for the treatment of critical patients with potential nefrotoxic therapies. Use of NGAL as early marker of AKI in the Emergency Department is discussed.

In vitro effect of amikacin on rat and human detrusor muscle contraction

INTRODUCTION

Normal and abnormal bladder contractions are principally mediated by acetylcholine released from postganglionic parasympathetic nerves. Since amikacin was reported to affect neurotransmission by a prejunctional mechanism, we investigated the effect of amikacin on isolated detrusor smooth muscle contraction to further evaluate its potential relaxant properties.

MATERIALS AND METHODS

Detrusor smooth muscle obtained from 15 rats and 8 patients undergoing surgery were studied through measurement of isometric muscular contraction induced with electrical field stimulation (EFS) (10-60 Hz), carbachol (10(-7) to 10(-3)M) and nicotine (10(-7) to 10(-3)M) in the presence or absence of 1 mM amikacin in a low-Ca medium.

RESULTS

Amikacin (1 mM) significantly reduced EFS-induced contraction of isolated rat and human detrusor muscle by 33 +/- 6.57% (p < 0.005) and 40 +/- 1.14% (p < 0.001), respectively. Contraction was restored after addition of calcium chloride (1 mM). The effect of amikacin was comparable to that of magnesium ions. Rat and human detrusor contractile response to nicotine was inhibited by 70 +/- 8.27% (p < 0.001) and 64 +/- 14.09% (p < 0.01) after the addition of amikacin (1 mM), while no significant effect was observed on carbachol-induced stimulation.

CONCLUSION

Amikacin significantly inhibited detrusor contraction evoked by prejunctional stimulation in vitro, suggesting a depressant effect on autonomic neurotransmission in urinary bladder.

Acute thrombosis of the renal artery secondary to closed abdominal trauma: our experience and literature revision

Aim

Thrombosis secondary to renal closed abdominal trauma is a rare event, most of the time it is clinically silent. We report here our experience.

Materials and Methods.

This is the case of a boy came to our observation after a road trauma with motorbike fall-out. The boy arrived in ED for head injury. The patient, stable for haemodynamics, had lacerated and contused injuries at pelvis and right buttock level. He underwent chest x-rays, brain CT and neurosurgery examination: all resulted negative. There was no macrohematuria, nor lumbar pain. Objectively abdomen was treatable. The patient was referred to temporary observation for 12 hours when he was asked to undergo abdomen ultrasound, which showed no documented lesions except for fluid collection at the pelvic level. To rule out all doubts, the patient had an abdominal CT scan, which showed a silent left kidney with suspected thrombosis at left renal level. The patient was sent to our attention after 15 hours: we decided to perform immediately selective arteriography with thrombus lysis. The arteriography documented a massive thrombosis. The thrombus lysis was impossible to be performed. To maintain the perfect functionality of the contralateral kidney we decided not to proceed further, but to perform only left nephrectomy. During surgery mesocolon laceration occurred, so the patient underwent also colic resection.

Discussion.

Thrombosis secondary to a closed renal abdominal trauma is an uncommon event, with little clinical expression. It is the consequence of an injury. Deceleration produces arterial dissection, which alters the blood flow to the kidney, which is then twisted and complicated with renal thrombosis. Quite common is the association with diaphragmatic rupture or urethral detachment. The alterations of renal parenchyma in the early hours are detectable only through CT scan, which represents the method of election, and which can highlight a functionally silent kidney.

Conclusions.

Renal thrombosis requires that diagnosis is done within the first 12 hours; a rapid revascularization should be promptly attempted.

[Acute thrombosis of the renal artery secondary to closed abdominal trauma: our experience and literature revision]

Thrombosis secondary to renal closed abdominal trauma is a rare event, most of the time it is clinically silent. We report here our experience. MATERIALS AND METHODS. This is the case of a boy came to our observation after a road trauma with motorbike fall-out. The boy arrived in ED for head injury. The patient, stable for haemodynamics, had lacerated and contused injuries at pelvis and right buttock level. He underwent chest x-rays, brain CT and neurosurgery examination: all resulted negative. There was no macrohematuria, nor lumbar pain. Objectively abdomen was treatable. The patient was referred to temporary observation for 12 hours when he was asked to undergo abdomen ultrasound, which showed no documented lesions except for fluid collection at the pelvic level. To rule out all doubts, the patient had an abdominal CT scan, which showed a silent left kidney with suspected thrombosis at left renal level. The patient was sent to our attention after 15 hours: we decided to perform immediately selective arteriography with thrombus lysis. The arteriography documented a massive thrombosis. The thrombus lysis was impossible to be performed. To maintain the perfect functionality of the contralateral kidney we decided not to proceed further, but to perform only left nephrectomy. During surgery mesocolon laceration occurred, so the patient underwent also colic resection. DISCUSSION. Thrombosis secondary to a closed renal abdominal trauma is an uncommon event, with little clinical expression. It is the consequence of an injury. Deceleration produces arterial dissection, which alters the blood flow to the kidney, which is then twisted and complicated with renal thrombosis. Quite common is the association with diaphragmatic rupture or urethral detachment. The alterations of renal parenchyma in the early hours are detectable only through CT scan, which represents the method of election, and which can highlight a functionally silent kidney. CONCLUSIONS. Renal thrombosis requires that diagnosis is done within the first 12 hours; a rapid revascularization should be promptly attempted.

Hypokalemic rhabdomyolysis in a patient with a laparoscopic adjustable gastric banding

Rhabdomyolysis is an acute skeletal muscle disorder characterized by altered integrity of the cell membranes of muscle fiber cells. It can be related to a variety of factors: muscular trauma, muscle enzyme deficiencies, infections, drugs, toxins, alcohol ingestion, endocrinopathies and electrolyte imbalances such as hypokalemia. We report the case of a 46-year-old woman admitted to the Emergency Department for frequent episodes of vomiting associated with food intake in the last two weeks, general muscular weakness and myalgia. Physical examination on admission was unremarkable, except for a symmetrical and dominantly proximal muscular weakness of all four extremities. Blood pressure was 116/70 mmHg with a sinus bradycardia (53 beats/min) on the electrocardiogram. Laboratory tests showed a metabolic alkalosis with marked hypokalemia (K+= 1.9 mEq/l) and elevation of muscular enzymes (myglobin= 993 ng/ml, troponin T= 0,10 ng/ml e CK= 1113 U/l). No symptoms of recurrent rhabdomyolysis were reported, patient denied alcohol consumption and there was not clinical evidence of hyperthyroidism. A iatrogenic etiology could not be excluded for certain because patient was in therapy with lansoprazole (Naranjo algorithm 3/13) but, revealing medical history that she underwent a laparoscopic adjustable gastric banding for the treatment of a severe obesity, we focused our attention on hypokalemia, due to persistent vomiting. Fasting, administration of metoclopramide and infusion of potassium chloride resulted in steady improvement of clinical conditions and normalization of electrolyte imbalance. At the clinical follow-up of three months, after partial deflation of the gastric banding, the patient was asymptomatic with muscular enzymes and potassium levels in the normal range. Authors discuss the pathophysiologic mechanisms of these alterations.

Metformin-induced lactic acidosis in a type 2 diabetic patient with acute renal failure

Metformin is a biguanide commonly used in type 2 diabetes mellitus (DM). Lactic acidosis, a potentially life-threatening metabolic disorder, may be due to a number of different causes, including metformin therapy. We present a case of a severe metformin-induced lactic acidosis in a patient with type 2 DM, admitted to the emergency department with a history of dehydration due to diarrhoea and complicated by acute renal failure. Patient complained malaise and severe weakness and was tachypneic (Kussmaul's respiration), agitated and confused, with a Glasgow Coma Scale score of 13/15. Heart rate was 75 b/min and blood pressure 110/80 mmHg. The pH was 6.87, HCO3- 3 mmol/l, lactate 15 mmol/l, potassium 6.9 mEq/l. The renal function was markedly impaired with a creatinine of 9.75 mg/dl, and pancreatic enzymes, amylase and lipase, were also increased in absence of abdominal pain. Patient was treated with intravenous fluids, bicarbonate infusion and haemodialysis with bicarbonate buffered replacement fluid. Clinical conditions improved rapidly, with a progressive normalization of the acid-base balance and the other laboratory data. Authors discuss the pathophysiologic mechanisms of these alterations with particular regard to the role played by metformin as potential cause of lactic acidosis.

Conversion to rapamycin immunosuppression for malignancy after kidney transplantation: case reports

INTRODUCTION

Malignancies are a well-known complication of immunosuppressive therapy among renal transplant recipients, representing an important cause of long-term morbidity and mortality. Rapamycin has been shown to limit the proliferation of a number of malignant cell lines in vivo and in vitro.

METHODS

Eight patients developed the following malignancies after kidney transplantation (mean 102.6 months; range 12 to 252): metastatic gastric cancer (n = 1), metastatic colon cancer (n = 1), bilateral nephrourothelioma (n = 1), skin cancer (n = 1), Kaposi's sarcoma (n = 2), posttransplant lymphoproliferative disorder (PTLD) (n = 2). After the diagnosis of malignancy, the patients were switched from calcineurin inhibitor-based immunosuppression to rapamycin (monotherapy, n = 2), associated with steroids (n = 4) or mycophenolate mofetil (n = 2).

RESULTS

Both patients with metastatic cancer underwent chemotherapy and then succummbed after 6 and 13 months. After a mean follow-up of 20.3 months (range 2 to 47), the remaining six patients are free from cancer disease. Renal graft function was unchanged from diagnosis throughout the follow-up.

CONCLUSION

Our observations suggested that rapamycin-based immunosuppression offered the possibility of regression of nonmetastatic tumors. Nevertheless, it is difficult to assess whether tumor regression was attributed to Rapamycin treatment or to the reduced immunosuppression.

Amikacin: A Novel Modulator of Vesical and Prostate Efferences. An in vitro Experimental Study

The autonomic efferent neurotransmission to the bladder and prostate smooth muscle is a potential target for drug therapy of specific low urinary tract disfunction (LUTD). Since amikacin and other amynoglicosides were reported to affect neurotransmission by a pre-junctional mechanism, we investigated the effect of amikacin on isolated rat and human detrusor smooth muscle contraction and on isolated rat and human prostate contraction, to further evaluate its potential relaxant properties.

Materials and Methods

Samples of detrusor smooth muscle and prostate tissue, obtained from 97 rats and 16 patients undergoing surgery, were studied through the measurement of isometric contraction induced by electrical field stimulation (EFS) and other pharmacological stimuli in the presence or absence of 1mM amikacin in a low-Ca medium.

Results

Amikacin 1 mM significantly reduced contraction of isolated rat and human detrusor muscle and prostate, achieved with pre-junctional stimulation, while no significant effect was observed on contraction induced by pharmacological post-junctional stimulators. EFS contraction inhibited by amikacin was restored after addition of calcium chloride. The amikacin effect was comparable to the effect of magnesium ions, which are known to exert a pre-junctional inhibition of neurotransmitter release.

Conclusions

Amikacin significantly inhibited rat and human detrusor and prostate contraction evoked by pre-junctional stimulation in vitro, suggesting a depressant effect on autonomic efferent neurotransmission. Further pharmacokinetics studies and researches on related compounds may hold potential for future development in the treatment of specific low urinary tract disfunction (LUTD).

Nitric oxide test during cardiac catheterization decreases the serum concentrations of S100B protein in adult patients with idiopathic pulmonary hypertension

OBJECTIVE

Cardiac catheterization (CC) is a life-threatening procedure in adult patients. Complicated by idiopathic arterial pulmonary hypertension (IPAH), there is a potential risk of central nervous system (CNS) damage. We measured serum levels of a well-established brain damage marker, namely S100B, collected before, during and after CC in adult patients in whom the nitric oxide (NO) test had been performed.

MATERIAL AND METHODS

In 12 adult patients who had undergone CC for IPAH diagnosis, we recorded clinical and standard monitoring procedures (laboratory variables and echocardiographic patterns) and serum concentrations of S100B before (time 0), during (time 1) and after the NO test (time 2) and at 24 h after (time 3) the procedure in samples obtained from the systemic and pulmonary circulation. Patients were subdivided into NO test responders (n=6) and non-responders (n=6). Neurological evaluation was performed at admission and at discharge from hospital.

RESULTS

Adult patients subjected to CC showed no overt neurological injury at discharge from hospital. No significant differences (p > 0.05 for all) in S100B serum levels between groups at times 0, 1 and 3 have been shown independently from the sampling site. It was noteworthy that the concentration of protein in the responders group at time 2 was significantly decreased (p < 0.05, for all) compared to the responder group and to baseline values. A significant correlation was found between arterial oxygen partial pressure and individual S100B concentration in the pulmonary and systemic bloodstream in the entire study group (R = -0.66 and R = 0.71, respectively; p < 0.05, for both).

CONCLUSIONS

The data suggest that S100B protein assessment, as well as the NO test, may be useful when monitoring possible CNS damage during CC in patients with IPAH, and may also be valuable in relation to brain functions, especially when performed as an emergency procedure in severely hypoxic patients.

First Record of Verticillium dahliae on Potato in Malta

Potato is an important and highly valued crop throughout the Maltese Archipelago. Much of the production is exported to Holland. In January 2005, minor wilts and chlorosis of potato plants were observed in a field at Hal-Farrug, Luqa (Malta). Verticillium dahliae Kleb (1) was isolated on potato dextrose agar (PDA) from vascular tissue excised from the base of the plants. Three different isolates were obtained, all of which were typically distinguished by verticillately shaped conidiophores and the abundant production of microsclerotia on PDA. In May 2005, colonies of these three isolates were cultured in potato dextrose broth (PDB), from which conidial suspensions of each isolate were prepared with sterile distilled water to a concentration of 10⁷ ml^-1. For each isolate, 10 7-day-old potato seedlings were inoculated via root immersion in the inoculum suspension and transplanted to 20-cm diameter plastic pots containing a soil/peat mixture (1:1 [v/v]). Seedlings treated in the same way with sterile distilled water were used as a control. All plants were kept under controlled glasshouse conditions (20 ± 3°C) and watered to field capacity as required. Minor chlorosis and wilt of the pair of lower-most leaves was noted 7 days after inoculation. During subsequent weeks, wilt began to appear in the typical half-leaf form, while chlorosis was noted on all organs of the plants, including the principal stem (3). Symptoms were absent on the control plants. Measuring the weight of the new tubers produced by each plant revealed no apparent difference between inoculated and healthy plants; nevertheless, inoculated plants resulted in more tubers with a smaller diameter in respect to those of the uninoculated plants. V. dahliae was never isolated from tubers. Little to no variation in symptom severity was noted among plants inoculated with the three individual isolates. At the end of June, V. dahliae was reisolated on PDA from all inoculated plants, in particular, from vascular tissues originating from principal and lateral stems, crowns, and roots. All attempts to isolate the pathogen from control plants were unsuccessful. Molecular detection of the pathogen by using species-specific primers and real-time Scorpion PCR (2) confirmed the results obtained by the classical isolation method. The low symptom severity observed by the growers in the field, usually mistaken for normal dieback of aged plants, might explain why V. dahliae was never reported before on potatoes in the Maltese Archipelago. References: (1) D. L. Hawksworth and P. W. Talboys. No. 256. Descriptions of Pathogenic Fungi and Bacteria. Commonwealth Mycological Institute (CMI), Kew, Surrey, UK, 1970. (2) F. Nigro et al. Pages 454-461 in: Proc. Convegno Internazionale di Olivicoltura. VI Giornate Scientifiche SOI, Spoleto, 2002. (3) W. R. Stevenson et al., eds. Compendium of Potato Diseases. 2nd ed. The American Phytopathological Society, St Paul, MN, 2001.

Submassive acute pulmonary thromboembolism with normal D-dimer. A case report

Pulmonary thromboembolism is a relatively common disease in an Emergency Department. Diagnosis, often difficult, is based on careful evaluation of risk factors, clinical examination, radiological and laboratory investigations. Plasma D-dimer, a degradation product of cross-linked fibrin with low specificity and very high sensibility, is considered extremely useful as screening to rule out a pulmonary thromboembolism. We report the case of a 74 year old woman who presented in the Emergency Department suffering from the sudden onset of dyspnea 4 hours before. Plasma D-dimer (automated latex-enhanced turbidimetric test) was normal (253 ng/mL; normal value: 278 ng/mL), but spiral CT angiography showed a sub-massive thromboembolism of the principal branch of the right pulmonary artery, also involving the middle and the inferior lobar branches. A cardiac echo-color-Doppler demonstrated an enlargement of the right cardiac section with telediastolic pressure in the pulmonary artery of 74 mmHg (normal value 4-12 mmHg). A second measurement of plasma D-dimer, 12 hours later, remained in the normal range (274 ng/mL) and only after four days was there a significant increase (1017 ng/mL). The authors, taking the case as a starting point, stigmatize the difficulties that such diagnosis involves, despite indications of guidelines.

Plasma bubble formation induced by holmium laser: an in vitro study

OBJECTIVES

To use the elementary physical measurements of temperature and size to prove that the thermal effects produced by the holmium laser's pulses are due to the formation of a plasma bubble. The physical phenomenon related to high temperatures generated during procedures with the holmium laser (holmium:yttrium-aluminum-garnet) was the object of our interest.

METHODS

Using a double micrometric slide attached to a 550-microm optic fiber and two thermocouples submerged in water, a series of pulses of 0.8 J at 10 to 30 Hz was delivered from a holmium:yttrium-aluminum-garnet laser, and we recorded temperatures on both frontal and lateral planes. Subsequently, samples of prostatic tissue and small stones were treated with 1.5 J at 20 Hz on both frontal and lateral planes.

RESULTS

Treatment with 1.5 J at 30 Hz (frontal plane) and with 1.5 J at 20 Hz (lateral plane) produced the ablation of the structure of the thermocouple at 2 mm and 1 mm, respectively, indicating plasma formation. The dimensions of the bubble after the delivery of 1.5 J at 20 Hz was 2 x 1.5 mm. Coagulation of the prostatic tissue took place at 1 mm from the plasma bubble, on both frontal and lateral planes.

CONCLUSIONS

The plasma bubble that forms at the tip of the fiber connected to the holmium:yttrium-aluminum-garnet laser makes it possible to work on stones and soft tissues. The coagulation of the prostatic tissue is caused by the hot water-vapor bubble that forms on the edge of the plasma bubble. During lithotripsy, guidewires and baskets within the expansion area of the plasma bubble risk damage.

[Can anemia be corrected in hemodialysis patients with thalassaemia minor? ]

BACKGROUND

Anemia is an important negative prognostic factor for dialysis patients, whose correction reduces hospitalisation and mortality. Besides, the presence of the thalassaemia minor (Thal-m) in haemodialysed patients causes erythropoietin resistance and more serious anemia. The goal of this study is the correction of anemia (Hb >11 g/dL) in haemodialysed Thal-m patients.

MATERIALS AND METHODS

Multicentric, prospective and controlled 12-month study for the correction of anemia (up to values ranging from 11 to 12 g/dL) followed by a 12-month observation period. Ten Thal-m patients with inadequate anemia correction were studied after therapy with rHuEPO. Their age at the beginning of the study was 62.8+/-4 years while their dialytic age was 89+/-20 months.

RESULTS

During the study we observed no changes in dry weight (p=NS), no increase in interdialytic weight (p=NS), cardiac frequency (p=NS), serum albumin (p=NS), serum aluminium (p=NS), PTH (p=NS), URR (p=NS), flow FAV (p=NS), TSAT (p=NS) and ferritin (p=NS) (maintained at their optimal values by means of intravenous therapy with trivalent iron. The hypotensive therapy (1.6 drug/patient/year) required no modifications during the 24-month study. The rHuEPO dose varied from 200.3+/-94.3 to 286.6+/-116.2, 317.0+/-119.5, 446.9+/-142.3, and 407.0+/-130.5 U/kg/wk (p < 0.0001 vs. initial value) (from the start to the 3rd, 6th, 9th and 12th month, respectively). The dose was subsequently reduced to 385.2+/-119.7 U/kg/wk at 15 months (p < 0.0001 vs. initial value) and remained unchanged until the end of the study. Simultaneously, the Hb values at corresponding times were 9.2+/-0.9, 9.4+/-1.1, 10.2+/-1.4, 10.9+/-1.5, 11.2+/-1.4 and 11.0+/-1.4 (p=0.002 vs. initial value). The correction of anemia produced progressive reduction in cardiac mass from 141+/-12 to 120+/-10 and 110+/-8 g/mq at the beginning, 12th month and 24th month (p < 0.0001), respectively. During the study the hospitalisation time was 4.3+/-1.2 day/patient/year during the 3-month run-in period, 3.4+/-1.4 day/patient/year during the first year, and 3.1+/-1.1 day/patient/year during the second year (p=0.098).

CONCLUSIONS

In conclusion we can say that the question of Thal-m in dialysis patients cannot be ignored or underestimated. The rHuEPO dosage in these patients must be reassessed (a dose of 450 U/kg/wk corresponding to approximately 60,000 units/week is acceptable and does not produce an increase in side effects if the correction is done gradually); moreover, other factors responsible for EPO-resistance must be eliminated (hyperthyroidism, aluminium intoxication, iron overloaded or deficiency).

Nicotinic acetylcholine receptors in the autonomic control of bladder function

Micturition is achieved through complex neurological mechanisms involving somatic, autonomic and central components. This article briefly reviews recent findings on the autonomic control of urinary bladder function. Neuronal nicotinic acetylcholine receptors mediate fast synaptic transmission in autonomic ganglia, and activation of nicotinic receptors in parasympathetic bladder neurons produces contraction of the detrusor muscle. Autonomic ganglia contain transcripts for the alpha(3), alpha(4), alpha(5), alpha(7), beta(2) and beta(4) nicotinic subunits, which can assemble to form multiple nicotinic receptor subtypes, but the exact nicotinic receptor subunit composition in bladder ganglia is unknown. Mutant mice lacking the alpha(3) or the beta(2) and the beta(4) nicotinic subunits have enlarged bladders with dribbling urination and develop urinary infection and bladder stones. Bladder strips from alpha(3) null mice do not respond to nicotine but contract when stimulated with a muscarinic agonist or electric field stimulation. Mice lacking the beta(2) subunit have no overt bladder phenotype, and their bladders contract in response to nicotine. Surprisingly, bladder strips from beta(4) mutant mice do not respond to nicotine despite the absence of major bladder dysfunction in vivo. These findings suggest that nicotinic receptors containing the alpha(3) and the beta(4) subunits are necessary for normal bladder function.

Extraordinary bone involvement in a gaucher disease type I patient

We report on a 63-year-old patient with Gaucher disease type I who developed severe bone involvement with destructive lesions and huge soft tissue extension in both humeri that appeared to evolve slowly. The clinical course and histopathological findings in our patient suggested a progressive extraosseous extension of the storage cells into the soft tissue, accompanied by a striking increase of fibrotic tissue and resulting in an impressive deformity. The extraordinary bone involvement in this patient expands our knowledge on the most severe skeletal complications of untreated Gaucher disease.

Multiorgan autonomic dysfunction in mice lacking the beta2 and the beta4 subunits of neuronal nicotinic acetylcholine receptors

Transcripts for the beta2 and the beta4 nicotinic acetylcholine receptor (nAChR) subunits are found throughout the CNS and the peripheral nervous system. These two beta subunits can form heteromultimeric channels with any of the alpha2, alpha3, alpha4, or alpha5 subunits in heterologous expression systems. Nonetheless, the subunit composition of native nAChRs and the role of different nAChR subtypes in vivo remain unclear. We prepared null mutations for the beta2 and the beta4 genes and bred beta2-/-beta4-/- mice by mating mice of identical beta2-/-beta4+/- or beta2+/-beta4-/- genotype. The beta2-/- and the beta4-/- single-mutant mice grow to adulthood with no visible phenotypic abnormalities. The beta2-/-beta4-/- double mutants survive to birth but have impaired growth and increased perinatal mortality. They also present enlarged bladders with dribbling urination and develop urinary infection and bladder stones. The ocular pupils are widely dilated and do not constrict in response to light. Histological studies revealed no significant abnormalities of brain or peripheral tissues except for hyperplasia in the bladder mucosa of beta4-/- and beta2-/-beta4-/- mutants. Bladder strips from beta2-/-beta4-/- mice did not respond to nicotine but contracted when stimulated with a muscarinic agonist or electric field stimulation. Bladder strips from beta4 mutants did not respond to nicotine despite the absence of major bladder dysfunction in vivo. Acetylcholine-activated whole-cell currents were absent in superior cervical ganglion neurons from beta2-/-beta4-/- mice and reduced in neurons from beta4-/- mice. Although there is apparent redundancy and a superficially normal phenotype in beta2-/- and beta4-/- mice, physiological studies indicate major deficits in the beta4-/- mice. Our previous description of a similar phenotype in alpha3-/- mice and the current data suggest that the alpha3 and the beta4 subunits are major components in autonomic nAChRs. The phenotype of the beta2-/-beta4-/- and alpha3-/- mice resembles the autosomal recessive megacystis-microcolon-hypoperistalsis syndrome in humans.

Clinical and neuroradiological follow-up in mucopolysaccharidosis type III (Sanfilippo syndrome)

Mucopolysaccharidosis type III (Sanfilippo syndrome) is an autosomal recessive disorder characterised by progressive nervous system involvement with mental retardation, behavioural problems and seizures. Three patients, of 20 months to 12 years of age, were followed up for 3 years both clinically and by using brain magnetic resonance imaging (MRI). Our results suggest that in MPS III patients MRI findings, including atrophy and abnormal or delayed myelination, may precede the onset of overt neurological symptoms. The increasing neurological morbidity is accompanied by different degrees of progressive atrophic changes, mainly affecting the cerebral cortex and the corpus callosum. However, it appears that, across subjects, the rate of MRI changes is unrelated to the severity of the clinical phenotype. On this basis it could be argued that in MPS III the worsening of the neurological symptoms might not necessarily reflect only the progressive cerebral abnormalities detectable by MRI.

[Synchronous and metachronous bilateral tumors of the testis: a single institution experience of 11 cases and review of the literature]

Bilateral testicular tumors represent a very rare event and account for 2.7% of all testicular neoplasms. 15% of bilateral testicular tumors occurs simultaneously in both testicles, but in 85% of cases the second neoplasia appears in the remaining testicles of patients affected by unilateral testicular tumor after a very variable period of time. The aim of this work was to value our experience on 11 cases of bilateral testis tumors: six arised simultaneously in both gonads (five germ cell tumors and one Leydig cell tumor) and five with metachronous appearance (all germ cell tumors). A comprehensive valuation has been made considering other cases reported in literature until 1996, in order to identify predisposing conditions to bilateral disease. Examining separately synchronous and metachronous neoplasms, as far as we know, only 218 cases of simultaneous bilateral testicular tumors are reported in literature, and most of them are pure seminomas; however, after 1988 this result has been reversed in favour of neoplasms with non-seminomatous elements: this data suggests inadequate classification in the past. Moreover, considering 243 cases of metachronous neoplasms, 126 of them (51.9%) began as non-seminomatous tumors: this disagrees with an old belief that patients affected by seminoma are more prone to develop a second tumor in the remaining testicle. It has been also possible to confirm that testis sparing surgery allows to maintain both fertility and endocrinous function. This technique can be used in any potentially benign neoplasms (as Leydig cell tumors) while the same treatment modality, although already reported in literature, needs more experience to be considered as a successful therapy for germinal tumors.

Adjuvant and immunostimulating properties of the recombinant Bm86 protein expressed in Pichia pastoris

The cattle tick Boophilus microplus has remained a latent problem to the cattle industry. The recombinant vaccine GAVAC against the cattle tick has proved its efficacy and, conveniently, combined with the use of chemicals could be the solution to this problem. As this vaccine is based in the recombinant concealed antigen Bm86, it has to be given periodically to the animal to maintain an adequate level of antibodies. Some other commercially available vaccines for cattle also have to be given periodically, which creates the possibility of combining vaccines for cattle. In an attempt to evaluate the possible interactions of the Bm86 with other vaccine antigens, a potent stimulatory effect was demonstrated of the recombinant Bm86 on the humoral immune response to the recombinant Hepatitis B surface antigen in mice, and to the inactivated Infectious Bovine Rhinothraqueitis virus in cattle. These results make the Bm86 antigen expressed in Pichia pastoris a good candidate for combining vaccines for cattle because of its dual role, immunogen and adjuvant.

Haemostatic studies in carbohydrate-deficient glycoprotein syndrome type I

CDG syndrome (CDGS) type I is the most frequent form of a group of metabolic disorders characterised by a defect of the carbohydrate moiety of glycoproteins. A large number of plasma glycoproteins, including clotting factors and inhibitors, are decreased and stroke-like episodes have been described in about half of the reported patients. We studied blood coagulation factors, inhibitors and D-dimer plasma levels in four subjects, aged 12-23 years, with CDGS type I. Factors VIII, XI, antithrombin III activity, antigen plasma levels of antithrombin III, free protein S and protein C were decreased whereas protein C as activity was normal. In addition two patients had reduction of factors II, V, VII, IX, X reflecting the phenotypic heterogeneity associated with CDGS type I. D-dimer plasma concentrations were elevated in all subjects. The hypercoagulable state as consequence of the combined deficiencies of coagulation inhibitors could contribute to the stroke-like phenomena in CDGS type I.

Characterization of ewe's milk by capillary zone electrophoresis

The purpose of the present work was to develop a procedure able to separate and identify the major protein components of ewe's milk by capillary zone electrophoresis (CZE). Thirty-five individual milk samples of Massese breed were analyzed using a coated capillary. The analyses were performed at pH 3.0 at a temperature of 40 degrees C in the presence of 6 M urea. The purification of casein fractions was carried out by preparative fast protein liquid chromatography and the CZE results were confirmed by polyacrylamide agarose gel electrophoresis (PAAGE). The identification of whey proteins was also carried out by comparison with high-performance liquid chromatography data. The present study permitted the identification of the major components of ewe's milk by high-resolution electropherograms and characteristic migration times (tM). it was also possible to detect the presence of genetic variants of beta-lactoglobulin. The tM of k-casein was determined after enzymatic action of chymosin by verifying the simultaneous formation of p-k-casein. In most of the samples a fast moving alpha-s2-casein variant was identified by comparison with PAAGE results. Minor genetic differences were found in other casein fractions for this pool of samples.

The molecular basis of canavan (aspartoacylase deficiency) disease in European non-Jewish patients

Canavan disease is an infantile neurodegenerative disease that is due to aspartoacylase deficiency. The disease has been reported mainly in Ashkenazi Jews but also occurs in other ethnic groups. Determination of enzymatic activity for carrier detection and prenatal diagnosis is considered unreliable. In the present study, nine mutations were found in the aspartoacylase gene of 19 non-Jewish patients. These included four point mutations (A305E [39.5% of the mutated alleles], C218X [15.8%], F295S [2.6%], and G274R [5.3%]); four deletion mutations (827delGT [5.3%], 870del4 [2.6%], 566del7 [2.6%], and 527del6 [2.6%]); and one exon skip (527del108 [5.3%]). The A305E mutation is pan-European and probably the most ancient mutation, identified in patients of Greek, Polish, Danish, French, Spanish, Italian, and British origin. In contrast, the G274R and 527del108 mutations were found only in patients of Turkish origin, and the C218X mutation was identified only in patients of Gypsy origin. Homozygosity for the A305E mutation was identified in patients with both the severe and the mild forms of Canavan disease. Mutations were identified in 31 of the 38 alleles, resulting in an overall detection rate of 81.6%. All nine mutations identified in non-Jewish patients reside in exons 4-6 of the aspartoacylase gene. The results would enable accurate genetic counseling in the families of 13 (68.4%) of 19 patients, in whom two mutations were identified in the aspartoacylase cDNA.

Inter- and intrafamilial variability in mucolipidosis II (I-cell disease)

In this paper nine patients with mucolipidosis II (I-cell disease) are described. They had clinical features commonly found in mucolipidosis II, including disproportionate dwarfism, coarse facial features and mental retardation. However, there was remarkable variability in age of onset, organ manifestation and radiological findings. Some had unusual clinical symptoms including pericardial effusion and profound brain atrophy. Striking differences in phenotypic expression were also seen in two affected siblings. Clinical heterogeneity is observed not only in mucolipidosis II but also in many other lysosomal storage disorders. The factors that may contribute to this clinical diversity are discussed.

Carbohydrate deficient glycoprotein syndrome type I: ophthalmic aspects in four Sicilian patients

Four patients with carbohydrate deficient glycoprotein (CDG) syndrome type I underwent ophthalmic examination. All of them had retinitis pigmentosa with extinguished scotopic electroretinogram. The importance of CDG syndromes as one of the metabolic causes of retinal dystrophy with 'bony spicule' pigment is stressed.

Encephalocraniocutaneous lipomatosis, Proteus syndrome, and somatic mosaicism

We report on a patient with manifestations of encephalocraniocutaneous lipomatosis and Proteus syndrome. Further comparison with other reported patients demonstrates a continuum, not 2 distinct entities that share common manifestations. This continuum supports the concept of somatic mosaicism.

Lysozyme: just an additive or a technological aid as well?

The effects of lysozyme on coagulation of milk and cheese making were studied by means of the gelograph, tristimulus colorimetry, ANS-fluorescence (hydrophobicity) and SDS-PAGE. Lysozyme binding to caseins caused structural differences during coagulation and it is proposed that, if the products have similar qualitative properties, lysozyme might be used as a technological aid giving shorter clotting times and higher yields.

On a rare atypical form of metachromatic leukodystrophy (MLD): "neurological non-mld patients with low levels of arylsulphatase A". Description of two cases

Two young patients (a brother and his sister) with low ASA levels who had myoclonic seizures since the age of eight years, were investigated by means of electrophysiological, neuroradiological and laboratory tests and submitted to a physical examination. In both patients, the disease started at the age of eight years with drug resistent myoclonic seizures. Intelligence was not impaired and ASA levels were lower than normal, but clinical features were not those of classic MLD. Electrophysiological study revealed altered SEPs and normal BAEPs (they are both altered in leukodystrophy). Therefore our findings conclude that tour patients must be considered "Neurological patients non-MLD with low levels of ASA".