Variation of enterohepatic circulation observed with 75SeHCAT images in the first three hours. Scintigraphic patterns and analysis of their association with the diagnosis of bile acid malabsorption

OBJETIVE

To evaluate the enterohepatic circulation of 75-Selenium turoselecolic acid (⁷⁵Se-SeHCAT) during the first 3 h and its correlation with the abdominal retention at the 7th day (AR₇), as contribution to the clinical study of biliar acid malabsorption (BAM).

MATERIALS AND METHODS

38 patients with chronic diarrhea were retrospectively studied. Acquisition protocol included static abdominal images at 1st, 2nd and 3rd hour and the 7th day after oral administration of the radiopharmaceutical. Images of 1-3 h determined 5 patterns of enterohepatic circulation that, due to their location, were characterized as: 1) gallbladder 2-3 h, 2) gallbladder 3 h, 3) gallbladder-abdomen 2-3 h, 4) abdomen, 5) upper left abdomen. The association of these patterns with the AR₇ (Fisher, STATA) were investigated. Patients were classified as Non BAM (AR₇ > 15%), mild-BAM (AR₇ 15-10%), moderate-BAM (AR₇ 10-5%) or severe-BAM (AR₇ < 5%).

RESULTS

19 patients had an AR₇ diagnostic of BAM (7 mild-BAM, 5 moderate-BAM, 7 severe-BAM). The pattern "gallbladder at 2-3 h" was statistically associated with Non BAM (p 0,008), while "gallbladder-abdomen at 2-3 h" was correlated with having BAM (p 0,029).

CONCLUSION

Variations detected at the abdominal level in images during the first 3 h were associated with changes in intestinal absorption and the incorporation of the radiopharmaceutical into the pool of bile acids, so visual interpretation of the images at 2nd and 3rd hour could be useful in the final assessment of the study.

Variation of enterohepatic circulation through the image with 75SeHCAT in the first 3 hours. Scintigraphic patterns and análisis of its association with the diagnosis of bile acid malabsorption

OBJETIVE

To evaluate the enterohepatic circulation of 75-Selenium turoselecolic acid (75Se-SeHCAT) during the first 3 hours and its correlation with the abdominal retention at the 7th day (AR7), as contribution to the clinical study of biliar acid malabsorption (BAM).

MATERIALS AND METHODS

38 patients with chronic diarrhea were retrospectively studied. Acquisition protocol included static abdominal images at 1st, 2nd and 3rd hour and the 7th day after oral administration of the radiopharmaceutical. Images of 1 to 3 hours determined 5 patterns of enterohepatic circulation that, due to their location, were characterized as: 1) gallbladder 2-3 hours, 2) gallbladder 3 hours, 3) gallbladder-abdomen 2-3 hours, 4) abdomen, 5) upper left abdomen. The association of these patterns with the AR7 (Fisher, STATA) were investigated. Patients were classified as Non BAM (AR7>15%), mild-BAM (AR7: 15-10%), moderate-BAM (AR7: 10-5%) or severe-BAM (AR7<5%).

RESULTS

19 patients had an AR7 diagnostic of BAM (7 mild-BAM, 5 moderate-BAM, 7 severe-BAM). The pattern "gallbladder at 2-3 hours" was statistically associated with Non BAM (p 0,008), while "gallbladder-abdomen at 2-3 hours" was correlated with having BAM (p 0,029).

CONCLUSION

Variations detected at the abdominal level in images during the first 3 hours were associated with changes in intestinal absorption and the incorporation of the radiopharmaceutical into the pool of bile acids, so visual interpretation of the images at 2nd and 3rd hour could be useful in the final assessment of the study.

Rapid recognition of irradiated dry-cured ham by on-line coupling of reversed-phase liquid chromatography with gas chromatography and mass spectrometry

The use of on-line coupling of reversed-phase liquid chromatography and gas chromatography (RPLC-GC) with the through oven transfer adsorption desorption (TOTAD) interface and mass spectrometry (MS) was proposed for testing different types of commercial Spanish dry-cured ham for irradiation treatment at various doses (0, 1.5, 2, and 4 kGy). The qualitative analysis of radiation-specific compounds (e.g., n-pentadecane, 1-hexadecene, 1,7-hexadecadiene, n-heptadecane, 8-heptadecene, and 2-dodecylcyclobutanone) can be simultaneously established in a single run with samples that have or have not been irradiated. The overall analysis, which takes less than 100 min, includes a rapid extraction step using a small amount of dichloromethane-methanol (1:1, vol/vol) and anhydrous sodium sulfate, the subsequent fractionation of the sample in the first dimension of the system (RPLC), the transfer of the target fraction to the second dimension, the GC separation, and the MS detection. The calculated limits of detection in ham were lower than 22 ng/g. Repeatability studies provided relative standard deviation values of 0.8 to 13.5%.

Natural variability of the enantiomeric composition of bioactive chiral terpenes in Mentha piperita

The variability of the enantiomeric distribution of biologically active chiral terpenes in Mentha piperita plants from different geographical origins was evaluated by solid phase microextraction-gas chromatography-mass spectrometry (SPME-GC-MS). The optimisation of some parameters (i.e. exposure temperature, extraction time and type of fibre) affecting SPME-extraction enabled relative standard deviations ranging from 4 to 13% to be achieved. The use of two different chiral stationary phases allowed to separate the identified chiral terpenes into their corresponding enantiomers as well as to verify the enantiomeric excesses of those compounds which were enantiomerically resolved on both phases. For all chiral terpenes, the enantiomeric composition varied within a very narrow range all over the samples. Consequently, it may be stated that the enantiomeric composition of chiral terpenes in Mentha piperita appears to be independent of the geographical origin of the plant and, thus, any alteration in the characteristic value may be related to an adulteration or inadequate sample handling. These results support the usefulness of the enantiomeric composition of bioactive chiral terpenes in Mentha piperita in authenticity studies.

On-line reversed–phase liquid chromatography-gas chromatography coupled to mass spectrometry for enantiomeric analysis of chiral compounds in fruit beverages

A method based on the on-line coupling of reversed phase liquid chromatography with gas chromatography/mass spectrometry (RPLC-GC-MS) for the chiral evaluation of characteristic constituents of fruit beverage aroma was investigated. The consideration of a variety of parameters involved in the transfer step allowed to achieve relative standard deviations ranging from 0.4 to 10% in most cases and detection limits from 0.2 to 2.5 mg/l. By applying the developed method to fruit beverages, racemic mixtures of ethyl 2-methylbutanoate and gamma-nonalactone were found. This fact suggests the eventual addition of artificial aromas. The method proposed in the present work can be useful to assess reliably the authenticity of aqueous samples, such as fruit beverages.

Effect of thermal treatment during processing of orange juice on the enantiomeric distribution of chiral terpenes

Chiral terpenes in orange juices were examined by solid-phase microextraction-gas chromatography-mass spectrometry to study the dependence of their enantiomeric composition on the thermal treatment applied during the industrial manufacture. The experimental conditions used in the isolation and concentration of the compounds of interest produced relative standard deviations ranging from 2.9 to 15.1% when absolute areas were used and from 1.7 to 18.3% when normalized areas were used. Recovery varied between 8.8 and 56.1%, and detection limits ranged from 0.11 to 0.32 microg/ml. The enantiomeric compositions of the majority of the chiral terpenes varied within a reasonably narrow range. Nevertheless, the enantiomeric ratio of two monoterpene alcohols, alpha-terpineol and linalool, exhibited considerable variation according to the thermal treatment used in the manufacture of the juices. Therefore, the knowledge of the enantiomeric composition of alpha-terpineol and linalool might be useful for thermal treatment control purposes.

Enantiomeric distribution of chiral compounds in orange juices according to their geographical origins

Chiral terpenes in nonprocessed orange juices of different geographical origins were examined by two different approaches: steam distillation-solvent extraction-gas chromatography-mass spectrometry (SDE-GC-MS) and solid-phase microextraction-gas chromatography (SPME-GC). The two sample preparation techniques were compared with regard to their effectiveness in determining the enantiomeric distributions of chiral compounds. Most target compounds exhibited constant enantiomeric ratios in all juices when either of the two approaches was used. Exceptions were found for terpinen-4-ol and beta-citronellol, whose of enantiomeric purity ratios varied significantly according to the geographical origin of the sample. These results may aid in guaranteeing the authenticity and thus the quality and safety of orange juice. A comparison between the two extraction procedures revealed SPME to be more reliable for stereochemical studies, since harsh experimental conditions that can bring about racemization are not required in such studies.

The promise of gene therapy in gastrointestinal and liver diseases

Gene therapy consists of the transfer of genetic material to cells to achieve a therapeutic goal. In the field of gastroenterology and hepatology gene therapy has produced considerable expectation as a potential tool in the management of conditions that lack effective therapy including non-resectable neoplasms of the liver, pancreas and gastrointestinal tract, chronic viral hepatitis unresponsive to interferon therapy, liver cirrhosis, and inflammatory bowel disease.

Solid-phase microextraction for studies on the enantiomeric composition of filbertone in hazelnut oils

The enantiomeric distribution of filbertone was determined in unroasted and roasted hazelnut oils of different geographical origins by using solid-phase microextraction (SPME) and capillary gas chromatography. An optimization procedure including SPME fiber, extraction time, exposure temperature, and sample volume enabled the best conditions to be selected. Under the optimized conditions, detection limits were in the micrograms per liter level for both enantiomers of filbertone with relative standard deviation values of 7.1 and 4.9% for R-filbertone and S-filbertone, respectively. The proposed approach allowed the rapid determination of the enantiomeric composition of filbertone and demonstrated that its variability is an inherent property of the natural compound. Analysis of two batches of hazelnut oils obtained from either unroasted or roasted hazelnuts showed, in general, significantly higher amounts of filbertone in roasted hazelnut oils.

Efficacy and safety of risperidone in the treatment of schizoaffective disorder: initial results from a large, multicenter surveillance study. Group for the Study of Risperidone in Affective Disorders (GSRAD)

BACKGROUND

An adequate therapy for psychotic disorders needs to be effective against mood as well as psychotic symptoms. Analyses of data from clinical trials of risperidone in schizophrenia and small open-label studies in mania suggest that risperidone may have this broad efficacy profile. We present data on a 6-week trial of risperidone for the treatment of schizoaffective disorder that was part of a larger, 6-month surveillance study of patients with affective disorders.

METHOD

One hundred two patients suffering from schizoaffective disorder (DSM-IV or ICD-10) entered the trial. Inclusion criteria consisted of a current DSM-IV diagnosis of schizoaffective disorder, bipolar type; DSM-IV manic or mixed psychotic episode; and a Young Mania Rating Scale (YMRS) score > 7 for a mixed episode (> 20 for a manic episode). Assessments included the YMRS, the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HAM-D), the 4-item Clinical Global Impressions (CGI) scale, and the UKU Side Effect Rating Scale subscale for neurologic side effects. For patients entering the study, open-label risperidone therapy was added to their existing regimens of mood-stabilizing treatments. Other antipsychotic drugs were not allowed.

RESULTS

Ninety-five patients completed the 6-week trial. At week 6, the mean +/- SD dose of risperidone was 4.7+/-2.5 mg/day. The mean scores on the assessment scales at baseline and week 6 (unless otherwise stated) were as follows: YMRS, 22.7 and 4.7, an improvement of 18.0 points (p < .0001); PANSS (at baseline and week 4), 74.1 and 54.2, an improvement of 19.9 points (p < .0001); HAM-D, 14.0 and 7.4, an improvement of 6.6 points (p < .0001); CGI (at baseline and week 4), 2.6 and 1.7, an improvement of 0.9 points (p < .0001). At week 4, most patients had shown improvement in symptom severity, and 9.3% were completely symptom-free. There were no statistically significant differences between baseline and week 4 in the severity of extrapyramidal symptoms as measured by the UKU. Risperidone was well tolerated; side effects were few and generally mild.

CONCLUSION

The results to date with risperidone indicate that it may have both antipsychotic and mood-stabilizing properties. Despite the limitations of the open-label design, the results indicate that risperidone is a safe and effective therapy in combination with mood-stabilizers for the treatment of patients with manic, hypomanic, and depressive symptoms of mixed episodes in schizoaffective disorder, bipolar type.

Influence of tumor characteristics on the outcome of liver transplantation among patients with liver cirrhosis and hepatocellular carcinoma

Hepatocellular carcinoma (HCC) may recur after liver transplantation (LT), mainly in patients with multinodular and large tumors. However, factors predictive of outcome after LT in patients with small tumors remain ill defined. We investigated which factors were related to mortality or tumor recurrence among 47 liver transplant recipients with liver cirrhosis and HCC and compared them with 107 patients with liver cirrhosis without tumor who underwent LT in the same period. Patients with HCC were older (P <.001), more frequently had cirrhosis of a viral origin (P <.001), and had lower Child-Pugh scores (P <.001) than patients without tumor. Survival of patients with and without tumor was not significantly different (P =.20). Among patients with HCC, those with lower recurrence-free survival rates had liver cirrhosis of a viral origin, vascular invasion, bilobar disease, and tumor-node-metastasis (TNM) stage IV. At multivariate analysis, the only factor associated with mortality or recurrence was TNM stage IV (P =.02). Our results suggest that in patients with HCC and TNM stage IV, LT might be contraindicated.

[Risperidone in the treatment of psychotic disorders associated with mental retardation]

INTRODUCTION

The safety and effectiveness of risperidone in patients with a diagnostic of mental retardation and/or psychotic and disturbance disorder was assessed in an open and observational study.

MATERIAL AND METHODS

A total of 127 patients with DSM-III-R diagnoses of mental retardation together with psychotic disturbance (psychotic and/or behaviour disturbance) was included in an open label surveillance study. The study objectives were to evaluate safety and efficiency of risperidone in these patients during a six-month period. Risperidone was assessed by the Clinical Global Impression (CGI), schizophrenia subscales of Scale for Evaluating Emotional Disorders in Severely and Profoundly Mentally Retarded Persons (DASH) and Assessment and Information Rating Profile (AIRP), UKU subscale for neurological side effects and spontaneous reports.

RESULTS

Ten patients (7.9%) were excluded from the statistical analysis due to protocol violation. Seventeen patients (14.5%) dropped out. Risperidone was used at a mean dosage of 2.98 (2.37 mg daily. Risperidone produced a significant reduction, vs baseline, in the mean total scores of CGI and DASH-AIRP scales from day 15 onwards. There was a significant reduction in the total UKU subscale for neurological, autonomic side effects scores and psychotic symptoms. Risperidone was generally well tolerated. During the 6 months of study period, 93.2% of the patients did not suffer any adverse event; the resting 7.7% suffered one or more side effects.

DISCUSSION

In this study, risperidone was a safety and effectiveness treatment in patients with a diagnostic of mental retardation and psychotic and/or disturbance disorder associated.

Determination of the enantiomeric composition of gamma-lactones in edible oils by on-line coupled high performance liquid chromatography and gas chromatography

A new method is proposed for the determination of the enantiomeric composition of gamma-lactones in different vegetable edible oils (i. e., olive oil, almond oil, hazelnut oil, peanut oil, and walnut oil), and its potential for authenticity control is underlined for a limited number of samples. The method is based on the direct injection (i.e., without requiring a sample pretreatment step) in on-line coupled reversed phase liquid chromatography to gas chromatography (RPLC-GC) using a chiral stationary phase in the GC-step. Different experimental values for both speed of sample introduction into GC and volume of the transferred fraction are considered to improve the recoveries obtained. Relative standard deviations lower than 10% and detection limits ranging from 0.06 to 0.22 mg/L were achieved for the investigated gamma-lactones.

[Risperidone in the treatment of psychotic, affective and behavioral symptoms associated to Alzheimer's disease]

INTRODUCTION

A total of 235 patients with diagnoses of Alzheimer's dementia together with psychotic and/or affective symptomatology, as well as behavioral disturbances was included in an open label postmarketing surveillance study. The study objectives were to asses: 1) risperidone efficiency in psychotic and affective symptomatology and behavioral disturbances; 2) risperidone influence in the patient's performance, 3) dosage range at which efficiency is observed; and 4) safety in this group of patients. Patients were observed during a six month period. Risperidone was used at a mean dosage of 1.23 +/- 0.86 mg daily (range: 0.5-4.5 mg daily).

MATERIAL AND METHODS

Risperidone was assessed by the Clinical Global Impression (CGI), Geriatric Depression Scale (GDS), Neuropsychiatric Inventory (NPI), Clinical Deterioration Rating (CDR), UKU subscale for neurological side effects and spontaneous reports. Patients were evaluated at baseline, 15 days and months 1, 2, 4 and 6. Sixteen patients (6.8%) were excluded from the statistical analysis due to protocol violation. Fifty four patients (24.7%) dropped out.

RESULTS

Risperidone produced a significant improvement in the mean total scores of CGI, NPI, GDS (patient's satisfaction, hope.) and CDR (judgment and problem solving, community affairs, hobbies.) scales. Extrapyramidal symptoms improved from day 15 onwards in patients who had received antipsychotic treatment previously; in naive treated patients these symptoms did not change during the study period.

CONCLUSIONS

Risperidone was well tolerated. Only 6 (2. 7%) discontinued treatment due to adverse events. Ninety seven percent of the patients did not suffer any adverse event; the resting 2.7% suffered one or more side effects: sedation (1.4%), constipation (0.5%) and vomiting (0.5%) among others.

Rapid analysis of cholesterol-elevating compounds in coffee brews by off-line high-performance liquid chromatography/high-resolution gas chromatography

A new method is proposed to analyze the cholesterol-elevating cafestol and kahweol which allows their rapid and reliable determination in different coffee brews. The method involves the preseparation of the sample by high-performance liquid chromatography, the collection of the selected fraction, and its subsequent analysis by high-resolution gas chromatography using a programmed temperature vaporizer operated in the split mode as sampling system. Under the experimental conditions investigated, recoveries as high as 87% (cafestol) and 94% (kahweol) were achieved while detection limits equal to 0.06 and 0.04 ppm for cafestol and kahweol, respectively, were obtained. Examples are given comparing levels of cafestol and kahweol resulting from the same ground roasted coffee by different brewing methods, which show the lowest values for brews prepared from coffee bags.

Enantiomer analysis of chiral lactones in foods by on-line coupled reversed-phase liquid chromatography-gas chromatography

A new application is proposed for the on-line coupling of reversed-phase liquid chromatography to gas chromatography (RPLC-GC) that allows the GC chirospecific analysis of gamma-lactones in fruits and commercially available fruit-containing products. The use of a programmed temperature vaporizer as an interface with the system makes the transfer of large volume fractions (i.e., 2520 microL) of aqueous eluents from LC to GC possible (speed of sample transfer, 1800 microL/min). Relative standard deviations obtained for the investigated lactones under the experimental conditions vary from 7 to 14%. The described system enlarges the LC-GC application field and overcomes the limitations reported thus far concerning the use of typical normal-phase eluents (i.e., the transfer of rather small volume fractions at low speeds of sample introduction).

Use of a programmed temperature vaporizer for off-line SFE/GC analysis in food composition studies

A simple procedure is proposed for off-line supercritical fluid extraction and capillary gas chromatography using a programmed temperature vaporizer (PTV) injector. The independent control of flow and temperature of the supercritical fluid is achieved by means of a variable restrictor (i.e., nozzle). The described system combines some advantages of the on-line coupling SFE/GC (high sensitivity and reduced sample handling) and the off-line approach (simpler performance and depressurization outside the chromatographic column). The proposed procedure and the solvent recovery method used to collect the extracted analytes are applied to the analysis of the essential oil obtained from Rosmarinus officinalis L. Also, a comparative study with the extracts obtained by using the simultaneous distillation extraction technique (SDE) is presented.

Effect of smoking on plasma and platelet fatty acid composition in middle-aged men

The effect of tobacco cigarette smoking on plasma and platelet fatty acid composition was studied in 219 male subjects. The effect of tobacco on plasma malondialdehyde-like material (MDA-LM) was also evaluated. In the total fatty acid percentage composition in plasma, an increase in the saturated fatty acids at the expense of polyunsaturated fatty acids was observed in those subjects who smoked more than 20 cigarettes/day. In the total fatty acid composition of platelets, an increase in myristic acid (14:0) and palmytoleic acid (16:1) was found. Additionally, when the fatty acid composition of the different platelet lipid fractions was evaluated, an increase in 14:0 and 16:0 + 16:1 was observed in phospholipids. Finally, the plasma MDA-LM level was significantly higher in those subjects who smoked more than 10 cigarettes/day. The biochemical variations found in this study may be compatible with the greater incidence of CHD observed in smokers.