IBD-PODCAST Spain: A Close Look at Current Daily Clinical Practice in IBD Management

BACKGROUND

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity.

AIMS

The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact.

METHODS

IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396).

RESULTS

A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control.

CONCLUSION

Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD.

First-Pass Effect in M1-Occlusion Stroke Patients Treated with Combined Stent-Retriever/Large-Bore Distal Aspiration Catheter Thrombectomy

INTRODUCTION

Combined stent-retriever/large-bore distal aspiration catheter (LB-DAC) thrombectomy was recently introduced to treat large-vessel occlusion; however, it is unclear whether larger inner diameters improve outcomes. We compared angiographic and clinical outcomes in patients with occlusions of the M1 segment of the middle cerebral artery treated with mechanical thrombectomy using extra-LB-DAC versus LB-DAC in combination with stent-retrievers.

METHODS

We analyzed consecutive patients with M1 occlusion included in the ROSSETTI registry treated with non-balloon guide catheter combined LB-DAC/stent-retriever thrombectomy between June 2019 and April 2022. We compared demographics, baseline clinical variables, procedural variables, angiographic outcomes, and clinical outcomes [National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) and modified Rankin scale score at 3 months] between patients treated with extra-LB-DAC (Sofia Plus, MIVI Q6, Catalyst7; inner diameter, 0.068″-0.070″) versus LB-DAC (Sofia 5F, MIVI Q5, Catalyst 6; inner diameter, 0.055″-0.064″). Primary outcome was the first-pass effect (FPE) rate, defined as near-complete/complete reperfusion (mTICI 2c-3) after a single pass of the device.

RESULTS

We included 324 patients (extra-LB-DAC, 185, 57.1% patients). Demographics, clinical data, and clinical outcomes were similar between the two groups; however, there was a trend towards improvement in National Institute of Health Stroke Scale score at 24 h (24h-NIHSS) in the cohort treated with extra-LB-DAC 9 points (IQR 4;16 points) vs. 12 points (IQR 4;18 points, P = 0.083). Patients treated with extra-LB-DAC had higher FPE rate (47% vs. 30.9%; P = 0.003) and higher modified FPE (mTICI ≥ 2b after a single pass) rate (65.9% vs 46.8%; P = 0.001). The use of extra-LB-DAC was an independent factor in predicting FPE (odds ratio 1.982, 95% confidence interval 1.250-3.143, P = 0.004).

CONCLUSION

Our results suggest that in combined LB-DAC/stent-retriever thrombectomy, a larger aspiration catheter inner diameter is associated with higher rates of FPE and mFPE.

Clinical and color Doppler ultrasound evaluation of polyacrylamide injection in HIV patients with severe facial lipoatrophy secondary to antiretroviral therapy

BACKGROUND/PURPOSE

Facial lipoatrophy in HIV patients, secondary to antiretroviral therapy (ART) with thymidine analogs, has been related to important psychosocial alterations and poor adherence to treatment. Polyacrylamide gel (PAAG) is a filler that has been used for treating facial lipoatrophy in HIV patients. The aim was to assess the clinical and sonographic anatomical changes after injection of PAAG in HIV patients with facial lipoatrophy secondary to ART.

METHODS

HIV patients receiving ART and suffering from severe facial lipoatrophy were recruited and underwent clinical and color Doppler ultrasound evaluation prior to PAAG application (AQUAMID^® ) and sonographically monitored at 18 months and clinically followed up for 36 months after the procedure. Adverse effects were recorded based on occurrence and complexity.

RESULTS

A total of 33 patients were evaluated, 30 men (91%) and 3 women (9%) with an average age of 49.6 years (±8.4). Clinical improvement assessed by a dermatologist had an average score of 5.9 (±0.7) on a scale of 1-7. On color Doppler ultrasound there was a significant increase of the thickness of the subcutaneous tissue (SCT) in both nasofold lines when comparing before and after PAAG injection (P < 0.01) and no signs of inflammation (hypervascularity). User satisfaction was qualified as excellent or good in all cases. Only two patients experienced adverse effects (hematoma and puncture site infection), which was successfully managed without consequences.

CONCLUSION

Treatment of facial lipoatrophy with PAAG seems to be effective in HIV patients and no signs of complications were observed in the monitoring at 36 months after injection. Color Doppler ultrasound can identify the filler deposits and the anatomical changes of the SCT non-invasively.

Endovascular treatment of intracranial aneurysms using the Pipeline Flex embolization device: a case series of 30 consecutive patients

BACKGROUND

The Pipeline Flex embolization device has some peculiarities in comparison with the previous generation device. Despite recent reports of the modified delivery system, its safety is still unknown.

OBJECTIVE

To illustrate the intraprocedural and periprocedural complication rate with this new device in 30 consecutive patients.

MATERIAL AND METHODS

Clinical, procedural, and angiographic data, including aneurysm size and location, device or devices used, angiographic and clinical data were analyzed.

RESULTS

30 patients harboring 30 aneurysms were analyzed. 39 devices were placed properly. Multiple Pipeline embolization devices (PEDs) were used in 7 cases. In 28 devices the distal end opened fully from the beginning with a complete wall apposition. In the remaining 11 devices, distal-end opening of the devices was instant but partial, but fully opened easily after recapture. Among the 30 procedures, recapture and reposition of the Pipeline Flex was performed four times owing to proximal migration/malposition of the device during delivery. Four intraprocedural/periprocedural complications occurred, of which 2 resulted in major complications, with neurologic deficits persisting for longer than 7 days. The 30-day morbidity rate was 6.6%, with no deaths. No aneurysm rupture or parenchymal hemorrhage was seen.

CONCLUSIONS

The Pipeline Flex embolization device allows more precise and controlled deployment than the first-generation device. The number of devices and the complication rate during the learning curve are lower than reported with the first-generation PED. The new delivery system and the resheathing maneuvers do not seem to increase the intraprocedural complication rate in comparison with the first-generation PED.

Diagnostic accuracy of the faecal immunochemical test for colorectal cancer in symptomatic patients: comparison with NICE and SIGN referral criteria

AIM

The diagnostic accuracy of the faecal immunochemical test (FIT) at a 100 ng/ml threshold for colorectal cancer (CRC) was compared with National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) referral criteria.

METHOD

A multicentre, prospective, blind study of diagnostic tests was carried out in two Spanish health areas. In 787 symptomatic patients referred for a diagnostic colonoscopy, we determined whether patients met NICE and SIGN referral criteria. All patients performed one FIT determination (OCsensor(™) ). The sensitivity and specificity for CRC detection were determined with McNemar's test. The diagnostic odds ratio as well as the number needed to scope (NNS) to detect a CRC were calculated.

RESULTS

We detected CRC in 97 (12.3%) patients; 241 (30.6%) had an FIT ≥ 100 ng/ml and 300 (38.1%) and 473 (60.1%) met NICE and SIGN referral criteria. The FIT had a higher sensitivity for CRC detection than NICE criteria (87.6%, 61.9%; P < 0.001) and SIGN criteria (82.5%; P = 0.4). The specificity of FIT was also higher than NICE and SIGN criteria (77.4%, 65.2%, 42.7%; P < 0.001). The odds ratios of FIT, NICE and SIGN criteria for the diagnosis of CRC were 24.24 (95% CI 12.91-45.53), 3.04 (95% CI 1.96-4.71) and 3.51 (95% CI 2.03-6.06). The NNS to detect a CRC in individuals with an FIT ≥ 100 ng/ml was 2.83 (95% CI 2.4-3.41) and in individuals who met NICE and SIGN criteria it was 5 (95% CI 3.98-6.37) and 5.95 (95% CI 4.85-7.35).

CONCLUSION

Our study suggests that FIT is more accurate for the detection of CRC than the current NICE and SIGN referral criteria in symptomatic patients referred for colonoscopy.

Should we monitor with bispectral index in all patients at high risk for seizures in the operating room?

We report the case of a patient with a cerebral aneurysm, located in the left middle cerebral artery. During the clipping of this aneurysm, the bispectral index (BIS) increased for no apparent reason. This was then interpreted as intraoperative non-convulsive status epilepticus. This clinical condition may have negative impact in the prognosis of the patient, so it is very important to be able to detect this conditions as early as possible. Measuring the BIS while the patient is anaesthetised could be useful in this situation, considering that an increase in values greater than 60, associated with acidosis and without any other peri-anaesthetic explanation, may provide evidence of a convulsive equivalent state, allowing appropriate action to be taken.

[Intravascular treatment for acute carotid occlusion with an intracranial tandem lesion]

We present the case of a patient with an acute obstruction in the origin of the internal carotid artery that was associated with occlusion of segment one of the ipsilateral medial cerebral artery and severe neurologic deterioration. We describe the neuroimaging findings (unenhanced cranial computed tomography [CT], CT angiography, CT perfusion studies, and cerebral angiography) and the intravascular treatment (mechanical and pharmacological intra-arterial fibrinolysis). Treatment yielded good morphological and clinical results; we also analyze the follow-up of the patient.

Perfusion computed tomography-guided subacute endovascular reperfusion in a patient with carotid occlusion

Most patients with symptomatic internal carotid artery occlusion have a single minor or major hemispheric stroke. A minority of patients have ipsilateral retinal ischemia, recurrent strokes, or transient ischemic attacks. Whereas spontaneous carotid recanalization is rare, acute surgical recanalization has been attempted, with mixed results. Recently, acute endovascular recanalization has been performed and described as feasible and relatively safe. We describe a patient with symptom recurrence related to hemodynamic factors after occlusion of the carotid artery who was successfully treated 14 days after symptom onset.

Diagnóstico de muerte encefálica mediante tomografía computarizada multicorte: angio-TC y perfusión cerebral

BD was diagnosed by clinical examination, electroencephalogram (EEG), Transcranial Doppler (TCD) and multislice CT of 64 detectors. Initially, a brain perfusion study was performed. This was followed by supra-aortic trunk and brain artery angiography with acquisition of images using 0.5 mm slices, from the origin of the aortic root to the vertex. In all the patients, BD diagnosis was verified by clinical examination, EEG and TCD. Brain perfusion never detected brain blood flow. The angioCT through internal carotid arteries and vertebral arteries demonstrated complete absence of intracranial circulation, observing circulation of the external carotid artery branches. Sensitivity and specificity of the method compared with clinical examination was 100%. These findings demonstrate that the study of brain perfusion and brain angiography by multislice CT scan is a rapid and minimally invasive technique, that is easily available and that shows the absence of brain blood flow through the four vascular trunks. This technique makes it possible to made the diagnosis of BD with high diagnostic safety. Its use has special interest in patients with clinical diagnostic difficulty due to treatment with sedative drugs and serious metabolic alterations.

Clinical and immunological characteristics of type 1 diabetes mellitus in a northwestern Colombian population

We underwent a project aimed to define the clinical and immunological characteristics of type 1 diabetes (T1D) in a Colombian population. This was a multicenter and cross-sectional study. Patients were systematically interviewed and their medical records reviewed, using a questionnaire that sought information about demographic, clinical and immunological characteristics. Glutamic acid decarboxylase antibodies (GADA), tyrosine phosphatase antibodies (IA-2A) and insulin antibodies (IAA) were examined by radioimmunoassay. There were 107 patients with T1D. Male:female ratio was 1:1. Half of the patients developed diabetes ketoacidosis at onset. GADA, IA-2A, and IAA were detected in 45%, 40%, and 69% of the cases, respectively. GADA positive patients were older and had a less duration of disease than patients without these autoantibodies (p<0.01). Association between breast feeding with the presence of antibodies or clinical characteristics was not observed. The results highlight some differences of T1D expression according to geographic location and ethnicity. Differences in age at onset and clinical variables may point to an environmental factor or deficient access to health care system. Genetic studies underway will provide important information in this population. These results might help to define public health policies in our population to improve T1D diagnosis, patients' quality of life and their outcome.

Psychiatric issues in the management of patients with multidrug-resistant tuberculosis

INTRODUCTION

Psychiatric issues present a challenge in the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs and psychosocial factors require aggressive management.

SETTING

A community-based non-governmental health organization in Lima, Peru.

OBJECTIVE

To review the literature for psychiatric complications associated with anti-tuberculosis medications, to describe the incidence and prevalence of depression, anxiety and psychosis among individuals receiving MDR-TB therapy, and to detail the management approach used in this cohort.

METHODS

A retrospective case series was performed among the first 75 patients to receive individualized MDR-TB therapy in Lima, Peru, between 1996 and 1999.

RESULTS

Baseline depression and baseline anxiety were observed in respectively 52.2% and 8.7% of this cohort. Most individuals with baseline depression experienced improvement of depressive symptoms during the course of TB therapy. The incidence of depression, anxiety and psychosis during MDR-TB treatment was 13.3%, 12.0% and 12.0%, respectively. While the majority of individuals with depression, anxiety and psychosis required psychiatric pharmacotherapy, cycloserine was successfully continued in all but one case.

CONCLUSION

Psychiatric comorbidities are not a contra-indication to MDR-TB therapy. Management of psychiatric complications is possible without compromising anti-tuberculosis treatment.

[GB virus C: lack of association with transaminases levels, CD4 and HIV viral load in aids patients]

OBJECTIVE

To study the prevalence of GBV-C-RNA in sera of HIV-infected patients and determine whether differences in immunological condition and hepatic disease exist between GBV-C positive and negative patients.

METHODS

The presence of GBV-C-RNA was determined in sera of 222 HIV-positive patients by semi-automated RT-PCR. A comparison of GBV-C-RNA positive and negative patients was made by studying a series of clinical and analytical parameters. This same comparison was made in particular between those coinfected with HCV and GBV-C and those who only presented GBV-C.

RESULTS

Prevalence of GBV-C-RNA was 28.8%. The most frequent hepatotropic virus was HCV, appearing in 71.6% of cases. Coinfection with HCV and HGV was present in 17% and 8.6% only had GBV-C. Patients positive for GBV-C-RNA showed clinical and analytical characteristics similar to those found in GBV-C-RNA negative patients. Among the HCV-GBV-C coinfected and those presenting HGV as the only virus it was observed that the coinfected group presented alterations in transaminases and predominance of parenteral transmission as a risk factor for HIV, whereas the GBV-C group presented normal transaminases and predominance of sexual transmission. No differences were perceived in mean CD4 and HIV-RNA values in both groups.

CONCLUSIONS

Being positive for GBV-C in HIV-positive patients does not influence the presence of hepatic disease that in these patients is frequently accompanied by coinfection with other hepatotropic viruses. Moreover, it does not seem to influence the viremia of the HIV nor the CD4 cell counts.

Comparison of rizatriptan 10 mg vs. zolmitriptan 2.5 mg in the acute treatment of migraine. Rizatriptan-Zolmitriptan Study Group

The efficacy and tolerability of rizatriptan (MAXALT) and zolmitriptan (ZOMIG) were compared in a randomized, double-blind, double-dummy, stratified (on prior use of rizatriptan and/or zolmitriptan), placebo-controlled, single attack study in 766 patients. Rizatriptan tended to provide freedom from pain sooner than zolmitriptan (hazard ratio 1.26, P = 0.075), acting within 60 min following dosing. More patients were pain free at 2 h on rizatriptan than on zolmitriptan (43.2% vs. 35.6%, P=0.041), while headache relief at 2 h was similar (70.5% vs. 66.8%). At 2 h, fewer patients on rizatriptan had symptoms of photophobia (35.6% vs. 43.5%, P = 0.029) and nausea (25.2% vs. 32.5%, P=0.046), and more patients on rizatriptan had normal function (45.4% vs. 37.0%, P=0.025) than zolmitriptan. Headache recurred in 28% of patients taking rizatriptan, 29% taking zolmitriptan and 26% taking placebo. Both active treatments were effective compared to placebo and were well tolerated. The most common side-effects with rizatriptan were asthenia/fatigue, somnolence and dizziness, while the most common side-effects with zolmitriptan were asthenia/fatigue and dizziness.

Interferon alfa-2b plus ribavirin for chronic hepatitis C patients who have not responded to interferon monotherapy

BACKGROUND

The role of combination therapy is poorly defined in chronic hepatitis C patients who are non-responders to interferon.

AIM

To assess the efficacy, safety and tolerance of interferon alfa-2b plus ribavirin in chronic hepatitis C patients who do not respond to interferon monotherapy.

METHODS

A total of 127 non-responder patients with chronic hepatitis C received 3 mU t.i.w. of interferon alfa-2b plus 1000-1200 mg ribavirin daily for 48 weeks. Effects of therapy were evaluated by serum aminotransferases and hepatitis C virus (HCV) RNA levels.

RESULTS

Twenty-nine (23%) patients had an end-of-treatment response. Six months after treatment, 20 (16%) patients were sustained responders. Early loss of HCV RNA was the strongest predictor of a sustained response (P < 0.0001). Remission was also more frequent in patients with genotype 1b (P < 0.02), elevated alanine aminotransferase (P < 0.03) and low gamma glutamiltranspeptidase (P < 0.002). Treatment was discontinued in 21 (17%) patients: in 14 for intolerance and in seven due to side-effects.

CONCLUSIONS

Combination therapy with interferon plus ribavirin produced a sustained response in 16% of chronic hepatitis C patients who were non-responders to interferon. This combination was safe and well tolerated.

Long-term re-treatment with interferon and ribavirin combination therapy in patients with chronic hepatitis C who are non-responders to interferon alone: a preliminary study

We evaluated the efficacy and tolerance of ribavirin and IFN-alpha combination therapy over 12 months in 28 patients who were non-responders to IFN-alpha alone. Of 24 patients who have finished the therapy, 6 (25%) obtained a complete response (normal ALT and negative HCV RNA) at the end of treatment and maintained a sustained response 27% (5/18).

[The efficacy of interferon alfa treatment in chronic hepatitis C in relation to the serum concentration of RNA-HCV and the viral genotype]

BACKGROUND

To determinate the viral variables (viremia and genotype) and patients variables (route and years of infection, histology, etc) related with response to the treatment with alpha intefferon in patients with chronic hepatitis C.

SUBJECTS AND METHODS

We have studied 50 patients with chronic hepatitis C that received an intefferon treatment during a year. In all them it was accomplished a hepatic biopsy before of the beginning of treatment and it was studied the viral load by quantitative PCR (Monitor, Roche) at the beginning of treatment, at four weeks and at the end of treatment. It was determined the HCV genotype by method INNO-LIPA (Boehringer Inghelheim).

RESULTS

8 patients (16%) achieved a complete sustained response during all the follow-up period (13.8 + 1.6 months); 8 patients responded but relapsed when the intefferon was interrupted and 34 patients not responded. The responders had lower viremia (p < 0.032) and HCV RNA negative at the fourth treatment week (p < 0.0082). The genotype 1b was the most frequent, the one which was presenting a smaller percentage of response and it was associated with a higher viremia. Cirrhotic patients were the worse responders. Ex-lDAs were better responders than the others groups, however this difference did not show statistics meaning.

CONCLUSIONS

A low pretreatment HCV-RNA level seems to be indicative of a sustained response to IFN, Whereas a high level seems to be indicative of a non sustained response to IFN. Negativization of HCV-RNA at week four is a good indicator of response to intefferon. Genotype 1b is the most frequent and the worse responder. To have 1b genotype, high pretreatment HCV-RNA level and to be viremic at four treatment seems to be indicative of non response.

[Measurement of total serum IgE by enzyme immunoassay with three commercial reagents]

We measured total serum IgE in 14 patients with allergic diseases and 16 healthy subjects, using three commercial ELISA kits. The correlation of results among the three kits was analyzed using Passing and Bablock regression parameters. Results show that measurements of the different kits do not coincide. One kit shows differences using sera from normal subjects. There is no correlation among kits when using sera from allergic patients. It is concluded that it is not possible to determine exactly the amount of IgE using these kits, specially in subjects with elevated levels.

Dietary fish oil and cytochrome P-450 monooxygenase activity in rat liver and kidney

Lauric acid hydroxylation and aminopyrine N-demethylation were studied in kidney and liver microsomes from rats treated with fish oil. Different doses of fish oil containing 20% eicosapentaenoic acid and 10% docosahexaenoic acid were provided daily to the rats for seven days. In all the groups studied, the lauric acid metabolism was higher in kidney microsomes and the aminopyrine metabolism in the liver microsomes. Although no effect on the renal cytochrome P-450 concentration was detectable, all four fish oil doses increased the hepatic concentration of cytochrome P-450 by a mean 27%. The higher fish oil doses used increased the renal and hepatic microsomal metabolism of aminopyrine. The lauric acid metabolism was increased by fish oil only in the liver. Fish oil, a known inducer of fatty acid peroxisomal beta-oxidation, also induced microsomal activity. These results show that liver and kidney respond in different ways to dietary factors such as fish oil. In addition, our study would suggest that fish oil increased the activity of two different families of liver cytochrome P-450. The activity of kidney lauric acid 11- and 12-hydroxylation, however, was not modulated by fish oil.

Kidney drug metabolizing activities in streptozotocin diabetic rats

1. Streptozotocin-induced diabetes produced significant changes on the drug metabolizing enzyme machinery of rat kidney microsomes. 2. It reduced the cytochrome P-450 content by 30%, this effect being reversed by insulin therapy. 3. Total androstenedione oxidative metabolism was increased 2.5-fold and insulin treatment partially antagonized this activation. 4. Total testosterone hydroxylase activities were not modified by diabetes nor by insulin but the formation of 2 alpha OH testosterone and 6 beta OH testosterone were distinct in diabetes or insulin treated diabetic rats. 5. Only UDP-glucuronyltransferase activity for PNP was found in kidney microsomes. Diabetes determined a lower UDPGT substrate efficiency not reversed by insulin therapy.

Recovery of the extensor digitorum longus muscle in the rat following L4 nerve sectioning

The purpose of this study was to define the time course and the extent of recovery of muscle weight and tension in the extensor digitorum longus (EDL) muscle following partial denervation in nine-week-old male rats (300 to 325 g). The L4 nerve underwent unilateral sectioning while the opposite side served as a sham-operated control. The muscle weight and tension of the control and the partially denervated group were examined at two (n = 15), eight (n = 15), 12 (n = 15), and 16 (n = 15) weeks after L4 nerve sectioning. The partially denervated muscle weights as a percentage of respective controls were 58.6%, 56.1%, 68.4%, and 61.9% at two, eight, 12, and 16 weeks after L4 nerve sectioning. There was no significant difference (p > 0.05) between these percentages at the respective time intervals. The tetanic tensions compared with their respective matched controls were 14.5%, 32.8%, 50.0%, and 32.4% at these respective time intervals (p < 0.05). The muscle weight (MW) and muscle weight/body weight (MW/BW) of the partially denervated side as a percentage of its contralateral control remained unchanged throughout the duration of the experiment. The twitch tension (Pt), tetanic tension (Po), Pt/Po, and the Po/MW of the partially denervated muscle relative to its matched control increased between the second and the eighth week post-partial denervation (p < 0.05). After the eighth week post-L4 nerve sectioning, there was no further increase in these parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of alloxan and streptozotocin induced diabetes in rats: differential effects on microsomal drug metabolism

1. Liver microsomes from alloxan or streptozotocin diabetic rats displayed differential drug metabolizing abilities in vitro. 2. Only streptozotocin liver microsomes exhibited changes in the cytochrome P-450 normal spectral characteristics. 3. Overall testosterone metabolism was significantly increased in streptozotocin diabetic liver microsomes, whereas it was markedly decreased in alloxan diabetes. Mixed function oxidase activity for aminopyrine was similar. 4. Glucuronidation reaction rates towards morphine, oestrone and p-nitrophenol were also markedly distinct in both models as well as after insulin treatment. 5. Results suggest that diabetogenic agents modify sex related isoenzymes of cytochrome P-450 differently and selectively reduce the synthesis of certain UDP-glucuronyltransferase forms.

[H2 antagonists as inhibitors of cytochrome P-450 in rat liver: in vitro and in vivo effects]

Cytochrome P-50 is a well known participant in the metabolism of xenobiotics as well as an activator or inactivator of hepatotoxic substances and carcinogenic agents. H2 antagonists, cimetidine, famotidine and ranitidine were used to inhibit cytochrome P-450 in rat liver. After 200 mg cimetidine, 85% inhibition of cytochrome P-450 in vitro and 50% in vivo were demonstrated through demethylation of aminopyrine. Inhibition was further confirmed by differential absorption spectra (Type II). The percentage inhibition obtained with famotidine or ranitidine were lower than those obtained with cimetidine. Inhibition of the microsomal oxidative system by cimetidine could lead to decreased production of superoxide radicals and protection against damage induced by toxic agents activated in the liver.

[Gastric metastasis of renal cell adenocarcinoma]

Gastric metastases are rare, usually discovered at autopsy. The most frequent ones are breast and bronchial cancer, as well as malignant melanoma. The case of a patient with upper gastroenterological hemorrhage due to an ulcerated metastasis from a renal cell carcinoma is presented.

[Amyloid colitis]

A patient is reported who had urolithiasis and pyonephrosis of the right kidney. In the terminal phase of his disease he developed chronic diarrhea and hematochezia. Sigmoidoscopy showed changes in the colo-rectal mucosa compatible with ulcerative colitis with moderate activity. Histology demonstrated large amyloid deposits of the AA type in the lamina propia around the vessels and with atrophy and ulceration if the epithelium.

Multiple antigens in the rat visceral yolk sac induce teratogenic antisera

Preparative isoelectric focusing was used to fractionate the supernatant from a homogenate of day 19 rat visceral yolk sac. Three fractions, of pI ranges 3.5-5.0, 5.0-7.0, and 7.0-9.0, were isolated and used to immunize rabbits, by four or six weekly injections, each containing 5 mg protein. The resulting antisera were all teratogenic when injected into rats on day 9 of gestation, but widely differing potencies were observed. The most potent antiserum was that against yolk sac components focusing in the pI 7.0-9.0 range: An optimum teratogenic dose of 50 mg protein per kg body weight was observed, and a dose of 100 mg/kg was shown to cause 100% embryonic resorption. Antiserum against the fraction focusing in the pI 3.5-5.0 range was the least teratogenic: A significant incidence of embryonic malformation and death was seen only at doses of 600 mg/kg and above. The two fractions that yielded the more teratogenic antisera were refocused over narrower pH ranges, yielding four subfractions in the pI 5.0-7.0 range and eight subfractions in the pI 7.0-9.0 range. Antisera against each of these 12 fractions were raised in rabbits; most of these antisera were shown to be teratogenic, although of differing potencies. It is concluded that the yolk sac contains many antigens that can elicit antibodies with teratogenic and yolk sac-localizing properties.

Diabetes in female rats; changes in liver microsomal aminopyrine N-demethylase and UDP-glucuronyl transferase activities

Short or long term diabetes in female rats produced remarkable activation of aminopyrine N-demethylation, inhibition of oestrone and p-nitrophenol glucuronidation and no changes in morphine UDP-glucuronyltransferase activity in vitro. Km and Vmax for these reactions were determined. Insulin treatment partially antagonized diabetes activation of aminopyrine N-demethylation: it restored decreased UDP-glucuronyltransferase activities for oestrone and p-nitrophenol only in long term and short term diabetes, respectively. Insulin also markedly inhibited morphine glucuronidation. Triton X-100 also displayed a differential pattern of activation for the glucuronidation reactions in liver microsomes of diabetic rats. Results suggest that diabetes in female rats may increase the actual amount of enzyme protein for aminopyrine metabolism and to decrease that for oestrone and p-nitrophenol.

[Aorto-duodenal fistula: endoscopic diagnosis]

We report the case of a patient with hemorrhage due to secondary Aortoenteric Fistula (AEF), diagnosed by emergency oral endoscopy. We stress the importance of early diagnosis in these patients by virtue of a so-called "warning hemorrhage", which usually occurs hours or weeks before the appearance of a massive hemorrhage which is soon fatal. The importance of emergency endoscopy in the early diagnosis of these cases is emphasized.

Drug metabolism in Octodon degus: low inductive effect of phenobarbital

1. Differential effects of phenobarbital pre-treatment on liver microsomal drug metabolizing enzymes were registered in Octodon degus. 2. Glucuronidation reaction for morphine was decreased but that for p-nitrophenol was significantly increased. 3. Oxidative reactions such as naphthalene hydroxylation, morphine and aminopyrine N-demethylation were modestly increased. 4. In phenobarbital treated Octodon degus, testosterone metabolic pathways were decreased, not inducible or absent. 5. Spectral studies revealed two binding sites with different affinities for aniline in Octodon degus liver microsomes. 6. The poor phenobarbital induction on drug metabolism in Octodon degus may be a result of deficiency of androgen metabolic pathways associated to drug metabolizing enzymes.

A new physiologic correction technique for re-establishment of pulmonary circulation. Experimental surgical development

A new physiologic technique is presented for surgical correction of truncus arteriosus, pseudotruncus, transposition of the great arteries, double right ventricular outflow tract with subpulmonary ventricular septal defect and certain cases of Fallot's tetralogy. The basis of the technique are creation of a neo-right atrium, neo-pulmonary trunk, neo-right atrioventricular valve and a neo-pulmonary valve by right angular atriotomy and insertion of a homologous pericardial patch with a monocuspid valve. The pulmonary circulation is re-established by anastomosis of the neo-pulmonary trunk to the pulmonary tree. The technique was used on 26 mongrel dogs. In 14 the experiments were preliminary, to evaluate the technique's validity, and in the other 12 it was performed with extracorporeal circulation and the hemodynamic status was studied at 30 and 180 min postoperatively. The technique and its results and potential advantages are described. Clinical application is considered to be feasible.