Analysis of temporal artery biopsies in an 18-year period at a community hospital

OBJECTIVE

To identify analytical and clinical variables that may improve the effectiveness of temporal artery biopsy (TAB) for the diagnosis of giant cell arteritis (GCA).

MATERIALS AND METHODS

A retrospective study of TABs conducted between 1989 and 2007 at the 450-bed Hospital Parc Taulí, Sabadell. Demographic data, clinical manifestations, analytical data prior to the biopsy and final diagnoses were recorded, including only those cases in which these data were reflected in the clinical history.

RESULTS

In this period, 278 TABs were conducted in 181 women (65.1%) and 97 men (mean age 74 years). Seventy-nine (28.4%) were positive (GCA+) and 199 (71.5%) negative (TAB-). The most frequent final diagnoses in the TAB- group were: polymyalgia rheumatica (PMR) (18.6%), giant cell arteritis plus negative TAB (GCA-) (13.6%), tension headache (7.5%), infection (7.5%), other vasculitis (7.5%), and neoplasm (6.0%). The GCA+ group was compared with the TAB- group, the GCA- group and the PMR group. In the multivariate analysis only headache (RR 3.6), jaw claudication (RR 2.9) and abnormal temporal artery on palpation (RR 2.5) revealed statistical differences between the GCA+ and TAB- groups.

CONCLUSION

One third of the biopsies performed at our centre were positive for GCA. The clinical variables that best predicted a positive TAB in our series were headache, jaw claudication, and abnormal temporal artery on palpation.

A new type of arthropod photoreceptor

A new type of photoreceptor for the phylum Arthropoda, found in the class Collembola (Arthropoda, Hexapoda) is reported. This new light-sensitive structure consists of a pair of interocular vesicles present in the genus Vesicephalus Richards, 1964 and is anatomically related to the cluster of ommatidia. The absence of a lens, the presence of a rabdome in the upper part of the vesicle and the reflection and refraction of light by a hemolymph bubble with incidence to the rhabdomeric structure are the main traits of this new photoreceptor.

A new species and a new record of ectoparasitic mites from thrips in Turkey (Acari: Trombidiidae and Erythraeidae)

Trombidium telletxeae n. sp. is described from a larva parasitic on Odontothrips sp. (Thysanoptera: Thripidae) from Turkey. Grandjeanella multisetosa Zhang & Goldarazena is also reported for the first time in Turkey. A host list for ectoparasitic larval mites on thrips in Turkey is presented.

Recurrent hydrochlorothiazide-induced pulmonary edema

Hydrochlorothiazide-induced pulmonary edema is an unusual but life-threatening adverse reaction. It causes hypoxemia, hypotension, tachycardia, fever, and occasionally electrocardiographic and echocardiographic abnormalities. The mechanism of production is, probably, idiosyncratic.

[Autoimmune hemolytic anemia and CREST syndrome]

There are few studies addressing the frequency and etiology of anemia in progressive systemic sclerosis. Anemia is present in about 25% of these patients. Among the implicated causes are ferropenia, generally associated with gastrointestinal hemorrhage, and renal failure. In a considerable number of patients, the specific etiology of anemia remained unknown. We report a 59-year-old female with autoimmune hemolytic anemia and incomplete CREST syndrome. We emphasize the rarity of autoimmune hemolysis as a cause of anemia in systemic sclerosis, and we discuss its significance as indirectly supporting the possible autoimmune pathogenesis of that condition.

[Primary antiphospholipid syndrome: study of 27 patients]

The clinical and biological features of a series of 27 patients with the recently described primary antiphospholipid syndrome are reported. Most of them belonged to a cohort of 90 patients who were carriers of lupus anticoagulant, which had been detected in the systematic evaluation of prolonged activated partial thromboplastin times in our hospital. Since the diagnosis they underwent a prospective protocol of follow up, with a peak follow up period of 9 years. The mean age of the 27 patients was 40.8 years and there were virtually no differences between sexes. Venous thrombosis was the most common clinical finding (16 episodes in 14 of the 27 patients). The most prevalent laboratory findings were lupus anticoagulant and IgG anticardiolipin antibodies.

Fetal loss treatment in patients with antiphospholipid antibodies

A group of seven young women with antiphospholipid antibodies, histories of recurrent fetal loss, and no live births is reported. Two patients had systemic lupus erythematosus, and the other five fulfilled criteria for the primary antiphospholipid syndrome. A false Venereal Disease Research Laboratory (VDRL) test was present in four of the patients, three had a previous episode of arterial or venous thrombosis, or both, and two had thrombocytopenia. Prednisone and acetylsalicylic acid were given, and monthly controls of lupus anticoagulant activity were carried out. The dose of acetylsalicylic acid was fixed while the dose of steroids was adjusted according to the degree of lupus anticoagulant activity. A fetal survival was obtained in 7/9 (78%) of the pregnancies. Three of the newborn infants had transitory lupus anticoagulant activity. A search for antiphospholipid antibodies should be carried out in patients with otherwise unexplained fetal losses, falsely positive VDRL tests, thrombosis, or thrombocytopenia as the treatment of such patients with prednisone and acetylsalicylic acid is highly effective.

Glucose effect on PDt in rat and laying-hen small intestine both in presence and absence of calcium

The effect on the transmural potential from adding glucose under different conditions of sodium and calcium has been studied in rat and laying-hen intestine in vitro with the technique for measuring Transmural Potential Difference. The glucose, in sodium-free mediums, has no effect on the Transmural Potential Difference in rat intestine, whether calcium be present or absent. As to hen intestine, the PDt increased when calcium is present in the medium, both in the absence and presence of sodium. Glucose absorption was also determined in vivo by using mediums with/without calcium. In rat intestine glucose absorption was not affected by the presence of calcium, while its presence enhanced glucose absorption in hen intestine.

Effect of calcium concentration on the transmural potential difference and the intensity of the short-circuit current in the small intestine of rat, chicken and hen

The effect of calcium concentration on the Transmural Potential Difference and the Intensity of the Short-circuit Current in rat, chicken and laying hen small intestine has been studied in vitro both in the presence and absence of sodium. The results show that calcium, in the presence of sodium, produces an increase in potential and current intensity much greater in hen intestine than in chicken and rat. In the absence of sodium, the response of the potential as regards calcium concentration in hen intestine is parallel to the one obtained in the absence of sodium: a rise in the potential until it reaches a maximum value that corresponds to a calcium concentration of 10.8 mM in the medium, followed by a drop in the potential. However, rat intestine responds differently: the potential, negative at the serosal, becomes more and more positive with higher concentrations of calcium until it practically disappears.

[Oxygen uptake and active transport of glucose by small intestine of lizard Lacerta galloti (author's transl)]

The lizard intestine capability for active transport of D-glucose has been studied in vitro at 30 degrees C. A release of glucose and fructose from intestinal tissue to the medium took place throughout the incubation period. An active transport of glucose against a concentration gradient from the mucosal to the serosal compartment was found, but in a Na+--free medium (Tris as a substitute) this process was strongly inhibited--. The oxygen uptake was 50% higher in the presence of glucose than in its absence.

Electrochemical potential of calcium as index of intestinal permeability in rat and chicken

The electrochemical potential of calcium between the serosal and the mucosal sides of the small intestine in both rat and chicken have been studied in vitro. Techniques to measure the Transmural Potential Difference and the Short-circuit Current Intensity have been used. Our results indicate that the permeability coefficient of calcium in rat intestine towards the serosal is sixfold over that towards the mucosal. In chicken intestine it is approximately of the same order on either side. The permeability coefficient is defined as the ratio delta Eexp/ delta Etheor, where delta Eexp stands for the difference, experimentally measured, of the electrochemical potential under two distinct conditions of calcium in the medium, and delta Etheor stands for its expected value under conditions of zero permeability.

Competitive kinetics of sugar active transport in snail intestine

Everted intestinal rings of the snail Cryptomphalus hortensis accumulate labelled sugars against a concentration gradient. The active transport of D-galactose (KT = 3.6 mM) is competitively inhibited by D-glucose (Ki = 8.2 mM) and by 3-0-methylglucose (Ki = 24 mM), but it is not affected by L-arabinose, D-fructose, L-arabinose and D-mannitol penetrate into the tissue at the same rate, they do not develop accumulation gradient, and all of them follow the kinetics of a diffusion process. D-glucose, on the contrary, like galactose, penetrates much more quickly and accumulates against a gradient.

Intestinal absorption of sugars and amino acids in the earthworm

Absorption of glucose, galactose, fructose and leucine from luminal to coelomic compartments across the intestinal wall of Scherotheca sp. seems to be a simple diffusion process and not a product of active transport or facilitated diffusion. A concentration gradient never developed from identical initial concentrations of the 14C-labelled substrates on either side of in vitro everted intestinal sacs. The rates of net passage of glucose and galactose were in linear function with the respective sugar concentration gradient. A competition between these two sugars was not observed. The diffusion rate of glucose was higher from mucosal to serosal than in reverse direction. Intestinal tissues synthesized glycogen from glucose in the medium, this process being strongly inhibited by dinitrophenol.

[Effect of the ionic environment and of various neurotransmitters on spontaneous motility in snail intestine (author's transl)]

A spontaneous rhythmic motility of the isolated intestine in snail, Chryptomphalus hortensis, has been registered at 30 degrees C with the aid of an electronic transductor and an appropriate amplification. These slow regular movements are affected by ionic composition changes in the suspension medium. Na+, K+ and Ca++ ions prove to be important in this motility, and the addition of Ba++ markedly stimulates it. ACh produces hypermotility from 1.8 X 10(-11) g/ml. Its effect decreases in the presence of atropine and increases in that of pyridostigmine. The intestine is sensitive to 5-HT from 10(-10) g/ml, which stimulates its activity. The effect of histamine is weak. Low concentrations of adrenaline tend to increase the amplitude, whereas concentrations from 10(-5) g/ml onward produce a cease of motility in relaxation.

Effect of inhibitors on the intestinal active transport of glucose in tortoise

Glucose intestine active transport in tortoise Testudo hermanni robertmertensi Wermuth has been studied in vitro in the presence of known sugar active transport inhibiting substances. The final Serosal/Mucosal gradient is practically the same in aerobic and anaerobic conditions. A 10(-4) M concentration of DNP inhibits active transport of glucose and increases O2 uptake; a 10(-3) M concentration reinforces transport inhibition and lowers O2 uptake to normal values. Nullification of glucose active transport was not achieved by any of the DNP essayed concentrations. NaF greatly inhibits both glucose active transport and O2 uptake, whereas phlorizin inhibits transport and does not affect respiration. Tortoise intestine is able to obtain the required energy for its glucose active transport through both aerobic and anaerobic metabolism. Besides its oxidative phosphorylation uncoupling action, DNP also appears to affect glycolysis. Glycolysis inhibition and intestinal epithelial alteration may be responsible for the strong inhibition caused by NaF. Phlorizin seems to inhibit sugar transport by competence on the sugar carrier, at membrane level, without disturbing cellular metabolism.

Active transport of sugars in tortoise intestine

The tortoise intestine capability for active transport of sugars has been studied in vitro at 30 degrees C, using labelled sugars. A release of glucose from the glycogen stores of the intestinal wall to the medium took place throughout the incubation period of the sacs. An active transport of 14C-D-glucose against a concentration gradient from the mucosal to the serosal compartment was evident, whereas no such activity could be detected for 14C-D-galactose. The tissue oxygen uptake was 36% higher with glucose than with galactose in the medium.

Sodium dependence of intestinal active transport of sugars in snail (Cryptomphalus hortensis Müller)

Active transport of sugars (D-galactose, D-glucose, 3-0-methylglucose and L-arabinose) by sacs of everted intestine of snail (Cryptomphalus hortensis) was strongly inhibited, but not abolished, when all Na from the bathing solutions was substituted by K, Tris, Mg or Ca. Absence of Na produced also a marked inhibition of O2 consumption by the tissue. Omission of other cations (K, Ca, Mg), substituted by Tris, did not affect sugar transport or O2 uptake. Sodium seems to play a specific and important but not indispensable rôle in sugar active transport by snail intestine. Since anaerobiosis did not affect sugar transport, this Na role is independent of its effect on O2 uptake.

Effect of anaerobiosis, dinitrophenol and fluoride on the active intestinal transport of galactose in snail

The active transport of galactose across the intestinal wall (everted sacs) of the snail Cryptomphalus hortensis Müller has been studied in vitro, under several metabolic conditions. Anaerobiosis does not change the serosal/mucosal galactose gradients which are developed in oxygen atmosphere. Dinitrophenol (10(-4) M) greatly increased the O2 uptake by the tissue and clearly inhibits the sugar transport. At 5 times 10(-4) M concentration, DNP totally prevents the uphill transport while the O2 uptake is normal. The inhibition produced by DNP does not increase by anaerobiosis. Fluoride inhibits the galactose transport and also the O2 uptake. It is deduced that in snail intestine the energy for the active transport of galactose can be supplied by aerobic as much as by anaerobic metabolism. The inhibition by dinitrophenol seems to be independent of its uncoupling action on the oxidative phosphorylation. The inhibitory effect of NaF may be due both to glycolisis inhibition and to alteration of the digestive epithelium.

Active transport of sugars by the intestine of snail (Cryptomphalus hortensis Müller)

Sugar transport by sacs of everted intestine of snail have been measured in vitro at 30 degrees C. D-galactose, D-glucose and 3-O-methylglucose were actively transported against a concentration gradient from the mucosal to the serosal compartment. The transport of these sugars was inhibited by 5 times 10(-8) to 10(-6) M phlorizin. L-arabinose was also accumulated in the serosal compartment against a concentration gradient; in this case, transport was not affected by phlorizin. The snail intestine did not show any ability for D-fructose active transport but there was a clear uptake of this sugar by the tissue. The O2 uptake of the snail intestine was not significantly affected by the presence of either sugars or phlorizin.

Effect of coumarin and some coumarin derivatives on active transport and passive diffusion of sugars by chicken and rat intestine, in vitro

The effect of coumarin, 4-hydroxycoumarin, coumarin-3-carboxylic acid and acenocoumarol on the active transport of D-galactose and the passive diffusion of arabinose by intestinal sacs was studied. All these substances, when added to the mucosal medium of incubation at concentrations from 10(-4) to 10(-3) M, inhibit the active transport of D-galactose and increase the diffusion of arabinose. Oxygen uptake by the intestinal tissue is only inhibited by coumarin-3-carboxylic acid. The results suggest that the effects obtained are probably due to an alteration in intestinal permeability, to inhibition of cell metabolism and to molecular size.