Long-term exposure to duodenal levodopa/carbidopa infusion therapy improves quality of life in relation especially to mobility, activities of daily living, and emotional well-being.

BACKGROUND: Continuous duodenal levodopa infusion (DLI) is an effective therapy that improves quality of life (QoL) in advanced Parkinson's disease (PD). However, in which aspects improve the patients their QoL has been poorly documented. METHODS: We evaluated 39-item Parkinson's disease Quality of Life Questionnaire Summary Index score (PDQ-39SI) changes analyzing its different domains in nine patients with advanced PD treated with DLI. RESULTS: All the patients (64.7 ± 11.1 years, 55.5% men) improved PDQ-39SI 6 months after beginning with DLI (29.7 ± 8.6, P = 0.008) and after median duration infusion of 25.3 ± 8.8 months (34.8 ± 11.2, P = 0.008) compared with baseline (55.6 ± 11.5). All domains except social support improved significantly at 6 months. Mobility (P = 0.012), activities of daily living (P = 0.015), and emotional well-being (P = 0.008) improved significantly at the end of the follow-up. CONCLUSIONS: DLI improves QoL in patients with advanced PD after short- and long-term exposure. Whereas all domains except social support improve after 6 months under DLI, only mobility, activities of daily living and emotional well-being improve significantly after long-term exposure to DLI.

Endoscopic follow-up of gastric ulcer in a population at intermediate risk for gastric cancer.

OBJECTIVES: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. PATIENTS AND METHODS: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. RESULTS: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn s disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). CONCLUSIONS: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy.

[Low birth weight is a risk factor for type 1 diabetes]. / El bajo peso al nacer es un factor de riesgo de diabetes mellitus tipo 1.

INTRODUCTION AND AIM: Over recent years, the increasing incidence of type 1 diabetes mellitus (T1DM) has been associated with different factors, particularly increased obesity in childhood. The aim of this study was to find out if there was any relationship between birth weight, body mass index (BMI) increase during the first two 3 years of life, and BMI at diabetes onset with age at diagnosis, in a cohort of children diagnosed with T1DM. MATERIAL AND METHOD: Data from 100 Caucasian children with T1DM of both sexes (57 boys, 43 girls) between 10 months and 16 years of age, mean age 84.45 months (SD; 52.4), were studied. We analysed the following variables: age at diagnosis, gestational age, weight and height at birth, at two years of age and at diabetes diagnosis, expressed as SD scores (SDS). RESULTS: All children were between 38-40 weeks of gestational age. Diabetic patients have lower birth weight (-2.88 ((-0.51)-(-0.066)) and lower BMI at birth compared with healthy children -0.5 ((-0.77)-(-0.23)). Diabetic children have a significant increase in BMI during the first two years of life (4.58 versus 2.17; P<0.001). Children with the lowest BMI at birth (12.77 versus 13.06; P<0.006) are the youngest at onset of the disease. BMI at diagnosis was not related to any of the variables studied. There were no gender differences either. CONCLUSIONS: The low BMI at birth and the later increase in the following years of life seem to be related to intrauterine environment as a risk factor for T1DM.

Cost of osteoporotic hip fracture in Spain per Autonomous Region. / Coste de la fractura de cadera osteoporótica en España por comunidad autónoma.

OBJECTIVE: We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. METHODS: Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. RESULTS: Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). CONCLUSIONS: OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits.

High levels of mouse thymosin beta4 mRNA in differentiating P19 embryonic cells and during development of cardiovascular tissues.

The self assembly of actin and the large number of actin-binding proteins are important in the establishment of cell shape and function during embryogenesis. Thymosin beta4 (Tbeta4) is a small acidic peptide that participates in the regulation of actin polymerization in mammalian cells. In the present work, we report the presence of the mRNA encoding for Tbeta4 in mouse embryonic stem cells and its induction in P1 9 embryonal cells stimulated to differentiate into ectodermal-like (neurons and glia) or mesodermal-like cells (cardiac and skeletal muscle). The induction of Tbeta4, mRNA in P19 cells was confirmed by in situ hybridization analysis of early mouse postimplantation embryos. Noteworthy, we observed an important hybridization signal in several areas of the embryo specially in blood vessels and in heart tissues, suggesting a role for this peptide in angiogenesis. In conclusion, the results presented here demonstrate the expression of Tbeta4 gene during early embryogenesis which immediately suggests an important role for this peptide in developmental processes requiring actin-based functions such as the formation of cardiovascular system.

[Gastroparesis and other gastrointestinal symptoms in Parkinson's disease]. / Gastroparesia y otros sintomas gastrointestinales en la enfermedad de Parkinson.

Different gastrointestinal symptoms, such as excessive salivation, deterioration and other disorders affecting the teeth, dysphagia, gastroparesis, gastroesophageal reflux, constipation, difficult defecation or loss of weight are frequent events in all the stages of the development of Parkinson's disease and affect at least a third of the patients. These symptoms reflect the dysfunction of the enteric nervous system, and the stomach is one of the organs where alpha-synuclein is first deposited. Other factors, such as the dysfunction of structures in the central nervous system like the dorsal motor nucleus of the vagal nerve, hormonal factors or secondary effects deriving from the consumption of antiparkinsonian drugs, are involved in its origin. The present article offers a detailed review of the epidemiological, pathophysiological, clinical and therapeutic management aspects of the different gastrointestinal symptoms in Parkinson's disease.

TITLE: Gastroparesia y otros sintomas gastrointestinales en la enfermedad de Parkinson.Diferentes sintomas gastrointestinales, como salivacion excesiva, deterioro y otros trastornos de las piezas dentarias, disfagia, gastroparesia, reflujo gastroesofagico, estreñimiento, dificultades en la defecacion o perdida de peso, son frecuentes en todos los estadios evolutivos de la enfermedad de Parkinson y afectan al menos a un tercio de los pacientes. Estos sintomas reflejan la disfuncion del sistema nervioso enterico, siendo el estomago uno de los organos donde mas precozmente se deposita la alfa-sinucleina. Otros factores, como la disfuncion de estructuras del sistema nervioso central como el nucleo motor dorsal del nervio vago, factores hormonales o efectos secundarios derivados del consumo de farmacos antiparkinsonianos estan implicados en su origen. El presente articulo revisa en detalle aspectos epidemiologicos, fisiopatologicos, clinicos y de manejo terapeutico de los diferentes sintomas gastrointestinales en la enfermedad de Parkinson.

Thymosin beta10 mRNA expression during early postimplantation mouse development.

The beta-thymosins are a family of monomeric actin sequestering peptides that regulate actin dynamics within the cells. During embryogenesis the control of actin polymerization is essential in processes such as cell migration, angiogenesis and neurogenesis. Here we report that the levels of thymosin beta10 (Tbeta10) mRNA strongly increase during early postimplantation mouse embryogenesis as well as during in vitro P19 cell differentiation, indicating that this peptide plays an important role in early development. Moreover, analysis of the spatial distribution of Tbeta10 mRNA in 9.5-12.5 days postcoitum mouse embryos showed a remarkable presence of this transcript in mesenchymal structures as well as in the mantle layer of spinal cord. Interestingly, we observed differences in the distribution of the mRNAs encoding Tbeta10 and Tbeta4, another member of the beta-thymosin family, suggesting different roles for these peptides during mouse embryogenesis.

Expression of thymosin beta4 messenger RNA in normal and kainate-treated rat forebrain.

Thymosin beta4 is a major actin-sequestering peptide widely distributed in mammalian tissues, including the nervous system. In the present study, we analyse the expression of thymosin beta4 in normal and kainate-treated rat forebrain. In untreated animals, thymosin beta4 messenger RNA is mainly expressed in neurons of the hippocampal formation, neocortex and amygdaloid complex, as well as in oligodendrocytes. Other high-expressing areas are the tanycytic ependyma of the infundibulum, the substantia nigra pars compacta, and the supraoptic and premammillary nuclei. In rats treated with kainate, an excitotoxin that induces synaptic activation in the CA1-CA3 pyramidal neurons of the hippocampus, the levels of thymosin beta4 were clearly increased in the hippocampus and neocortex during the first 2-3 h after injection. In the long term, kainate causes neuronal degeneration in the CA1-CA3 regions of the hippocampus and functionally related structures, provoking a depletion of thymosin beta4 messenger RNA in these areas; however, the levels of this transcript are restored two weeks after kainate injection. Moreover, we have found that, in these degenerating zones, gliosis is accompanied by an elevation of the levels of thymosin beta4 messenger RNA, particularly in the CA1-CA3 region of the hippocampus, the lateral geniculate nucleus and the mammillothalamic tract. The present results demonstrate the existence of relatively high levels of thymosin beta4 messenger RNA in several areas of the rat forebrain, indicating that this peptide plays an important role in the regulation of actin polymerization in these regions of the brain. Moreover, the elevation of this messenger RNA after kainate treatment suggests a function of thymosin beta4 in the production and remodelling of neuronal processes. Finally, our findings provide evidence for a participation of this actin-sequestering molecule in the reactivity of certain types of glial cell that follows kainate lesions.

Expression of the thymosin beta10 gene in normal and kainic acid-treated rat forebrain.

Thymosin beta10 (Tbeta10) is a small actin-sequestering peptide widely distributed in mammalian tissues including nervous system. Here, we analyze the expression of Tbeta10 gene in normal and kainic acid (KA)-treated rat forebrain by in situ hybridization. Our results showed a defined regional pattern of the mRNA encoding for Tbeta10 in both normal and KA-treated rat forebrain. The presence of this transcript in different regions of the rat forebrain, including hippocampus, neocortex and several brain nuclei, provides evidence for the participation of Tbeta10 in the control of the actin dynamics that takes place in neurons. Furthermore, the analysis of the forebrain in KA-treated rats revealed an activation of the Tbeta10 gene linked to gliosis.

Differential expression of thymosins beta(4) and beta(10) during rat cerebellum postnatal development.

The beta-thymosins are a family of actin monomer-sequestering proteins widely distributed among vertebrate classes. The most abundant beta-thymosins in mammalian species are thymosin beta(4) (Tbeta(4)) and thymosin beta(10) (Tbeta(10)), two small peptides (43 amino acids) sharing a high degree of sequence homology. In the present work, we have analyzed the distribution of Tbeta(4) and Tbeta(10) in the developing and adult rat cerebellum using in situ hybridization and immunohistochemistry techniques. Our results show that the temporal and cellular patterns of expression of both beta-thymosins are different. In the young (7 and 18 postnatal days) and adult (1 and 4 months old) rat cerebellum, Tbeta(4) was mainly expressed in the glia (microglia, Golgi epithelial cells and oligodendrocytes), neurons (granule cells and Purkinje cells), and in the capillaries. In 14-month-old rats, the Tbeta(4) immunoreactivity was only detected in some microglia cells. In young and adult animals, most of the Tbeta(10) immunoreactivity was localized in several types of neuronal cells including granule cells, Golgi neurons and Purkinje cells. In old animals, a faint Tbeta(10) signal could be detected in a few Purkinje cells. Our results suggest that each beta-thymosin could play a different function in the control of actin dynamics.

Significant increase in eradication rates of Helicobacter pylori infection with two consecutive dual therapies (omeprazole and amoxycillin or omeprazole and clarithromycin). A randomized study in 450 Spanish patients.

Helicobacter pylori infection is associated with peptic ulcer disease and chronic gastritis, and eradication of the microorganism markedly reduces the recurrence of peptic ulcer. However, a major problem is the choice of a treatment that is effective, has high eradication rate, and is well tolerated by patients. We evaluated the eradication of H. pylori infection in patients with chronic gastritis (CG), duodenal ulcer (DU), and gastric ulcer (GU) after two dual therapies (omeprazole with either amoxycillin or clarithromycin). Of 450 patients initially included in the study, 207 had CG, 187 DU and 56 GU, and all presented with H. pylori infection. Diagnosis was made from endoscope examination, biopsy samples, rapid urease test and 13C-urea breath test (UBT). H. pylori infection was considered to be present when two of the tests had positive results. All patients were randomized to one of two regimens: (A) omeprazole (20 mg b.i.d.) plus amoxycillin (750 mg t.i.d.) or (B) omeprazole (40 mg b.i.d.) plus clarithromycin (500 mg t.i.d.). The duration of each of the regimens was 2 weeks. Fifty-eight patients who showed H. pylori infection after the first treatment (27 with CG, 24 with DU, and 7 with GU) were allocated to a second therapy. H. pylori eradication was assessed by UBT, 6 weeks after the end of the therapies; positive values were those higher than 5 delta units. A second consecutive dual therapy of omeprazole plus an antibiotic (amoxycillin or clarithromycin) not used in the first therapy improved on the eradication rates obtained with the first regimen. The overall eradication rates were also higher, but no significant differences were found between amoxycillin and clarithromycin. The best results were obtained in those patients with GU.

Hepatitis C virus infection detected by viral RNA analysis in porphyria cutanea tarda.

The high prevalence (62%) of anti-HCV in patients with porphyria cutanea tarda (PCT) found in a recent study prompted us to speculate that hepatitis C virus (HCV) infection could contribute to liver damage in this disease. The relationship between a positive serologic test and infectivity remains elusive, as anti-HCV false-positive reactivity has been described in some patients with chronic liver disease. Hence, it needs to be established if HCV infection plays a role in the pathogenesis of liver injury, or anti-HCV positivity may be an epiphenomenon in PCT patients. The aim of this study was to evaluate the existence of true HCV infection by verifying the presence of serum viral RNA in patients with PCT. HCV RNA was studied in sera from 36 patients with clinical and biochemical features of PCT using a polymerase chain reaction technique. Additionally, 26 patients with chronic alcoholic liver disease and 29 patients with different dermatological lesions but with no liver disease were studied as control groups. HCV RNA was positive in 29 of 36 patients (80.5%) with anti-HCV positive PCT. For alcoholic liver disease and dermatological disease controls the values for HCV RNA were 11.5% and 3.4%, respectively. HCV infection was found to be significantly higher in patients with PCT than in controls (P < 0.001), demonstrating that most subjects with clinically expressed PCT have true HCV infection. These data support the hypothesis that liver damage in some patients with PCT may be attributed to prolonged HCV infection, suggesting that treatment for chronic hepatitis C could be indicated.

Scoliosis induced by asymmetric lordosis and rotation: an experimental study.

STUDY DESIGN: An experimental study of the influence of intrinsic muscle imbalance on the spinal column of a growing rabbit. OBJECTIVES: To create an in vivo experimental model of scoliosis for comparison with human scoliosis. SUMMARY OF BACKGROUND DATA: There is evidence that asymmetric lordosis may produce scoliosis and that there is muscle imbalance in scoliotic patients. METHODS: Surgical tethering of the spinous apophysis and transverse apophysis of rabbits was performed at three upper levels on the same side of the spine to simulate dominance of one side of the paravertebral musculature over the other. RESULTS: All animals exhibited scoliosis that was convex toward the side opposite that receiving surgery. Radiography showed the curve to increase with time. Postmortem examination of vertebrae revealed structural alterations similar to those produced in human scoliosis. CONCLUSIONS: Intrinsic muscle imbalance in the spinal column of the experimental growing animal may produce scoliosis with characteristics similar to those of human idiopathic scoliosis.

The relationship between pes cavus and idiopathic scoliosis.

STUDY DESIGN: The incidence of pes cavus and scoliosis was studied in three groups of patients. Group A contained 130 patients with idiopathic scoliosis, Group C contained 210 patients with idiopathic pes cavus, and Group B (control) contained 200 patients of similar age. OBJECTIVES: To investigate the joint presentation of pes cavus and idiopathic scoliosis, because both deformities may share a common etiology linked to muscle imbalance. SUMMARY OF BACKGROUND DATA: Sixty five percent of Group A patients (85 of 130) had an abnormally high plantar arch, compared to only 9.5% (19 of 200) of Group B control subjects. Nine percent (20 of 210) of the patients in Group C had scoliosis curves, compared to only four patients in Group B. METHODS: Radiographs were taken to determine the type of scoliosis curve, its location, and its magnitude, and to identify the incidence of spina bifida occulta in the three groups. The incidence and degree of pes cavus were established by means of foot prints. Statistical analyses were performed on all results. RESULTS: A statistically significant relationship (P < 0.01) was found for the incidence of pes cavus between Group A (scoliosis) and Group B (control), and for the incidence of scoliosis between Group C (pes cavus) and Group B (control). No statistical significance was observed for the other relationships investigated (sex, curve location, magnitude, spina bifida). CONCLUSIONS: There was a significant correlation between scoliosis and pes cavus--spina bifida was not an etiologic factor. Therefore, in certain patients where scoliosis and pes cavus present jointly, deformity may be secondary to altered balance or to disorders of the central nervous system.

Delayed diagnosis of fatigue fractures in the elderly.

A retrospective study was made of 30 stress fractures in elderly patients engaged in noncompetitive sporting activities, mostly marching and running. Fractures were located exclusively in the lower limbs. In many cases the diagnosis was delayed and in several cases was incorrect because the stress fracture was mistaken for other conditions. Given that the number of senior citizens engaged in active life and sporting activities is constantly growing, physicians should be aware of this type to ensure early diagnosis and appropriate treatment.

Wrist involvement in Hansen's disease.

We performed a neurological and radiological study of the wrists of 58 patients with Hansen's disease and 60 age-matched healthy control subjects. Significant differences (p < 0.01) were found between the groups in the carpal glenoid sector, the radial physeal widening index, the carpal ulnar distance, the carpal index and in distal radio-ulnar discrepancy. Comparison of the results in three subgroups of leprous patients with sensory impairment (group A-1), motor deficit (A-2) and no neurological impairment (A-3), showed significant differences (p < 0.01) between group A-1 and the other two. This suggests that in these patients the changes in the carpus and radiocarpal joint may be caused by neuropathic arthropathy of the wrist. Our findings are of particular interest since there are few reports of neuropathic arthropathy in non-weight-bearing joints.

Clinical features of ten cases of osteopoikilosis.

A retrospective study was carried out of the ten cases of osteopoikilosis seen at this Orthopedic Unit over a 15-year period in order to determine the reasons why patients seek consultation, preliminary diagnosis, and associated lesions. Eight patients consulted for problems not related to the locomotor apparatus, and diagnosis was by chance; the other two presented joint pain. The preliminary diagnosis was osteoblastic metastasis in five patients and osteopoikilosis in the other five. None of the patients displayed skin or visceral involvement, but three presented bone alterations. Definitive diagnosis was made by measurement of biochemical markers of bone remodeling, radiography of both hands, and bone scan. Bone biopsy was performed in one case. Although rare, the radiographic symptoms of osteopoikilosis are sufficiently specific to avoid false diagnoses, which may give rise to rigorous and expensive studies for other important disorders.

[Usefulness of the breath test with urea-13C in the diagnosis of Helicobacter pylori infection]. / Utilidad del test del aliento con urea-13C en el diagnóstico de la infección por Helicobacter pylori.

BACKGROUND: Many diagnostic methods of variable diagnostic profitability are available to detect infection by Helicobacter pylori. The aim of this study was to evaluate the usefulness of the European method of the breath test with urea-13C and compare the results with common histologic methods, the rapid urease test and serology. METHODS: Thirty-six patients who attended the Endoscopy Unit for recurrent symptomatology of the upper digestive tract were included in the study. A patient was considered to present infection by Helicobacter pylori on positivity of 2 of the usual methods: histology, rapid urease test and serology. RESULTS: The breath test with urea-13C was positive in 25 patients (13CO2 > 5 per 1,000) and negative in 10 patients with 100% specificity and 96% sensitivity. The specificity of the rapid urease test, histology and serologic tests were 90, 90 and 80%, respectively with 92, 88, and 88% sensitivity, respectively. CONCLUSIONS: The European method of the breath test with urea-13C is simple, non invasive and achieves the greatest profitability in the determination of Helicobacter pylori.

Bilateral luxatio erecta humeri.

The authors report one case of bilateral inferior dislocation of the shoulder, a rare form of injury, accounting for only 0.5% of all shoulder dislocations. Bilateral cases are even less frequent, with only six cases reported in the literature. The injury was complicated by paresia of the left axillary nerve and sensory alterations in both median nerves, without any associated osteoarticular or vascular injuries. The patients made a complete functional recovery within three years.

Bilateral congenital dislocation of the patella.

We report the case of a six-year-old boy with Down syndrome who presented with flexion contractures of both knees and genu valgum. The diagnosis of bilateral congenital dislocation of the patella was established by clinical and xray examination. The patient was treated surgically with a satisfactory result.