A non-destructive sampling method for food authentication using gas chromatography coupled to mass spectrometry or ion mobility spectrometry.

The study of volatile compounds obtained by gas chromatography (GC) coupled to mass spectrometry (MS) or ion mobility spectrometry (IMS) may be very useful to protect food quality, especially when using a non-destructive sampling method. In this work, the authentication of the highly appreciated dry-cured Iberian ham by those techniques was studied and compared. The results obtained show the suitability of a non-destructive sampling method coupled to headspace sampling (HS)-GC-IMS or HS-GC-MS to determine volatile markers in the feeding Iberian pig regime. Although both methods were suitable to differentiate the ham categories, HS-GC-IMS was more sensitive detecting a higher number of compounds than HS-GC-MS, which provided accurate qualitative results. The results of principal component analysis showed that ethanol, 2-propanol and 3-methylbutanol, identified by HS-GC-IMS, and 3-methylbutanal and heptane, identified by HS-GC-MS, could be considered potential markers to identify ham from different feeding regimes.

Small Ruminant Lentiviruses in Sheep: Pathology and Tropism of 2 Strains Using the Bone Marrow Route.

The objective of this work was to comparatively study the tissue tropism and the associated pathology of 2 autochthonous small ruminant lentivirus (SRLV) field strains using an experimental infection in sheep through the bone marrow. Fifteen male, SRLV-free lambs of the Rasa Aragonesa breed were inoculated with strain 697 (nervous tissue origin, animals A1-A6), with strain 496 (articular origin, animals B1-B6), or with uninfected culture medium (C1-C3). Clinical, serologic, and polymerase chain reaction (PCR) evaluations were performed periodically. Two lambs from each infected group and a control animal were euthanized at 134, 273, and 319 days postinfection. Tissues were analyzed by gross and histopathologic evaluation; immunohistochemistry for CD3, CD4, CD8, CD68, and FoxP3 cell markers; lung morphometric evaluation; and tissue proviral quantification by PCR. All infected animals became positive either by enzyme-linked immunosorbent assay and/or PCR, with group B lambs showing the highest serologic values and more consistently positive PCR reactions. Group A lambs showed representative lung lesions but only mild histopathologic changes in the central nervous system (CNS) or in carpal joints. Contrarily, group B lambs demonstrated intense carpal arthritis and interstitial pneumonia but an absence of lesions in the CNS. Proviral copies in tissues were detected only in group B lambs. Experimental infection with these SRLV strains indicates that strain 496 is more virulent than strain 697 and more prone to induce arthritis, whereas strain 697 is more likely to reproduce encephalitis in Rasa Aragonesa lambs. Host factors as well as viral factors are responsible for the final clinicopathologic picture during SRLV infections.

Manejo del síndrome de abstinencia alcohólica en los pacientes críticos / Management of the syndrome of alcohol withdrawal in critical patients

El manejo del síndrome de abstinencia alcohólica es un desafío en los pacientes críticos. Con frecuencia, se desconocen los antecedentes de consumo de alcohol o este dato es incompleto, lo que limita la identificación de quienes pueden desarrollar este síndrome. El cese abrupto del consumo de alcohol coloca a estos pacientes en alto riesgo de sufrir síndrome de abstinencia alcohólica grave. Típicamente, las benzodiacepinas son consideradas las drogas de primera línea para el manejo de estos casos. Sin embargo, si el paciente progresa a un estado más grave con convulsiones o delirium tremens, puede ser necesario administrar medicación adyuvante a las benzodiacepinas, como el propofol o la dexmedetomidina, o emplear estas últimas drogas como terapias alternativas en aquellos que no responden a las benzodiacepinas. La aparición de convulsiones representa un fuerte factor de riesgo para la progresión a un síndrome de abstinencia alcohólica grave, con el desarrollo posterior de delirium tremens hasta en el 30% de los casos. El delirium tremens es el cuadro más grave y ocurre en el 5-20% de los pacientes con este síndrome, con una mortalidad hasta del 25% sin tratamiento y que se reduce al 0-1% con tratamiento. Es importante conocer el antecedente del consumo de alcohol para evitar el síndrome de abstinencia alcohólica o tratar rápidamente sus síntomas más graves, y mejorar la supervivencia de estos pacientes.(AU)

Alcohol withdrawal syndrome (AWS) is a well-known and a challenging condition occurring in critically ill patients. Frequently, history of alcohol abuse is unknown when the patient is admitted to the intensive care unit, limiting the identification of those who could develop AWS. The abrupt cessation of a heavy or constant drinking put these patients in high risk of suffering from this syndrome in its severe form. Typically, benzodiazepines are considered the first line of treatment. However, if clinical conditions progress to epileptic seizures or delirium tremens or are refractory to benzodiazepines, adjuvant drugs like propofol or dexmedetomidine might be an option to control the severe symptoms. Delirium tremens can occur in up to 30% of patients; it is the most severe picture with a mortality of 25% without treatment and that can be reduced to almost 0-1% with treatment. It is important to appropriately identify alcohol abuse in order to avoid the early clinical manifestations of AWS or rapidly treat its most severe symptoms and improve survival.(AU)

Patterns of lesion and local host cellular immune response in natural cases of ovine maedi-visna.

This study investigates the nervous form of ovine maedi-visna by histological and immunohistochemical techniques. The aim was to study the lesion types and the local cellular immune response related to each lesion type, and the possible relationship between these parameters. Thirty-four Assaf ewes were studied, 29 of which had shown nervous signs. Microscopical lesion patterns were described according to location, extent and predominance of inflammatory cell type. Immunohistochemical labelling of T cells (CD3(+), CD4(+), CD8(+) and cells expressing the γδ form of the T-cell receptor), B cells and macrophages revealed clear differences between the lesion patterns. Two main lesion types were described. Lymphocytic lesions had areas of mild-moderate injury characterized by a predominance of infiltrating T cells. Histiocytic lesions were more severe and had extensive areas of malacia and dominant infiltration by macrophages and B cells. Each animal had a unique lesion pattern and these differences could be due to individual resistance to the progression of infection. The lymphocytic lesions appear to represent initial or latent phases of slow progression, in which the animal presents some natural resistance to the infection. The histiocytic pattern may reflect a poor immune response or a greater virulence of the viral strain.

Visna/Maedi virus genetic characterization and serological diagnosis of infection in sheep from a neurological outbreak.

An extensive outbreak characterized by the appearance of neurological symptoms in small ruminant lentivirus (SRLV) infected sheep has been identified in Spain, but the genetic characteristics of the strain involved and differential diagnostic tools for this outbreak remain unexplored. In this work, 23 Visna-affected naturally infected animals from the outbreak, 11 arthritic animals (both groups presenting anti-Visna/Maedi virus serum antibodies), and 100 seronegative animals were used. Eight of the Visna-affected animals were further studied post-mortem by immunohistochemistry. All had lesions in spinal cord, being the most affected part of the central nervous system in six of them. A representative strain of the outbreak was isolated. Together with other proviral sequences from the outbreak the virus was assigned to genotype A2/A3. In vitro culture of the isolate revealed that viral production was slow/low in fibroblast-like cells but it was high in blood monocyte-derived macrophages. The long terminal repeat (LTR) of the viral genome of this isolate lacked an U3-duplication, but its promoter activity in fibroblast-like cells was normal compared to other strains. Thus, viral production could not be inferred from the LTR promoter activity in this isolate. Analysis of the viral immunodominant epitopes among SRLV sequences of the outbreak and other known sequences allowed the design of a synthetic SU peptide ELISA that detected the Visna affected animals, representing a tool of epidemiological interest to control viral spread of this highly pathogenic strain.

Infección del sitio de salida de los catéteres venosos centrales y su asociación con bacteriemia relacionada con catéter / Infection of the exit site central venous catheters and its association with bacteremia related to catheter

Introducción: Los catéteres venosos centrales (CVC) plantean un alto riesgo de infección. La infección del sitio de salida (ISS-CVC) es la menos estudiada, y se desconoce su asociación con la bacteriemia asociada a catéter (BAC) y su impacto en la evolución del paciente. Objetivo: Evaluar la asociación entre ISS-CVC, BAC y mortalidad. Materiales y métodos: Estudio prospectivo, de observación. Pacientes internados en una Unidad de Terapia Intensiva médico/quirúrgica que requirieron la colocación de CVC desde el 01/06/2010 hasta el 01/04/2012. Se evaluaron datos epidemiológicos, BAC (según criterios de los CDC) y gérmenes. Se utilizaron media ± DE, mediana y rango intercuartílico, y porcentajes. Resultados: Durante este período, ingresaron 575 pacientes, el 98% requirió CVC. Datos de los pacientes: edad 41 ± 26 años, APACHE II 15 ± 7, 96% con ventilación mecánica, días de ventilación mecánica 41 (33-63), días de internación 43 (25-67). Todos los CVC con ISS fueron retirados y cultivados. Se observaron 51 ISS: 5,5/1000-días-catéter: 33% subclavia, 38% yugular, 29% femoral. Seis pacientes con ISS (12%) tuvieron BAC (0,65/1000-días-catéter): 3 subclavias, 2 yugulares, 1 femoral; 2 con halo y 8 con secreción purulenta. Tiempo de permanencia del CVC: 7,5 días (5-10). Clínica al momento de la ISS: shock 50%, fiebre 83%, SOFA 6 ± 3. El 83% de las infecciones fueron monomicrobianas: 83% por bacilos gramnegativos (2 Klebsiella, 2 Pseudomonas, 1 Serratia y 1 Acinetobacter), 17% por enterococos resistentes a vancomicina. La mortalidad fue del 50%. Conclusión: Aunque la ISS provocó una baja incidencia de BAC, la mortalidad fue alta. Al parecer, la ISS no es un factor predictivo de BAC.(AU)

Introduction: Central venous catheters (CVC) are widely used and pose a high risk of infection. There are few studies on insertion site infection (ISI-CVC), and both its association with catheter-associated bloodstream infection (CABSI) and the outcome of patients are unknown. Objective: To determine the association between ISI-CVC, the presence of CABSI and mortality. Materials and methods: Prospective observational study. All patients admitted to a medical/surgical Intensive Care Unit requiring CVC insertion from 06/01/2010 to 04/01/2012 were included. Epidemiological data, CABSI (according to CDC criteria) and microorganisms involved were evaluated. Mean ± SD, median and interquartile range, and percentages were used. Results: During the period study, 575 patients were admitted, 98% required CVC. Patient´s data: age 41 ± 26 years, APACHE II 15 ± 7, 96% on mechanical ventilation, days on mechanical ventilation: 41 (33-63), length of stay 43 (25-67) days. All CVCs with ISI were removed and cultured. Fifty one ISI were observed (5.5/1000-catheter-day). Six patients with ISI (12%) presented CABSI (0.65/1000-catheter-day): 3 in subclavian, 2 in jugular, 1 femoral; 2 with erythema and 8 with purulent secretion. CVC permanence: 7.5 day (5-10). Signs and/or symptoms at the moment of ISI: shock 50%, fever 83%, SOFA 6 ± 3. The 83% of infections were caused by one microorganism: 83% due to gram-negative bacilli (2 Klebsiella, 2 Pseudomonas, 1 Serratia, and 1 Acinetobacter), 17% due to vancomycin-resistant enterococci. The mortality rate was 50%. Conclusion: Although ISI-CVC presented a low incidence of CABSI, mortality rate was high. The ISI-CVC might have a little predictable value for CABSI.(AU)

In vitro properties of small ruminant lentivirus genotype E.

Small ruminant lentivirus genotype E lacks the dUTPase subunit and vpr-like gene. Two strains (Roccaverano and Seui) with identical genetic organization have been described, with the env HV1-HV2 domains being the most divergent. Although dUTPase and vpr-like deletions have been involved in the RT fidelity in non dividing cells, both strains were able to replicate efficiently in blood derived macrophages (BDM), while virus production of E1 subtype was reduced or abrogated in replicating fibroblastic-like cells. The transcriptional activity of genotype E was similar in these two cellular populations. When viral pseudotypes were generated with the env of both viruses, Roccaverano pseudotype displayed a paranuclear localization on BDM, suggesting a different mechanism of entry. Polymorphic GAS and TAS sites in the U3 region, further suggest that a population different from classically activated macrophages can be infected by these viruses, opening new insights into lentiviruses with low or null pathogenic potential.

Impacto de la crisis económica argentina sobre la incidencia de infecciones y la evolución en la Unidad de Cuidados Intensivos / Impact of the economic crisis Argentina on the incidence of infections and the evolution in Intensive care unit

Introducción. La crisis económica argentina disminuyó la provisión adecuada de insumos en los hospitales públicos. Objetivos. 1) Evaluar si la reducción de insumos impactó en la evolución de los pacientes; 2) cuantificar la provisión de insumos durante los períodos precrisis (P1), crisis y poscrisis (P2); 3) evaluar la incidencia de infecciones durante los tres períodos. Materiales y métodos. Se evaluó la densidad de incidencia de las infecciones intrahospitalarias, la estadía en la Unidad de Terapia Intensiva y la mortalidad en los tres períodos. Los datos se presentan como media ± desviación estándar, mediana [IC 0,25-0,75] y porcentajes de acuerdo con su naturaleza. Las comparaciones se efectuaron con la prueba t o ji cuadrado. Se consideró significativo un valor p <0,05. Resultados. Durante la crisis, ingresaron pacientes con menos enfermedades preexistentes, permanecieron más días ventilados y aumentó significativamente el número de infecciones por paciente. En el período P2, se detectó una caída significativa del número de pacientes infectados con respecto a los dos períodos anteriores. En el período P1, no hubo diferencias entre la mortalidad de los infectados y de los no infectados (25% contra 33%, p = 0,31). Durante la crisis, la mortalidad de los no infectados fue menor (19% contra 40%, p = 0,0005). La provisión de insumos disminuyó durante la crisis. Las infecciones intrahospitalarias se incrementaron en forma absoluta y como densidad de incidencia durante la crisis, y descendieron en el período P2. Conclusión. Durante la crisis económica, se recortaron los gastos de insumos y aumentó el número de infecciones por paciente.(AU)

Introduction. The collapse of the Argentinean economy in 2001 caused a shortage of material resources in public hospitals. Objectives. 1) To evaluate whether the decrease of material resources affected the outcome of patients in the Intensive Care Unit; 2) to quantify the provision of resources received in the Intensive Care Unit during three periods: Pre-crisis (P1), crisis, and post-crisis (P2); 3) to evaluate the incidence of infections during the three periods. Materials and methods. We compared the incidence of nosocomial infec- incidence of nosocomial infections; Intensive Care Unit stay, and mortality in the three periods. Data are presented as media ± SD, median [IQ 0.25-0.75], and percentages according to their nature. Comparison were performed using t test and chi-squared test. A p value <.05 was considered significant. Results. During the crisis, patients with less co-morbidities were admitted, they spent more time on mechanical ventilation, and the number of infections per patient was higher. Instead, during P2, there was a significant reduction of patients infected in relation to P1 and the crisis period. In P1, mortality did not differ between infected versus non-infected patients (25% vs. 33%; p = 0.31). However, during the crisis, mortality in non-infected patients was lower (19% vs. 40%; p = 0.0005). In the crisis, provision of materials decreased. Nosocomial infections increased. The incidence of infections decreased during P2. Conclusion. Resource availability decreased significantly during the economic crisis with a marked increase in the incidence of infections in the Intensive Care Unit. (AU)

LTR promoter activity of SRLV genotype E, strain Roccaverano.

The highly divergent, small ruminant lentivirus (SRLV) genotype E Roccaverano strain has a full genome consisting of 8,418 nucleotides, which lack the entire dUTPase subunit of the pol gene, the vpr-like accessory gene, and the 71-bp repeat of the U3 region within the long terminal repeat (LTR). These deletions affect in reverse transcriptase fidelity in non-dividing cells (dUTPase and vpr-like) and in the regulation of viral replication. Surprisingly, this SRLV strain was able to replicate efficiently in non-dividing cells (i.e., blood-derived macrophages), while replication in fibroblastic-like cells was somewhat restricted. To evaluate whether this observation was due to the presence/absence of specific transcription factors within these fibroblasts, U3 transcriptional activity was measured in the different cell types and revealed that both fibroblasts and macrophages were able to activate the viral promoter in the same manner. Among the transcription factor-binding sites present within the U3 region, the highly conserved Ap4 tandem repeat was shown to be sufficient for LTR promoter activity.

Use of B7 costimulatory molecules as adjuvants in a prime-boost vaccination against Visna/Maedi ovine lentivirus.

RNA transcripts of the B7 family molecule (CD80) are diminished in blood leukocytes from animals clinically affected with Visna/Maedi virus (VMV) infection. This work investigates whether the use of B7 genes enhances immune responses and protection in immunization-challenge approaches. Sheep were primed by particle-mediated epidermal bombardment with VMV gag and env gene recombinant plasmids together with plasmids encoding both CD80 and CD86 or CD80 alone, boosted with gag and env gene recombinant modified vaccinia Ankara virus and challenged intratracheally with VMV. Immunization in the presence of one or both of the B7 genes resulted in CD4+ T cell activation and antibody production (before and after challenge, respectively), but only immunization with CD80 and CD86 genes together, and not CD80 alone, resulted in a reduced number of infected animals and increased early transient cytotoxic T lymphocytes (CTL) responses. Post-mortem analysis showed an immune activation of lymphoid tissue in challenge-target organs in those animals that had received B7 genes compared to unvaccinated animals. Thus, the inclusion of B7 genes helped to enhance early cellular responses and protection (diminished proportion of infected animals) against VMV infection.

Mucosal immunization against ovine lentivirus using PEI-DNA complexes and modified vaccinia Ankara encoding the gag and/or env genes.

Sheep were immunized against Visna/Maedi virus (VMV) gag and/or env genes via the nasopharynx-associated lymphoid tissue (NALT) and lung using polyethylenimine (PEI)-DNA complexes and modified vaccinia Ankara, and challenged with live virus via the lung. env immunization enhanced humoral responses prior to but not after VMV challenge. Systemic T cell proliferative and cytotoxic responses were generally low, with the responses following single gag gene immunization being significantly depressed after challenge. A transient reduction in provirus load in the blood early after challenge was observed following env immunization, whilst the gag gene either alone or in combination with env resulted in significantly elevated provirus loads in lung. However, despite this, a significant reduction in lesion score was observed in animals immunized with the single gag gene at post-mortem. Inclusion of IFN-gamma in the immunization mixture in general had no significant effects. The results thus showed that protective effects against VMV-induced lesions can be induced following respiratory immunization with the single gag gene, though this was accompanied by an increased pulmonary provirus load.

Saccular aneurysms of the extracranial internal carotid artery. Experience and review of the literature.

The aim of this study was to describe the surgical technique employed and our results in the treatment of saccular aneurysms of the internal carotid artery at the extracranial level. We describe 3 cases of patients with saccular aneurysms of the extracranial internal carotid who underwent surgery at our unit within the last 3 years. We report on indications for treatment, surgical technique and results in terms of morbidity-mortality and also review the pertinent literature. Surgical treatment was indicated on the grounds of the patients being symptomatic: 2 had a history of cerebral ischemia, and 1 showed local compression symptoms. The surgical approach was presternocleidomastoid cervicotomy extended distally, and in 2 patients was accompanied by nasotracheal intubation to achieve adequate exposure. In 2 cases, we performed an aneurysmectomy with end-to-end anastomosis. In the third patient, the aneurysm neck was ligated from within the sac followed by aneurysmectomy. There was no mortality or neurological morbidity (local or general). The patients remain free from neurological symptoms with a patent carotid axis. Our clinical experience suggests that, despite the anatomically unfavorable location of this type of aneurysm and the greater complexity of the surgical technique, this patient group can be effectively treated. The frequent presence of an elongated carotid axis and an aneurysmal neck means the surgeon can easily restore arterial continuity by direct procedures.

Molecular characterization and phylogenetic study of Maedi Visna and Caprine Arthritis Encephalitis viral sequences in sheep and goats from Spain.

Small ruminant lentiviruses (SRLV) are widely spread in many countries, including Spain. However, little is known about the genetic characteristics of Spanish goat and sheep SRLV. In this study, segments from three genomic regions (pol, gag-p25 and LTR) were amplified using DNA isolated from three Spanish autochthonous sheep (one) and goats (two). Animals (one per flock) belonged to distantly located, single-species flocks (goat or sheep). Sequence analysis showed conservation of regions that are putatively relevant to viral survival. Sequences of Spanish goat and sheep SRLV were allocated into phylogenetic trees (phylograms) with known SRLV groups. The phylograms corresponding to the pol, gag-p25 and LTR regions analyzed presented a compatible topology. This showed that Spanish caprine and ovine SRLV sequences belonged to the A or D phylogenetic groups and were closer to sheep SRLV prototypes (A1 group) than to goat SRLV prototypes (B or C groups), according to the current classification [Shah, C., Boni, J., Huder, J.B., Vogt, H.R., Muhlherr, J., Zanoni, R., Miserez, R., Lutz, H., Schupbach, J., 2004a. Phylogenetic analysis and reclassification of caprine and ovine lentiviruses based on 104 new isolates: evidence for regular sheep-to-goat transmission and worldwide propagation through livestock trade. Virology 319 (1), 12-26]. It was not possible to amplify in the three genetic regions the expected fragment in additional Spanish caprine and ovine SRLV proviral DNA sequences with the PCR primers used. This suggests that there is heterogeneity at the primer binding site among Spanish SRLV sequences. It also illustrates the need to develop diagnostic tests that are sensitive in local breeds.

Evaluación del Sequential Organ Failure Assessmente (SOFA) score para predecir mortalidad en los pacientes críticos, y comparación con los scores APACHE II Y SAPS II / Sequential Organ Failure Assessment Assessed (SOFA) score to predict mortality in critically ill patients, and comparison with APACHE II scores and SAPS II

Objetivos: 1) Determinar la utilidad del SOFA score y sus variables derivadas como predictores de mortalidad 2) correlacionar la mortalidad estmada por el SOFA score y derivadas, con la predicha por APACHE II y SAPS II. Materiales y métodos: Diseño: cohorte prospectiva. Lugar UTI polivalente de un hospital escuela. Pacientes: los ingresados desde el 1/5/01 al 14/4/03. Al ingreso se calcularon los scores pronósticos APACHE II y SAPS II y SOFA inicial, y diariamente (hasta 30 días de internación), el score SOFA con los peores valores del día anterior. Adicionalmente se calcularon las siguintes variables derivadas: SOFA medio: valor promedio de la internación; SOFA total: suma de todos los valores diarios; delta SOFA 48hs: diferencia entre el SOFA inicial y a las 48 hs del ingreso; y SOFA máximo: el valor más alto registrado. Análisis estadístico: primeramente, se calculó el área bajo la curva ROCd (AUC) correspondiente a las 5 variables citadas, a APACHE IIy a SAPS II, y luego se compararon con refencia a la que presentó mayor AUC en el procedimeinto anterior...

Control of salt gland activity in the hatchling green sea turtle, Chelonia mydas.

We studied the control of salt gland secretion in hatchling Chelonia mydas. The threshold salt load to activate salt secretion was between 400 mumol NaCl 100 g bodymass (BM)-1 and 600 mumol NaCl 100 g BM-1, which caused an increase in plasma sodium concentration of 13% to 19%. Following a salt load of 2700 mumol NaCl 100 g BM-1, salt gland secretion commenced in 12 +/- 1.3 min and reached maximal secretory concentration within 2-7 min. Maximal secretory rate of a single gland averaged 415 mumol Na 100 g BM-1 h-1. Plasma sodium concentration and total osmotic concentration after salt loading were significantly higher than pretreatment values within 2 min. Adrenalin (25 micrograms kg BM-1) and the cholinergic agonist methacholine (1 mg kg BM-1) inhibited salt gland activity. Atropine (10 mg kg BM-1) reversed methacholine inhibition and stimulated salt gland secretion when administered with a subthreshold salt load. Arginine vasotocin produced a transient reduction in sodium secretion by the active gland, while atrial natriuretic factor, vasoactive intestinal peptide and neuropeptide Y had no measurable effect on any aspect of salt gland secretion. Our results demonstrated that secretion of the salt gland in C. mydas can be modified by neural and hormonal chemicals in vivo and that the cholinergic and adrenergic stimulation of an exocrine gland do not appear to have the typical, antagonist actions on the chelonian salt gland.

Validated method for quantitation and identification of 4,4-desmethylsterols and triterpene diols in plant oils by thin-layer chromatography-high resolution gas chromatography-mass spectrometry.

Alkaline hydrolysis was performed on a series of different vegetable oils. The unsaponifiable lipid matter was extracted with ethyl ether, and the class of 4,4-desmethylsterols (sterols) plus the triterpene diols (diols) erythrodiol, uvaol, and betulinol were isolated by thin-layer chromatography. A validated method using the acetate derivatives of sterols instead of their silyl ethers is presented. The acetate derivatives were analyzed by high resolution gas chromatography (HRGC). Retention time, precision, recovery studies, and absolute response factors were calculated for these esters, and GC/mass spectrometric structure of the assigned retention times was confirmed for the sterols and triterpene diols.

Symptomatic lipoma of the duodenum.

A case of duodenal lipoma causing massive hemorrhage is described. Literature on the subject is reviewed.