Advanced MRI techniques: biomarkers in neuropsychiatric lupus.

Objectives The objective of this study was to determine whether advanced MRI could provide biomarkers for diagnosis and prognosis in neuropsychiatric systemic lupus erythematosus (NPSLE). Methods Our prospective study included 28 systemic lupus erythematosus (SLE) patients with primary central NPSLE, 22 patients without NPSLE and 20 healthy controls. We used visual scales to evaluate atrophy and white matter hyperintensities, voxel-based morphometry and Freesurfer to measure brain volume, plus diffusion-tensor imaging (DTI) to assess white matter (WM) and gray matter (GM) damage. We compared the groups and correlated MRI abnormalities with clinical data. Results NPSLE patients had less GM and WM than controls ( p = 0.042) in the fronto-temporal regions and corpus callosum. They also had increased diffusivities in the temporal lobe WM ( p < 0.010) and reduced fractional anisotropy in the right frontal lobe WM ( p = 0.018). High clinical scores, longstanding disease, and low serum C3 were associated with atrophy, lower fractional anisotropy and higher diffusivity in the fronto-temporal lobes. Antimalarial treatment correlated negatively with atrophy in the frontal cortex and thalamus; it was also associated with lower diffusivity in the fronto-temporal WM clusters. Conclusions Atrophy and microstructural damage in fronto-temporal WM and GM in NPSLE correlate with severity, activity and the time from disease onset. Antimalarial treatment seems to give some brain-protective effects.

A regulatory gene network related to the porcine umami taste receptor (TAS1R1/TAS1R3).

Taste perception plays an important role in the mediation of food choices in mammals. The first porcine taste receptor genes identified, sequenced and characterized, TAS1R1 and TAS1R3, were related to the dimeric receptor for umami taste. However, little is known about their regulatory network. The objective of this study was to unfold the genetic network involved in porcine umami taste perception. We performed a meta-analysis of 20 gene expression studies spanning 480 porcine microarray chips and screened 328 taste-related genes by selective mining steps among the available 12,320 genes. A porcine umami taste-specific regulatory network was constructed based on the normalized coexpression data of the 328 genes across 27 tissues. From the network, we revealed the 'taste module' and identified a coexpression cluster for the umami taste according to the first connector with the TAS1R1/TAS1R3 genes. Our findings identify several taste-related regulatory genes and extend previous genetic background of porcine umami taste.

Cocoa consumption reduces NF-κB activation in peripheral blood mononuclear cells in humans.

BACKGROUND AND AIMS: Epidemiological studies have demonstrated an association between high-polyphenol intake and reduced incidence of atherosclerosis. The healthy effects of cocoa-polyphenols may be due to their antioxidant and anti-inflammatory actions, although the exact mechanisms are unknown and depend on the matrix in which cocoa-polyphenols are delivered. Nuclear factor κB (NF-κB) is a key molecule in the pathophysiology of atherosclerosis involved in the regulation of adhesion molecules(AM) and cytokine expression and its activation is the first step in triggering the inflammatory process. The aim of this study was to evaluate the effect of acute cocoa consumption in different matrices related to the bioavailability of cocoa-polyphenols in NF-κB activation and the expression of AM. METHODS AND RESULTS: Eighteen healthy volunteers randomly received 3 interventions: 40g of cocoa powder with milk (CM), with water (CW), and only milk (M). NF-κB activation in leukocytes and AM (sICAM, sVCAM, E-selectin) were measured before and 6h after each intervention. Consumption of CW significantly decreased NF-κB activation compared to baseline and to CM (P < 0.05, both), did not change after CM intervention, and significantly increased after M intervention (P = 0.014). sICAM-1 concentrations significantly decreased after 6h of CW and CM interventions (P ≤ 0.026; both) and E-selectin only decreased after CW intervention (P = 0.028). No significant changes were observed in sVCAM-1 concentrations. CONCLUSIONS: The anti-inflammatory effect of cocoa intake may depend on the bioavailability of bioactive compounds and may be mediated at least in part by the modulation of NF-κB activation and downstream molecules reinforcing the link between cocoa intake and health.

Heat stress of gilts around farrowing causes oxygen insufficiency in the umbilical cord and reduces piglet survival.

Late gestating sows are susceptible to high ambient temperatures, possibly causing farrowing complications and reducing piglet survival. This experiment aimed to quantify in the days leading up to farrowing the impact of sow heat stress (HS) on farrowing physiology and survival of the piglets. Pregnant primiparous sows (gilts) were allocated to either thermoneutral control (CON, n = 8; constant 20 °C) or cyclical HS conditions (n = 8; 0900 h to 1700 h, 30 °C; 1700 h to 0900 h, 28 °C) from d 110 of gestation until farrowing completion. Gilt respiration rate, skin temperature and rectal temperature were recorded daily, and farrowing duration was quantified by video analyses. Blood samples were collected from the piglet umbilical vein at birth. At 48 h of age, piglet growth was quantified by morphometric analyses. The thermal exposure model induced HS and respiratory alkalosis in the gilts, as indicated by increased respiration rate, rectal temperature, skin temperature (all P < 0.001), plasma cortisol (P = 0.01) and blood pH (P < 0.001). Heat-stressed gilts took longer to start expelling placentae (P = 0.003), although the active farrowing duration was not significantly different between treatments. Stillbirth rates were higher in the HS group (P < 0.001), with surviving piglets at birth having lower umbilical vein partial pressure of oxygen (P = 0.04), oxygen saturation rate (P = 0.03) and tending to have increased lactate concentrations (P = 0.07). At birth, piglet skin meconium staining scores were greater in the HS group (P = 0.022). At 48 h of age, piglets from the HS group had reduced small intestinal length (P = 0.02), reduced jejunal crypt depth (P = 0.02) and lighter absolute brain weight (P = 0.001). In contrast, piglet BW, growth rate, relative organ weight and small intestinal mucosal barrier function did not change between treatments. Collectively, these findings demonstrated gilt HS during late gestation caused farrowing complications and reduced the umbilical oxygen supply to the piglets at parturition, leading to increased risks of piglet stillbirth with implications on impaired neonatal survivability and development.

Review: Chemosensing of nutrients and non-nutrients in the human and porcine gastrointestinal tract.

The gastrointestinal tract (GIT) is an interface between the external and internal milieus that requires continuous monitoring for nutrients or pathogens and toxic chemicals. The study of the physiological/molecular mechanisms, mediating the responses to the monitoring of the GIT contents, has been referred to as chemosensory science. While most of the progress in this area of research has been obtained in laboratory rodents and humans, significant steps forward have also been reported in pigs. The objective of this review was to update the current knowledge on nutrient chemosensing in pigs in light of recent advances in humans and laboratory rodents. A second objective relates to informing the existence of nutrient sensors with their functionality, particularly linked to the gut peptides relevant to the onset/offset of appetite. Several cell types of the intestinal epithelium such as Paneth, goblet, tuft and enteroendocrine cells (EECs) contain subsets of chemosensory receptors also found on the tongue as part of the taste system. In particular, EECs show specific co-expression patterns between nutrient sensors and/or transceptors (transport proteins with sensing functions) and anorexigenic hormones such as cholecystokinin (CCK), peptide tyrosine tyrosine (PYY) or glucagon-like peptide-1 (GLP-1), amongst others. In addition, the administration of bitter compounds has an inhibitory effect on GIT motility and on appetite through GLP-1-, CCK-, ghrelin- and PYY-labelled EECs in the human small intestine and colon. Furthermore, the mammalian chemosensory system is the target of some bacterial metabolites. Recent studies on the human microbiome have discovered that commensal bacteria have developed strategies to stimulate chemosensory receptors and trigger host cellular functions. Finally, the study of gene polymorphisms related to nutrient sensors explains differences in food choices, food intake and appetite between individuals.

Effect of dietary energy level and oil source on broiler performance and response to an inflammatory challenge.

Broiler chicks were fed one of five diets from 3 d of age: a low energy diet containing 7% cellulose (ME 2,714 kcal/kg), or high energy diets containing approximately 7% of either tallow, corn oil, safflower oil, or fish oil (each 3,302 kcal/kg). Half of the chicks were injected intra-abdominally with Salmonella typhimurium lipopolysaccharide (LPS) on Day 11, sephadex on Day 13, and Freund's complete adjuvant on Day 15; samples were collected on Day 16. The uninjected chicks served as controls. In a second experiment, 3-d-old chicks were fed one of eight isocaloric diets containing tallow as the sole supplemental fat source, or tallow plus either 2% corn oil, 1, 1.5, or 2% fish oil, or fish meal at an amount to provide 1, 1.5 or 2% supplemental oil. Half of the chicks were injected intra-abdominally with S. typhimurium LPS on Days 10, 12 and 14; the uninjected chicks served as controls. Samples were taken on Day 15. In Experiment 1, the cellulose diet decreased performance to 10 d of age relative to the other diets, whereas immunogen injection decreased weight gain and feed efficiency and increased indices of inflammation among all dietary groups. Fish oil at approximately 7% of the diet did not improve weight gain. Fish oil diets improved weight gain and feed efficiency in Experiment 2 relative to the other diets, in spite of minimal effects on indices of inflammation. Injection of LPS decreased performance and increased inflammation across dietary treatment, although the second LPS injection was less potent in altering performance responses and inflammation compared to the first injection, indicating that repeated injections of LPS amy cause the chicks to become refractory to that stimulus. The fish meal diets resulted in poorer performance than similar levels of lipid provided as fish oil. Lower levels of dietary fish oil were more efficacious in improving broiler performance than higher levels, and fish oil provided from fish meal was not as efficacious as oil per se, possibly due to nonlipid components of the meal.

Use of a polytetrafluoroethylene tube and patch in the repair of a difficult duodenal stump.

In the cases where a primary anastomosis is unable after a duodenal resection, special care must be taken to avoid any complication in the duodenal stump such as suture dehiscence. Wall inflammation is an important factor in the development of this complication. We report a case of a 35-year-old woman who had previously undergone to pyloric exclusion due to a wall defect occurred after a bilio-digestive anastomosis, which complicated with a posterior duodenal stump dehiscence. The acute edema of the stump walls that resulted after it because exposure to bile conducted to heroic measures for its closure: first, the use of a polytetrafluoroethylene tube as duodenostomy and posteriorly a patch of the same material for its final closure. Both gave successful results in the repair of a refractory duodenal stump dehiscence.

Feed preference in pigs: relationship between cereal preference and nutrient composition and digestibility.

The present work aimed to identify the nutritional characteristics that best explain cereal feed preference in pigs. A total of 25 cereals of known preference (at 60% of inclusion in complete feed) from a previous study were evaluated. The cereals were analyzed for DM, OM, crude fiber, ether extract, CP, GE, digestible starch, and glycemic index. Additionally, for 12 of the cereals, complete feeds (the same composition as those previously used to measure preference) were prepared, analyzed for DM, OM, CP, and starch, and fed to pigs (33 ± 5.1 kg BW) fitted with ileal T-cannulae to assess the apparent ileal (AID) and total tract digestibility (ATTD) of these nutrients using titanium dioxide as an indigestible marker. The relationships among the different energy and nutrient contents were studied by principal component (PC) analysis, and the correlations between the generated PC scores and cereal preference were analyzed. A correlation between preference and the second PC obtained with data of the 25 cereals was observed (P < 0.01), which indicated that crude fiber (negatively) and digestible starch, OM, and glycemic index (positively) were correlated with feed preference. Statistically significant linear relationships with preference were confirmed for crude fiber, digestible starch, and glycemic index (R(2) = 0.38, 0.36, and 0.23, respectively; P < 0.02). Similarly, the first PC obtained with data of the 12 feeds also correlated with preference (P < 0.01), indicating that the digestible nutrients (positively) and the nondigestible nutrients (negatively) were correlated with preference. Statistically significant relationships with preference were observed for the contents of starch (total, digestible AID, and digestible ATTD: R(2) = 0.62, 0.66, and 0.63, respectively; P < 0.01), AID DM (digestible and nondigestible: R(2) = 0.41 and 0.44, respectively; P < 0.05), ATTD DM (digestible and nondigestible: R(2) = 0.67 and 0.70, respectively; P < 0.01), AID OM (digestible and nondigestible: R(2) = 0.45 and 0.43, respectively; P < 0.05), and ATTD OM (digestible and nondigestible: R(2) = 0.64 and 0.66, respectively; P < 0.01). It is concluded that cereal preference in pigs is positively related with their content in digestible nutrients, such as starch, and negatively related with their nondigestible nutrients, such as crude fiber.

Feed preference in pigs: effect of selected protein, fat, and fiber sources at different inclusion rates.

Three double-choice feeding experiments were conducted to study the effect of different feedstuffs on feed preference in pigs. Fifteen protein sources, 6 fat sources, and 3 fiber sources were evaluated in Exp. 1, 2, and 3, respectively. Pigs were offered a series of double choices between a common reference diet and the diet with the ingredient under evaluation. The reference diet contained a soybean meal product with 56% CP (SBM-56), sunflower oil, and wheat bran, which were considered as the feedstuffs of reference for the protein, fat, and fiber sources, respectively. Preference, expressed as percentage of the tested diet to total feed intake, was affected by feedstuff nature and by its inclusion rate. In Exp. 1, feeds with fish meal at 50 and 100 g·kg⁻¹, dried porcine hydrolyzed protein at 50 g·kg⁻¹, and lupine, soybean meal with 44% CP, and dried skim milk at 100 g·kg⁻¹ were preferred (P < 0.05) to the reference feed with SBM-56. On the contrary, relative to SBM-56, an avoidance (preference less than 50%) was observed for potato protein at all inclusion rates tested, rapeseed meal and acid milk whey at 100 and 200 g·kg⁻¹, and dried porcine hydrolyzed protein, soybean protein concentrate, wheat gluten, and sunflower meal at 200 g·kg(-1). The storage of dried skim milk, soybean protein concentrate, and potato protein for 10 mo resulted in a reduction (P < 0.001) of their preference values. In Exp. 2, the feed with palm oil (at 30 g·kg⁻¹) was preferred (P < 0.05), whereas feeds with linseed oil (at 30 and 100 g·kg⁻¹) and soybean oil (at 100 g·kg⁻¹) were avoided (P < 0.05) when contrasted with the reference feed with sunflower oil. Finally, in Exp. 3 diets with dehydrated alfalfa and sugar beet pulp at 130 g·kg⁻¹ had a reduced (P < 0.05) preference compared with the reference diet with wheat bran. It is concluded that feedstuff nature, inclusion rate, and freshness affect feed preference in pigs. Feedstuff preferences should be taken into account during diet formulation, particularly at critical stages such as immediately after weaning.

Feed preferences and performance of nursery pigs fed diets containing various inclusion amounts and qualities of distillers coproducts and flavor.

We evaluated the preferences of nursery pigs for diets containing increasing distillers dried grains with solubles (DDGS), varying in color, or high-protein distillers dried grains (HP-DDG) and the effects of flavor supplementation on pig preference and growth performance. In Exp. 1 through 5, diet preference was determined in weanling pigs adjusted to a commercial diet for at least 10 d, and then housed individually for a 2-d double-choice preference test. In Exp. 1, a total of 60 pigs (11.6 ± 0.3 kg of BW) were given a choice between a reference diet (0% DDGS) and test diets containing 0, 10, 20, or 30% DDGS. In Exp. 2, a total of 80 pigs (10.8 ± 0.1 kg of BW) were given a choice between a reference diet (0% HP-DDG) and diets containing 0, 10, 20, or 30% HP-DDG. In Exp. 3, a total of 80 pigs (10.3 ± 0.2 kg of BW) were given a choice between a reference diet (0% DDGS) and a diet containing 0%, 30% light, or 30% dark DDGS. In Exp. 4, a total of 80 pigs (11.2 ± 0.2 kg of BW) were given a choice between a reference diet without DDGS and a diet containing either 0% DDGS, 10 or 20% light DDGS, or 10 or 20% dark DDGS. In Exp. 5, a total of 108 pigs (9.0 ± 0.2 kg of BW) were given a choice between a reference diet (0% DDGS and no flavor) and a diet without or with flavor and containing 0, 10, or 20% DDGS. In Exp. 1 and 2, DDGS and HP-DDG, respectively, linearly decreased (P < 0.01) pig preference. In Exp. 3, dark DDGS were preferred (P < 0.05) compared with light DDGS. In Exp. 4, preferences were linearly reduced (P < 0.01) with DDGS inclusion, and dark DDGS tended (P = 0.06) to be preferred compared with light DDGS. In Exp. 5, DDGS reduced preference (P < 0.01) and flavor reduced preference (P < 0.01) regardless of DDGS level. In Exp. 6, a total of 192 pigs (6.7 ± 0.1 kg of BW) were fed starter 1 diets without or with flavor for 1 wk. Subsequently, pigs were fed starter 2 and 3 diets (2 wk each) containing 0, 10, or 20% DDGS while continuing to receive their respective flavor treatment. Flavor addition during the starter 1 phase increased ADFI (P = 0.02), and DDGS inclusion tended to decrease ADG (P = 0.06) and decreased ADFI (P = 0.03) during the starter 2 phase. Volatile components in DDGS and HP-DDG varied greatly depending on the source. Nursery pigs preferred a diet without DDGS or HP-DDG, and this appeared to be unrelated to color differences between sources. Knowledge of volatile compounds that enhance or suppress the palatability of feed may lead to further development of feed additives for masking relatively unpalatable, albeit cost-effective, ingredients.

Feed preference in pigs: effect of cereal sources at different inclusion rates.

The palatability of different cereals was studied in 2 two-way choice (preference) experiments using pigs of 56 d of age and 17 kg of BW. In Exp. 1, the effect of 24 cereals vs. a common reference diet containing white rice on feed preference in pigs was studied. Pigs were offered free choice between the reference diet and a diet with the cereal under study for 4 d. Barley, corn (2 sources), wheat, cassava meal, biscuit meal, rye, sorghum, and 1 source of oats were tested at inclusion rates of 300 and 600 g x kg(-1). Short-grain rice (whole, brown, or extruded white), long-grain white rice (raw and cooked), extruded barley, extruded corn, extruded wheat, oats (2 sources), thick rolled oats, cooked oats, and naked oats (raw, extruded, or micronized) were tested at inclusion rates of 150, 300, and 600 g x kg(-1). Relative preference of cereals (% of total feed intake) was affected by type of cereal and by rate of inclusion. The diets containing extruded rice (150 g x kg(-1)), extruded naked oats (150, 300, and 600 g x kg(-1)), or naked oats (150 and 300 g x kg(-1)) were preferred (P < 0.05) by pigs to the reference diet. However, the reference diet was preferred (P < 0.05) to the diets containing 150, 300, and 600 g x kg(-1) of cooked long-grain rice, oats, or cooked oats, 300 and 600 g x kg(-1) of extruded wheat, wheat, corn, sorghum, or unhulled short-grain rice, and 600 g x kg(-1) of thick rolled oats, extruded corn, rye, extruded barley, micronized naked oats, barley, cassava, or biscuit meal. Extrusion improved (P < 0.05) preference values for corn and naked oats by pigs, but had no effect on barley, rice, or wheat. In Exp. 2, the preferences of pigs for oats and barley were studied using mash and pelleted diets. Diet form did not affect preference in oats diets. However, for barley, greater preference values were obtained when measured in pelleted form compared with mash form. Additionally, direct 2-way choices were also performed between oats and barley diets and between diets presented in mash and pelleted forms. Pigs preferred barley to oats, and preferred diets presented in pelleted form to those presented in mash form. In conclusion, cereal type, inclusion rate, and diet form affected feed preference in pigs. Using cereals with greater preference values may contribute to the formulation of more palatable feeds, which enhance feed intake of piglets at critical stages such as weaning time.

Feed preference in pigs: relationship with feed particle size and texture.

In previous studies, we observed important differences in the feed preferences of pigs resulting from changes in only 1 dietary ingredient. The present experiment was conducted to study the relationship between the feed preference values of feeds reported previously and their particle size and texture characteristics. The effect of individual feed ingredients was studied when added to a common basal diet. In addition to the basal diet, which included rice, a soybean meal product containing 56% CP, sunflower oil, and wheat bran, a total of 126 diets were studied. Of these, 63 were prepared by replacing the rice in the basal diet with another cereal, 29 by replacing the soybean product with different protein sources, 19 by replacing the sunflower oil with different lipid sources, and 6 by replacing the wheat bran with different fiber sources. Cereals were studied at inclusion rates of 150, 300, and 600 g x kg(-1); protein sources were studied at 50, 100, and 200 g x kg(-1); lipids were studied at 15, 30, and 100 g x kg(-1); and fiber sources were studied at 65 and 130 g x kg(-1). The particle size profile of all the diets was determined by using a 9-screen sieve shaker. The geometric mean particle size, particle size uniformity, number of particles per gram, surface area (cm(2) x g(-1)), and percentage of fine (passing through a 250-microm sieve) and coarse particles (remaining in a 2,000-microm sieve) were calculated. The texture properties (hardness, fragility, chewing work, and adhesiveness) of the feeds were also determined by using a texture analyzer. The Pearson correlation coefficients of these variables with feed preference were as follows: geometric mean particle size (r = 0.07; P = 0.45), particle size uniformity (r = 0.16; P = 0.07), number of particles per gram (r = -0.05; P = 0.61), surface area (r = -0.07; P = 0.46), percentage of coarse particles (r = 0.04; P = 0.65), percentage of fine particles (r = -0.12; P = 0.19), hardness (r = -0.21; P = 0.02), fragility (r = -0.20; P = 0.03), chewing work (r = -0.33; P < 0.001), and adhesiveness (r = 0.02; P = 0.78). It was concluded that the texture properties of the feed could explain in part the feed preferences observed in pigs, whereas particle size characteristics had less impact.

Prevention of immunologic stress contributes to the growth-permitting ability of dietary antibiotics in chicks.

The growth-permitting ability of antibiotics fed to broiler chicks was studied as it relates to the state of activation of the immune system. In Experiment 1, chicks were fed two levels of antibiotics (0 or 100 mg streptomycin + 100 mg penicillin/kg diet) and were raised either in an environment with poor sanitation to create a chronic immune stress or in a clean environment. Chicks raised in the unsanitary environment and not fed antibiotics had significantly lower (P < 0.05) rates of weight gain and efficiencies of feed utilization, and higher levels of plasma interleukin-1, compared with chicks raised in the clean environment or chicks raised in the unsanitary environment and fed antibiotics. Adding antibiotics to the diet of birds in the clean environment did not affect any variable. In Experiment 2, chicks were raised in a conventional environment and fed two levels of an antibiotic (0 or 100 mg tetracycline/kg diet). After a 15-d feeding period, half of the chicks were injected with Salmonella typhimurium lipopolysaccharide to create an acute immunologic stress. Feeding antibiotic resulted in improved weight gain, feed consumption and efficiency of feed utilization. Lipopolysaccharide-injected birds developed heavier livers, spleens and intestines relative to body weights and higher rectal temperatures and hepatic metallothionein concentrations, presumably due to an immunologic stress. Omitting antibiotic from the diet resulted in similar changes. These results indicate that feeding antibiotics may permit growth by preventing immunologic stress and associated metabolic changes brought about by monokines including interleukin-1.

Dietary energy source and density modulate the expression of immunologic stress in chicks.

To determine how dietary energy level and source influence feed intake, growth and energy partitioning drug immunologic stress, growing chicks were fed diets based on cornstarch and casein with varying energy densities and injected every other day for 6 d with either saline (control), Salmonella typhimurium lipopolysaccharide or heat-killed Staphylococcus aureus. Salmonella typhimurium lipopolysaccharide decreased growth and feed consumption at low energy densities. When the dietary energy density was increased above 13.4 kJ/g using cornstarch, but not corn oil, the growth depressing effect of immunogens was eliminated. Immunologically stressed chicks had a greater proportion of gain in visceral organs and less in the carcass, regardless of the nutrient density of the diet. Immunologic stress decreased intake of metabolizable energy of chicks fed a diet with low nutrient density and increased it for those fed a diet with high nutrient density. Chicks injected with S. typhimurium lipopolysaccharide lost more energy as heat than controls when differences in metabolizable energy intakes were accounted for and modified their preference between two diets differing in metabolizable energy density and fat content as a result of the challenge. Control chicks selected between the 11.7 and 14.2 kJ/g diets to obtain an energy density of 13.2 kJ/g compared with 12.5 kJ/g in the S. typhimurium lipopolysaccharide-challenged chicks. The S. typhimurium lipopolysaccharide-challenged chicks consumed similar amounts of the low energy diet but decreased intake of the high energy diet.

High incidence of pericardial effusion in non-Hodgkin's lymphoma: usefulness of echocardiography.

In a consecutive group of patients with non-Hodgkin's lymphoma a prospective study was designed to detect pericardial and myocardial abnormalities at presentation for initial clinical staging. Thirty-two patients, ranging from 15 to 65 (mean, 46) years of age, were studied. Twenty-six (81%) were in Stages III and IV. Echocardiographic examination revealed that 17 patients (53%) had pericardial effusion (PE). Four subjects with lymphoblastic lymphoma and extensive mediastinal involvement had clinical and echographic signs of cardiac-tamponade. In 5 cases, pericardiocentesis was performed; abnormal lymphoblasts were demonstrated in 4. In one of these, the histological diagnosis of lymphoma was performed from analysis of the PE. The follow-up ranged from 3 to 32 (mean, 12.3) months. There was no difference in the survival rates whether or not PE was present: 70 and 68% respectively at 1 yr. No patient required intracavitary chemotherapy or surgery. We conclude that PE in advanced non-Hodgkin's lymphoma with large mediastinal masses is frequent. Once tamponade is treated, the presence of PE has no adverse effect on survival at 1 yr.

Pyruvate kinase deficiency and leg ulcers.

We report a family with a new pyruvate kinase (PK) variant in which leg ulcers have been present in four of the five affected homozygous family members, but not in any of the unaffected individuals. The propositus, an 18-yr-old boy, suffered from recurrent crises of hemolytic anemia and leg ulcers. A splenectomy was performed and the leg ulcer was treated un-successfully with a pinch graft. Studies ondialyzed hemolysates showed that the enzyme was kinetically abnorma, being almost entirely resistant to activation by fructose diphosphate. THE THERMOSTABILITY OF THE ENZYME WAS MODERATELY DECREASED, AND THE ELECTROPHORETIC MOBILITY WAS NORMAL. One may speculate that the development of leg ulcers in some kinships with PK deficiency may be related to variants of PK which exert unusual effects on the rheologic properties of the red cell in vivo.

Use of a polytetrafluoroethylene tube and patch in the repair of a difficult duodenal stump

In the cases where a primary anastomosis is unable after a duodenal resection, special care must be taken to avoid any complication in the duodenal stump such as suture dehiscence. Wall inflammation is an important factor in the development of this complication. We report a case of a 35-year-old woman who had previously undergone to pyloric exclusion due to a wall defect occurred after a bilio-digestive anastomosis, which complicated with a posterior duodenal stump dehiscence. The acute edema of the stump walls that resulted after it because exposure to bile conducted to heroic measures for its closure: first, the use of a polytetrafluoroethylene tube as duodenostomy and posteriorly a patch of the same material for its final closure. Both gave successful results in the repair of a refractory duodenal stump dehiscence.