Implicación pronóstica de la sospecha clínica inicial en la disección de aorta torácica. Revisión de los métodos diagnósticos utilizados / Prognostic significance of the initial diagnostic suspicion in cases of thoracic aortic dissection. review of the diagnostic techniques

Objetivo. Analizar la importancia de la sospecha clínica inicial en el diagnóstico de la disección de aorta torácica y la influencia en su pronóstico, revisar los diferentes métodos complementarios utilizados. Material y métodos. Se estudiaron retrospectivamente 33 casos de disección de aorta torácica entre enero de 1993 y junio de 1998, valorándose parámetros clínico-epidemiológicos, diagnósticos de ingreso y pruebas complementarias. Los resultados cualitativos se valoraron mediante 2.Resultados. La sintomatología típica de disección (dolor torácico, abdominal e interescapular) se apreció en 19 (58 por ciento) casos. La sospecha clínica al ingreso se realizó en 9 (27 por ciento) de los pacientes, siendo diagnósticos tardíos/casuales 22 (67 por ciento ) casos. Se realizó el diagnóstico de disección a través de la necropsia en 2 (6 por ciento) ocasiones. Diagnósticos erróneos de ingreso fueron: cardiopatía isquémica en 9 casos; isquemia de miembros inferiores en 3. Se realizó el diagnóstico de cólico hepático, neumonía, gastroenteritis, síncope, cólico nefrítico, aneurisma de aorta abdominal, pancreatitis y dolor osteomuscular respectivamente en un caso. El retraso en el diagnóstico no influyó significativamente en la mortalidad. La prueba diagnóstica que se utiliza en nuestro medio en primer lugar es la tomografía axial computarizada (TAC). La aortografía se utiliza como prueba confirmatoria del diagnóstico. Conclusiones. No se valoran adecuadamente los datos de la clínica inicial. La mortalidad es mayor en el grupo de pacientes en el cual no hay sospecha clínica inicial de disección de aorta (AU)

Coffee consumption and bladder cancer in nonsmokers: a pooled analysis of case-control studies in European countries.

BACKGROUND: Coffee consumption has been associated with an excess bladder cancer risk, but results from epidemiological studies are inconsistent. This association has been long debated, in part due to the potential confounding by smoking. We examined the risk associated with coffee consumption in nonsmokers in a pooled analysis of ten European bladder cancer case-control studies. METHODS: The pooled data set comprises 564 cases and 2929 hospital or population controls who had never smoked. They were enrolled in ten studies conducted in Denmark, Germany, Greece, France, Italy and Spain. Information on coffee consumption and occupation was re-coded following standard criteria. Unconditional logistic regression was applied adjusting for age, study center, occupation and gender. RESULTS: Seventy-nine percent of the study population reported having drunk coffee, and 2.4% were heavy drinkers, reporting having drunk on average ten or more cups per day. There was no excess risk in ever coffee drinkers (OR = 1.0, 95% CI 0.8-1.3) compared to never drinkers. The risk did not increase monotonically with dose but a statistically significant excess risk was seen for subjects having drunk ten or more cups per day (OR = 1.8, 95% CI 1.0-3.3). This excess was seen in both men and women. There was no evidence of an association of the risk with duration or type of coffee consumption. The pooled results were not dependent on the findings of any specific study, but they depended on the type of controls with an overall excess risk observed only for studies using hospital controls. CONCLUSION: Nonsmokers who are heavy coffee drinkers may have a small excess risk of bladder cancer. Although these results cannot be attributed to confounding by smoking, the possibility of bias in control selection cannot be discarded. On the basis of these results, only a very small proportion of cancers of the bladder among nonsmokers could be attributed to coffee drinking.

[Screening for colorectal cancer in Catalonia. Results of a population survey]. / Situación actual del cribado del cáncer colorrectal en Cataluña. Resultados de una encuesta poblacional.

BACKGROUND: In recent years, the usefulness of programs for the prevention of colorectal cancer has been demonstrated in the general population as well as on specific risk groups. However, its implantation rate is unknown in our area. This study was aimed at evaluating the level of introduction of colorectal cancer screening. METHOD: A telephonic survey has been carried out using a pre-established questionnaire to find out if the interviewed had undergone a fecal occult blood test, digital rectal examination, barium enema and/or colorectal endoscopy with the final aim of colorectal cancer prevention. Moreover, the knowledge of both above mentioned explorations and the colorectal cancer clinical manifestations have also been evaluated. Individual characteristics determining these aspects have also been investigated. RESULTS: Only two (0.8%) of the 250 subjects included had undergone a screening procedure (digital rectal examination). In contrast, in female population, 142 women (82%) had been included in a surveillance program to detect early signs of breast or gynecological cancer. In addition, a low level of knowledge of these explorations has been observed (digital rectal examination: 58%; colorectal endoscopy: 56%; barium enema: 44%; fecal occult blood test: 41%). This low level was also observed regarding to clinical manifestations associated with colorectal cancer. CONCLUSIONS: In contrast with gynecological cancer, colorectal cancer screening has not yet been introduced in Catalonia. Moreover, the knowledge of the available information regarding to preventive strategies is very low.

Impact of autologous blood predonation on a comprehensive blood conservation program.

Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use in cardiac operations. The aim of our study was to verify the effectiveness of this procedure and to see whether it is compatible with a comprehensive blood conservation program. Three hundred forty-eight patients (group 1) donated an average of 657 +/- 199 mL of blood before open heart operation, whereas 344 patients (group 2) without autologous predonation were used as a control. The two groups were compared with regard to homologous blood use and the possibility of applying other blood conservation measures. Homologous transfusion rate in group 1 was 12.6%, whereas in group 2 it was 46% (p < 0.001). Patients with three units of predonated autologous blood had a transfusion rate of 0.8% (p < 0.001 compared with group 2). In group 1, acute normovolemic hemodilution was accomplished in a lower number of patients and with a lower average withdrawal (338 +/- 102 versus 403 +/- 145 mL; p < 0.001). Other blood conservation measures such as the return of mediastinal drainage and use of residual blood of extracorporeal circulation were applied with similar results in both groups. In our experience, preoperative autologous donation was compatible with the application of other blood conservation measures, but acute normovolemic hemodilution was achieved in a lower number of patients. Preoperative autologous donation proved to be a highly effective method for reducing banked blood use and therefore homologous blood exposure during and after cardiac operations.

Follow-up study of thyroid function in polytransfused thalassemic patients.

The aim of our investigation was to evaluate thyroid function by a follow-up study in 45 polytransfused thalassemic patients, since endocrine abnormalities are frequent consequences of iron overload in thalassemia major. Significant changes of thyroid function have been revealed in the time elapsing the observation, despite unchanged haematological parameters; at the end of the present study five patients were affected by overt hypothyroidism and 15 patients by subclinical hypothyroidism. Ultrasound thyroid volume in 13 randomly selected patients was greatly reduced, while thyroid Magnetic Resonance Imaging (MRI) was not able to detect tissue alterations. Inversely, liver MRI was markedly reduced in 14 patients and negatively related to ferritine levels (P< 0.01). We conclude that polytransfused thalassemics are frequently affected by thyroid disfunction; haepatic haemosiderosis due to iron overload seems influence hormonal peripheral metabolism, although the patients display a moderate compliance with iron chelation therapy. Therefore, periodic thyroid investigation should be carried out in thalassemic subjects in order to detect patients who need hormone replacement therapy.

[Treatment of neonatal hyperbilirubinemia]. / Il trattamento dell'iperbilirubinemia neonatale.

Hyperbilirubinemia remains one of the most common and more important pathological conditions in the newborn. The possibility that low levels of serum bilirubin could be responsible for bilirubin encephalopathy in the small premature infant is of great concern for the neonatologist. In fact, premature newborns, as recognized more than 70 years ago by Y1ppo, are prone to develop hyperbilirubinemia. The so-called physiologic of developmental hyperbilirubinemia could be harmful for the small preterm infant, who is at risk of developing bilirubin encephalopathy in the presence of low plasma bilirubin concentrations. Current methodologies for suppressing severe neonatal jaundice include: 1) Attempts to stimulate liver conjugating enzymes by drugs, such as phenobarbital. 2) Attempts to degrade bilirubin "in vivo" by phototherapy. 3) Exchange transfusion. It is too soon to consider Sn-protoporphyrin as a drug for the prevention and treatment of neonatal hyperbilirubinemia. However, if it can be shown that the use of tin-protoporphyrin can serve as a safe and less costly alternate treatment, a considerable improvement in the management of neonatal jaundice will be achieved.

Characterization and identification of 6 mutagens in opium pyrolysates implicated in oesophageal cancer in Iran.

Previous epidemiological studies have indicated an association between the ingestion of opium pyrolysates, dietary deficiencies, and a high incidence of oesophageal cancer in subjects in north-east Iran. Laboratory studies have shown that pyrolysates of opium and particularly of morphine, a major opium alkaloid, are highly mutagenic in bacteria and induce sister-chromatid exchanges in mammalian cells after metabolic activation. We now report the ability of these pyrolysates to transform Syrian hamster embryo cells in culture and present some evidence for their carcinogenicity in mice and hamsters following topical, subcutaneous, intratracheal and intragastric administration. 6 of the most abundant mutagenic compounds present in morphine pyrolysate were isolated and purified by high-performance liquid chromatography and characterized by gas chromatography/mass spectrometry and 1H-Fourier transform nuclear magnetic resonance spectroscopy. These hitherto unknown compounds, all containing a hydroxy-phenanthrene moiety, were identified as: 3-methyl-3H-naphth[1,2-e]indol-10-ol; 1,2-dihydro-3-methyl-3H-naphth[1,2-e]indol-10-ol; 6-methylaminophenanthren-3-ol; 2-methylphenanthro[3,4-d] [1,3]oxazol-10-ol; 2,3-dimethyl-3H-phenanthro[3,4-d]imidazol-10-ol and 2-methyl-3H-phenanthro[3,4-d]imidazol-10-ol. Mutagenicity in Salmonella typhimurium TA98 of these compounds increased in the order listed, the last compound being 35 times more active than benzo[a]pyrene. The mechanisms, by which these mutagens are formed and metabolically activated are discussed.

Cerebral sites of central action of dermorphin on intestinal motility in the rat.

Dermorphin (DM), microinjected at 0.4 nmoles/rat into various sites of the periaqueductal gray matter (PAG), provokes complete inhibition of intestinal propulsion always coupled with full analgesia and catalepsy. When electrolytic lesions were made in the raphe magnus nucleus (NRM) a slight but significant reduction of intestinal inhibition evoked by DM into the PAG was observed. In contrast, pretreatment into the NRM 10 days before DM with a selective antiserotoninergic agent (5,6 DHT 15 microgram/rat), did not influence intestinal inhibition. As expected, both lesions reduced DM-induced analgesia but catalepsy was not affected. DM-induced inhibition of intestinal transit was therefore unaffected by subdiaphragmatic vagotomy. Finally, some other central brain regions were found sensitive to DM for the above effects such as the lateral and medial hypothalamus and mid-line thalamus. Negative results were obtained for the supraoptic nuclei and postero-medial cortical amygdaloid nucleus. Some considerations are put forward about the existence in the central nervous system of selective areas involved in intestinal modulation and their relationship with those mediating other opiate behavioural effects.

Serum corticosterone as a quantitative test of the phlogistic potency of various agents topically applied in the rat.

The application into the rat conjunctiva of various phlogistic agents, such as croton oil, mustard oil and formaldehyde, elicits an increase of serum corticosterone linearly related to the log of the applied concentrations, so that from their parallelized regression lines it is possible to calculate the phlogistic potency of each tested agent in reference to croton oil. The time kinetic of such an increase (elicited by croton oil) is compared with that of two other parameters previously adopted as indirect quantitative indices of the phlogosis: the adrenal ascorbic acid depletion and the liver tyrosine-alpha-ketoglutarate transaminase increase. Serum corticosterone is shown to be the quickest and the most sensitive of the adopted indices, even if the phlogistic potency of the tested agents and the precision of these evaluations substantially coincides whatsoever the index adopted. Finally the pathways of adrenocortical activation are investigated and it is shown that the activation may be peripherally blocked by topical application of corticosteroids (but not of local anesthetics) and centrally by hypophysectomy or parenteral administration of pentobarbital plus morphine.

Persistent estrus in rats after anterolateral hypothalamic microinjections of 6-hydroxydopamine.

Bilateral injections of 30 mug of 6-hydroxydopamine (6-OHDA, as base) into the anterolateral hypothalamic area induced constant vaginal cornification (CVC), polyfollicular ovaries and uterine hypertrophy in cyclic adult female rats. There were no important changes in the vaginal patterns or ovarian and uterine morphology in animals given injections in the same area with the solvent only and in animals given injections with 6-OHDA in the anterior amygdaloid area. It is suggested that the persistent estrus after anterolateral hypothalamic injections of 6-OHDA results from lesions of central catecholaminergic pathways, which are probably involved in gonadotropin secretion.

[Effects of hypothalamic microinjections of 6-hydroxydopamine (6-OHDA) on estral cycle and morphology of the genital tract in the female rat (author's transl)]. / Effectos de microinyecciones intrahipotalámicas de 6-hidroxidopamina (6-OHDA) sobre el cicle estral y la morfologia del tracto genital de la rata hembra

To determine whether central catecholaminergic pathways are involved in the neural contral of gonadotrophin secretion, they were interrupted at the hypothalamic level by microinjections of 6-hydroxydopamine (6-OHDA). The effects on ovulation, estral cycle and ovarian and uterine histology were studied. Microinjections of 50 mug of 6-OHDA hydrobromyde were made bilaterally into the anterolateral hypothalamus in a group of rats. Another group was injected with 25 mug of 6-OHDA, while a control group recieved an equivalent volume (5 mul) of saline with ascorbic acid. Animals injected with 50 mug of 6-OHDA showed blockade of ovulation, vaginal cytology characteristics of persistent estrous, polyfollicular ovaries and enlarged uteri with hypertrophic endometrial glands. In the group injected with 25 mug, similiar effects were demonstrated, but the number of affected animals was smaller than that in the 50 mug group. Control animals dit not show modifications, either in estral cycle or in ovarian and uterine histology. These results suggest that 6-OHDA injected into the anterolateral hypothalmus interferes with catecholaminergic pathways that participate in the neural control of ovulation.

Blockade of ovarian compensatory hypertrophy and ovulation in the rat by hypothalamic implants of an anticholinergic drug.

PIP: The participation of a central cholinergic system in the control of hypophysial folliculotrophin release was confirmed in an experiment in which 250 gm of atropine sulfate, a blocking agent, was implanted in the anterior and lateral hypothalamic areas of rate; 22 rats were killed after 15 days, 24 after 30 days, and 10 were hemicastrated the same day of implantation and sacrificed 15 days later. A significantly prolonged diestrous phase from 4-12 days were observed in 43 of 46 intact rats implanted with atropine, suggesting an inhibition in the ovulatory discharge of gonadotrophins; lowered ovarian weight after 15 days due to a decrease in number and diameter of corpora lutea indicated that the drug may mainly affect the release of luteinizing hormone. Normal ovarian weight, morphology, and ovulatory activity was resumed after 30 days indicating that the blockade of ovulation was a transient consequence of the neural action of atropine. Ovarian compensatory hypertrophy in hemicastrated rats was prevented by the same dose of atropine but without disturbance in the estrous cycle, indicating incomplete inhibition of folliculotrophin release.^ieng