Dietary alterations in plasma very low density lipoprotein levels modify renal excretion of urates in hyperuricemic-hypertriglyceridemic patients.

Hyperuricemic-hyperlipidemic patients exhibit decreased renal excretion of urates relative to purely hyperuricemic patients; also, very low density lipoprotein (VLDL) levels are inversely proportional to the amount of urate excreted. Based on this knowledge, the aim of this study was to alter VLDL levels by dietary manipulation and assess its effect on uric acid levels and renal excretion of uric acid. Thirty-six men were studied in 2 groups consisting of 20 primary hyperuricemic (group I) and 16 primary hyperuricemic-hypertriglyceridemic patients (group II). The patients were analyzed for apoproteins and lipoproteins, urate levels, and renal excretion of uric acid in a first, basal determination, after 3 weeks of a 1200-Cal diet, and after another 3 weeks of a 2500-Cal diet. After the 1200-Cal diet, patients in group I exhibited significantly decreased levels of cholesterol (P < 0.05) and apoprotein CIII (P < 0.05). There were significant differences in renal excretion of uric acid (P < 0.05) between the basal and third determinations. Patients in group II exhibited significantly decreased levels of triglycerides (P < 0.01), VLDL cholesterol (P < 0.01), VLDL triglycerides (P < 0.01), and VLDL apoprotein B (P < 0.05) after the 1200-Cal diet; all of these parameters returned to values similar to the basal levels on completion of the 2500-Cal diet. With regard to purine parameters, the low calorie diet led to significantly increased fractional excretion of uric acid (P < 0.01) and uric acid clearance (P < 0.01), both of which decreased significantly to values near basal after the 2500-Cal diet. The results obtained in this study reveal that the decreased levels of triglyceride and VLDL components that arise from a low calorie diet are accompanied by increased renal excretion of urates and that the increase in the amount of this type of lipoprotein particle with an increase in dietary energy offsets the increase in renal excretion of urate.

Effectiveness of daily low-dose cotrimoxazole prophylaxis for Pneumocystis carinii pneumonia in liver transplantation--an open clinical trial.

Pneumocystis carinii pneumonia (PCP) is an important infection in the setting of liver transplantation. Without prophylactic measures, the incidence of PCP reached 30% in our first 10 liver transplant patients. All patients but one, who had concomitant invasive aspergillosis, recovered with intravenous cotrimoxazole. We therefore prospectively studied, in an open clinical trial, the efficacy and safety of prophylaxis with daily low-dose cotrimoxazole (480 mg) in 60 patients. The incidence of PCP dramatically decreased to 1.7% (P<.01). Treatment was well tolerated, and discontinuation of therapy was only necessary in two patients with leukopenia. Nevertheless, the number of episodes of leukopenia was similar in both groups. Cotrimoxazole prophylaxis was not associated with increased nephrotoxicity. An overall benefit in the incidence of bacterial infection was not observed. We conclude that daily low-dose cotrimoxazole is effective and safe for prevention of PCP after liver transplantations.

Allergens induce apoptosis in lymphocytes from atopic patients.

Repeated stimulation of immune cells may induce an "activation-induced cell death" (AICD) program. Allergy is characterized by the cyclic activation of allergen-reactive immune cells. To study the effects of allergen stimulation in cell proliferation and apoptosis in atopic subjects, peripheral blood mononuclear cells (PBL) from 40 atopic patients with positive reactivity to the allergens Olea Europaea (OE) and Lollium Perenne (LP) (20 without immunotherapy and 20 with specific immunotherapy) and 10 normal subjects were cultured with the allergens OE and LP. PBL from atopic patients proliferate more vigorously than cells from normal subjects after culture in vitro with both allergens, although PBL from atopic subjects without immunotherapy proliferate more than PBL from atopic subjects with immunotherapy. The study of cell proliferation shows that in atopic patients PBL mainly exhibit the CD4/CD45RO phenotype. This preferential proliferation is more evident in PBL from atopic patients treated without immunotherapy. Cell culture with specific allergens induces apoptosis in PBL from atopic patients. The percentage of apoptosis increased when atopic patients had been previously treated with immunotherapy. In addition to the observed increase in cell proliferation, apoptosis mainly occurs in the CD45RO cells that support the involvement of these cells in allergy. Furthermore, results obtained in cells from immunized patients suggest that an AICD process may partly at least explain the mechanism of action of allergen immunotherapy.

Pre-emptive oral ganciclovir can reduce the risk of cytomegalovirus disease in liver transplant recipients.

A cohort of 65 liver transplant recipients was prospectively monitored with qualitative polymerase chain reaction (PCR) in plasma. The first 25 patients did not receive prophylaxis. From a consecutive group of 40 recipients, 11 high-risk patients donor CMV-seropositive/receptor CMV-seronegative (D+/R-), persistent CMV replication) received pre-emptive oral ganciclovir (1000 mg three times daily), when a marker of risk was identified, until day 90. The overall incidence of cytomegalovirus (CMV) disease at six months was 20% (five of 25 patients) in the non-prophylaxis group and 2.5% (one of 40 patients) in the group treated with pre-emptive oral ganciclovir (relative risk, 0.11; 95% confidence interval; 0.01-0.96; P = 0.04). The PCR sensitivity for detecting CMV disease was 80%, the specificity was 90%, and the positive and negative predictive values were 66% and 95%, respectively. Adverse events, graft rejection and survival were similar between groups. We conclude that pre-emptive oral ganciclovir in high-risk patients can reduce the risk of CMV disease.

Sensitivity to Cupressus: allergenic significance in Córdoba (Spain).

The detection of high levels of Cupressaceae pollen concentration in the air from January to April for several years in our area prompted analysis of the incidence and allergenic significance of sensitivity to this pollen. Furthermore, this is the highest winter-blooming taxa in the city of Córdoba. Skin prick tests were carried out over a one-year period on 1532 patients suffering from respiratory disorders (asthma and/or rhinoconjunctivitis). A total of 42 variables were studied in Cupressus-positive and Cupressus-negative patients; the data obtained were analyzed using a statistical software package. Sensitivity to Cupressus was found in 13% of all outpatients attending the unit, 18% of patients with respiratory disorders and 35% of patients with pollinosis. No significant differences were found between Cupressus-positive (C+) and Cupressus-negative (C-) patients with regard to mean age, sex, patient environment (i.e., rural, semi-rural, urban), personal or family history of atopy, clinical symptoms or evolution after immunotherapy (which did not include this antigen). More C+ patients were found in the higher age brackets (over 25 years old; p < 0.05); C+ patients showed greater duration (p < 0.05) and slower development (p < 0.05) of symptoms, and were also found to be more sensitive to other pollens (p < 0.001). All the Cupressus-sensitive patients also reacted positively to Olea and Fraxinus, compared to 77% and 51% in the two Cupressus-negative groups.

Humoral immunity in different phases of contact dermatitis.

Although cell-mediated hypersensitivity seems to be the main immunological response of man in contact dermatitis, recent studies suggest the potential involvement of antibody-mediated and basophilic cutaneous hypersensitivity in the physiopathology of this affection. The aim of this work was to contribute data intended to clarify the possible involvement of factors traditionally assigned to humoral hypersensitivity in the pathology of contact dermatitis. For this purpose blood levels of the different immunoglobulins were determined in patients with contact dermatitis. Three phases were considered, namely, one in which the patients showed typical clinical signs (acute phase), another in which the lesions had subsided (intercrisis phase) and a third in which the signs had recurred (acute outbreak). All those patients who concomitantly suffered from or had any personal or family antecedents of type I hypersensitivity were excluded from the study. The results found were compared with those obtained for a control gorup consisting of healthy individuals with no atopic antecedents. No significant differences were found between the results obtained in the three phases. However, the IgE levels of the patients were significantly higher than those of the control group, whereas the differences in the IgE, IgA and IgM levels were insignificant.

In vivo evaluation of cellular immunity in different phases of contact dermatitis.

Contact dermatitis is a delayed hypersensitivity reaction involving the skin as shock organ. In a delayed cutaneous hypersensitivity reaction to contact with an antigen, the afferent, central and efferent phases of the immune reaction remain untouched and the individual concerned has a nonspecific inflammatory response capacity. Hence, delayed cutaneous hypersensitivity tests and the dinitrochlorobenzene (DNCB) test are of great use in evaluating this type of reaction. This prompted us to evaluate the in vivo response of patients suffering from contact dermatitis, as studies on this topic have been focused on animal experimentation or in vitro techniques. We chose 30 patients with contact dermatitis and studied them at three different stages, namely, when the patients showed the typical clinical signs (acute phase), when the lesions had subsided (intercrisis phase) and when the signs had recurred (acute outbreak). We subjected them to delayed cutaneous hypersensitivity tests and the DNCB test. Both techniques revealed a decrease in the response in the intercrisis phase with respect to the other two phases and to a control group.

Linear monitoring of patients sensitive to Olea and grass pollens treated with immunotherapy based on glutaraldehyde-modified (allergoid) extracts.

Extracts modified with glutaraldehyde (allergoid) have been offered to allergologists for immunotherapy in the last few years as supposedly clinically effective agents that diminish undesirable side-effects (allergenicity vs. immunogenicity). In order to acquire experience in the use of this therapeutic resource, we monitored a group of patients with pollinosis sensitive to Olea, grass pollens or both, who suffered from seasonal rhinoconjunctivitis (SRC) or rhinoconjunctivitis and seasonal asthma (RCSA) and were administered allergoid treatments standardized in biological units (HEP). The patients were monitored by determination of specific IgE and IgG4, endpoint prick tests and conjunctival provocation tests (CPT) with two types of antigen: Lolium perenne and Olea europaea. Measurements were made at baseline (T1), when the maximal tolerated dose had been given (T2) and 1 year after the treatment was started (T3). According to our results, this type of extract is tolerated quite well and causes no alterations in specific IgG4 or IgE levels. On the other hand, it features significantly decreased allergen-specific skin reactivity and increased response thresholds to the CPT (p < 0.01). A high correlation between skin and conjunctival provocation tests was observed at some stages (r = 0.79, p < 0.01).

Study of lymphocyte subpopulations at different stages of contact dermatitis.

Contact dermatitis has traditionally been regarded as a T-lymphocyte-mediated delayed hypersensitivity reaction. This has led authors to focus their studies of this affection on establishing the role played by lymphocytes and the different lymphocyte subpopulations in its pathophysiology. However, as most of the research conducted on contact dermatitis has so far been carried out on experimental animals, we believed it of interest to study the potential alterations to the immune system involved in contact dermatitis in humans. For this purpose, we chose 30 patients suffering from contact dermatitis in whom we studied the blood levels of total lymphocytes, as well as those of CD3, CD4 and CD8, and the CD4/CD8 ratio. These parameters were determined at three clinical stages, namely, the clinical stage (acute phase), a period when the symptoms had subsided (intercrisis phase) and another when the lesions recurred (acute outbreak). The aim of this work was to study the changes in these lymphocyte subpopulations in each of the stages. We also studied a control group consisting of 30 healthy subjects in order to contrast the results obtained. We found no significant differences among the results obtained at the three stages. However, they did differ from those obtained for the control group: the patients had lower CD4 and CD8 levels than their healthy counterparts, the differences only being significant in the acute phase.

IgG4 levels in relation to Olea europaea immunotherapy.

We determined olive pollen-specific IgG4 levels in 100 patients, 39 of whom had been subjected to no immunotherapy (IT) for Olea (31 allergic and 8 nonallergic individuals) and 61 of whom had been administered IT as extracts, including Olea pollen (29 extracts in BUs, 24 allergenic extracts polymerized with glutaraldehyde:Allergoid and 8 extracts standardized in PNUs). IgG4 levels were correlated to the clinical picture, type of extract and average cumulative dose (ACD). We found average IgG4 levels of 0.80 +/- 0.74, 8.60 +/- 13.07 (p < 0.01) and 1.42 +/- 2.5 micrograms/ml (n.s.) for the untreated group and those treated with BU and Allergoid, respectively. The difference between the IT-BU-treated and IT-Allergoid-treated patients was significant at p < 0.01. On the other hand, we found no significant differences among the average IgG4 levels of the three groups in relation to age or sex. The group of asthmatic patients treated with BU extracts had average IgG4 levels of 16 +/- 17.34 micrograms/ml, while those of the rhinoconjunctivitic, non-asthmatic group were 5.05 +/- 6.149 micrograms/ml, with p < 0.05 (Student's "t" test). Thus, patients treated with extracts polymerized with glutaraldehyde had IgG4 levels that were similar to those of the patients subjected to no IT. Also, the group treated with IT extracts standardized in BUs had increased IgG4 levels that were correlated with the cumulative dose, particularly in asthmatic patients.

Variability of lipid phenotypes in hyperuricaemic-hyperlipidemic patients.

We studied changes in the hyperuricaemia-associated lipid phenotypes of primary hyperuricaemic-hyperlipidemic patients, none of whom was obese, hypertensive or an alcohol drinker. The patients were monitored for three months during which they were placed on a strict diet. The results obtained showed that phenotype IIB was most frequently associated with hyperuricaemia, followed by phenotypes IV and IIA. Lipid phenotypes were found to change in most patients during the study, even though most of them remained hyperuricaemic-hyperlipidemic. We also determined apoprotein B in each determination and found that over half the patients possessed increased levels of this apolipoprotein. The results confirm that hyperuricaemia is not associated to a unique lipid phenotype since the phenotype of a given patient may change with time, even in the absence of propitiating external factors.

Hyperuricemia-hyperlipemia association in the absence of obesity and alcohol abuse.

We carried out a study of 43 male asymptomatic subjects with high levels of uric acid but showing no signs of arterial hypertension, obesity or alcohol abuse. Initially, we investigated cholesterol levels, triglycerides in blood serum and the very low density lipoprotein fraction. The results showed asymptomatic hyperuricemia, frequently associated with mixed hyperlipidemia or hypertriglyceridemia. In our cases, however, the association was not connected to exogenous factors such as obesity or alcohol consumption. We also found the very low density lipoprotein fraction to be anomalous compared to the control group, which suggests that the metabolism of this lipoprotein is altered by the aforesaid association.

Renal excretion of urate by hyperuricaemic-hyperlipidemic patients.

We studied the renal urate excretory function in two groups of hyperuricaemic male patients composed of individuals with associated hyperlipidemia and hyperuricaemic-normolipidemic individuals, respectively. Both the hyperlipidemia and the hyperuricaemia were primary inasmuch as none of the patients studied was obese or had an above-normal alcohol intake or blood hypertension. The results obtained show that hyperuricaemic-hyperlipidemic patients have higher serum levels of uric acid and poorer urate excretion as reflected in smaller clearance and fractioned excretion of the metabolite than hyperuricaemic-normolipidemic patients. This, in turn, suggests the occurrence of differences in the extent of the urate handling anomalies between the two groups of patients.

[Survival outcome in chronic alcoholism: a 10 year follow-up study]. / Factores pronósticos de supervivencia en el alcoholismo crónico en un estudio de seguimiento a 10 años.

UNLABELLED: Alcoholism is a major cause of death. To date, there have been reported few studies examining the factors associated with mortality in alcoholics who are hospitalized for medical reasons. The aim of this study was to analyze the survival rate of those alcoholic subjects and to identify outcome variables. PATIENTS AND METHOD: Among all alcoholic patients admitted from January 1986 to December 1988 in the Department of Internal Medicine 1 of the Reina Sofia University Hospital in Córdoba (Spain), 162 met the inclusion criteria. Information was compiled from protocols, medical records,death certificates and interviews to patients and family members.A prospective cohort design was also used. Average age was 50.7 (10.7) years; 91.4% were males, 69.9% smokers,65.7% were married, 19.8% had ascites, and the average follow-up was 8.7 years. 59 patients survived, 56 died, and 47 did not complete the study period. In the covariate analysis, age, marital status,alcoholism duration, bilirubin levels, ascites and albumin concentrations had statistical signification. Four variables were included in the regression model: age (OR, 1.07; 1.03-1.12); ascites (OR,2.09; 1.05-4.15); bilirubin (OR, 1.42; 1.20-1.67) and marital status (OR, 2.39; 1.17-4.85). CONCLUSIONS: In our study, age, an increase in bilirubin level, presence of ascites, and marital status (single, widowed or separated) were associated with a significantly lower survival rate in chronic alcoholics.

[The medical care in internal medicine in relation to consultations]. / Estudio de la actividad asistencial de Medicina Interna en relación a las interconsultas.

OBJECTIVE: To study the characteristics of interconsultations from Traumatology (TM), Urology (UR) and Psychiatry (PC) to Internal Medicine (IM). MATERIAL AND METHODS: Interconsultations from TM, UR and PC to IM from November 2000-April 2001 were analyzed. A medical care program was established and supervised by a physician specifically assigned for this purpose. RESULTS: 105 TM, 30 PC and 23 UR interconsultations were reported. The mean age and percentage of women were greater for the TM group. Hip fracture was the principal cause for hospital admission. Cardiac pathologies were the most frequently associated pathology. The mean Charlson Index was 6.07 (TM), 3.10 (PC) and 6.17 (UR). The principal cause for consultation was dyspnea. The most frequent diagnosis was respiratory infection. The mortality rates for the patients were 9.52% (TM), 13% (UR) and 0% (PC). When comparing rapid medical care for patients admitted to TM from 2000-2001 versus 1999-2000, we found the response to interconsultations to be most rapid. and 9.95% mortality for the 2000-2001 period versus 13.84% mortality for the 1999-2000 period. CONCLUSIONS: The TM interconsultations proved to be both complex and frequent. The majority of interconsultations were for elderly women with hip fractures and multiple pathologies requiring rapid medical assistance. A response system adapted to these interconsultations improved the quality of care and mortality.

[A synchronous association of a double colonic adenocarcinoma and hypernephroma: an infrequent case of multiple primary neoplasms]. / Asociación sincrónica de doble adenocarcinoma de colon e hipernefroma: un caso infrecuente de neoplasia primitiva múltiple.

It has been reported that exceptional association exists between primary colon cancer and hypernephroma. In this paper we are reporting a case of a male patient carrying an hypernephroma synchronous with a proximal colonic adenocarcinoma in addition to a second adenocarcinoma, growing on a tubular adenoma, nearly of first. These findings get seen as partially coincidental with some features of the cancer family syndrome (Lynch syndrome II), and we have considered that genetics conditions, like those of Lynch syndrome II, could to explain some multiple neoplasms in patients carrying then.