Astaxanthin extraction from shrimp wastes and its stability in 2 model systems.

The objective of this work was to study the stability of astaxanthin, obtained from shrimp wastes, and incorporated to 2 model systems: egg albumin protein solution and sunflower oil. Shrimp wastes were ensiled by a treatment with formic/acetic acids (4%-4% v/w wastes) and stored at 4 degrees C for 24 h. The pigment was extracted with organic solvents (petroleum ether:acetone:water, 15 : 75 : 10) and concentrated. The storage parameters studied were: illumination (light/dark), temperature (4/20 degrees C), atmosphere (air/air-free), and storage time (0, 1, 2, 3, 4, 5 wk). Results showed that total xantophylls and astaxanthin were more stable in sunflower oil than in the protein system. Total xantophylls showed more stability than astaxanthin, possibly due to the presence of other, more stable carotenoids quantified together with xantophylls. Astaxanthin concentration was significantly affected by storage time; its degradation followed a first-order reaction rate under all the studied conditions. This pigment was stable only for 17 d, even when stored in air-free flasks, under refrigeration, and in the dark.

The Latin American Consortium of Studies in Obesity (LASO).

Current, high-quality data are needed to evaluate the health impact of the epidemic of obesity in Latin America. The Latin American Consortium of Studies of Obesity (LASO) has been established, with the objectives of (i) Accurately estimating the prevalence of obesity and its distribution by sociodemographic characteristics; (ii) Identifying ethnic, socioeconomic and behavioural determinants of obesity; (iii) Estimating the association between various anthropometric indicators or obesity and major cardiovascular risk factors and (iv) Quantifying the validity of standard definitions of the various indexes of obesity in Latin American population. To achieve these objectives, LASO makes use of individual data from existing studies. To date, the LASO consortium includes data from 11 studies from eight countries (Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Peru, Puerto Rico and Venezuela), including a total of 32,462 subjects. This article describes the overall organization of LASO, the individual studies involved and the overall strategy for data analysis. LASO will foster the development of collaborative obesity research among Latin American investigators. More important, results from LASO will be instrumental to inform health policies aiming to curtail the epidemic of obesity in the region.

Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease.

BACKGROUND: Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned. OBJECTIVE: To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations. METHODS: We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points. RESULTS: WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively. CONCLUSION: WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

Unexpected diminished innervation of epidermis and dermoepidermal junction in lichen amyloidosus.

BACKGROUND: Lichen amyloidosus is a localized, chronic, pruritic skin disease characterized by deposition of amyloid in the papillary dermis. The pathogenesis of the pruritus of lichen amyloidosus is largely unknown. OBJECTIVES: To determine any change in the nerve fibre density in lichen amyloidosus lesions as an explanation for itch. METHODS: Using an antibody to protein gene product (PGP) 9.5, the immunohistochemical analysis of the skin biopsies of 30 Hispanic patients with clinicopathologically proven lichen amyloidosus and of 11 healthy Hispanic controls matched for age, sex and site was performed. RESULTS: Unexpectedly, the mean amount of PGP9.5 stain, a measure for nerve fibre amount, for the healthy controls was higher than the lichen amyloidosus group both in the epidermis (P < 0.0019) and dermoepidermal junction (P < 0.0064). No change was observed in the papillary dermis. Furthermore, the proportion of area covered by PGP9.5 showed a significant decrease in the epidermis (P < 0.0024) and dermoepidermal junction (P < 0.0075) in lichen amyloidosus compared with healthy controls. Age, gender and body site were found not to be influencing factors in nerve fibre amounts in lichen amyloidosus samples. CONCLUSIONS: We speculate that the severe pruritus observed in lichen amyloidosus might be the result of the hypersensitivity of the remaining nerve fibres as a response to an unexplained neurodegeneration of the absent nerve fibres.

Essential type II mixed cryoglobulinemia causing pyoderma gangrenosum-like ulcers.

A 47-year-old, otherwise healthy woman presented with multiple deep ulcers located primarily on her lower extremities that presented 6 days ago as blisters. A biopsy revealed livedoid vasculopathy, without any evidence of vasculitis. Extensive laboratory workup was positive only for type II cryoglobulins.

[Cardiac resynchronization through a persistent left superior vena cava]. / Resincronización cardíaca a través de una vena cava izquierda persistente.

Cardiac resynchronization therapy is effective in the treatment of patients with severe heart failure and intraventricular dysynchrony. However, we are sometimes faced with the unexpected presence of a persistent left superior vena cava. We report the case of a patient with dilated cardiomyopathy and left ventricular dysynchrony in which we implanted a resynchronization pacemaker exclusively through a persistent left superior vena cava that did not communicate with the right vena cava.

Resincronización cardíaca a través de una vena cava izquierda persistente / Cardiac resynchronization through a persistent left superior vena cava

La resincronización cardíaca es eficaz en pacientes con insuficiencia cardíaca y criterios de asincronía intraventricular. Sin embargo, durante el implante podemos encontrarnos excepcionalmente con la existencia inesperada de una vena cava izquierda persistente. Presentamos un caso de miocardiopatía dilatada en el que se implantó con éxito un dispositivo de resincronización, exclusivamente a través de una vena cava izquierda persistente no comunicada con la vena cava derecha

Cardiac resynchronization therapy is effective in the treatment of patients with severe heart failure and intraventricular dysynchrony. However, we are sometimes faced with the unexpected presence of a persistent left superior vena cava. We report the case of a patient with dilated cardiomyopathy and left ventricular dysynchrony in which we implanted a resynchronization pacemaker exclusively through a persistent left superior vena cava that did not communicate with the right vena cava

Spontaneously remitting dermatomyositis.

Dermatomyositis (DM) is an inflammatory myopathy of skeletal muscle with characteristic cutaneous findings. It is a rare disorder with a bimodal age distribution that affects almost twice as many women as men. One category of DM, normal-enzyme DM, is characterized by cutaneous changes only at baseline, normal serum muscle enzyme levels and myositis demonstrated by electromyography (EMG) and/or muscle biopsy specimens. Typically, patients with normal-enzyme DM progress to severe muscle involvement and require systemic corticosteroid therapy. The patient we report has normal-enzyme DM confirmed by serial serum enzymes, EMG, and skin and muscle biopsies but is unique in that she never experienced progression of muscle weakness although muscle involvement was documented histologically and by EMG. Follow-up examination after 1 year revealed near-complete resolution of cutaneous involvement after topical therapy and no evidence of muscle weakness.

Síndrome coronario agudo sin elevación del segmento ST por lesión aguda del tronco común de la arteria coronaria izquierda. Presentación de 6 pacientes / Non-st elevation acute coronary syndrome due to an acute lesion in the left main coronary artery. Report of 6 cases

Objetivo. Describir el perfil de los pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) por lesión aguda del tronco común de la arteria coronaria izquierda (TCI).Diseño. Serie de casos consecutivos (enero 2002 a febrero 2003) con seguimiento hasta el alta hospitalaria. Ámbito. Unidad Coronaria y Unidad de Hemodinámica y Cardiología Intervencionista de un hospital general. Pacientes y método. Se estudió a 6 pacientes con SCASEST y lesión aguda del TCI en la coronariografía. Se analizan la clínica, el electrocardiograma (ECG) basal y con dolor, los marcadores cardíacos, el ecocardiograma y los hallazgos del cateterismo cardíaco. Resultados. De los 6 enfermos (varones; 43-76 años), 2 presentaban angina inestable y 4 infarto agudo de miocardio sin onda Q (IAMNQ) con shock cardiogénico (n = 2), edema pulmonar (n = 1) o fibrilación ventricular (n = 1). El ECG con dolor mostró cambios del segmento ST en 7 derivaciones con descenso en DI (1-4 mm), DII (1-2 mm), V4-V6 (1-4 mm) y ascenso en aVR (0,5-2,5 mm), y un sumatorio en valor absoluto (ST [DI, DII, aVR, V4-V6]) 10 mm. La coronariografía (1-48 h) evidenció una estenosis 70 por ciento del TCI, por lo que en 2 pacientes se procedió a cirugía y en 4 a angioplastia e implante de stent, con buen resultado final. Conclusiones. En los pacientes con SCASEST y disfunción ventricular izquierda severa, arritmias ventriculares graves o ECG con cambios marcados del segmento ST en 7 derivaciones que incluyan DI, DII, aVR, V4, V5, V6, se debe sospechar una lesión aguda del TCI y plantear una estrategia invasiva urgente o incluso de emergencia (AU)

Lack of association between Helicobacter sp colonization and gallstone disease.

Recently, Helicobacter sp has been identified in resected gallbladder tissue and in collected bile from Chilean patients with chronic cholecystitis. Therefore, it an association between bile Helicobacter sp and gallbladder cancer has been proposed. Interestingly, both Helicobacter colonization and gallstone disease (GD) happen very frequently in Chile. However, whether there is an association between Helicobacter colonization and GD has not been completely studied. The aim of this study was to determine the incidence of Helicobacter in human gallbladder tissues with GD. The study included 95 Mexican patients undergoing cholecystectomy. Collected gallbladder specimens were assessed to identify Helicobacter sp using histology, immunohistochemistry, and polymerase chain reaction (PCR) analysis using Helicobacter-specific 16-S ribosomal RNA primers. Of the 95 specimens examined in detail, all had stones as follows: 56 (59%) had chronic cholecystitis; 7 (7.4%), acute cholecystitis: 15 (16%), both chronic and acute cholecystitis, 10 (9.5%), cholesterolosis, and 7 (7.4%), lymphoid hyperplasia. Specimens were considered positive for Helicobacter when histology was positive. Only 1 of the 95 specimens was positive for Helicobacter by immunohistochemistry analysis; 1 of 32 cases, by PCR. These results suggest a low incidence of Helicobacter in the gallbladder epithelium of Mexican patients with GD. However, we can not discard the existence of uncommon Helicobacter sp in gallbladder epithelium and its association with gallstone pathogenesis. Additionally, this study suggests no apparent association between GD and Helicobacter colonization in a Mexican population.

[Permanent pacing of the bundle of His after radiofrequency atrioventricular node ablation in patients with suprahisian conduction disturbances]. / Estimulación permanente del haz de His tras ablación mediante radiofrecuencia del nodo auriculoventricular en pacientes con trastorno de la conducción suprahisiano.

INTRODUCTION AND OBJECTIVES: The asynchronic contraction of the left ventricle due to left bundle branch block or right ventricular pacing is inferior from a hemodynamic point of view to the synchronic contraction through the conduction system. Several authors have reported some cases of pump failure and deterioration of mitral regurgitation after AV nodal ablation. Alternative sites of pacing such as the right ventricular outflow tract pacing have been proposed in order to avoid these complications. Direct His bundle pacing might be a new alternative for permanent pacing, however, it has not been extensively evaluated in humans yet. Our aim is to prove the feasibility of permanent His pacing in terms of stability, thresholds and pump function. POPULATION: patients without structural heart disease, selected for AV nodal ablation due to uncontrolled paroxysmal atrial fibrillation, or for pacemaker implantation due to supraHis conduction disturbance, with normal conduction system. An active fixation permanent lead was placed in His position using an steering guidewire and a diagnostic catheter as an anatomical reference. We also implanted a lead in the right atrial appendage and both were connected to a DDDR generator. Pacing thresholds and ecocardiographic ventricular function parameters were evaluated (ejection fraction, cavity size, mitral regurgitation). RESULTS: 12 patients met the inclusion criteria. Successful His pacing was achieved in 8 out of 12 cases (66%) with acceptable thresholds at implantation (1.24 +/- 0.13 volts at 0.5 ms) and during follow up at 3 months (1.31 +/- 0.20 volts at 0.5 ms). Neither a significant change in the ecocardiographic parameters not a deterioration in the clinical status caused by ablation or stimulation was evidenced. CONCLUSION: The His bundle may be the site of choice for long term pacing in patients with AV block and normal infraHis conduction system.

Histologic changes of the gastric mucosa associated with primary gastric lymphoma in endoscopic biopsy specimens.

CONTEXT: Recently, we have observed intestinal metaplasia, atrophy, and dysplasia in the mucosa adjacent to primary gastric lymphoma (PGL) in gastrectomy specimens. OBJECTIVE: To determine the frequency and type of epithelial disorders at the histopathologic level in the mucosa adjacent to PGL in endoscopic specimens. DESIGN: We studied 54 endoscopic biopsies from patients harboring PGL. We searched for the following morphologic changes in the gastric mucosa: intestinal metaplasia; atrophy; dysplasia; epithelial erosion; and atypical regeneration of the glandular epithelium. Other nonepithelial findings such as lymphoid follicles, Helicobacter pylori, and lymphoma grade, were also recorded. For comparative purposes, 50 endoscopic biopsies with gastric adenocarcinoma and 50 biopsies with chronic gastritis associated with H pylori infection were also studied. RESULTS: The 54 biopsies included 28 (52%) low-grade and 26 (48%) high-grade PGLs. We found intestinal metaplasia in 32 biopsies (59%), atrophy in 20 biopsies (37%), dysplasia in 2 biopsies (4%), erosion of the epithelium in 33 biopsies (61%), and atypical regenerative changes of the glandular epithelium in 10 biopsies (19%). Lymphoid follicles were found in 21 biopsies (39%), and H pylori was demonstrated in 31 biopsies (57%). When groups were compared, the frequency of epithelial changes in biopsies from patients with PGL and adenocarcinoma was similar. Intestinal metaplasia or atrophy were present in only 10% of biopsies from patients with gastritis, and dysplastic glands were not identified. CONCLUSIONS: Biopsies from patients with PGL showed chronic damage of the gastric mucosa at diagnosis, including precancerous conditions. Intestinal metaplasia and atrophy were among the most frequent disorders, but dysplasia was also occasionally present. Endoscopists and pathologists must be acquainted with such changes and look for them in the initial biopsy, as well in subsequent samples. This practice is particularly important when reviewing biopsies from patients with low-grade mucosa-associated lymphoid tissue (MALT)-lymphomas who are eligible for eradication treatment for H pylori.

Ablación del nodo aurículo-ventricular y marcapasos definitivo en el tratamiento de taquiarritmias auriculares: resultados y evolución a medio y largo plazo / Atrioventricular node ablation and permanent pacemaker for atrial tachyarrhythmias treatment: results and evolution at medium and long-term

Objetivos. Evaluar los resultados de la ablación por radiofrecuencia del nodo aurículo-ventricular (NAV) e implante de marcapasos definitivo (MPD) en pacientes con taquiarritmias auriculares graves, refractarias a tratamiento farmacológico y no curables con ablación, y su evolución a medio-largo plazo. Métodos. Revisar retrospectivamente las características clínicas de los enfermos, eficacia de la técnica, modos de estimulación y evolución posterior en cuanto a complicaciones, mortalidad, calidad de vida, tratamiento antiarrítmico, ingresos hospitalarios y en los pacientes que padecían insuficiencia cardíaca (ICC), capacidad funcional. Resultados. Cuarenta pacientes (14 hombres, 26 mujeres) con edad media de 68,7 (10,1) años e historia de arritmias auriculares (32 paroxísticas, 8 crónicas) de 64,8 (57,3) meses de duración. El bloqueo AV se logró en todos los casos (100 por ciento).El modo de estimulación se eligió según la arritmia de base. Hubo cuatro complicaciones no mortales. Tras un seguimiento medio de 15,4 (10,3) meses, se redujo significativamente el número de visitas a urgencias por año (5,47 [5,1] frente a 0,47 [0,97]; p < 0,001), los días de ingreso hospitalario/año (29,3 [15,6] frente a 8,3 [5,2]; p < 0,001), el número de cardioversiones eléctricas por paciente/año (2 [3,1] frente a 0,32 [1,2]; p < 0,01) y el uso medio de antiarrítmicos por paciente (2,61 [1,34] frente a 0,77 [0,75]; p < 0,001). El 92,1 por ciento de los pacientes presentó mejoría de su calidad de vida y mejoró significativamente la clase funcional de la New York Heart Asociation (NYHA) en los enfermos con ICC (2,68 [0,88] frente a [1,73] [0,8]; n = 19; p < 0,01). Se registraron cinco fallecimientos hasta el final del seguimiento. Conclusiones. En nuestra experiencia, la ablación del NAV con implante de MPD constituye una alternativa terapéutica eficaz y segura para aquellos enfermos con taquiarritmias auriculares de dificil control farmacológico y no curables mediante técnicas de ablación convencionales (AU)

Low grade adenocarcinoma simulating benign glandular lesions in needle prostatic biopsy.

In order to define the frequency and morphological characteristics of low grade adenocarcinomas misdiagnosed as benign prostatic hyperplasia in needle prostatic biopsies, we reviewed 135 consecutive needle biopsies with prostatic cancer. In three biopsies (2.2%) low grade adenocarcinoma was found as a single neoplastic pattern simulating benign hyperplastic gland in some histological fields and prostatic adenosis in others. These biopsies showed the histological features described for carcinomas originating in the transition zone and were seen in isolated histological fields. Retrospectively, it was found that these biopsies showed features of adenocarcinoma although some histologic criteria of malignancy such as infiltrative pattern, prominent nucleoli and nuclear enlargement were seen only focally. Blue mucinous secretions, crystalloids, occasional stromal single cells and mitotic figures were absent. We conclude that a detailed analysis of architectural and cytological features must be made of all glandular proliferations, since this type of low grade adenocarcinoma can occasionally be found in needle prostatic biopsies as the only neoplastic pattern in needle biopsy specimens and simulate benign glandular lesions.

Pharmacokinetics of clofibrate in familial hypercholesterolemia.

Some patients with familial hypercholesterolemia (FHC, type II) are highly responsive to the cholesterol-lowering effect of clofibrate, while others are not only resistant to this effect but may even show an increase in plasma beta-lipoproteins. In an attempt to find an explanation for these striking differences, we have studied the pharmacokinetics of clofibrate in FHC patients at both extremes of responsiveness. The results disclosed several major differences between the two groups. Plasma clofibric acid (CPIB) measured during the chronic administration of the drug was significantly higher in the responders than in the non-responders, whether all patients in each group or only those with tendon xanthomas were considered. Plasma CPIB concentrations were negatively correlated with body weight in the responders but not in CPIB-resistant patients. They were also inversely proportional to decreases in plasma beta-lipoprotein cholesterol after chronic clofibrate administration in the responsive group, but directly proportional to increases in the non-responders. Increasing the dose of clofibrate from 2 to 3 g/day in CPIB-resistant patients always resulted in an increase in plasma CPIB levels, but this was followed in some patients by a decrease and in others by an increase in plasma beta-lipoprotein cholesterol concentrations, so that the overall effect was not statistically significant. The half-life of plasma CPIB was measured over 48 h after a single 1-g dose of clofibrate in patients who had not received this drug for at least 3 weeks. Half-life was significantly longer in the responsive patients. In addition, the bioavailability and the rate of absorption of clofibrate tended to be higher in this group than in the resistant patients. We suspect that both groups differ not only in the metabolic handling of clofibrate but also in some aspect of their beta-lipoprotein cholesterol metabolism.