[Computed tomography characteristics of isolated caecal ischaemia]. / Características en tomografía computarizada de la isquemia cecal aislada.

OBJECTIVE: The aims of this review are to describe the main characteristics for the CT diagnosis of isolated caecal ischaemia (ICA) and give details of the differential diagnosis with other conditions with a similar clinical picture. MATERIAL AND METHODS: A retrospective study was conducted to review the CT findings of 4 patients diagnosed with ICA in our hospital. The parameters recorded to analyse their characteristics in the CT were: maximum thickness of the caecum wall, the appearance of the peri-caecum fat, presence of free fluid, signs of caecal or portal pneumatosis, the appearance of the caecal appendix, and general signs of the presence of vasculopathy. RESULTS: In all cases it was recorded that there was a thickening of the walls of the blind loop with an abrupt transition between the caecal wall and the walls of the ascending colon wall. In all cases the caecal thickening had a characteristic image in the central area. Signs of caecal pneumatosis were observed in two cases. All of them had an appendix with normal characteristics. CONCLUSIONS: The combination of caecal wall thickening with oedematous characteristics, with no changes in the appendix, ileum and colon, suggest the diagnosis of caecal ischaemia, particularly with the presence of pneumatosis.

Simultaneous evaluation of the circulating levels of both Th1 and Th2 chemokines in patients with autoimmune Addison's disease.

BACKGROUND: Chemokines play a key role in the recruitment of the immune cells into the autoimmune process. Thus, the simultaneous evaluation of circulating levels of Th1-related chemokines, such as CX chemokine ligand 10 (CXCL10) and macrophage inflammatory proteins 1α (CCL3/MIP-1α), and Th2-related chemokines, such as macrophage inflammatory proteins 1 ß (CCL4/MIP-1ß) could be useful in the approach to some autoimmune diseases, including autoimmune Addison's disease (AAD). AIM: To evaluate plasmatic levels of MIP-1α, MIP-1ß, CXCL10 and adrenocortical antibodies in patients with AAD under treatment with corticosteroids. PATIENTS AND METHODS: Twelve women and 5 men (group 1) were divided in 2 subgroups: 9 subjects with isolated AAD (group 1a) and 8 with AAD associated with chronic autoimmune thyroiditis (group 1b). MIP-1α, MIP- 1ß and CXCL10 were evaluated in the serum of all patients and in 20 healthy controls, using a system for microarray suspension. RESULTS: The levels of MIP-1α, MIP-1ß and CXCL10 resulted significantly increased vs controls (p<0.001). An inverse significant correlation between the serum levels of MIP- 1ß and the duration of the disease was observed. CONCLUSION: High levels of MIP-1α and MIP-1ß associated with increased levels of CXCL10 in AAD seem to indicate a role of these chemokines in the autoimmune pathology of adrenal gland through the recruitment in loco of Th1 and Th2 cells. The simultaneous measurement of Th1-related chemokines (CXCL10 and MIP-1α) and of Th2-related chemokine MIP-1ß in the serum of patients with AAD would sustain a novel preliminary hypothesis on the immune microenvironment of chronic autoimmune inflammation within adrenal glands.

Removal of humic substances from water by means of calcium-ion-enriched natural zeolites.

The ability of the natural zeolited Neapolitan Yellow Tuff (NYT) enriched with calcium ions to remove humic acids from water was evaluated by batch adsorption equilibrium tests and dynamic experiments carried out by percolating humic acid solutions through a small NYT column (breakthrough curves). Under the experimental condition explored, the sorption capacity increases with the ionic strength and has the highest value at pH 7.4. The partition coefficient for a low concentration of humic acid ([humic acid] --> 0), at pH 7.4 in 0.01 M sodium chloride, was approximately 1000 L/kg, versus the value of approximately 100 L/kg in the absence of the alkaline metal salt. Therefore, after humic acids have been adsorbed in a column filled with the calcium-ion-enriched tuff, a reduction of the salt concentration in the ongoing solution enhances the release of the adsorbed material. These findings show that NYT can be used for the removal of humic acids from water.

Double loop reconstruction following pancreaticoduodenectomy for malignant tumor: Short-term outcome.

BACKGROUND: To evaluate the use of a double loop reconstruction following pylorus preserving proximal pancreaticoduodenectomy (PPPPD). METHODS: Morbidity and mortality were evaluated in 55 patients undergoing PPPPD for malignant tumors, followed by a double loop reconstruction. RESULTS: The mean intra-operative blood loss was 908mL±531. In-hospital mortality was 5.4% (3/55 pts). The mean length of hospital stay was 17±5 days (range 12-45 days). Postoperative complications occurred in 25 patients (46.2%). Five patients developed an anastomotic leak, one biliary and four pancreatic (4/55; 7%). Delayed gastric emptying occurred in 8 patients (14.5%). Reoperation was required in two patients for hemorrhage. CONCLUSIONS: A double loop alimentary reconstruction following PPPPD led to a low incidence of DGE and pancreatic fistula. Although mortality rate was higher than that reported by referral centres, this technique has been performed in a not specialized unit attaining acceptable results.

Characterization of the human lipocortin-2-encoding multigene family: its structure suggests the existence of a short amino acid unit undergoing duplication.

Human genomic clones of the gene encoding lipocortin (LIP) 2 (p36) and of three pseudogenes have been isolated and characterized. The LIP2 gene is at least 40 kb long and consists of 13 exons. The three pseudogenes present typical features of retroposons and, together with the gene, probably represent the entire LIP2 multigene family. Chromosomal assignment of the four loci is proposed. The hypothesis that an ancestral unit coding for 15 to 20 amino acids may have been involved in the evolution of the gene is discussed.

1,8-Naphthalic anhydride antidote enhances the toxic effects of captan and thiram fungicides on Azospirillum brasilense cells.

The effects of ten fungicides, six herbicides and four insecticides on the nitrogen-fixing bacterium Azospirillum brasilense were examined. The fungicides captan and thiram were the most toxic among the compounds tested. Cell growth and nitrogenase activity of the bacterium were markedly inhibited by low concentrations of the two fungicides. Antidote 1,8-naphthalic anhydride increased by a factor of 2 the cellular level of glutathione. The addition of the antidote in the presence of captan or thiram caused a similar increase in the glutathione content, but at the same time enhanced the toxicity of the two fungicides.

Risk factors for sternal wound and other infections in pediatric cardiac surgery patients.

BACKGROUND: This study was undertaken to determine the incidence, pathogens and risk factors associated with development of sternal wound and other infections in children undergoing cardiac surgery. METHODS: Retrospective chart review was performed for all cardiac surgeries performed on children <18 years of age at Upstate Medical University at Syracuse between January, 1996, and June, 1998. For evaluation of risk factors for sternal wound infection, only patients undergoing sternotomy are included in the analysis: those with infection are compared with those without for preoperative, intraoperative and postoperative risk factors. RESULTS: Sternal wound infection developed in 10 of 202 (5%) children after median sternotomy. Superficial sternal wound infection developed in 6 (3%) children, and 4 (2%) had deep infection. Children with sternal wound infection had lower age, higher American Society of Anesthesiologist score, longer preoperative stay, longer period of ventilation and inotropic support, longer intensive care unit and total postoperative hospital stays and increased leukocyte band cell counts preoperatively and on Postoperative Day 1 than those without sternal infection. Causative agents for sternal wound infection were Staphylococcus aureus (6), Pseudomonas aeruginosa (1) and Haemophilus influenzae non-type b (1). In addition 32 bacterial infections occurred at nonsurgical sites after 28 procedures. Infections included pneumonia, urinary tract infection and bacteremia. Longer bypass time and longer operation time were two additional risk factors for nonwound infection. CONCLUSION: Infections continue to be a significant cause of morbidity in cardiac surgery patients. Knowledge of risk factors for infection could be useful in preventive and treatment strategies for these high-risk groups.

Thioguanine resistance, ouabain resistance and sister chromatid exchanges in V79/AP4 Chinese hamster cells treated with potassium dichromate.

The biological activity of potassium dichromate (K2Cr2O7) was assayed in V79/AP4 Chinese hamster cells by measuring two mutational end points, thioguanine (TG) resistance and ouabain (OUA) resistance, and two non-mutational end points, cytotoxicity and sister chromatid exchanges (SCE). By exposing the cells for 1 h to the chemical, all biological end points examined were affected by the treatment in a dose-dependent manner. Moreover the combined use of the two selective systems indicated that chromium induces base-pair substitutions in mammalian cells in culture.

8-Azaguanine versus 6-thioguanine: influence on frequency and expression time of induced HGPRT- mutations in Chinese hamster V79 cells.

Chinese hamster V79 cells were mutagenized with ethyl methanesulfonate at various concentrations. Clones resistant to 8-azaguanine (20 and 80 micrograms/ml) or 6-thioguanine (4 micrograms/ml) were selected at different times after the treatments. The total yield of induced mutations was only slightly affected by the kind and concentration of purine analog used in the selection. However, full phenotypic expression of the mutants selected with 8-azaguanine was achieved earlier than that of mutants resistant to 6-thioguanine. This result seems to be best explained by the reported lower affinity of 8-azaguanine for the wild-type HGPRT enzyme, thus providing evidence that, in this gene-mutation assay, the phenotypic expression time has a physiological component.

Analysis by BrUdR-labelling technique of induced aneuploidy in mammalian cells in culture.

To study the origin of induced aneuploid cells, the BrUdR-labelling technique was applied to V79/AP4 Chinese hamster cells treated with colcemid or benomyl. In this way we were able to recognize the cells which had undergone one cellular division after the treatment since their chromosomes exhibited sister-chromatid differentiation. The results showed that the induced aneuploid cells can have either a few or numerous additional chromosomes depending on the concentrations of the drug. Moreover, it could be established that aneuploid cells with numerous additional chromosomes were obtained mainly when polyploid cells were also present in the treated population. This strongly suggests that the excess of additional chromosomes found in the aneuploid cells induced by the highest concentrations may be derived by disturbances of the whole mitotic apparatus rather than by a multiplicity of errors affecting individual chromosomes.

A comparative study of different experimental protocols for mutagenesis assays with the 9-azaguanine resistance system in cultured Chinese hamster cells.

Both spontaneous and EMS-induced mutant frequencies were determined in cultured cells from V79 Chinese hamsters using three different experimental protocols. After optimal expression time was attained, mutation frequencies only remained constant when a protocol was used in whcih the cell density was maintained below critical values both before and during mutant selection. The identification of such a plateau allows, besides more reliable and reproducible estimates of mutation frequency, reduction in the size of experiments for quantitative evaluation of mutagenicity. Determination of mutation frequencies over a wide range of expression times becomes in fact unnecessary.

A comparison of the 8-azaguanine and ouabain-resistance systems for the selection of induced mutant Chinese hamster cells.

The forward mutation selection system based on resistance to 8-azaguanine has been widely used with cells cultured from a diversity of species and with a variety of mutagens. Ouabain resistance is an alternative selective system. Both systems show a substantial influence of expression time on the number of resistant variants observed after addition of the selective agent such that the frequency reaches a maximum which is dose dependent, and then declines rapidly. Metabolic cooperation has been propsed as the mechanism responsible for this decline with the 8-azaguanine system, but it is less likely to account for the loss of ouabain-resistant variants where it is necessary to invoke generalised effects on the viability of variants due to overcrowding on the plates. A comparison of the two selective systems showed that, with the exception of gamma-irradiation, which was apparently non-mutagenic in the ouabain system, there was broad agreement between the two systems for each mutagen tested. Ethyl methanesulphonate was the most efficient mutagen by a substantial factor. Ouabain resistance permitted greater discrimination particularly between weak mutagens because of the low frequency of spontaneous variants (4 x 10(-7) and also produced data with less intrinsic variability. The absence of gamma ray induced mutation in the ouabain system shows that it may fail to detect certain types of mutagens. Thus the two systems should be used to complement each other. Mutation by the fungicide captan was evaluated using both systems and the positive results indicate that it may pose a hazard to man.

A genetic analysis of the adenine phosphoribosyl transferase locus in Chinese hamster V79-AP4 cells: relevance to mutagenesis studies.

The chromosomal location of the autosomal locus aprt has been investigated in the permanent Chinese hamster cell line V79-AP4 by standard somatic cell genetics methodologies. Aprt is functionally dizygous in V79-AP4 and the 2 alleles map on 2 chromosome 3 homologs, in agreement with the chromosome assignment of the gene in Chinese hamster primary cells. Chromosome G-banding and a Southern blot analysis of V79-AP4 DNA, using as a probe the cloned Chinese hamster aprt gene, have not revealed any structural alteration at either of the 2 aprt alleles. One of the chromosomes 3 has, however, a terminal deletion in its long arm and is therefore morphologically marked. These findings could make V79-AP4 an interesting cell system for the study of mutational mechanisms at the aprt locus in Chinese hamster.

T'ai Chi Chih as an intervention for heart failure.

A program of T'ai Chi Chih, a modified T'ai Chi exercise, was piloted in a study comprised of a small sample of individuals with heart failure. A conceptual framework guided the study design, integrating theories of the neurohormonal dynamics of heart failure with mind-body holistic perspectives of health. Comparisons of pre- and post-measures of heart failure symptoms, general health, mental health, functional capacity, and energy perceptions support the potential of T'ai Chi Chih in managing heart failure symptoms and improving quality of life. In this article, quantitative interviews capture the meaning of experiencing a complementary therapy as an intervention for chronic illness. Participation in T'ai Chi Chih by individuals with heart failure is a cost-effective, noninvasive alternative strategy that warrants continued investigation.

[Predictive models for ART]. / Les modèles prédictifs de grossesse en AMP.

A predictive model is a mathematical expression estimating the probability of pregnancy, by combining predictive variables, or indicators. Its development requires three successive phases: formulation of the model, its validation--internal then external--and the impact study. Its performance is assessed by its discrimination and its calibration. Numerous models were proposed, for spontaneous pregnancies, IUI and IVF, but with rather poor results, and their external validation was seldom carried out and was mainly inconclusive. The impact study-consisting in ascertaining whether their use improves medical practice--was exceptionally done. The ideal ART predictive model is a "Center specific" model, helping physicians to choose between abstention, IUI and IVF, by providing a reliable cumulative rate of pregnancy for each option. This tool would allow to rationalize the practices, by avoiding premature, late, or hopeless treatments. The model would also allow to compare the performances between ART Centers based on objective criteria. Today the best solution is to adjust the existing models to one's own practice, by considering models validated with variables describing the treated population, whilst adjusting the calculation to the Center's performances.

[Staging rectal cancer]. / Estadificación del cáncer de recto.

Rectal cancer has a high incidence in our area. The different treatment options that can be used in each case depend fundamentally on the extension of the tumor at the time of diagnosis. Thus, radiologists have a central role in the management of this disease. We discuss the optimum imaging technique for staging rectal cancer, some fundamental histological aspects, and the accepted semiology in the interpretation of different imaging studies carried out in these patients, as well as the diagnostic performance of each technique. We provide a general overview of the prognosis and different treatment options. This knowledge is very useful for radiologists participating in multidisciplinary teams and for understanding the transcendence of the information provided by image interpretation in these patients.