Kaposi's sarcoma developing in a liver graft.

The case reported herein involved a patient who developed Kaposi's sarcoma (KS) in the liver graft, with severe liver disfunction and eventually the patient's death. This patient is our only KS case among the 7 neoplasias arising de novo (6 lymphoproliferative syndromes) in a series of 402 liver transplants (382 immunosuppressed with cyclosporine and prednisolone and 20 with FK-506 and prednisolone). The anatomic distribution of the KS in the autopsy study, and the HLA haplotypes typed in the donor and in the recipient, suggest that the KS arose in the stromal endothelial cells of the donor liver.

Posttraumatic stress disorder in incarcerated juvenile delinquents.

OBJECTIVE: To assess the prevalence of posttraumatic stress disorder (PTSD) in severely delinquent subjects and to measure associated personality characteristics. METHOD: Eighty-five incarcerated boys (mean age 16.6, SD = 1.2) with mostly violent offenses were studied. The sample was representative of the California Youth Authority population. They received a standard psychiatric screen, a semistructured interview for PTSD, and self-report questionnaires measuring personality traits and defenses. A nonclinical sex- and age-matched group was used for comparing psychometrics. RESULTS: Subjects suffered from PTSD at higher rates than other adolescent community samples and at higher rates than those found in county probation camps. Thirty-two percent fulfilled criteria for PTSD, 20% partial criteria. One half of the subjects described the witnessing of interpersonal violence as the traumatizing event. Psychometric results converged in the predicted way: Subjects with PTSD showed elevated distress, anxiety, depression, and lowered restraint, impulse control, and suppression of aggression; they had high levels of immature defenses such as projection, somatization, conversion, dissociation, and withdrawal. CONCLUSIONS: PTSD occurs at high rates in delinquents, and this finding has implications for management and treatment. Personality characteristics that might put individuals at risk for the development of PTSD were identified.

Seasonal variations of antioxidant imbalance in Cuban healthy men.

OBJECTIVE: To determine the antioxidant imbalance in healthy Cuban men 2y after the end of the epidemic neuropathy (50 862 cases from 1991 to 1993) and to evaluate its change over 1 y. DESIGN: Prospective study. SETTING: La Lisa health centres (Havana, Cuba). SUBJECTS: One-hundred and ninety-nine healthy middle-aged men were selected and 106 completed the study. Subjects were studied at 3 month intervals over 1 year. INTERVENTIONS: No invervention. MAIN OUTCOME MEASURES: An assessment of dietary intake and the determination of blood lipid peroxides (TBARS), glutathione, diglutathione, glutathione peroxidase, superoxide dismutase, vitamin E, carotenoids, copper, zinc and selenium were performed at each period. RESULTS: While dietary zinc, vitamins C and E, carotenoids and fat dietary intakes and blood concentrations were low for adult men compared to international reference ranges, serum TBARS concentrations were high at every period. Some significant seasonal variations were observed. The lowest carotenoids (P < 0.002) and vitamin C(P = 0.0001) intakes, serum beta-carotene (P = 0.0001) and lutein/zeaxanthin (P < 0.05) concentrations, and the highest blood TBARS (P = 0.0001) and diglutathione (P < 0.001) concentrations were observed at the end of the rainy season (October). This period seemed to pose the greatest risk of antioxidant imbalance. CONCLUSIONS: Cuban men still represent a vulnerable population in terms of antioxidant imbalance. A national program of vegetable growing and increase in fruit and vegetable consumption is now evaluated in Cuba.

Autophagy promotes T-cell survival through degradation of proteins of the cell death machinery.

Autophagy is implicated in regulating cell death in activated T cells, but the underlying mechanism is unclear. Here, we show that inhibition of autophagy via Beclin 1 gene deletion in T cells leads to rampant apoptosis in these cells upon TCR stimulation. Beclin 1-deficient mice fail to mount autoreactive T-cell responses and are resistant to experimental autoimmune encephalomyelitis. Compared with Th17 cells, Th1 cells are much more susceptible to cell death upon Beclin 1 deletion. Cell death proteins are highly increased in Beclin 1-deficient T cells and inhibition of caspases and genetic deletion of Bim reverse apoptosis. In addition, p62/sequestosome 1 binds to caspase-8 but does not control levels of procaspase-8 or other cell death-related proteins. These results establish a direct role of autophagy in inhibiting the programmed cell death through degradation of apoptosis proteins in activated T cells.

Selective coronary-caval shunt using internal jugular autograft, in the treatment of portal hypertension.

The selective coronary-caval shunt is considered to be one of the better procedures in the surgical treatment of portal hypertension. We have altered the previously described technique by using an internal jugular vein grafting which possesses some advantages. We have performed this shunt utilizing an internal jugular vein autograft in eight patients, who had at least one major hemorrhage from esophageal varices three to twelve months before operation. There were no postoperative deaths. All four patients are still alive three months to six years after shunting without bleeding episodes. In the X-ray and endoscopic studies the esophagogastric varices were noted to be markedly smaller in size than they were before shunting.

Treatment of splenic artery aneurysm after distal splenorenal shunt. A case report.

A patient with splenic artery aneurysm which developed after creation of selective distal spleno-renal shunt for hepatic cirrhosis and portal hypertension was presented. Three months after operation, an aneurysm of the splenic artery with a diameter of about 20 mm was detected. This aneurysm reached 4 cm three months later, and a resection was carried out. An arterial continuity was established by means of end-to-end anastomosis of the sectioned arterial ends. Because the flow through the splenic artery was about 60% of the total flow of the selective distal spleno-renal shunt, it is important to maintain continuity in order to avoid thrombosis of the shunt.