Changes in the gut microbiota of pseudoxanthoma elasticum patients.

OBJECTIVE: Pseudoxanthoma elasticum (PXE) is a rare autosomal disorder with a variable phenotype that may be modulated by environmental factors. Plasma vitamin K (VK) levels may be involved in the ectopic calcification process observed in PXE. Since VK2 is predominantly produced by the gut microbiota, we hypothesized that changes in the gut microbiota of PXE patients might exacerbate the calcification process and disease symptoms. METHODS: Twenty PXE patients were included in the study and 60 gut microbiota profiles from the Biofortis laboratory database were used as controls. RESULTS: The Rhodospirillaceae family was more abundant in the PXE group while the Sphingomonadaceae family was more abundant in the control group. In a PXE severity subgroup analysis, microbiota dispersion was lower in "severe" than in "non-severe" patients, which was confirmed by permutation multivariate analysis of variance at the phylum, family and genus ranks. However, no significant association was found in a model incorporating relative abundance of bacterial families, severity score, and different blood and fecal VK species. CONCLUSION: These results suggest slight compositional changes in the gut microbiota of PXE patients. Further studies are needed to substantiate their impact on VK metabolism and the calcification process.

Evaluation of natural zeolite as microorganism support medium in nitrifying batch reactors: influence of zeolite particle size.

An evaluation of natural zeolite as a microorganism carrier in nitrifying reactors operated in batch mode was carried out. Specifically, the influence of zeolite particle sizes of 0.5, 1.0 and 2.0 mm in diameter on microorganism adherence to zeolite, ammonium adsorption capacity and the identification of microbial populations were assessed. The greatest amount of total biomass adhered was observed for a zeolite particle size of 1 mm (0.289 g) which was achieved on the 12th day of operation. The highest ammonium adsorption capacity was observed for a zeolite particle size of 0.5 mm, which was 64% and 31% higher than that observed for particle sizes of 1.0 and 2.0 mm, respectively. The maximum de-sorption values were also found for a zeolite particle size of 0.5 mm, although when equilibrium was reached the ammonium concentrations were similar to those observed for a zeolite particle size of 1.0 mm. It was also found that the experimental data on ammonium adsorption fitted very well to the Freundlich isotherm for the three particle sizes studied. Finally, the nitrifying reactors showed similar microbial populations independently of the particle size used as microorganism carrier. The dominant bacterial community was Gammaproteobacteria making up 80% of the total population found. Betaproteobacteria were also identified and made up 12% approx. of the total population. Ammonium Oxidant Betaproteobacteria and Nitrobacter were also detected.

Sequential thoracic metastasectomy prolongs survival by re-establishing local control within the chest.

OBJECTIVE: The value of sequential thoracic metastasectomies is unknown. We evaluate repeat metastasectomy for limited recurrences within the thorax. METHODS: From July 1988 to September 1998, 54 patients underwent 2 to 6 separate sequential procedures to excise metastases after recurrence isolated to the thorax. Kaplan-Meier survival and Cox modeling determined prognostic variables. RESULTS: Thirty-three men and 21 women, 22 to 76 years underwent 2 (100%, n = 54), 3 (50%), 4 (22%), or 5 to 6 (11%) metastasectomies. Fifty-four percent of patients had carcinoma, 35% sarcoma, 9% germ cell, and 2% melanoma. There were no operative deaths; all late deaths occurred from cancer. Median follow-up was 48 months. Cumulative 5-year survival from the second procedure was 57%. After the second, third, fourth, and fifth procedures, respectively, permanent control was achieved in 15 (27%) of 54 patients, 5 (19%) of 27, 1 (8%) of 12, and 0 of 7. Recurrence amenable to additional surgery occurred in 27 (50%) of 54, 12 (44%) of 27, 6 (50%) of 12, and 1 (17%) of 6. Mean hazard for the development of unresectable recurrence increased from 0.21 after the second procedure to 0.91 after the fifth procedure. The 5-year survival for the 27 patients undergoing only 2 metastasectomies was 60% (median not yet reached), 33% for the 15 patients undergoing only 3 metastasectomies (median 34.7 months), and 38% for the 12 patients undergoing 4 or more (median 45.6 months). From the time a recurrence was declared unresectable, patients had a 19% 2-year survival (median 8 months). CONCLUSIONS: Multiple attempts to re-establish intrathoracic control of metastatic disease is justified in carefully selected patients, but the magnitude of benefit decays with each subsequent attempt.

Levonorgestrel-only emergency contraception: real-world tolerance and efficacy.

Levonorgestrel-only emergency contraception was introduced onto the market in France in May 1999 on the heels of a large-scale clinical trial demonstrating its enhanced efficacy and tolerance over the combined estrogen-progestin reference method. To evaluate the product's real-world tolerance and efficacy in the more than 20 months that it has been on the market, a retrospective study was performed among large-scale prescribers in France. One hundred physicians were asked to complete a written questionnaire outlining their practices with regards to their prescription of the product as well as their knowledge and evaluation of the product's tolerance and efficacy. Results from 82 respondents representing over 2,000 administrations demonstrate that physicians judge levonorgestrel-only emergency contraception to be very well tolerated and without unexpected side effects. Further, respondents report a pregnancy rate similar to that chronicled in the large-scale clinical trial (less than 3%), thus substantiating conclusions regarding the product's considerable efficacy and its potential for reducing the rate of unintended pregnancies.

Epithelial reattachment after gingivectomy in the rat.

It is known that an epithelial reattachment occurs a few days after gingivectomy. Depending upon the surgical procedure and the animal species used, different times have been proposed to obtain a complete reattachment. Nevertheless, it is not known whether there is a correlation between the time required and the sequence of morphologic events involved in this process. To investigate this matter, gingivectomies were performed in the maxillary molars of rats. Specimens were taken 1 to 14 days after the operation and processed for light and electron microscopy. The new junctional epithelium appeared at the 5th day, but the earliest signs of reattachment complex formation were evident at the 8th day. Rudimentary hemidesmosomes and lamina lucida appeared in epithelial cells bordering remnants of fibrin. Anchoring filaments that formed between the earliest hemidesmosomes and the subjacent fibrin crossed the lamina lucida. Simultaneously, segments of lamina densa appeared. At the 11th day insertion of tonofilaments into the attachment plaques and insertion of anchoring filaments in the lamina densa were observed. At the 14th day, full development of the reattachment complex was evident.

[Hemangioblastoma of the cerebellum, bulbo-spinal cord syringomyelia and bilateral pheochromocytoma]. / Hemangioblastome du cervelet, cavité bulbo-médullaire, phéochromocytome bilatéral.

A probable diagnosis of an incomplete form of von Hippel Lindau disease was made in a case of combined cerebellar hemangioblastoma, pontobulbar cavitation and bilateral pheochromocytoma. A survey of the literature review found only 3 similar cases among 64 patients reported as having combined lesions. A wide variety of lesions are in fact encountered.

[Does cholestasis change the clinical usefulness of CA 19-9 in pacreatobiliary cancer?]. / Modifica la colestasis la utilidad clínica del CA 19-9 en cáncer pancreatobiliar?

BACKGROUND: CA 19-9 is used for diagnosis of gastrointestinal neoplasia, mainly pancreatic and biliary cancer. False positive results have been described in cholestasis. OBJECTIVE: To establish the clinical value of CA 19-9 in the diagnosis of pancreatic and biliary cancer in patients with and without cholestasis. METHODS: Five hundred forty-eight medical records of patients with serum CA 19-9 determination performed from May-1996 to June-1998 were reviewed. Cases were grouped by final diagnosis; malignancy was established by histology or clinical and radiological characteristics. ROC curves were used to calculate ideal cut-off values (ICV) for the test. Cholestasis was defined as bilirrubinemia above 3 mg/dL. RESULTS: Thirty percent of serum determinations were done in patients with non-pancreatic and non-hepatobiliary benign diseases (only 1.3% with values > or = 100 U/mL). CA 19-9 levels were higher in pancreatic and hepatobiliary malignancy compared to benign diseases of the same origin, as well as in pancreatic cancer when compared with hepatobiliary cancer. ICV for differentiation of malignant hepatobiliary diseases was set around 100 U/mL, with increased specificity when compared with the usual cut-off value (37 U/mL). Cholestasis increased the values of the antigen in malignant and benign diseases and modified the efficacy of the test by increasing sensitivity while decreasing specificity. The ICV for determining resectability in pancreatic tumors was 224 U/mL. CONCLUSIONS: CA 19-9 is a valuable test for diagnosis of malignant pancreato-hepatobiliary disease. Given that cholestasis modifies the operational characteristics of the test, a cut-off value has to be tailored for each patient depending on the clinical setting, so to maintain the usefulness of the marker.

Autoantibody formation in D-penicillamine-treated rheumatoid arthritis.

One hundred and two rheumatoid arthritis patients were tested before treatment for the presence of 16 autoantibodies. Low titers of antinuclear factors appeared, but there were no antitissue antibodies. At different intervals during the treatment of a 2nd series of 176 patients, elevations of antinuclear factors were observed that correlated slightly with either autoimmune or toxic side effects. Antitissue antibodies were seen only in pemphigus and myasthenia after the onset of these complications. The practical value of systematic evaluation for autoantibodies in penicillamine-treated rheumatoid patients is questionable.

Chromoblastomycosis: a clinical and molecular study of 18 cases in Rio de Janeiro, Brazil.

BACKGROUND: Chromoblastomycosis (CBM) is a chronic subcutaneous mycosis caused by dematiaceous fungi. METHODS: We described epidemiological data, clinical presentation, and treatment of 18 cases of CBM diagnosed in Rio de Janeiro, Brazil. Diagnosis was obtained by mycological, histopathological findings demonstrating typical muriform cells with confirmation of isolated by DNA sequencing of the ribosomal internal transcribed spacer. RESULTS: The majority of patients were male (72.2%) ranging from 39 to 83 years old, farm laborers and construction workers. The duration of disease varied from four months to 32 years. The most common presentations were verrucous form in ten (55.6%) patients, followed by tumoral in three (16.7%) patients, primarily of moderate (55.6%) and severe (38.9%) intensity. Lower (44.4%) and upper limbs (33.3%) were the most affected sites. Fonsecaea pedrosoi isolated from 14 (77.8%), and Cladophialophora carrionii isolated from one case (5.6%). Fifteen patients (83.3%) were treated. Six patients (40%) received oral itraconazole 200-400 mg/day, five patients (33.3%) received oral itraconazole 200-400 mg/day combined with fluconazole 200 mg/day, and four (26.7%) patients were submitted to surgery. The duration of therapy varied from 12 to 48 months. Cure rate was 80% (12/15). No relapse was observed after two years of follow-up. CONCLUSIONS: Success was due to attending a center with specialized clinical care, laboratory support, and pharmaceutical care.

Cladophialophora carrionii: a rare agent of chromoblastomycosis in Rio de Janeiro State, Brazil.

A 73 year-old male farm laborer from a rural area presented a 15 year history of extensive tumoral lesions over his left leg. Histological studies of skin biopsy showed pseudoepitheliomatous hyperplasia and granulomatous chronic inflammatory process with muriform cells, confirming chromoblastomycosis (CBM). Cladophialophora carrionii was isolated in culture. Treatment with itraconazole 400 mg/day for 12 months resulted in complete remission of lesions. As far we aware, this is the first case report of CBM caused by Cladophialophora carrionii in Rio de Janeiro State, Brazil.

[Cerebrovascular disease in a Neurologic Intermediate Care Unit in Chile. Analysis of 459 consecutive patients]. / Características de la enfermedad cerebrovascular en un Servicio de Cuidados Intermedios Neurológicos, en Chile. Análisis de 459 pacientes consecutivos.

BACKGROUND: Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. AIM: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. MATERIAL AND METHODS: Retrospective review of clinical records of 459 patients (mean age 65+/-48 years, 238 female) that were admitted to our unit during a period of 37 months. RESULTS: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. CONCLUSIONS: The most common type of stroke is ischemic and high blood pressure is the main risk factor.

[Generalities on clinical trials of the effectiveness of non-steroidal anti-inflammatory agents]. / Généralités sur les essais cliniques d'efficacité des anti-inflammatoires non steroïdiens.

Non-steroidal antiinflammatory drugs represent a strictly symptomatic treatment since they act mainly on pain and act fast. One week cross-over study models confirm the intrinsic pharmacodynamic effect of the test product, specify daily doses and optimal dosage regimens and enable comparison of the product with a reference drug. These studies must be conducted in out-patients, by an experienced investigator, using a double-blind design in a sufficiently large number of patients. Rheumatoid arthritis, ankylosing spondylitis and osteoarthritis of the hip and knee are the most suitable models for such studies. A long-term efficacy study is best done by analyzing the rate of withdrawals from treatment as a function of time.

[Evaluation of the long term effect of antirheumatic drugs with the survey rate method]. / Evaluation de l'effet au long cours des médicaments antirhumatismaux par la méthodes des taux de poursuite.

In the long term study of antirheumatic drugs, drop out of patients (for failure of effect or side effects) can analysed with "survey rate" methods. Survey rates become in drug tests "treatment continuation rates". With this method D-penicillamine and levamisole have been compared. Penicillamine has better "continuation rate" not because of better tolerance, but because of better long term effectiveness compared with levamisole.

[The contour of the normal foot. A statistical study]. / Cosidérations sur l'assise du pied normal. Etude statistique.

The authors, thanks to a statistical study on 292 young adults with healthy feet, have established the common occurrence, that has been suspected clinically, of the arched foot in the classical sense of the term. If one makes an exception of the black race where the flat foot is rather frequent, the white population normally has an arched foot (incipiens, of the 1st or 2nd degree) in 58.2 per cent of cases in men, which increases to 78.8 per cent in women. As for the classically " normal " foot which rather deserves the term " intermediary ", it is found in the white race in 1/3 of subjects.