Treatment of acquired perforant dermatoses with allopurinol / Tratamento de dermatose perfurante adquirida com alopurinol

Perforating dermatoses are papulonodular cutaneous pathologies characterized by transepithelial extrusion of components of the extracellular matrix of the dermis, by inflammation or degeneration. When secondary, the systemic diseases are called Acquired Perforating Diseases. Our letter aims to report a case of acquired perforating dermatoses secondary to chronic renal dialysis. The treatment with Allopurinol proved to be effective in this case. Allopurinol would act as an antioxidant, reducing the inflammatory reaction in tissues and consequent damage to the collagen fibers (AU)

Dermatoses perfurantes são patologias cutâneas papulonodulares que se caracterizam pela extrusão transepitelial de componentes da matriz extracelular da derme, por inflamação ou degeneração. Quando são secundárias as doenças sistêmicas são chamadas Doenças Perfurantes Adquiridas. Nossa carta tem como objetivo relatar caso de dermatose perfurante adquirida secundária a insuficiência renal crônica dialítica. O tratamento com Alopurinol se mostrou eficaz neste caso. O Alopurinol atuaria como antioxidante, reduzindo a reação inflamatória nos tecidos e consequentes danos nas fibras colágenas (AU)

Tratamento da Gota na Atenção Primária à Saúde / Treatment of Gout in the Primary Health Care / Tratamiento de la Gota en la Atención Primaria de la Salud

Objetivo: O objetivo desta revisão é fornecer informação atualizada e orientações práticas sobre a abordagem da gota na Atenção Primária à Saúde. Métodos: Foram pesquisadas normas de orientação clínica, revisões sistemáticas, meta-análises e estudos originais publicados entre 1 janeiro de 2011 e 31 dezembro de 2016, nas línguas inglesa, portuguesa e espanhola. Resultados: Os fármacos de primeira linha no tratamento da gota aguda são os anti-inflamatórios não esteroides, a colchicina e os corticoides, em monoterapia ou associação. Na gota crônica são usados hipouricemiantes, sendo a primeira linha o alopurinol. O febuxostate e os uricosúricos são alternativas ao alopurinol em casos de intolerância ou ineficácia. A profilaxia das crises de gota agudas está recomendada quando se inicia o tratamento hipouricemiante durante pelo menos 6 meses. Conclusão: A abordagem correta da gota deve fazer parte das competências de um médico especialista em Atenção Primária à Saúde de modo a prestar cuidados adequados à comunidade.

Objective: The objective of this review is to provide updated information and practical guidelines on the approach of gout in Primary Health Care. Methods: We conducted a survey of clinical guidelines, systematic reviews, meta-analyses and original studies published between January 1, 2011 and December 31, 2016 in the English, Portuguese and Spanish languages. Results: First-line drugs in the treatment of acute gout are non-steroidal anti-inflammatory drugs, colchicine and corticosteroids, in monotherapy or combination. In chronic gout, the first-line of hypouricemic therapy is allopurinol. Febuxostat and uricosurics are alternatives to allopurinol in cases of intolerance or ineffectiveness. The prophylaxis of acute attacks is recommended when starting hypouricemic treatment for at least 6 months. Treatment of asymptomatic hyperuricemia is not recommended. Conclusion: The correct approach to gout should be part of the skills of a Primary Care physician in order to provide adequate care to the community.

Objetivo: El objetivo es proporcionar información actualizada y orientación práctica sobre la terapéutica de la gota en la Atención Primaria de Salud. Métodos: Se estudiaron las guías clínicas, revisiones sistemáticas, meta-análisis y estudios originales publicados entre el 1 de enero de 2011 y el 31 de diciembre de 2016, en el inglés, portugués y español. Resultados: Los fármacos de primera línea en el tratamiento de la gota aguda son anti-inflamatorios no-esteroides, la colchicina y los corticosteroides, solos o en combinación. En la gota crónica son utilizados hipouricemiantes, y el alopurinol es lo fármaco de primera línea. Febuxostat y uricosúricos son alternativas al alopurinol en los casos de intolerancia o ineficacia. Se recomienda la profilaxis de las crisis agudas en el tratamiento hipouricemiante durante al menos 6 meses. No se recomienda el tratamiento de la hiperuricemia asintomática. Conclusión: La terapéutica de la gota debe formar parte de las competencias de un médico especialista en Atención Primaria de Salud a fin de proporcionar la atención adecuada a la comunidad.

The influence of allopurinol and post-conditioning on lung injuries induced by lower-limb ischemia and reperfusion in Wistar rats

Abstract Purpose: To analyze the effects of allopurinol and of post-conditioning on lung injuries induced by lower-limb ischemia and reperfusion. Methods: Thirty rats were used. They were divided in 5 groups: (1) group A: abdominal aortic dissection only, (2) group B: ischemia and reperfusion, (3) group C: administered allopurinol (100mg/Kg) a few hours before procedure, (4) group D: post-conditioned and (5) group E: administered allopurinol and post-conditioned. With the exception of group A, all groups were submitted to infrarenal aortic ischemia for 2 hours, and reperfusion for 72 hours. After euthanasia, lungs were removed for histological analysis. They were graded under two scores: pulmonary injury (neutrophil infiltration, interstitial edema, vascular congestion, and destruction of lung architecture) and lymphocytic score (neutrophil infiltration, lymphoid aggregate and secondary follicle). Results: On the pulmonary injury score, the degree of injury was smaller than in groups D and E, when compared to group B, p<0.05. Group C did not obtain the same result (p>0,05). On the lymphocytic score, there was no statistic difference among groups, p>0.05. Conclusion: Both post-conditioning and the combination of allopurinol and post-conditioning were effective in remote lung protection induced by lower-limbs I/R. When used in isolation, allopurinol showed no protective effect.

Drug Eruptions Induced by Allopurinol Associated with HLA-B*5801.

Allopurinol, a drug commonly used for treating gout and hyperuricemia, is a frequent cause of drug eruptions. Recent investigations suggest that HLA‑B*5801 allele is a very strong marker for allopurinol‑induced cutaneous adverse drug reactions (cADRs). In this article we report two cases of allopurinol‑induced drug eruptions in patients carrying the HLA‑B*5801 allele and review the literature on the association between HLA‑B*5801 and allopurinol‑induced cADRs based on a MEDLINE and PubMed search.

What is the Incidence of Kidney Stones after Chemotherapy in Patients with Lymphoproliferative or Myeloproliferative Disorders?

Introduction This study describes the incidence and risk factors of de novo nephrolithiasis among patients with lymphoproliferative or myeloproliferative diseases who have undergone chemotherapy. Materials and Methods From 2001 to 2011, patients with lymphoproliferative or myeloproliferative disorders treated with chemotherapy were retrospectively identified. The incidence of image proven nephrolithiasis after chemotherapy was determined. Demographic and clinical variables were recorded. Patients with a history of nephrolithiasis prior to chemotherapy were excluded. The primary outcome was incidence of nephrolithiasis, and secondary outcomes were risk factors predictive of de novo stone. Comparative statistics were used to compare demographic and disease specific variables for patients who developed de novo stones versus those who did not. Results A total of 1,316 patients were identified and the incidence of de novo nephrolithiasis was 5.5% (72/1316; symptomatic stones 1.8% 24/1316). Among patients with nephrolithiasis, 72.2% had lymphoproliferative disorders, 27.8% had myeloproliferative disorders, and 25% utilized allopurinol. The median urinary pH was 5.5, and the mean serum uric acid, calcium, potassium and phosphorus levels were 7.5, 9.6, 4.3, and 3.8 mg/dL, respectively. In univariate analysis, mean uric acid (p=0.013), calcium (p<0.001)), and potassium (p=0.039) levels were higher in stone formers. Diabetes mellitus (p<0.001), hypertension (p=0.003), and hyperlipidemia (p<0.001) were more common in stone formers. In multivariate analysis, diabetes mellitus, hyperuricemia, and hypercalcemia predicted stone. Conclusions We report the incidence of de novo nephrolithiasis in patients who have undergone chemotherapy. Diabetes mellitus, hyperuricemia, and hypercalcemia are patient-specific risk factors that increase the odds of developing an upper tract stone following chemotherapy. .

Prevention of Comorbidity and Acute Attack of Gout by Uric Acid Lowering Therapy

The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA) or =6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at baseline and at last follow-up visit. Frequency of acute gout attacks were also compared between the groups. During the mean follow up period of 7.6 yr, the yearly rate of acute attack and the new development of HTN, DM, CVD and urolithiasis was lower in the adequately treated group compared to the inadequately treated group. Tight control of uric acid decreases the incidence of acute gout attacks and comorbidities of gout such as HTN, DM, CVD and urolithiasis.

Medical and Dietary Therapy for Kidney Stone Prevention

The prevalence of kidney stone disease is increasing, and newer research is finding that stones are associated with several serious morbidities. These facts suggest that emphasis needs to be placed not only on stone treatment but also stone prevention. However, there is a relative dearth of information on dietary and medical therapies to treat and avoid nephrolithiasis. In addition, studies have shown that there are many misconceptions among both the general community and physicians about how stones should be managed. This article is meant to serve as a review of the current literature on dietary and drug therapies for stone prevention.

Tofo intramuscular del vasto externo en el muslo izquierdo / Tophus intramusculaire du vaste externe de la cuisse gauche / Intramuscular tophus in the external vastus of the left thigh

Introducción: la gota es una alteración del metabolismo de las purinas caracterizada por hiperuricemia, con rara implicación de la región del muslo y en específico intramuscular. Objetivo: presentar este caso por la rareza de este tipo de tumoración en la porción intramuscular. Descripción: se presentó el caso clínico de un varón de 64 años, sin el diagnóstico previo de gota, que fue intervenido quirúrgicamente por una masa tumoral de partes blandas en el muslo izquierdo, con resección muscular en bloque. Se hizo una revisión de la literatura y se analizó su presentación clínica, hallazgos histológicos, pruebas diagnósticas de imagen y tratamiento terapéutico. Conclusiones: el estudio anatomopatológico confirmó el diagnóstico de tofo gotoso intramuscular del músculo vasto externo. Actualmente, el paciente se encuentra libre de síntomas y en seguimiento por el servicio de reumatología y de ortopedia.

Introduction: gout is a disorder of purine metabolism characterized by hyperuricemia, with rare involvement of the thigh region, let alone intramuscular involvement. Objective: present this case due to the rarity of this type of tumor in the intramuscular portion. Description: a clinical case is presented of a male 64-year-old patient with no prior gout diagnosis, who had been operated on for a tumor mass of soft parts in the left thigh with en bloc muscle resection. A bibliographic review was conducted and an analysis carried out of the clinical presentation, histological findings, diagnostic imaging tests and therapeutic treatment. Conclusions: anatomopathological examination confirmed the diagnosis of intramuscular gout tophus of the external vastus muscle. At present the patient is free of symptoms and is being followed-up by the rheumatology and orthopedics service.

Introduction: la goutte est une altération du métabolisme des purines, caractérisée par une hiperuricémie et une rare implication de la région de la cuisse, spécifiquement de la région intramusculaire. Objectif: présenter un cas manifestant la rareté de ce type de tumeur sur la portion intramusculaire. Description: le cas d'un patient du sexe masculin, âgé de 64 ans, sans diagnostic antérieur de goutte, traité chirurgicalement par résection musculaire en bloc d'une masse tumorale des parties molles de sa cuisse gauche, est présenté. Une révision de la littérature est effectuée, et sa présentation clinique, les résultats histologiques, les tests diagnostiques par image, et le traitement thérapeutique, sont analysés. Conclusions: le diagnostic de tophus gouteux intramusculaire du muscle vaste externe est confirmé par l'examen anatomopathologique. Le patient est actuellement libre de ces symptômes au suivi du Service de rhumatologie et d'orthopédie.

Síndrome de lisis tumoral en pediatría / Tumoral lysis syndrome in pediatrics

Tumor lysis syndrome is a metabolic emergency resulting from the rapid and massive destruction of tumor cells, spontaneously or secondary to cytolytic therapy for cancer. This results in a huge imbalance of internal environment by releasing large amounts of intracellular contents into the interstitial and intravascular space, with serious clinical consequences or even death. The pediatric population is especially at risk of tumor lysis syndrome because it has a high rate of fast-growing tumors, such as those of hematologic origin. Proper recognition of the risk factors that can cause this syndrome, as well as specific prevention and treatment has substantially decreased complications and improved survival in these patients.

El síndrome de lisis tumoral es una emergencia metabólica derivada de la rápida y masiva destrucción de células tumorales en forma espontánea o secundaria a terapia citolítica del cáncer. Esta situación produce un enorme desequilibrio del medio interno al liberarse grandes cantidades de contenido intracelular al espacio intersticial e intravascular, con consecuencias clínicas serias e incluso mortales. La población pediátrica está especialmente expuesta a sufrir síndrome de lisis tumoral ya que presenta una tasa elevada de tumores de rápido crecimiento, como son los de orígenes hematológicos. El adecuado reconocimiento de los factores de riesgo que pueden causar este síndrome, así como su prevención y tratamiento específicos han disminuido sustancialmente las complicaciones y mejorado la sobrevida de estos pacientes.

Clinical and parasitological evaluation of dogs naturally infected by Leishmania (Leishmania) chagasi submitted to treatment with meglumine antimoniate and allopurinol / Avaliação clínica e parasitológica de cães naturalmente infectados por Leishmania (Leishmania) chagasi submetidos a tratamento com antimoniato de meglumina e alopurinol

Aiming to assess the efficacy of the treatment, to verify the occurrence of possible disease relapses and to search for the presence of parasites after the treatment, seven dogs naturally infected by Leishmania sp., were submitted to a treatment with meglumine antimoniate and allopurinol. For this, lymph node and bone marrow aspiration biopsies were carried out at seven moments. After the end of the six-month observation period all dogs were submitted to euthanasia. Then, spleen and liver “imprints” and in vitro cultures were carried out to search for amastigote forms of the parasite. All animals presented remission of the symptoms and during all the observation period no dog presented relapse of the disease, although amastigote forms of the parasite were observed in two of the animals at the end of the experiment. Thus, it was possible to conclude that the treatment promotes clinical healing but it does not eliminate the parasites completely.

Com objetivo de avaliar a eficácia do tratamento, verificar a ocorrência de possíveis recidivas da doença e pesquisar a presença de parasitas após a realização do tratamento, foram utilizados sete cães naturalmente infectados por Leishmania sp., submetidos a tratamento com antimoniato de meglumina e alopurinol. Para tanto, foram realizadas punções biópsias aspirativas de linfonodos e de medula óssea em sete momentos. Após o término dos seis meses de observação, todos os cães foram submetidos à eutanásia e realizados “imprints” e cultivo in vitro do baço e fígado para a pesquisa de formas amastigotas. Todos os animais apresentaram remissão dos sintomas e durante todo o período de observação nenhum cão apresentou recidiva da doença apesar de ter sido observada a presença de formas amastigotas do parasita em dois animais, ao término do experimento. Desta forma, foi possível concluir que o tratamento promove a cura clínica, entretanto não elimina completamente os parasitas.

Serum Cystatin C is a Potential Endogenous Marker for the Estimation of Renal Function in Male Gout Patients with Renal Impairment

Serum creatinine level is the most commonly used indices for assessment of glomerular filtration rate (GFR), even though these indices have been shown to have some limitations in clinical practice. We investigated the diagnostic efficacy of serum cystatin C compared to that of serum creatinine levels and identified the relating factors associated with changes in serum cystatin C levels in gout patients with renal impairment. A total of 68 gouty patients with renal impairment were enrolled in this study. Diagnostic efficacy of serum cystatin C levels was evaluated through non-parametric receiver operating characteristic (ROC) analysis. The risk factors for changes in serum cystatin C levels were confirmed using multivariate regression analysis. With 24-hr urine creatinine clearance (Ccr) as the reference for GFR, 1/cystatin C (r=0.702, P<0.001) showed a significantly higher correlation with Ccr than 1/creatinine (r=0.665, P<0.001). Multivariate correlation analysis demonstrated that the clinical parameters for increased serum cystatin C are a higher stage of chronic kidney disease, older age, use of allopurinol, and lower high density lipoprotein-cholesterol. The area under the curve (AUC) at ROC plots identified that of serum cystatin C was significantly greater than that of serum creatinine (AUC 0.804 of cystatin C and AUC 0.745 of creatinine). The study suggests that serum cystatin C is a reliable endogenous marker for the assessment of renal function or GFR in gout patients with renal impairment.

Guías clínicas de la enfermedad de Chagas 2006: parte VI: tratamiento antiparasitario de la enfermedad de Chagas / Guidelines for the Chagas disease: part VI: antiparasitic treatment for Chagas disease

As expert consensus has been arisen about universal antiparasitic treatment for all patients infected with Trypanosoma cruzi, most important drugs licensed for Chagas disease treatment are reviewed: nifurtimox and benznidazol, their mechanisms of action, doses, treatment schedules, adverse effects and contraindications. Two other drugs used for Chagas disease treatment, for which a Chilean experience may be exhibited, are allopurinol and itraconazole. Indications for treatment of Chagas disease in immunocompetent patients and inmunocompromised hosts are detailed. This chapter refers besides to the evaluation and monitoring of antiparasitic therapy in inmunocompromised patients, the availability of drugs and includes various forms facsímiles suggested to perform clinical and laboratory follow up of patients that undergo treatment, indicating the prescribed drug, adverse effects and time of follow up.

Con el consenso de expertos de que todo paciente infectado con Trypanosoma cruzi debiera recibir tratamiento anti-parasitario, se revisan los principales medicamentos aprobados para la enfermedad de Chagas: nifurtimox y benznidazol, sus mecanismos de acción, dosis, duración del tratamiento, efectos adversos y contraindicaciones. Se mencionan otros dos medicamentos utilizados en el tratamiento, en el que existe alguna experiencia nacional, como son allopurinol e itraconazol. Se revisan las indicaciones de tratamiento de la enfermedad de Chagas en personas inmuno-competentes y las indicaciones de tratamiento en hospederos inmunodeprimidos. Este capítulo finaliza abordando la evaluación y monitorización de la terapia antiparasitaria en inmunodeprimidos, la disponibilidad de medicamentos e incluye facsímiles de formularios sugeridos para realizar el seguimiento clínico y de laboratorio de los pacientes que son sometidos a tratamiento, indicando el fármaco utilizado, los efectos adversos y el tiempo de seguimiento.

Inappropriate prescription of allopurinol in a teaching hospital.

BACKGROUND: Allopurinol is a drug that is widely used to treat hyperuricemia, but it is often prescribed inappropriately. OBJECTIVE: The authors conducted a study to look for the appropriate allopurinol prescription and diagnosis of gout in the out-patient clinics at a university hospital. MATERIAL AND METHOD: One hundred and forty-five patients who were newly prescribed allopurinol (128 males and 17 females, mean +/- SD age of 58.5 +/-14.1 years) were enrolled in this study. RESULT: Only 77 (53.1%) received allopurinol with appropriate indications. Thirty-eight patients (26.2%) did not have allopurinol dose adjustment according to the patients' creatinine clearance. Among 131 patients, prescribed allopurinol for the diagnosis of gout, only 55 (42.0%) were diagnosed in accordance with the American Rheumatism Association criteria. CONCLUSION: Inappropriate use of allopurinol (both the indication and prescribed dosage) and inappropriate diagnosis of gout are major problems even in a large teaching hospital. An educational campaign program is warranted for achieving appropriate diagnosis of gout, and eliminating the inappropriate use of allopurinol.

The role of allopurinol in experimental acute necrotizing pancreatitis.

BACKGROUND & OBJECTIVES: Acute pancreatitis (AP) in its severe form can lead to severe complications and death. Translocation of bacteria from the gut is one of the most important factors in the development of septic complications and mortality in acute pancreatitis. Oxygen-derived free radicals have been suggested to play a major role in the pathogenesis of AP. Xanthine oxidase enzyme is an important source of reactive oxygen metabolites. We undertook this study to evaluate the effect of allopurinol on bacterial translocation, oxidative stress and the course of AP in a rat model. METHODS: Male Sprague-Dawley rats (n=48) were randomly allocated into three equal groups. Acute pancreatitis (AP) was induced in group II (AP+Saline), and group III (AP+allopurinol) by retrograde infusion of taurocholate into the common biliopancreatic duct. Group I rats (Sham) received normal saline infusion into the common biliopancreatic duct for mimicking pressure effect. Group III rats were treated with allopurinol intraperitoneally for 48 h after induction of pancreatitis. Blood samples were drawn from all animals for biochemical analyses and pancreatic tissues were examined for bacterial translocation. RESULTS: Acute pancreatitis was developed in all groups, but not in group I (Sham), as indicated by microscopic parenchymal necrosis, fat necrosis and abundant turbid peritoneal fluid. Pathologic score of the pancreatitis in the allopurinol group (14.0 +/- 0.5) was lower when compared with group II (19.2 +/- 0.6) (P<0.001). Bacterial translocation to pancreas in group treated with allopurinol was significantly lower when compared with control group (p<0.02). Plasma glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) levels were higher and malondialdehyde (MDA) levels were lower in allopurinol group when compared with those in control groups. INTERPRETATION & CONCLUSION: Our findings suggested that addition of allopurinol to the treatment protocol in the acute pancreatitis might improve the pathologic score, bacterial translocation and oxidative stress parameters. However, more studies need to be done to confirm these findings.

Rare presentation of leucocytosis.

We present the case of a 44 years man who presented to us with persistent leucocytosis. Following relevant investigations, we diagnosed him to have Chronic Neutrophilic Leukaemia (CNL); a rare haematological disorder. Ten months later, he remains non-responsive to standard line of treatment.

Effect of allopurinol in chronic nonbacterial prostatitis: a double blind randomized clinical trial

INTRODUCTION: The exact mechanism of chronic nonbacterial prostatitis has not been yet elucidated and the outcome with the current management is dismal. In this trial, we studied the effect of allopurinol in the treatment of this disease. MATERIALS AND METHODS: In this randomized double blind controlled trial, a calculated sample size of 56 were grouped into "intervention group" who received allopurinol (100 mg tds for 3 months) with ofloxacin (200 mg tds) for 3 weeks (n = 29) and "control group" who received placebo tablets with ofloxacin (n = 27). PatientsÆ scores based on the National Institute of Health Chronic Prostatitis Symptom Score were recorded before therapy and then every month during the study. A four-glass study was performed before intervention and after 3 months. RESULTS: The 2 groups were similar regarding outcome variables. In the first month of study, a significant but similar improvement in symptom scores was observed in both groups. Microscopic examination of prostate massage and post-massage samples were also similar in both groups. No side effects due to allopurinol were observed in patients. CONCLUSION: We did not find any advantage for allopurinol in the management of chronic prostatitis versus placebo in patients receiving routine antibacterial treatment.

Chronic zosteriform cutaneous leishmaniasis.

Cutaneous leishmanasis (CL) may present with unusual clinical variants such as acute paronychial, annular, palmoplantar, zosteriform, erysipeloid, and sporotrichoid. The zosteriform variant has rarely been reported. Unusual lesions may be morphologically attributed to an altered host response or owing to an atypical strain of parasites in these lesions. We report a patient with CL in a multidermatomal pattern on the back and buttock of a man in Khozestan province in the south of Iran. To our knowledge, this is the first reported case of multidermatomal zosteriform CL. It was resistant to conventional treatment but responded well to a combination of meglumine antimoniate, allopurinol, and cryotherapy.

La mejoría electrocardiográfica con el tratamiento de la enfermedad de Chagas crónica, es independiente de la persistencia de Trypanosoma cruzi / No association between persistence of the parasite and electrocardiographic evolution in treated patients with Chagas disease

Background: International studies show a low compliance with norms for the management of cardiovascular risk factors. Aim: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. Material and Methods: Three hundred and fifty seven patients aged 64±13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9±2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. Results: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m2 and 2% smoked (versus 32% before the event). Conclusions: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high.

Effect of reperfusion after haemorrhagic ischaemia on the rat jejunal villi

This study was done to evaluate the ischaemtic lesions in the rat jejunal villi and the effect of allopurinol on such lesions, after the induced haemorrhagic shock. Thirty-five adult rats [200-250gm] were used. They were arranged into three groups, the first which [5 rats] served as a control while the remaining two [A and B 15 rats each] were utilized in the experiment. The rats in the experimental groups were anaesthetized with pentabarbital sodium and through the femoral vein 30 ml/kg of blood were withdrawn in a sterile heparinized syring and left for 2 hours then reinfused again. The rats of group B were given 50 mg / Kg allopurinol after blood withdrawal. The same dose was injected daily untill sample collection. Five rats from each experimental group were sacrificed 2 hours, 48 hours and five days after blood reinfusion, in succession. Samples from the jejunum were taken and processed to obtain Hx, E stained paraffin sections as well as ultrathin sections for E/M study. A loop of jejunum was opened and its mucosa was scraped, weighed, minced and homogenized in phosphate buffer [pH 7.4] and the supernatant was analyzed for the level of malondialdehyde [MAD] in the jejunal mucosa. The height of jejunal villi, the number of goblet cells over them as well as the level of [MDA] in the experimental groups were statistically analyzed for the test of significance as compared to the control. There was a significant shortening of jejunal villi, a concomitant decline in goblet cell number over them in the animals of group A compared to control. There was also a significant elevation of [MDA] level in group A as compared to the control. The hight of jejunal villi, the goblet cell number and the level of [MDA] in group B showed no significant changes when compared to control. Two hours after blood reinfusion, in group A, the tips of jejunal villi got broad and their covering cells became short with pyknotic nuclei. The underlying lamina propria showed subepithelial spaces and lymphocytic infiltration. The microvilli on the surface of absorptive cells were short, distorted and lacked their filamentous coat. There was also dilatation of rough and smooth endoplasmic reticula and swelling of mitochondria which possessed disrupted cristae. After 48 hours there were extensive mucosal lesions manifested as sloughing of the degenerated epithehum on the tips and lateral sides of the villi, while the lamina propria lodged wider subepithelial spaces, marked lymphocytic infiltration and haemorrhage, in some areas The absorptive microvilli were noticeably distorted while the cytoplasm contained markedly dilated endoplasmic reticulum, small distorted mitochondria, lysosomes and cytoplasmic vacuoles. Five days after blood reinfusion, in group A, the jejunal villi became denuded and some of them remained as ghosts. The lumen of the jejunum contained detached villi and necrotic materials. There were also marked necrosis and disintegration of the lamina propria. The remaining adsorptive cells lost their microvilli and their cytoplasm was disintegrated with distorted organdies, many vacuoles and lysosomes. After allopurinol treatment, in group B, the light and electron microscopic features of the jejunal villi and their covering cells were more or less similar to the control except for some lymphocytic infiltration. It could be concluded that the destructive effects of blood reinfusion in haemorrhagic shock on the jejunal villi could be alleviated by allopurinol administration