Serum proteolytic activities and antiproteases in human colorectal carcinoma.

Some proteolytic enzymes, trypsin, cathepsin B, cathepsin D, collagenase, elastase and their inhibitors, API and AMG, in serum of patients with colorectal carcinoma have been evaluated. Twenty patients belonged to stage B of colorectal carcinoma, twenty two patients to stage D (Astler and Coller classification) and a control group of thirty healthy volunteers were evaluated. Except in cathepsin D, patients exhibit higher enzymatic activities than healthy subjects, and both groups have all the proteolytic activities assayed in serum. Patients with disseminated disease have increased cathepsin B and collagenase levels, with a decrease of trypsin activity, showing an increment in API and AMG in sera. However, only the API values were significantly higher in patients with metastases. The coexistence of proteolytic activities in human sera together with their inhibitors is considered as well as the origin of these, tumoral and/or reactive, increments. Cathepsin B levels are raised in colorectal neoplasms and contribute to the destruction of the extracellular matrix and the proliferation of tumoral cells. There is evidence that a relation between collagenase like activity and tumor invasiveness exists. Cathepsin B and collagenase increases agree with the tumoral mass. On the other hand, trypsin decrease in metastatic carcinoma is probably related to the increment of their inhibitors, API and AMG, acute phase reactant proteins.

[Collagenous colitis: clinicopathologic study of 6 new cases]. / Colitis colágena: estudio clínicopatológico de seis nuevos casos.

Collagenous colitis (CC) is a newly recognized entity characterized clinically by chronic watery diarrhoea and pathologically by epithelial inflammatory injury and the presence of a thickened collagen band beneath the surface epithelium of the colon. Clinical and pathological data of six patients (5 women and 1 man, mean age 54 years) with this diagnosis have been reviewed. Chronic watery diarrhoea was the main symptom in all cases, ranging from 2 to 12 bowel movements a day (mean +/- SD, 5.5 +/- 2.3) lasting from 8 months to 19 years (mean +/- SD, 6.6 +/- 5.9 years). Laboratory, barium and endoscopic studies showed unspecific findings. Rheumatic and thyroid diseases as well as drug allergies were found in five cases. The cause of collagenous colitis and the mechanism of diarrhoea remains undefined, being the inflammatory and autoimmune hypothesis the most likely. Diagnosis was made by multiple rectal and colonic biopsies. Pathologic findings characteristic of CC were more prominent in proximal than in distal colonic specimens. Different treatments were applied and diverse clinic responses were obtained. A review of the literature is made.

[The treatment of primary biliary cirrhosis with ursodeoxycholic acid. The short- and median-term results and their relation to the study of the disease]. / Tratamiento de la cirrosis biliar primaria con ácido ursodesoxicólico. Resultados a corto y medio plazo y relación con el estudio de la enfermedad.

We present the results of the treatment with ursodeoxycholic acid (UDCA, 7-9 mg/kg body weight daily) of 17 patients with primary biliary cirrhosis (8 in stages I-II; 9 in stages III-IV). At two months the mean values of alkaline phosphatase, gammaglutamiltranspeptidase, alanine and aspartate aminotransferase were reduced (p less than 0.001, p less than 0.001, p less than 0.01 and p less than 0.01 respectively). This improvement persisted without increase during the first year. At two months the total bilirubin value was reduced (p less than 0.01) associated with a reduction in the conjugated fraction (p less than 0.05). Cholesterol and gammaglobulin mean values also decreased at two months (p less than 0.05). We found no changes in IgM levels and antimitochondrial antibody titers. The improvement was similar in both groups (early I-II and advanced III-IV stages) and the treatment showed no undesirable effects either in early or advanced stages. Almost all the patients with pruritus (6 out of 7) improved with the treatment and the use of cholestyramine was reduced in all.

[Detection of the degree of activity of ulcerative colitis. Behavior of serum alpha 1-proteinase inhibitor and alpha 2-macroglobulin]. / Detección del grado de actividad de la colitis ulcerosa. Comportamiento de alfa 1-proteinasa inhibidor y alfa 2-macroglobulina séricas.

The study of two proteins, acute phase reactants, alpha 1-proteinase inhibitor and alpha 2-macroglobulin, has demonstrated their utility in the diagnosis of the activity of ulcerative colitis. Alpha 1-proteinase inhibitor presented serum increases parallel to the degree of activity, permitting differentiation of asymptomatic, mild, moderate and severe phases of the disease. Increases in alpha 2-macroglobulin coincided with less-intense phases of the disease. The possible biological basis of this different behavior is discussed, as well as its potential inclusion among the biological tests currently used in clinical practice.

A multicenter, randomized, double-blind study comparing famotidine with cimetidine in the treatment of active duodenal ulcer disease.

The efficacy and safety of famotidine (40 mg at night), a new potent H2-receptor antagonist, has been studied in 119 patients by four investigators in four Spanish hospitals in a randomized double-blind comparative study with cimetidine (800 mg at night). Antacid tablets were allowed as additional treatment, if needed for pain relief. There were no significant differences between the groups in baseline characteristics, including duodenal ulcer size. Efficacy parameters included daytime and nocturnal symptom relief and duodenal ulcer healing, documented by endoscopy, and defined as complete reepithelization of the ulcer crater. Endoscopy was performed at baseline and after 4 and 6 weeks of treatment. One hundred and five patients fulfilled the evaluation criteria (51 patients in the famotidine group and 54 in the cimetidine group). After 4 weeks, in 91.6% of the patients receiving famotidine and 82.3% of the patients receiving cimetidine ulcers were healed. After 6 weeks, healing rates were 96% (famotidine) and 85.1% (cimetidine) (p = 0.056). Pain relief was rapid in both treatment groups, with a tendency to better response during the day in the famotidine group. The intake of antacids, as well as the clinical and laboratory safety profile were similar for both groups.

[Cirrhosis caused by thorotrast: apropos of a case]. / Cirrosis por thorotrast: a propósito de un caso.

We present the clinical case of a female patient with cirrhosis of the liver. The radiografic and histopathological studies demonstrated that de etiology of this cirrhosis was in relation with the use of thorotrast given during angiografic studies which the patient underwent 35 years ago.

[Haptoglobin in the biological diagnosis of gastric cancer (author's transl)]. / La haptoglobina en el diagnóstico biológico del cáncer gástrico.

Serum haptoglobin has been determined in a series of 69 patients with metastatic and non-metastatic gastric cancer. In both circumstances a marked increase of haptoglobin levels in comparison to the results in the control group was observed. A significant decrease was noticed in the presence of liver metastasis. Total alpha 2-globulin levels were also high in this patients, but a significant decrease was not observed in cases with liver metastasis. There was no parallelism between the values of haptoglobin and total alpha 2-globulins. The usefulness of these results in the diagnosis and prognosis of gastric cancer is stressed. Radial immunodiffusion using immunoserum anti-haptoglobin 1-1 is the technique of choice.