Takayasu's arteritis associated with Crohn's disease

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Cross-reactivity between Anisakis simplex sensitization and visceral larva migrans by Toxocara canis.

The aim of this work was to study cross-reactivity in the diagnosis of two related ascaridosis. Nineteen patients diagnosed with recidivous acute urticaria (RAU) caused by Anisakis simplex and 26 patients diagnosed with visceral larva migrans (VLM) caused by Toxocara canis were studied employing commercial diagnostic kits and "in house" assay kits. Cross-reactivity observed was greater when using "in house" assay kits, suggesting that T. canis excretory-secretory antigens were not only recognized by antibodies from patients with RAU but with greater intensity compared to the A. simplex excretory-secretory antigens.

Cross-reactivity induced by Anisakis simplex and Toxocara canis in mice.

The aim of this study was to verify whether cross-reactivity appeared between Toxocara canis and Anisakis simplex in an experimental rodent model. No cross-reactions were detected using sera from mice infected with T. canis eggs. When responses obtained against T. canis ES antigen using sera from BALB/c and C57BL/10 mice infected with T. canis eggs were compared with those obtained by testing sera from mice infected with one A. simplex L3, an increase in cross-reactions was observed using the C57BL/10 strain.

Algoritmo e interpretación de los nivelesplasmáticos de metadona / Algorithm and interpretation of the plasma levels of methadone

Objetivos: simplificar la interpretación de los niveles plasmáticos de metadona mediante un algoritmo que detecte los factores que modifican la efectividad del tratamiento con metadona como sustitutivo opiáceo, y facilitar el desarrollo de pautas de corrección de dosis para la estabilización del paciente. Material y métodos: se realiza el seguimiento clínico de 76 pacientes del Programa de mantenimiento con metadona de Majadahonda durante 3 años, para la objetivación del síndrome de abstinencia y ajuste de la dosis, se cuantifica el nivel plasmático de metadona por ELISA y la concentración de 1-glicoproteína ácida mediante nefelometría cinética como factor que pueda alterar la fracción libre de esta. Resultados: la aplicación del algoritmo a través de la determinación del nivel plasmático de metadona, nos ha permitido disminuir las dosis eficaces, detectar interacciones medicamentosas, estabilizar a un porcentaje significativo de pacientes tratados con inductores enzimáticos y determinar los candidatos para plantear una terapia alternativa con LAAM. Conclusión: la optimización del tratamiento sustitutivo con metadona implica la necesidad de monitorizar su eficacia a través de la determinación de los niveles plasmáticos individualizado para cada paciente. La aplicación de un algoritmo en la interpretación de los resultados obtenidos ofrece al clínico una herramienta para realizar un esquema de dosificación flexible y seguro, permitiendo evaluar las causas que puedan alterar la eficacia del tratamiento. (AU)

Animal models in ocular toxocariasis.

Ocular toxocariasis is a clearly defined disease. However, much remains to be learned concerning the migratory route, ocular changes, diagnosis and treatment. Studies in paratenic hosts have contributed to our understanding and will yield more information. Various experimental animals have been used, such as mice, rabbits, guinea pigs, primates, hamsters and gerbils. Of these, the last appear to be the most appropriate model due to their high susceptibility to ocular infection. Results obtained from different animal models are often not comparable due to the fact that dose and routes of inoculation are diverse. Early stages in the pathogenesis of ocular toxocariasis are manifested by haemorrhages in the anterior chamber and iris, replaced in time by accumulations of white cells. Ocular migration produces an early cell reaction, formed by an infiltration of neutrophils accompanied by vasculitis and retinal microinfarcts. Over a period of time, an increase of macrophages and the distribution of the infiltrates is observed. Later, granulomatous lesions are formed. These do not necessarily contain a larva and their appearance varies in different animal models. Local production of IgE and the presence of specific IgG have been described.

[Olanzapine efficacy in the treatment of cocaine abuse in methadone maintenance patients. Interaction with plasma levels]. / Eficacia del antipsicótico olanzapina en el tratamiento del abuso de cocaína en pacientes en mantenimiento con metadona. Interacción en los niveles plasmáticos.

INTRODUCTION: The aim of this study was to evaluate the efficacy of the treatment with antipsychotic olanzapine in cocaine abuse methadone patients. The decrease or interruption of cocaine consume as well as the possible pharmacokinetic interaction between olanzapine and methadone were studied. MATERIAL AND METHODS: Patients (n= 21) include in a methadone maintenance program (14 months), with DSM-IV criteria for opioid and cocaine dependence and without schizophrenic diagnostic, were treated with olanzapine 5 to 10 mg/day. The therapeutic outcomes were assessed by personal interviews, cocaine consumption, changes of consumption patrons (via of administration) and secondary effects to olanzapine. Withdrawal symptoms were measured by means of the abbreviate version of the scale of Gossop. Cocaine used was measured by urine analysis (enzymoimmnuoassay). The possible pharmacokinetic interaction between olanzapine and methadone was measured in plasma before and during the treatment in 15 patients. RESULTS: Olanzapine combined with methadone in cocaine abusers was well tolerated in an important proportion of patients. Moreover the consumption of cocaine was decreased or stopped in 53,2% of the patients. In addition, no withdrawal syndrome was observed in any patients. Furthermore the ratios of methadone plasma levels did not change in relation to the dose before and during the treatment, suggesting a lack of pharmacokinetic interaction between methadone and olanzapine. CONCLUSIONS: In conclusion the results of this preliminary study, led us to advance that olanzapine could be a useful treatment for cocaine abuse at least in patients in a Methadone Maintenance Program, with the advantage of not to induce any pharmacokinetic interaction with methadone.

Eficacia del antipsicótico olanzapina en el tratamiento del abuso de cocaína en pacientes en mantenimiento con metadona. Interacción en los niveles plasmáticos / Olanzapine efficacy in the treatment of cocaine abuse in methadone maintenance patients. Interaction with plasma levels

Introducción: El objetivo de este estudio fue evaluar la eficacia del tratamiento con olanzapina en pacientes que consumen cocaína incluidos en un programa de mantenimiento con metadona (PMM), valorando la disminución o el abandono de dicho consumo. Por otra parte se estudió la posible interacción farmacocinética entre olanzapina y metadona. Material y métodos: la muestra consta de 21 pacientes con criterios DSM IV de adicción a heroína y cocaína incluidos en un PMM (14 meses), sin diagnóstico de esquizofrenia, que fueron tratados con olanzapina (5-10 mg/día). En las entrevistas de seguimiento se evaluó el grado de cumplimiento de tratamiento, cambios en el patrón de consumo, vía utilizada y efectos secundarios atribuibles a olanzapina. También se evaluó el síndrome de abstinencia a opiáceos (SAO) a través de la versión de la escala abreviada de Gossop. El consumo de cocaína se valoró en los análisis de orina (enzimoinmunoanálisis) y la posible interacción entre olanzapina y metadona se evaluó en 15 pacientes de la muestra antes y durante el tratamiento, midiendo niveles de metadona en plasma. Resultados: La olanzapina, combinada con la metadona, en consumidores de cocaína, fue bien tolerada en una importante proporción de pacientes. El 52,3 por ciento de los pacientes, disminuyeron o dejaron el consumo de cocaína. Ninguno presentó SAO en relación al tratamiento y las ratios de los niveles plasmáticos medios de metadona en relación con las dosis antes y durante el mismo, no sufrieron modificaciones significativas, sugiriendo que no existe interacción farmacocinética entre ambos. Conclusiones: En conclusión los resultados de este estudio preliminar permiten avanzar que la olanzapina sería un fármaco de utilidad para el control del consumo de cocaína, al menos en pacientes en PMM, con el valor añadido de no producir ningún tipo de interacción farmacocinética con la metadona (AU)

Isotype specific immune responses in murine experimental toxocariasis.

In this work, a murine experimental model of toxocariasis has been developed in BALB/c, C57BL/10 and C3H murine strains orally inoculated with 4,000 Toxocara canis embryonated eggs, in order to investigate the isotype-specific immune responses against excretory-secretory antigens from larvae. T. canis specific IgG+M, IgM, IgG, IgA, IgG1, IgG2a and IgG3 were tested by ELISA. The dynamics of the specific immunoglobulins (IgG+IgM) production showed a contrasting profile regarding the murine strain. Conversely to the results obtained with the IgM isotype, the IgG antibody class showed similar patterns to those obtained with IgG+IgM antibodies, only in the case of the BALB/c strain, being different and much higher than the obtained with IgG+IgM antibodies, when the C3H murine strain was used. The antibodies IgG+IgM tested in BALB/c and C57BL/10 were both of the IgM and IgG isotypes. Conversely, in the C3H strain only IgG specific antibody levels were detected. The IgG1 subclass responses showed a similar profile in the three murine strains studied, with high values in BALB/c, as in the case of the IgG responses.

Isotype specific immune responses in murine experimental toxocariasis

In this work, a murine experimental model of toxocariasis has been developed in BALB/c, C57BL/10 and C3H murine strains orally inoculated with 4,000 Toxocara canis embryonated eggs, in order to investigate the isotype-specific immune responses against excretory-secretory antigens from larvae. T. canis specific IgG+M, IgM, IgG, IgA, IgG1, IgG2a and IgG3 were tested by ELISA. The dynamics of the specific immunoglobulins (IgG+IgM) production showed a contrasting profile regarding the murine strain. Conversely to the results obtained with the IgM isotype, the IgG antibody class showed similar patterns to those obtained with IgG+IgM antibodies, only in the case of the BALB/c strain, being different and much higher than the obtained with IgG+IgM antibodies, when the C3H murine strain was used. The antibodies IgG+IgM tested in BALB/c and C57BL/10 were both of the IgM and IgG isotypes. Conversely, in the C3H strain only IgG specific antibody levels were detected. The IgG1 subclass responses showed a similar profile in the three murine strains studied, with high values in BALB/c, as in the case of the IgG responses

Niveles plasmáticos de metadona. Resultados después de 15 meses de seguimiento en el Programa Municipal de Drogas de Majadahonda / Plasma methadone concentration by enzymoimmunoassay tecnique (EIA) after 15 months in patients of Drugs Program of Mahadahonda (Spain)

Analizamos los niveles de 71 pacientes en programa de metadona mediante técnicas inmunoenzimáticas (EIA) durante 15 meses, evaluando si eran útiles para valorar la dosis adecuada en función de la situación clínica individual a lo largo del tiempo y se relacionaban con la aparición de SAO, consumo de opiáceos, enfermedades asociadas (VIH y/o Hepatitis) e interacciones con fármacos. Hubo correlación en pacientes previamente estabilizados entre SAO y la disminución progresiva de los niveles p<0,01, con recaída en el consumo de heroína (33,5 por ciento). Los pacientes con benzodiacepinas precisaron mayores dosis (124mg.vs 86 mg). No hubo diferencias en las dosis ni en los niveles en pacientes VIH +, en cambio, los pacientes con VHC necesitaron dosis más altas para conseguir un nivel similar (99 mg vs 73 mg). No se observaron diferencias significativas ni en las dosis ni en los niveles entre pacientes con/sin medicación al inicio del estudio, posteriormente hubo un aumento progresivo de dosis (145ñ58 vs 81,6ñ31,2) p<0,01, con significación estadística, a partir de la tercera extracción, acompañada de una caída de las concentraciones plasmáticas (145ñ58 vs 81,6ñ31,2) p<0.01 coincidiendo con fármacos inductores del metabolismo de la metadona (228ñ33 vs 212,7ñ157,2). Por tanto los "Niveles plasmáticos Adecuados", más que las dosis adecuadas pueden utilizarse como instrumento clínico para valorar la eficacia del tratamiento con metadona y para detectar alteraciones en pacientes estabilizados (AU)

[Fluoxetine (FX) efficacy in the treatment of cocaine dependence methadone maintenance patients. Interaction with plasma levels]. / Eficacia de la fluoxetina (FX) en el tratamiento de la adicción a cocaína en pacientes en mantenimiento con metadona y su interacción en los niveles plasmáticos.

OBJECTIVES: The objective of this study was to assess the efficacy of fluoxetine (FX) treatment in cocaine dependent methadone (MTD) maintenance patients, to assess decrease or interruption of cocaine use and pharmacokinetic interaction between fluoxetine an methadone plasma levels. MATERIAL AND METHODS: The sample was composed of 11 patients with DSM IV criteria for opioid and cocaine dependence. We added Fluoxetine (20 mg per day) during 9 weeks in Majadahonda Drug Program. All patients were in methadone program a mean of 7.5 months. We made a psychiatry interview and the baseline severity of the mood disorder was assessed with the Clinical Global Impression ICG for therapeutic improvement. Cocaine use and fluoxetine treatment was measured in urine analysis and pharmacokinetic interaction between FX-MTD were measured with plasma levels of methadone. RESULTS: Fluoxetine was well tolerated combined with methadone. FX-MTD interaction didn't occur, resulting in no increased of MTD plasma level to dose before and after fluoxetine treatment. After fluoxetine treatment decreased cocaine use, changed cocaine tract from injected to smoked and improvement depressive symptoms.

[Cryoglobulinemia following liver transplantation for cirrhosis secondary to hepatitis C virus infection]. / Crioglobulinemia tras trasplante hepático por cirrosis secundaria al virus de la hepatitis C.

Hepatitis C virus (HCV) infection has been linked with some extrahepatic immunologic abnormalities. Cryoglobulinemia is one of the most frequently reported. Nevertheless, there are only a few reports of cryoglobulinemia in the setting of liver transplantation. More studies are needed to clarify the frequency of post-OLT cryoglobulinemia in patients with HCV-related cirrhosis and its impact on OLT outcome. A case of a patient who underwent liver transplantation because of HCV end-stage liver disease and in whom cryoglobulinemia appeared 3 years after transplantation is reported. Treatment with cyclophosphamide and steroids was attempted but patient died of septicemia 3 years after liver transplantation.

Serological evidence of toxocariasis in patients from Spain with a clinical suspicion of visceral larva migrans.

Sera from patients with clinical characteristics of toxocariasis were assayed using the ELISA method and larval excretory-secretory antigen. Four hundred and seven samples of Toxocara serology were received at the laboratory of Ciudad Sanitaria Juan Canalejo Hospital of Corunna, Spain, from 1984 to 1989. Of these, 30 were from adults, 332 from children and 45 from patients of unknown age, resulting in Toxocara seroprevalences of 23.3%, 32.8% and 17.7% respectively. The reasons for these serological differences in the rural and urban areas of Galicia, Spain are discussed.

[2 cases of toxocariasis (visceral larva migrans)]. / Dos casos de toxocarosis (larva migrans visceral).

BACKGROUND: Different epidemiological studies have demonstrated that specific anti-Toxocara antibodies are detected in the serum of a high percentage of the Spanish population. But very few clinical cases of visceral larva migrans are being confirmed. METHODS AND RESULTS: Two cases of visceral toxocarosis, in two sisters, are described. In the first, the prevailing clinic was swelling of joints and upper respiratory tract symptoms; and asthma and cutaneous allergic manifestations in the second patient. Both cases presented with an elevated blood eosinophil count, high levels of total IgE and high titlers of anti-Toxocara antibodies. All symptoms disappeared after treatment with diethylcarbamazine and they remain asymptomatic several months after. CONCLUSIONS: In pediatric population, toxocarosis should be ruled out in every patient with respiratory symptoms, allergic cutaneous manifestations and elevated blood eosinophil count. The anti-Toxocara antibodies assay is of great value in establishing the diagnosis of this parasitic disease.

Seroprevalence of toxocariasis in children and adults in Madrid and Tenerife, Spain.

A study on the seroprevalence of toxocariasis, using ELISA with Toxocara larval excretory-secretory antigens, was carried out on human populations in two regions of Spain. Sera from a population of 195 children from Madrid and 143 children from Santa Cruz de Tenerife (Canary Isles), showed a prevalence of 0% and 4.2% respectively. Sera from a population of 272 adults from Madrid and 803 adults from Santa Cruz de Tenerife showed a prevalence of 3.6% and 17.4%. Reasons for these differences in the seroprevalence of Toxocara in the different age groups from the two regions are discussed.

Cross-reactions of sera from Toxascaris leonina and Ascaris suum infected mice with Toxocara canis, Toxascaris leonina and Ascaris suum antigens.

The ELISA method using larval ES products and homogenized Toxocara canis, Toxascaris leonina and Ascaris suum adult worms extract, was used to determine the possible cross-reactions in BALB/c and C57BL/10 mice inoculated with embryonated eggs or adult worms extract of T. leonina of T. leonina or A. suum in single and multiple doses. When we used sera of mice infected with embryonated eggs of T. leonina against different heterologous Ag, no cross-reactions against T. canis ES and A. suum ES Ag were observed using a single dose. Similarly, in multiple doses no response against T. canis ES Ag was observed. In mice inoculated with adult worms extract of T. leonina cross-reactions with T. canis ES and A. suum ES Ag did not occur. Sera from BALB/c mice infected with embryonated eggs of A. suum, was tested using ES Ag from both A. suum and T. canis and no reactions were observed. This fact confirmed the resistance of this murine strain to A. suum embryonated eggs. When we used sera of susceptible C57BL/10 mice infected against different heterologous Ag, we observed no cross-reactions against T. canis ES Ag. In the case of both BALB/c and C57BL/10 and C57BL/10 mice immunized with a single dose of A. suum adult crude extract no cross-reactions were seen against ES T. canis Ag and with sera from C57BL/10 mice against ES T. leonina. These facts confirmed the specificity of the ES T. canis Ag.

Evaluation of mebendazole activity on experimental murine toxocariasis by immune complexes determination.

The mebendazole action on experimental murine toxocariasis, using different formulations and vehicles, was studied by means of the detection of antibodies and immune complexes by ELISA. After inoculation with 1000 embryonated Toxocara canis eggs, BALB/c mice were submitted to the anthelmintic treatment as follows: group 1 (control without treatment); group 2 (mebendazole (MBZ), Lomper, Steve Laboratories, Barcelona, Spain, suspended in 1% sodium carboxymethylcellulose (CMC) at a dose of 100 mg/kg/day); group 3 (MBZ, pure compound suspended in 1% CMC at a dose of 100 mg/kg/day); group 4 (MBZ, pure compound suspended in water at a dose of 100 mg/kg/day); group 5 (MBZ, pure compound, formulated to a solid dispersion at 10% in polyethylene glycol 6000 (PEG) then dissolved in water at a dose of 100 mg/kg/day); group 6 (MBZ, pure compound, formulated to a solid dispersion at 10% in PEG then dissolved in water at a dose of 50 mg/kg/day); group 7 (MBZ, pure compound, formulated to a solid dispersion at 10% in PEG then dissolved in water at a dose of 25 mg/kg/day). The treatments were administered on days 5-7 post-inoculation (p.i.) inclusive. The dynamics of the production of the specific antibodies for both excretory-secretory (ES) antigen or crude extract showed a similar profile as compared to the control group. In groups 2 and 6, from the beginning of the treatment, values of immune complexes fell rapidly and were undetectable for the remainder of the experiment. Reductions of immune complex levels by the 4th-6th, 2nd-3rd and 2nd-5th weeks p.i. were observed from groups 3, 5 and 7, respectively. In the other groups, similar profiles as compared to the control group were observed in the dynamics of the specific immune complexes. The evaluation of chemotherapy by immunological methods is a valid technique for the efficiency of the treatment without the disadvantages of larval recovery from several digested tissues. Mebendazole, pure compound, formulated to a solid dispersion in PEG, then dissolved in water reduced immune complexes from the beginning of the treatment. The larval immobilization produced by MBZ should entail a reduction in their metabolic activity with a reduction in the production of excretory-secretory substances which are responsible for the formation of immune complexes. The rapid clearance of specific immune complexes together with a total larvae reduction would explain the decrease in specific immune complexes, which detection is a valid technique for monitoring the efficiency of treatment.