Enhancing Endogenous Nitric Oxide by Whole Body Periodic Acceleration Elicits Neuroprotective Effects in Dystrophic Neurons.

We have previously shown that inadequate dystrophin in cortical neurons in mdx mice is associated with age-dependent dyshomeostasis of resting intracellular Ca2+ ([Ca2+]i) and Na+ ([Na+]i), elevated reactive oxygen species (ROS) production, increase in neuronal damage and cognitive deficit. In this study, we assessed the potential therapeutic properties of the whole body periodic acceleration (pGz) to ameliorate the pathology observed in cortical neurons from the mdx mouse. pGz adds small pulses to the circulation, thereby increasing pulsatile shear stress to the vascular endothelium, which in turn increases production of nitric oxide (NO). We found [Ca2+]i and [Na+]i overload along with reactive oxygen species (ROS) overproduction in mdx neurons and cognitive dysfunction. mdx neurons showed increased activity of superoxide dismutase, glutathione peroxidase, malondialdehyde, and calpain as well as decreased cell viability. mdx neurons were more susceptible to hypoxia-reoxygenation injury than WT. pGz ameliorated the [Ca2+]i, and [Na+]i elevation and ROS overproduction and further increased the activities of superoxide dismutase, glutathione peroxidase and reduced the malondialdehyde and calpains. pGz diminished cell damage and elevated [Ca2+]i during hypoxia-reoxygenation and improved cognitive function in mdx mice. Moreover, pGz upregulated the expression of utrophin, dystroglycan-ß and CAPON, constitutive nitric oxide synthases, prosaposin, brain-derived neurotrophic, and glial cell line-derived neurotrophic factors. The present study demonstrated that pGz is an effective therapeutic approach to improve mdx neurons function, including cognitive functions.

[Report about drug interactions in a hospital emergency department]. / Consecuencias de un reporte sobre interacciones medicamentosas en una emergencia hospitalaria.

In 1991, we report drug interactions found through the review of 100 clinical charts of an Emergency Department. Two years later we evaluated again the medical indications done at the same Emergency. There were no differences related to sex, age and number of drug administrated by patient when compared with the former group. There was, however, a significant decrease in the percentage of interactions and those important ones. Also, in the average of interactions and those important ones by patient. Among more used drug, antacid occupied a a second place with 36% and Ranitidine the ninth place with 16%. Cimetidine disappeared among the first ten medications. In those cases where antacid or Ranitidine were indicated, there were interactions in 54% and 25%, respectively, but these interactions were not significant. The results of this new analysis point out a significant decrease of drug interactions, showing that continuing education allows indicate the most adequate therapy to each patient.

[HLA, blood group, secretory factor, pepsinogen I, and Helicobacter pylori in duodenal ulcer patients]. / HLA, grupo sanguíneo, factor secretor, pepsinógeno I y Helicobacter pylori en ulcerosos duodenales.

Duodenal ulcer is a multifactorial entity where a genetic predisposition and extrinsic elements seem to concur in its origin. A series of genetic and extrinsic markers were determined in 50 patients with duodenal ulcer and 50 controls matched by age, sex and socioeconomical status. HLA antigens dit not have significant differences. Blood group O Rh+ was predominant (p < 0.01). Secretor status of antigen HBO in saliva was positive in 70% of patients (p < 0.001). Serum Pepsinogen I was increased in 85% of cases (p < 0.001). Immunoglobulin G anti H. pylori was positive in 62% of ulcerous (p < 0.001). The highest sensibility and negative predictive value was represented by increased serum pepsinogen levels (85%); the highest specificity and positive predictive value was to Ig G anti H. pylori (90 and 86%). These results affirm the polygenic character of the duodenal ulcer disease.

[Urinary epidermal growth factor and serum pepsinogen I in patients with duodenal ulcers]. / Factor de crecimiento epidérmico en orina y pepsinógeno I sérico en pacientes ulcerosos duodenales.

Absolute and corrected by creatinine excretion urinary Epidermal Growth Factor (EGF) values were determined in 23 duodenal ulcer patients and compared to a control group. Basal serum pepsinogen I levels were measured in the patient group. Absolute urinary EGF values in patients were lower than in control group, such difference however, as such of EGF corrected by urinary creatinine excretion were not statistically significant (p > 0.05). Absolute urinary EGF excretion in male patients was higher than in female patients (p < 0.05), but after establishing the ratio EGF/Creatinine, the difference disappeared. There was no correlation between EGF and Pepsinogen I, it was inverse with age and positive with creatinine excretion. Some mechanisms are considered to explain the urinary EGF normality in these patients. The increasing importance given to EGF in ulcerous diseases and further trends in research are analyzed.

[Hepatic glycogenosis: the clinical, biochemical and enzymatic aspects in a group of pediatric patients]. / Glucogenosis hepática: aspectos clínicos, bioquímicos y enzimáticos en un grupo de pacientes pediátricos.

Nine children with clinical diagnosis of glycogenoses were studied, types were confirmed through determination of levels and structure of glycogen, stimulation with glucagon and enzymatic defect analyses. Eight patients suffered glycogenoses type III and one, type VI. The major age group un type III was 1 to 2 years old (62.5%), the type VI was diagnosed in a preschool boy. Mean clinical features were: hepatomegaly, doll-like facies and short height. Major biochemical alterations were: transaminases elevation in both types, hypertriglyceridemia, hyperglycemia, metabolic acidosis and hyperuricemia only in glycogenoses III. One III type patient presented cardiovascular alterations. All patients showed increased concentrations of erythrocyte glycogen, with normal structure in type VI and abnormal in 75% of type III. Tree fourths of type III patients had a positive response to glucagon stimulation. No one presented glucose 6 phosphatase deficiency.

[Propranolol in children and adolescents with portal hypertension: its dosage and the clinical, cardiovascular and biochemical effects]. / Propranolol en niños y adolescentes con hipertensión portal: dosis, efectos clínicos, cardiovasculares y bioquímicos.

An adequate propranolol dose to reduce 25% the initial heart rate was searched in 19 children with portal hypertension. 13 were pre-hepatic and 6 hepatic hypertension, mean age: 6.96 +/- 3.48 years, range: 2-14 years. Treatment was started with 0.5 mg/kg/day increasing 0.25 mg/kg/day every third day, needing an average of 26 +/- 13 days (range: 6-54 days) to obtain the response. Daily dose ranged from 1 to 5.25 mg/kg/day (mean: 2.69 +/- 1.16). The highest daily dose was 175 mg, the lowest 23.4 mg (mean: 58.27 +/- 36.6 mg/day). Some parameters were evaluated before and after achieving the dose. There was a significant reduction of mean blood pressure (p < 0.01) and peripheral venous pressure (p < 0.05) in 68.4% of patients. A significant elevation (p < 0.001) of 24 hour urinary catecholamine levels occurred in 94.7%. Side effects were minimal. Propranolol could be considered a safe pharmacological option in these patients.

[Main drug interactions at a hospital emergency department. Analysis of 100 cases]. / Principales interacciones medicamentosas en una emergencia hospitalaria. Analysis de 100 casos.

We prospectively reviewed clinical charts of 100 consecutive patients that were admitted during the first trimester 1991 to the Emergency Department of a general hospital in order to determine the more frequent prescribed drugs and their interactions using a computer program (Drug Interaction Program), emphasizing in those drugs used to treat peptic ulcers. Number of drugs prescribed to each patient was 4.20 +/- 1.39. Antacids (39%) and cimetidine (35%) occupied the third and fourth place. There were interactions in 79 patients and in 66 of them (84%) they were important. Antacid and cimetidine were similarly prescribed, but of 35 patients who received cimetidine only 3 (8.5%) had a primary indication for its use (Gastrointestinal bleeding). Significant clinical interactions of cimetidine with other medications are analyzed. Our results indicate that drug interactions are a permanent risk in our hospitals. We suggest to use a computer program on drug interactions or an updated chart of medications in the emergency rooms of our hospitals.

[Delay of gastric emptying in dyspeptic patients: a study with radiopaque markers]. / Retardo del vaciamiento gástrico en pacientes dispépticos: un estudio con marcadores radiopacos.

We studied the gastric emptying of indigestible solids after the ingestion of radiopaque markers in 9 control subjects, 9 insulin-dependent diabetics and 9 dyspeptic patients. Along with a breakfast each individual swallowed 10 markers made of intravenous catheters filled with barium, then flat films of abdomen were taken 1, 2, 4 and 6 hours later. At fourth hour, all controls had emptied their markers, 11% of diabetics and 22% of dyspeptic patients (p < 0.001). By 6 hours, 33% of diabetics and 55% of dyspeptic subjects had emptied them (p < 0.001, p < 0.05). At 4 hour controls had discharged 10 markers, diabetics 2.5 +/- 0.6 and dyspeptic 4.9 +/- 0.7. By 6 hours diabetics emptied 4.9 +/- 0.7 and dyspeptic patients 7.9 +/- 0.6 markers. Through this reliable method, an evident delay of gastric emptying in diabetics and a good proportion of dyspeptic patients is showed.

[Levels of blood pepsinogen I in the offspring of patients with duodenal ulcer]. / Niveles de pepsinógeno i sérico en descendientes de ulcerosos duodenales.

Hyperpepsinogenemia I is a reliable subclinical marker of the genetical predisposition to suffer duodenal ulcer. For that reason we determine basal serum pepsinogen I (PG I) levels in 25 ulcerous patients and 75% of their offspring and to a control group matched by age and sex. PG I levels in patients and their offspring were significantly higher than those in controls and their offspring (p < 0.001). By establishing an upper normal value of PG I, we identified a subpopulation of normopepsinogenemic ulcerous patients and another with high values (9 normo PG I: 64.3 +/- 6.2 ng/ml vs 16 ulcerous patients with PG I levels: 142.1 +/- 19 ng/ml) (p < 0.001). Of 16 hyperpepsinogenemic patients, 11 offspring (27%) had increased values, what did not happen to any of the offspring of ulcerous patients with normal PG I or control group finding that 80% of male patients with high PG I gave birth to 1 or 2 children with increased values, suggesting a transmission thorough the male character. So gentic role plays an important place in our ulcerous patients but environmental factors appear to decisively influence on the establishment of the disease.

[Serum cationic trypsinogen: marker of exocrine pancreatic dysfunction in children with protein-calorie malnutrition]. / Tripsinógeno catiónico sérico: indicador de disfunción pancreática exocrina en niños con malnutrición proteíno-calórica.

Serum cationic trypsinogen, a non invasive, sensitive test to evaluate the exocrine pancreatic function was measured by radioimmunoassay in 31 children with different degrees of protein-calorie malnutrition (mild, moderate, severe) in whom mean serum albumin values were 3.7 +/- 0.7 g%; 3.1 +/- 0.9 g%; 2.3 +/- 0.4 g%, respectively and in a control group of 20 well-nourished children with mean serum albumin values of 3.9 +/- 0.7 g%. Mean serum trypsinogen levels were significantly elevated in children with malnutrition (mild: 28.5 +/- 2.4 ng/ml, moderate: 31.86 +/- 3.4 ng/ml, and severe: 36.52 +/- 7.8 ng/ml) compared with the mean values in the control group (17.7 +/- 2 ng/ml). (p < 0.001). We conclude that our results suggest evidence of a pancreatic damage in malnourished children and this disfunction increases according to the degree of malnutrition, allowing to be detected with this simple test even when the patient does not present qualitative steatorrhea.

[Study of colonic transit time with radiopaque markers in patients with chronic constipation]. / Estudio del tránsito colónico con marcadores radiopacos en pacientes con estreñimiento crónico.

We studied 30 young patients with idiopathic chronic constipation through the ingestion and colonic follow-up of 20 radiopaque markers, gotten from catheters of those used for intravenous lines. The number of markers were counted in each segment and total colon. Mean segmental and total colonic transit times were also calculated. There was a greater number of markers in each segment and total colon compared to 20 control subjects (p < 0.001). The mean colonic transit time was 61.4 hours (patients and 15.6 hours controls) (p < 0.001) occurring an important delay in the left colon and rectosigmoid (45.72 hours). So, in these patients there was predominantly a left colon dysfunction and the called outlet obstruction syndrome, likely related to their evacuatory habits. We do recommend this method as a valuable diagnostic tool for particularly observing the colonic progression and to offer a more rational assessment to the chronic constipated patient.

[Pituitary-gonadal hormonal evaluation in male patients with alcoholic liver cirrhosis]. / Evaluación hormonal hipofiso-gonadal en pacientes masculinos con cirrosis hepática alcohólica.

Pituitary-gonadal plasmatic hormonal values were measured in 26 alcoholic cirrhotic males and 20 healthy subjects. Total testosterone and luteinizing hormone mean levels were lower in the cirrhotic group (p < 0.05). Estradiol and prolactin were significant higher (p < 0.05 and p < 0.001, respectively). Follicle stimulation hormone mean values were normal. Pituitary-gonadal axis luteinizing hormone-testosterone and follicle stimulating hormone-estradiol were abnormal since the retrofeedback mechanism failed to work in each system. These results show a wide disturbance of the sexual hormonal function in our patients which certainly contributes to puzzle the complexity of the clinical and therapeutic aspects in these kind of patients.

[Serum pepsinogen I levels in bleeding duodenal ulcer]. / Níveles de pepsinógeno I sérico en el ulceroso duodenal sangrante.

We compared serum Pepsinogen I (PG I) levels in 25 bleeding duodenal ulcer patients, 25 non bleeding duodenal ulcer (DU) patients and 25 healthy subjects, matched by age and sex. Mean values of PG I in bleeding DU patients were slightly higher than those in non bleeding DU patients, such difference was not statistically significant. Nevertheless, it must be pointed out that 88% of hemorrhagic patients had increased PG I levels compared to 72% of non hemorrhagic patients. The difference between these two groups and the healthy group was highly significant (p < 0.001). We conclude that determination of serum PG I levels is a sensitive complementary diagnostic test in the ulcerous patient. Its capacity, however, to discriminate between bleeding and non bleeding DU patients failed to be found in these study. So, hemorrhage is always a challenge in the natural history of the duodenal ulcer patient.

[Serum pepsinogen I and duodenal ulcer disease]. / Pepsinógeno I sérico y enfermedad ulcerosa duodenal.

Duodenal ulcer is a common disease. It has always been said that it results from an imbalance between aggressive forces (HC1 and pepsin) and defensive forces that act on the mucosa. More attention has traditionally been paid to acid and relative less interest to pepsin. Two types of pepsinogen have been recognized as precursors of peptic activity in the lumen. Pepsinogen I has been more frequently implicated in ulcerogenesis. The aim of this review is to consider the different current pathophysiologic and clinical aspects, and to take into account its importance as a predictive and genetic marker in duodenal ulcer disease, which is always a challenge in the daily practice of gastroenterologists.