Breath methane in functional constipation: response to treatment with Ispaghula husk.

BACKGROUND: Colonic fermentation produces hydrogen (H2 ), and also produces methane (CH4 ) in subjects with methanogenic flora (M+). Methane production has been associated with chronic constipation (CC) and with changes in gut motility. To determine CH4 production in CC compared to controls, and to assess whether the therapeutic response to Ispaghula husk in CC differs between CH4 -producers and non-producers. METHODS: Forty-eight patients with functional constipation or irritable bowel syndrome-constipation and 19 healthy age-and-sex-matched volunteers (HV) filled in a 1-week symptom diary and a dietary questionnaire. They then underwent a lactulose breath test (LBT) to measure H2 and CH4 production (peak and area under the time-concentration curve, AUC-) and a colonic transit time (CTT) assessment. In patients, measurements were repeated after a 4-week treatment with Ispaghula husk. KEY RESULTS: Prevalence of M+ in patients was 60.5% vs 52.6% in HV (p = 0.37). Patients had significantly longer CTT and greater production of both H2 and CH4 during LBT. There was a significant correlation between CH4 production and CTT (r = 0.51; p = 0.07). Treatment response rate was similar for M+ and M- patients (58.3% vs 52.9%; p = 0.76) as were the increases in bowel movements and Bristol score, changes in abdominal discomfort and bloating. In M+, treatment reduced CTT (-10 ± 35 h; p = 0.029 vs baseline) and CH4 levels: peak CH4 (-13 ± 24 ppm; p = 0.014) and CH4 -AUC (-817 ± 3100 ppm/min; p = 0.04). CONCLUSIONS & INFERENCES: Although CH4 production has been associated with CC pathophysiology, we found that CH4 status did not negatively affect the response to Ispaghula husk treatment. The measurement of CH4 levels as a biomarker tool for CC requires further appraisal.

[Cholesterol crystals embolization. A case report]. / Embolismo por cristales de colesterol. A propósito de un caso.

Cholesterol Crystals Embolization is not a very frequent entity that happens in people with atheromatous disease of spontaneous for or after the realization of vascular manipulation (angiographic, angioplasty procedures, cardiovascular surgery) or more rarely with the treatment with oral anticoagulants and after thrombolytic therapy. The clinical presentation is according to the arterial affected territory and so from diagnosed cases in autopsy reports to florid clinic forms exist. The more frequent are the cutaneous manifestations with apparition of livedo reticularis and purple toes that could go accompanied of necrosis of lower limbs, consecutive from the renal manifestations and the gastrointestinal tract one. The diagnosis is based on the biopsy of organ affected lesions to level of arterioles, that revealed characteristic cholesterol clefts, above all the cutaneous biopsy, muscular and in any case renal. As for the treatment is symptomatic with analgesics, antiplatelet agents, anti-inflammatory, etc ... but it doesn't after the presage and the evolution of the illness. A clear contraindication exists to the use of oral anticoagulants and heparin.

Embolismo por cristales de colesterol. A propósito de un caso / Cholesterol crystals embolization. Case report

El embolismo por cristales de colesterol es una entidad poco frecuente que se da en personas con enfermedad arteroesclerótica de forma espontánea o tras la realización de manipulación vascular (cateterismos arteriales, arteriografías, cirugía cardiovascular...) o más raramente con el tratamiento con anticuagulantes orales y/o heparina o tras fibrinolisis.Da una variada sintomatología según el territorio arterial afecto y así existen desde formas diagnosticadas en necropsias hasta formas de clínica florida. Las más frecuentes son las manifestaciones cutáneas con aparición de livedo reticularis y/o dedos púrpuras que pueden ir acompañado de necrosis de miembros inferiores, seguida de la afectación renal y de la gastrointestinal. El diagnóstico se basa en la visualización de cristales de colesterol en biopsia del órgano afecto a nivel de arteriolas, sobre todo la biopsia cutánea, muscular y en algún caso renal. En cuanto al tratamiento es sintomático con analgésicos, antiagregantes plaquetarios, antiinflamatorios, etc., pero el curso del proceso es independiente del aplicado y no cambia la evolución del mismo. Existe una clara contraindicación al uso de anticuagulantes orales y heparina (AU)

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A double-blind randomised comparison of ropivacaine 0.5%, bupivacaine 0.375% - lidocaine 1% and ropivacaine 0.5% - lidocaine 1% mixtures for cataract surgery.

This study evaluated the efficacy and side-effects of plain ropivacaine compared with ropivacaine-lidocaine and bupivacaine-lidocaine mixtures for peribulbar blocks in cataract surgery. Ninety patients were randomly allocated to three groups and received peribulbar blockade using one of the three solutions. Speed of onset and quality of blockade were assessed using akinesia, surgical satisfaction and patient satisfaction. Complications and cardiovascular side-effects were noted. There was a slower onset of akinesia using ropivacaine alone, although at 10 min after injection all groups were equal in this respect. There was no difference in surgical or patient satisfaction between the groups. There were no differences in pain on injection, preblock and postblock blood pressure, heart rate or oxygen saturation. The optimal time to surgical incision after peribulbar blockade is not less than 15 min and plain ropivacaine fulfils this criterion.

Wedged hepatic venous pressure adequately reflects portal pressure in hepatitis C virus-related cirrhosis.

Wedged hepatic venous pressure (WHVP) is equivalent to portal venous pressure in patients with alcoholic liver diseases. However, it may underestimate portal pressure in nonalcoholics, which is important because hepatitis C virus (HCV) infection is a frequent cause of chronic liver disease. We investigated the agreement between directly measured portal pressure and WHVP in alcoholic and HCV-related liver diseases. Seventy-one patients with liver disease resulting from HCV infection (n = 32), alcohol (n = 25), or both (n = 14) underwent simultaneous measurements of WHVP (by hepatic vein catheterization) and portal pressure (by direct puncture). In 9 patients, measurements were repeated 20 minutes after acute iv propranolol administration. WHVP showed an excellent agreement with portal pressure in patients with cirrhosis resulting from either HCV, alcohol or both (intraclass correlation coefficient: 0.94, 0.93, and 0.97, respectively; P <.001). A discrepancy of >/=5 mm Hg was observed in 7 cases. WHVP underestimated portal pressure in only 1 case and exceeded portal pressure by >/=5 mm Hg in 6 patients. The WHVP response to propranolol closely and significantly correlated with changes in portal pressure (intraclass correlation coefficient: 0.87; P <.004). The simple and safe measurement of WHVP accurately reflects portal pressure in alcoholic and HCV-related liver disease. This technique also allows us to accurately assess the portal pressure response to propranolol in both alcoholic and HCV-related cirrhosis.

Coeliac plexus block using computed tomography guidance.

Coeliac plexus blocks have been used successfully in the treatment of abdominal pain in advanced cancer and in benign chronic abdominal pain. However, concern remains about occasional potentially serious complications. One possible way to reduce the risks of this procedure may be to improve imaging during the procedure. We report a series of 38 coeliac plexus blocks carried out under computer tomographic (CT) guidance, mostly using the anterior approach. The technique is described. Effectiveness and side-effect rates were similar to other reported series. There were no major complications. Analysis of contrast spread would indicate that anterior preaortic or bilateral contrast spread is necessary to obtain pain relief. Our experience would indicate that routine CT guidance can be a simple aid to coeliac plexus block, and can be achieved easily in a district general hospital. Improved imaging allows accurate needle placement, while avoiding vital structures such as the aorta and pleura. Accurate placement may also allow the use of reduced volumes of neurolytic drugs.

First Report of Pestalotiopsis guepini on Loquat in Argentina.

Loquat, Eriobotrya japonica (Thunb.) Lindl., is used as an ornamental plant in home gardens in the La Plata area of Buenos Aires, Argentina. During spring 1998, loquat branches with spotted leaves and fruits were submitted to the Plant Disease Diagnostic Laboratory. Symptoms on leaves consisted of small (2 to 5 mm in diameter), circular to oblong, greenish brown lesions that expanded to amphigenous, isolated, or confluent, dark brown spots. On fruits the disease appeared as circular to elongated, sunken spots. Advancing lesions spread over the surface resulting in the death of the fruit. Acervuli were observed within lesions. Isolations from symptomatic tissue onto acidified potato dextrose agar medium consistently yielded white fungal colonies of sparse aerial mycelium with acervuli containing black, slimy spore masses. The fungus was initially identified as Pestalotiopsis guepini (Desmaz.) Steyaert based on conidial and cultural characteristics (1), and the identification was confirmed by Institute Spegazzini, La Plata, Buenos Aires, Argen-tina. Loquat branches with fruit and 3- to 6-month-old loquat plants were mechanically injured and sprayed with a conidial suspension of one of the P. guepini isolates (4.5 × 105 per ml). Plants were incubated in a moist chamber for 48 h and then maintained in a greenhouse. After 6 days, lesions similar to the original symptoms were observed on the inoculated plant and P. guepini was reisolated, confirming Koch's postulates. Control plants sprayed with distilled water remained symptomless. This is the first report of P. guepini causing leaf and fruit spots on loquat in Argentina. Reference: (1) J. B. H. J. Desmazières. Ann. Sci. Nat. Ser. 2. 13:181, 1840.

First Report of Leaf Rust of Blueberry Caused by Pucciniastrum vaccinii in Argentina.

During March, 1997, a leaf rust was observed on Vaccinium corymbosum L. cv. Bluegold in Argentina. Leaf lesions began as chlorotic flecks that expanded and developed into necrotic spots with several uredinia. The typical orange pustules of the disease developed mostly on the abaxial sides of leaves. Urediniospores were elliptical to obovate (17 to 28 × 11 to 23 µm) and finely verrucose. Telia were round, covered by the epidermis, slightly elevated, and brown to black. Teliospores were sessile and oblong to columnar (7 to 11 × 14 to 17 µm) with two or more vertical cell walls, and were smooth and brown. Urediniospore and teliospore morphology and dimensions were consistent with the description of Pucciniastrum vaccinii (G. Wint.) Jørst (syn. P. myrtilli Arth.) (1). A pathogenicity test was conducted with 18-month-old cv. Bluegold plants. Fully expanded leaves were sprayed, using a hand-held sprayer, with freshly collected urediniospores (1 mg of spores per ml of 0.05% water solution of Tween 20), covered with plastic bags, and placed in a growth chamber at 20°C for 48 h with 12 h of light per day. The plastic bags were then removed and the plants mantained in a greenhouse. After 10 days, orange rust pustules similar to the original symptoms developed on all plants. As the rust was not reported on ornamental Ericaceae in Argentina, and hemlock, the alternate host, is not present in the area, it is suggested that P. vaccinii is cycling on blueberry. This is the first report of P. vaccinii on blueberry in Argentina. Reference: (1) P. R. Bristow and A. W. Stretch. 1995. Pages 20-22 in: Compendium of Blueberry and Cranberry Diseases. F. L. Caruso and D. C. Ramsdell, eds. American Phytopathological Society, St. Paul, MN.

Morphocultural variants of Septoria tritici isolates.

This is a morphocultural study under in vitro and in vivo condition on some Septoria tritici variants mainly originated from isolates collected from cultivars bearing Bobwhite 'S' and Kavkaz germplasm. The objective was to show the variability in cultural and morphobiometrical characters of atypical isolates (variants) derived from these germplasms and discuss the relationship with the pathogen's adaptative process. The isolates were grown on potato dextrosa agar and studies with the optical and scanning electron microscope were performed. The thallus behaviour and the vegetative structures were described. It was confirmed that these atypical structures belong the S. tritici thallus. Under in vivo condition the isolates developed typical leaf blotch lesions with normal pycnidia. These contained cylindrical cells or pycnidiospores smaller than spores of the "wild type". Possible reasons for the origin of these variants of S. tritici are considered.

Spontaneous bacterial empyema in cirrhotic patients: a prospective study.

Spontaneous bacterial empyema (SBEM) is an infection of a preexisting hydrothorax in cirrhotic patients and has seldom been reported. To determine its incidence and primary characteristics, all cirrhotic patients with pleural effusion underwent thoracentesis at our hospital either on admission or when an infection was suspected. Pleural fluid (PF) study included biochemical analysis, polymorphonuclear (PMN) leukocyte count, and culture by two methods: conventional and modified (inoculation of 10 mL of PF into a blood culture bottle at the bedside). SBEM was defined according to previously reported criteria: PF culture positive or PMN count greater than 500 cells/micro L, and exclusion of parapneumonic effusions. Sixteen of the 120 (13 percent) cirrhotic patients admitted with hydrothorax had 24 episodes of SBEM. In 10 of the 24 episodes (43 percent), SBEM was not associated with spontaneous bacterial peritonitis (SBP). PF culture was positive by the conventional method in 8 episodes (33 percent) and by the modified method (blood culture inoculation) in 18 (75 percent) (P = .004, McNemar). The microorganisms identified in PF were Escherichia coli in 8 episodes, Streptococcus species in 4, Enterococcus species in 3, Klebsiella pneumoniae in 2, and Pseudomonas stutzeri in 1. All episodes were treated with antibiotics without inserting a chest tube in any case. Mortality during treatment was 20 percent. We conclude that SBEM is a common complication of cirrhotic patients with hydrothorax. Almost half of the episodes were not associated with SBP; thus, thoracentesis should be performed in patients with cirrhosis, pleural effusion, and suspected infection. Culture of PF should be performed by inoculating 10 mL into a blood culture bottle at the bedside.

[In vitro tests of the antagonistic behavior of Trichoderma spp. against pathogenic species of the horticultural region of La Plata, Argentina]. / Ensayos in vitro del comportamiento antagónico de Trichoderma spp. frente a especies patógenas de la zona hortícola de La Plata, Argentina.

The antagonistic properties of seven Trichoderma species in front of the pathogens Fusarium oxysporum, F. equiseti, F. solani, Sclerotinia sclerotiorum, S. minor, Rhizoctonia sp. and Sclerotium rolfsii was evaluated in vitro. Those microorganisms were isolated from horticultural soils of La Plata in order to test the antagonistic-pathogenic relationship. Dual cultures on PDA 2% were used. All the species of Trichoderma grew in the culture medium with a colonization value higher than 50%. Differences in the antagonistic behaviour of the pathogens were observed depending on the species with which they interacted. The presence of diffusible metabolites to the medium was demonstrated in almost 80% of the pathogens antagonists tested.

[Porphyria cutanea tarda and human immunodeficiency virus infection]. / Porfiria cutánea tarda e infección por el virus de la inmunodeficiencia humana.

Recently, cases of porphyria cutanea tarda (PCT) have been reported associated with infection due to human immunodeficiency virus (HIV). We presented the cases of three males, former ethanol users, and which have had previously a contact with the Hepatitis B virus. In one of the patients symptomatology appeared after treatment with zidovudine was begun. We suggest that HIV infection associated with other toxic or viral factors could contribute to the early development of a PCT latent until that moment.

[Doppler echocardiography assessment of cardiac abnormalities in parenteral drug addicts]. / Valoración de las alteraciones cardíacas por ecocardiografía-Doppler de los pacientes adictos a drogas por vía parenteral.

We studied by Echocardiographic-Doppler 114 consecutive intravenous drugs addicts (IVDA); 91 were positive human immunodeficiency virus (HIV+) and 23 negatives. We classified them in five groups; beginning the negative HIV as group 0, and groups I to IV stratified according the Central Disease Control (CDC) classification. We compared the cardiac abnormalities founded between themselves and a control group presumed healthy persons of similar age. The cardiac cavities dimensions showed a statistic significant increased left ventricular end-systolic and diastolic diameters, right ventricular diameter, posterior wall and interventricular septum thickness and aortic root diameter compared with the control group; but all were in the normal range for age. The left ventricular fractional shortening was statistically different from control group related the other groups, and the group IV related other. The existence and severity of pericardial effusions were directly related to the illness stage. We founded moderate pericardial effusions in 25% patients in the 0 to III groups, increasing until 50% in the group IV. The presence of valvular vegetations, nearly 30% in our series, ought to the IVDA. We did not found relationship between the severity of valvular incompetence and the illness stage. We recorded a excellent correlation between the ratio T4/T8 lymphocytes with the progress of illness and the existence and severity of cardiac abnormalities.

Adrenocorticotropin administration increases testosterone secretion in adult male rats.

It appears that the effect of acute administration of pituitary-adrenal hormones on the pituitary-gonadal axis is species-dependent. However, no information is available with regard to the effect of acute adrenocorticotropin (ACTH) administration on testosterone secretion in rats. The present data indicate that acute ACTH administration can increase serum testosterone levels without modifying luteinizing hormone (LH) levels. Since this rise was not observed in castrated rats, it must be assumed that increased serum testosterone was of gonadal origin. The action of ACTH on testosterone secretion was likely an indirect one since there is no evidence at present for a direct, short-term action of the pituitary-adrenal axis on Leydig cell function.

Hallazgos en el contenido del íleon terminal obtenido por sonda de Miller-Abbott en un caso humano de Hymenolepiasis (H) nana

Los autores describen los elementos encontrados en el contenido íleal de un caso de Hymenolepis (H) nana, intubado con la sonda de Miller-Abbott. En el que previamente y durante dos meses se tomaron todas las medidas necesarias que aseguraron la imposibilidad de infestación externa(AU)