Phosphine-functionalized NHC Ni(ii) and Ni(0) complexes: synthesis, characterization and catalytic properties.

Two families of nickel complexes bearing chelating diphenylphosphine-functionalized NHC ligands [NiII(ArNHCPPh2)(allyl)]Cl 1a (Ar = Mes); 1b, (Ar = 2,6-iPr2-C6H3) and [Ni0(ArNHCPPh2)(alkene)] 2a (Ar = 2,6-iPr2-C6H3, alkene = styrene); 2b (Ar = 2,6-iPr2-C6H3, alkene = diethyl fumarate) have been prepared and fully characterized. VT-NMR experiments in solution reveal that the allyl derivatives 1a-b are stereochemically nonrigid. The solid-state structure of the Ni0 derivative 2b is also reported. These complexes display interesting catalytic properties in various cross-coupling reactions. The precatalyst [Ni0(ArNHCPPh2)(styrene)] 2a was found to be the most active system. The bulkiness of the N-substituent on the imidazole ring and the low oxidation state of the metal center in 2a accounted for its enhanced catalytic performance. This system catalyzed effectively the coupling of (hetero)aryl chlorides with a range of nucleophiles including Grignard reagents, boronic acids, secondary amines and indoles.

Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism.

The assessment of risk and appropriate treatment of patients with acute pulmonary embolism (PE) remains a challenge. The prognostic performance of cardiac troponin I (cTnI) in predicting 30-day all-cause mortality was prospectively assessed in consecutive haemodynamically stable patients with PE. The present study included 318 haemodynamically stable patients with PE. During the 30-day study period, 23 (7%) patients died. cTnI was elevated (>or=0.1 ng x mL(-1)) in 102 (32%) patients. An age >65 yrs, systolic blood pressure <120 mmHg and severity of illness assessed using the PE severity index (PESI) were significantly associated with an increased risk for mortality, but no significant association was found between elevation of cTnI and 30-day mortality in a logistic regression analysis. When only fatal PE was considered, multivariate analysis showed that severity of illness using the PESI and an elevated cTnI (odds ratio 3.7, 95% confidence interval (CI) 1.1-12.8) were associated with a significant increase in the risk for death. The negative predictive value (95% CI) of a negative cTnI for mortality was 93 (90-97)%. In conclusion, in haemodynamically stable patients with acute pulmonary embolism, cardiac troponin I was not an independent predictor of 30-day all-cause mortality, although it did predict fatal pulmonary embolism.

Eosinophil-selective mediators in human strongyloidiasis.

Strongyloides stercoralis infection is characterized by the production of IgE and eosinophils in peripheral blood. Experimental studies have demonstrated that eosinophils play an important role in protection against Strongyloides stercoralis, but the mechanisms regulating eosinophils are not known. In this study we have focused on analysing the molecules that selectively regulate eosinophil migration, namely eotaxin and interleukin-5 (IL-5), using an enzyme-linked immunosorbent assay in patients with strongyloidiasis. Serum expression of eotaxin and IL-5 were significantly increased in patients compared with the control group. This rise suggests that selective mediators of the eosinophil can have a role in immunity against S. stercoralis in human infection.

Routine use of pleural fluid cultures. Are they indicated? Limited yield, minimal impact on treatment decisions.

In pleural infection, it has been recommended that Gram stain and cultures should be obtained on a routine basis. However, this recommendation has not been tested prospectively. We evaluated the yield of microbiological studies in 259 patients with parapneumonic pleural effusion. Microbiological studies were positive on the pleural fluid of 50 patients (19.3%). In 48 of the 50 patients with positive microbiological results (96%), the need for pleural drainage was correctly predicted by pleural fluid parameters. There were no differences in hospital stay (9.5+/-2.5 days versus 9.9+/-3.2 days, P=0.68) or in mortality (2 deaths in each group, P=0.58) between the group of patients in which antibiotic treatment was changed according to microbiological results and the group of patients in which it is not. In conclusion, this study demonstrates that, at least in our institution, routine microbial investigation of pleural fluid adds very little to the standard management of parapneumonic effusions.

Relación de parámetros bioquímicos de estrés con índices de masa ósea / Relationship between biochemical factors associated to stress and bone mass indexes. AEBM reference 2003 award

Objetivos. Pretendemos observar si algunos de los parámetros bioquímicos asociados al estrés (cortisol plasmático y metanefrinas urinarias), se relacionan directamente con la aparición de osteoporosis en mujeres postmenopaúsicas, y por lo tanto, con una disregulación inmune, objetivable por alteraciones en factores bioquímicos como las citoquinas osteoclastogénicas (IL-1 e IL-6). Material y Métodos. En una cohorte de 173 mujeres, medimos cortisol, IL-1, IL-6, fosfatasa ácida tartrato-resistente (FATR) y metanefrinas urinarias, así como su densidad mineral ósea (BMD), en columna lumbar (L2-L4) y en cuello de fémur. Resultados. Obtuvimos una relación estadísticamente significativa (p<0.05), para las siguientes asociaciones: BMD en columna lumbar (L2-L4) y en cuello de fémur, respecto a metanefrinas urinarias (p=0.0319 y p=0.0234, respectivamente); IL-1-cortisol (p=0.0198); FATR-cortisol (p=0.015) e IL-6-FATR (p=0.016). Conclusiones. Existe una relación directa entre BMD disminuida y una elevación en un parámetro de estrés (metanefrinas urinarias), así como entre IL-1 y FATR con respecto a cortisol plasmático (índice bioquímico de estrés) (AU)

Índices bioquímicos de remodelado óseo y su relación con índices densitométricos de masa ósea / Biochemical markers of bone resorption and its relationship with the bone mass density index

El diagnóstico de osteoporosis y la identificación de pacientes con alto riesgo de fractura ha sido facilitada por el desarrollo de las técnicas densitométricas que permite definir la osteoporosis en base a las medidas de densidad de masa ósea. La medida de marcadores bioquímicos de recambio óseo, combinados con los resultados de las medidas de densidad de masa ósea podrían constituir un diseño que permita seleccionar poblaciones con alto riesgo de padecer osteoporosis. Con este objeto hemos analizado las relaciones existentes entre determinadas variables densitométricas (BMD, BMC, T score) y bioquímicas (FATR, Osteocalcina, PTH, Calciuria en ayunas), en 80 pacientes de la población de la provincia de Granada que hemos clasificado en base a diferentes variables densitométricas y clínicas relacionadas con su masa ósea. Hemos encontrado elevaciones significativas de la tasa de FATR en pacientes con osteoporosis respecto al grupo de pacientes de BMD normal, así como en el grupo establecido en base á la presencia o ausencia de fracturas en el que el aumento de resorción ósea se manifiesta tanto en la elevación de la excreción de calcio como en la tendencia de la FATR a elevarse, así como en la correlación negativa de esta enzima con los parámetros densitométricos de masa ósea. En base a estos resultados concluimos que existen indicios de que la FATR podría ser utilizada como marcador de resorción ósea así como indicador de riesgo de fractura. (AU)

Etiology and frequency of gas exchange abnormalities in cirrhosis.

OBJECTIVE: gas exchange abnormalities are frequent in cirrhosis. These abnormalities can be considered an indication or contraindication for liver transplantation. The aim of this study was to investigate the etiology and frequency of these alterations. METHOD: seventy-eight patients with cirrhosis and 20 healthy subjects were selected randomly. Arterial basal blood gases, diffusing capacity of carbon monoxide (DLco), pulmonary function test (PFT) and contrast transthoracic echocardiography (CTTE) with 0. 9% saline were done. RESULTS: patients showed lower DLco (79 +/- 23. 2 vs 96 +/- 20; p < 0.01), lower PaCO2 levels (32.2 +/- 4.5 vs 37.5 +/- 4; p < 0.001) and higher alveolar-arterial oxygen difference (AaPaO2) (22.5 +/- 11.4 vs 12 +/- 7.4; p < 0.001) than controls, but the difference between groups in mean PaO2 levels was not significant. Twenty-three patients (29.5%) had pulmonary vasodilatation (PV) and 28 (36%) altered PFT. Hypocapnia was the most frequently observed alteration in gas exchange (73.4%). Hypoxemia and decreased DLco were more frequent in the presence of altered PFT than in the presence of PV. Both PFT abnormalities and PV were associated with increased AaPaO2. Child stage was higher in patients with PV (7.9 +/- 2.3 vs 9.2 +/- 2; p = 0.01) than in those without PV. CONCLUSIONS: gas exchange abnormalities are frequent in cirrhosis. The most frequent alteration is hypocapnia, which is associated with PV. The main cause of severe hypoxemia in these patients is PFT abnormality. Pulmonary vasodilatation is more frequent and more severe in patients with advanced hepatocellular dysfunction.

Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography: advantages over contrast transthoracic echocardiography.

The aim of this study was to study the prevalence of hepatopulmonary syndrome (HPS) in cirrhotic patients, comparing the results obtained using contrast transthoracic echocardiography (CTTE) and contrast transesophageal echocardiography (CTEE) in the demonstration and grading of pulmonary vasodilatation (PV). We also analyzed the correlation between gas-exchange abnormalities and PV when it was demonstrated with both techniques. The prevalence of PV and HPS with CTEE in the 88 cirrhotic patients was 28% and 22%, respectively, and with CTEE, 42% (P < 0.05) (middle PV: 35% and significant PV: 7%) and 30% (P < 0.05), respectively. Fifty-six percent of patients diagnosed with PV and with CTTE presented with hypoxemia as did 49% using CTEE (83% of patients with significant PV had hypoxaemia). PaCO2 and diffusing capacity of CO were significantly more decreased in patients with PV than in patients without PV when CTEE was employed. We conclude that CTEE is superior to CTTE in the diagnosis and grading of PV in the diagnosis of HPS in cirrhotic patients, being more sensitive and presenting a better correlation with gas-exchange abnormalities. Given its high sensitivity, CTEE should be carried out in all patients with suspicion of HPS and normal or uncertain CTTE.

[Acute hepatic failure and Hodgkin's disease]. / Insuficiencia hepática aguda y enfermedad de Hodgkin.

We present the clinical outcome and imaging micro and macroscopic of a patient who died of e liver acute failure. Hodgkin disease with massive infiltration was found at necropsy. We offer a review of the liver complaint in this particular disease.

A case of secondary pulmonary hypertension due to microscopic pulmonary tumor cell embolism from gallbladder carcinoma.

We describe a case of subacute cor pulmonale caused by tumor embolism from a gallbladder carcinoma in a 63-year-old woman. The patient was admitted to hospital with increasing dyspnea. Physical examination and echocardiography showed signs of pulmonary hypertension. She died of circulatory failure. At autopsy microscopic studies revealed tumor embolism in the pulmonary vessels and subsequent lesions causing the lethal pulmonary hypertension. This is the first case report of pulmonary hypertension caused by embolism from a gallbladder carcinoma in the literature worldwide.

[Hepatitis B markers at 3 open centers for mentally retarded]. / Marcadores de la hepatitis B en tres centros abiertos para disminuidos psíquicos.

With the aim of investigating the prevalence of hepatitis B virus infection, we studied 161 mentally retarded patients with an age range of 1 to 56, in three open institutions from the Safor Area (Valencia). Some positive serum markers of HBV infection were found in 15 patients (9.3%). The mentally retarded older than 17, presented a prevalence of HBV markers (20.6%), in contrast to those under this age (1.1%) and against the control group (5.1%) (p < 0.001). HBsAg positive markers were found in three cases, representing 4.4% among the older than 17's, against 0.4% of the general population (p < 0.05). There was some positive correlation with personal history of hepatitis (p < 0.01) and severely handicapped patients (p < 0.05) an there was no association with sex, duration of stay and Down's Syndrome. Our results indicate that seropositive B prevalence is similar to the general population in the mentally retarded younger than 17 years old and higher from this age on, which confirms the need for active prophylaxis in the youngest of this collective. Reviewing the Spanish studies we observe a lower prevalence of HBsAg(carriers) and HBV markers in open institutions than in closed institutions.

Endobronchial hamartoma resected by rigid bronchoscope.

Endobronchial hamartomas are not very common and they are usually symptomatic because of bronchial obstruction. The diagnosis is made by fiberoptic bronchoscopy of thoracotomy and there are several possibilities of treatment but until now the most common has been surgical resection. We report the case of a man with an endobronchial hamartoma who was diagnosed by fiberoptic bronchoscopy and successfully treated by rigid bronchoscopy.

[The liver and AIDS]. / Hígado y SIDA.

Hepatic disorders in AIDS are very common, although the injuries observed are usually non-specific. This is the reason why the real usefulness of hepatic biopsy in this patients is being currently discussed. In this work, such aspect and the hepatic injuries observed in patients with AIDS are discussed. Current indications for hepatic biopsy are summarized, as well as its later manipulation in order to obtain maximum profitability of it.