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We screened BRCA1 and BRCA2 germline mutations in 60 high-risk breast and/or ovarian cancer patients and 20 relatives from Aragon (Spain) by DHPLC (Denaturing High Performance Liquid Chromatography) and direct sequencing of the entire coding sequence and the splicing sites of both genes. We have identified 17 different pathogenic mutations: 8 in BRCA1 and 9 in BRCA2 in 60 unrelated patients and 50% of relatives were carriers. The prevalence of pathogenic mutations in this study was 33.33%. Two truncating mutations are novel: c.5024_5025delGA in exon 16 of BRCA1 and c.2929delC in exon 11 of BRCA2 (numbered after GenBank U14680 and U43746). Multiplex Ligation Dependent Probe Amplification (MLPA) was performed for large mutational scanning of both genes and a large genomic deletion in BRCA1 was found (DelEx8-13). Furthermore, five mutations are described for the first time in Spanish population: c.1191delC, c.3478_3479delTT and c.6633_6637delCTTAA (BRCA1) and c.3972_3975delTGAG and 3908_3909delTG (BRCA2). Three mutations have been reported previously once in Spain: c.3600_3610del11 (BRCA1), c.5804_5807delTTAA (BRCA2) and c.9246C>A (BRCA2). The mutation c.5374_5377delTATG has been found before only in two unrelated families from Castilla-Leon, Spain (BRCA2). Frequent mutations described in Spanish population have also been present: c.187_188delAG, c.5242C>A and c.5385insC in BRCA1 and c.3492_3493insT and c.9254_9258delATCAT in BRCA2. c.5242C>A, 3972_3975delTGAG and c.5804_5807delTTAA were the recurrent mutations found. Fifteen different unclassified variants were identified (25% families). Although specific BRCA1 and BRCA2 mutations are recurrently reported as a result of genetic founder effects we conclude that heterogeneous ethnicity increases the variety of mutations that can be found in Spanish populations.

Cytokine balance alterations are responsible for some of the systemic and hepatic manifestations of alcoholism. The present study was aimed to evaluate the influence of both acute alcohol abstinence (in alcoholics) and acute alcohol intake (in healthy subjects) on serum IL-6, IL-8, IL-10, and IL-12 levels. Serum cytokine concentrations were determined on admission and after a median of 6 days of ethanol abstinence in 29 patients with alcohol withdrawal syndrome. The same determinations were made in five healthy volunteers at baseline and after 36 h of a single 60 g-dose alcohol intake. Increased serum levels of IL-6, IL-10 and, to a lesser extent IL-8, declined in the few days after alcohol abstinence in patients with alcohol withdrawal syndrome. Serum IL-8 values increased after alcohol intake in healthy subjects. Rapid variation of serum cytokine levels along with alcohol intake or abstinence should be taken into account in cytokine studies in alcohol abusers.

It has been reported that total serum IgE is increased in patients with alcoholic cirrhosis, but it is not clear if this fact is related to alcoholic liver disease or to alcohol intake.To measure serum IgE in a group of chronic alcoholics with different stages of liver injury in order to elucidate if IgE increase in related to alcoholic liver damage.Total serum IgE was determined by enzyme immunoassay in 186 chronic alcoholic patients (137 male/49 female) and 101 healthy controls. Patients and controls with known reasons for IgE elevation were excluded. Among alcoholic patients, 24 had fatty liver, 28 hepatic fibrosis, 29 alcoholic hepatitis, and 67 liver cirrhosis (38 patients were not evaluable concerning liver injury).Total serum IgE was found to be increased in alcoholics (median 154.5 IU/mL, range 1-7329 IU/mL) with respect to healthy controls (median 20 IU/mL, range1-1417 IU/mL) (P0.001). IgE increase was moderate (180-1000 IU/mL) in 60 alcoholics (32.3%) and marked (1000 IU/mL) in 27 (14.5%). Male alcoholics had higher IgE levels than females (median 191 IU/mL and range 1-7329 IU/mL vs 105 IU/mL and range 2-2189 IU/mL) ( P = 0.009). On logistic regression analysis, alcoholism, male sex and younger age (but not smoking) were independently associated with higher IgE levels. No clear relationship was noted between serum IgE and severity of alcoholic liver disease. Thus, no correlation was observed between IgE and parameters of liver function (serum bilirubin, albumin or prothrombin index). Likewise, IgE concentrations were not significantly different in patients with liver cirrhosis with respect to patients with less severe liver disease. Serum IgE was increased (180 IU/mL) in 47.8% of cirrhotics and in 44% of patients without liver cirrhosis. In contrast, other immunoglobulins (IgG, IgA and IgM) were significantly correlated with liver dysfunction.Chronic alcoholism should be considered as a cause of increased total serum IgE, regardless of the severity of the underlying liver disease.

There is an overexpression of cyclo-oxygenase 2 (COX-2) in Barrett's oesophagus (BO).To determine the long-term effect of a COX-2 inhibitor on cellular mechanisms involved in BO.A randomized controlled trial was conducted in BO patients allocated to continue the usual proton pump inhibitor (PPI) alone treatment, or PPI combined with rofecoxib (25 mg/day) for 6 months. Cell proliferation index and COX-2 expression in BO glands was determined in biopsy specimens at baseline and after treatment. Cell apoptosis, cyclin D1, p53 and vascular endothelial growth factor (VEGF) expression was also explored in a subset of patients. Student-t test and the U-Mann-Whitney test were used for quantitative and ordinal variables.Of 62 patients, 58 completed the study. A higher proportion of patients on rofecoxib + PPI exhibited a decrease in COX-2 expression compared to those treated with PPI alone, but cell proliferation index was not affected. Unlike PPI alone, rofecoxib + PPI was associated with an increase in the apoptotic cell index, a decrease in p53 cell staining and VEGF expression in mucosal vessels. No effect on low-grade dysplasia or cyclin D1 was observed.The addition of rofecoxib to PPI therapy does not affect cell proliferation index in BO cells after 6 months of therapy, but does reduce COX-2 and VEGF expression and increases cell apoptosis.

We studied the rate of apoptosis in the placental tissue of pregnancies complicated with intrauterine growth retardation (IUGR) and compared it with the results obtained in normal placentas. Our results clearly demonstrate a strongly increased rate of apoptosis in placentas of children born with IUGR, suggesting severe placental dysfunction. The significance of these findings needs further study.

To investigate the possibility of altered gene expression of growth factors in prenatal growth retardation, we assessed expression of the genes for insulin-like growth factor-I (IGF-I) and epidermal growth factor receptor (EGFR) by RT-PCR from human placentas at term delivery in two groups: appropriate for gestational age (AGA) and pregnancies complicated with IUGR. The placentas from IUGR gestations showed reduced IGF-I expression with a significance of p = 0.008, whereas we did not find any significant differences in EGFR gene expression.

Background: Withdrawal syndrome is a hallmark of alcohol dependence. The characteristics of alcohol consumption, closely related to dependence, could influence the development of alcoholic liver disease. The study aimed to investigate if patients with severe alcohol withdrawal syndrome have a peculiar profile of liver disease. Methods: The study included 256 heavy drinkers (aged 19–75 years, 70.3% males) admitted to an Internal Medicine Department. Patients admitted for complications of liver disease were not included. Severe alcohol withdrawal syndrome (seizures, disordered perceptions, or delirium) developed in 150 patients (58.6%). Alcohol consumption (daily quantity, duration, and pattern [regular or irregular]) was assessed by questionnaire. Liver biopsy was performed in all cases. Results: Patients with alcohol withdrawal syndrome showed a lower prevalence of liver cirrhosis and a higher prevalence of alcoholic hepatitis than patients without it. The negative association of alcohol withdrawal syndrome with liver cirrhosis persisted after we adjusted for sex, daily intake, duration, and pattern of alcohol consumption. Alcoholic hepatitis was independently associated with the irregular pattern of alcohol consumption, which was closely associated with severe alcohol withdrawal syndrome. Conclusions: The profile of liver injury is different in heavy drinkers who develop and who do not develop a severe alcohol withdrawal syndrome when admitted to the hospital.

HBV, HCV, and HIV have some transmission routes in common. Viral liver disease is a leading cause of mortality in HIV-infected patients. The study was aimed at evaluating the prevalence of HBV and HCV markers in subjects with different risk practices for HIV infection.A total of 699 subjects were studied Of these subjects, 517 were intravenous drug users (373 HIV-positive and 144 HIV-negative), 127 had heterosexual risk practice (66 HIV-positive and 61 HIV-negative), 31 had homosexual risk practice (all HIV-positive), 15 had post-transfusional HIV infection, and nine had HIV infection of unknown source. Patients with anti-HBc antibody were considered HBV-positive, and cases with anti-HCV antibodies were considered HCV-positive.Among patients with HIV infection, most intravenous drug users (79%) had markers of both HBV and HCV, compared with 20%, 11%, and 10% of cases infected by transfusional, heterosexual, and homosexual route, respectively (p0.001). Absence of both HBV and HCV markers was observed in most HIV-positive heterosexuals (62%) compared with 40% of post-transfusional cases, 32% of homosexuals and 4% of intravenous drug users (p: NS, p = 0.009, and p0.001, respectively). Isolated HBV-positivity was the most frequent pattern in HIV-infected homosexuals (58%), compared with 27% of post-transfusional, 21% of heterosexuals and 11% of intravenous drug users (p: NS, p0.001 and p0.001, respectively). HIV-negative intravenous drug users had a lower prevalence of HBV/HCV association than HIV-positive cases (p0.001). Isolated HCV-positivity was more frequent in HIV-negative than in HIV-positive intravenous drug users (27% vs. 6%, p0.001). In heterosexuals, isolated HBV-positivity was more prevalent in HIV-positive than in HIV-negative cases (21% vs. 7%, p = 0.04).HBV and HCV seroprevalence in HIV infected patients vary depending on the risk practice. This suggests a variable transmissibility depending on the route considered. Within the same risk practice, differences in HCV and HBV seroprevalence between HIV-positive and HIV-negative cases suggest that some factors associated with HIV infection may influence the rate of infection by HCV and HBV.

To determine the clinical manifestations of the relapse of the tuberculosis (TB) in the patients infected by the human immunodeficiency virus (HIV) and the degree of immunodeficiency shown.They are analyzed retrospectively 121 cases, all they HIV+, diagnosed of TB from November of 1985 until December of 1999. All they fulfilled correctly the specific treatment of the tuberculosis.Of 121 studied cases, a total of 13 (10.7%) presented relapse of tuberculosis finally of a mean of 31.8 months (range 1-95). In 7 cases the affectation was pulmonary (2 typical, 5 non typical), in 3 mixed (pulmonary and extrapulmonary) and in 3 extrapulmonary. The clinical sintomatology were present in 92% of the cases and, predominantly, was: fever (92%), cough (69%), sweating, weight loss (61%). Hepatomegaly results be the exploratory finding quite frequent (54%). The mean of CD4+ lymphocytes was 141.7 (range 3-406), in 8 (61%) the lymphocyte counts was inferior to 100 cells/mm3. PPD was positive in 1 case (14%) and with respect to delayed-type hypersensitivity reaction test, it was observed not normoergia in all the cases (100%).Relapse of the tuberculosis in patient infected by the VIH is presented with a manifested clinical expresivity in the course of a severe degree of immunodeficiency. In certain groups of risk as the intravenous drugs users, it must of be had a high level of suspicion of the relapse of the disease, above all in those patients that show low CD4+ lymphocyte counts.

To analyse the clinical manifestations and performance of the diagnosis methods in tuberculosis (TB) diagnosed in patients with human immunodeficiency virus infection (HIV), according to the location forms of disease (LF).We revised 80 cases of TB diagnosed in patients with infection by HIV. The data were gathered in relation to TB location, the clinical data and the microbiological and histological diagnosed studies. In the statistic analysis the values p0.05 were taken into account.The prevalence of LF was: 1) pulmonary forms (PF) 32 (40%), of which 12 were typical pulmonary (TP) and 20 atypical pulmonary (AP); 2) mixed forms (MF) 21 (26%); 3) extrapulmonary forms (EF) 19 (24%), of which 17 were lymphadenitis; 4) miliary tuberculosis (MT) 8 cases (10%). The prevailing symptoms were: fever (71%) mainly in MF and MT, cough (69%), with less frequency in AP, EF and MT (p0.05) and adenomegalies especially in EF and MF. The diagnosis was based on the study of the sputum smears and lymph node. The bacilloscope of the spontaneous sputum was 53% with a minor performance in the AP (p0.05), while in lymph node the smear for AFB was positive in 78% cases and caseous granulomas were observed in 87%.In our study the major confirmed locations were pulmonary and lymph node, the most important clinical symptoms were fever, cough and adenomegalies. The diagnosis was based, in the most of cases, on the microbiologic and histologic examination of bronchial secretion and lymph node samples.

A retrospective study of 80 HIV patients diagnosed with tuberculosis was carried out in order to evaluate the clinical presentation of tuberculosis (CPT) in relation to the degree of HIV-induced immunodeficiency, as determined by the CD4 lymphocyte count and reactivity to the tuberculin and delayed-type hypersensitivity reaction (DHR) skin tests by applying 2TU of RT-23 tuberculin, and the Muiltest IMC Merieux, respectively. CPT classification was undertaken on the basis of the location of the disease: pulmonary tuberculosis (PT), distinguishing between typical pulmonary (TP) and atypical (AP) according to the radiological pattern; extrapulmonary (ET); mixed tuberculosis (MT) pulmonary and extrapulmonary; and miliary tuberculosis. The CD4 lymphocyte count was 264.6 +/- 226.8, the TP had the highest number (505), MT had 132 (p < 0.001) and the miliary tuberculosis had 148 (p < 0.001), the lowest. The tuberculin skin test was positive in 35%, of which 11% were MT (p < 0.05). In the delayed-type hypersensitivity reaction, 67% were non-normoergic, of which 95% and 100% were MT and miliary tuberculosis, respectively (p < 0.05). There was a good overlap between CD4 depletion and skin tests. TP exhibited moderate immunodeficiency, AP severe immunodeficiency, and mixed and miliary TB extremely high immunodeficiency.

A 60 year-old white woman presented with sudden painless dysphagia, hoarseness and dysphonia. A diagnosis of sarcoidosis was made based on bilateral hilar lymphadenopathy, gallium uptake, elevated serum angiotensin-converting enzyme levels, as well as non-caseating granulomatous lymphadenitis in a prescalenic node. Symptoms were attributed to isolated vagus neuropathy, a rare form of presentation of neurosarcoidosis.

Malnutrition is one of the most important causes of normal growth disruption. Anthropometric methods are highly valuable in clinic pediatric diagnosis to determine the nutritional status of children and as recovery monitoring. In previous studies, we have demonstrated that the standards weight-age, height-age and weight-height of growing rats had similar distribution to those in normal children. However, to improve the diagnostic effectiveness of anthropometric information, statistical analysis to normally and non-normally distributed variables should be applied. One hundred Wistar rats (50 male and 50 female rats) from weaning (day = 25, weight = 35-40 g) to 70 days of age were fed with a commercial diet. Water and diet were offered "ad libitum". Body weight and height were recorded every two or four days, respectively. Percentiles of weight vs age, height vs age and weight vs height were plotted for male and female rats. The statistical criterion for classifying the anthropometric measurements into nutritional categories was based on percentiles cutoff and Z-score. The Z-score was calculated according to: Z = (standard mean value-subject value/standard deviation of standard). The statistical anthropometric categories of growing rats were similar to those obtained in children. This evidence suggest that the rat can be used as an experimental model to infer and predict the nutritional response in children.

Background It has been reported that total serum IgE is increased in alcohol abusers, but the mechanisms responsible are not known. Production of IgE depends on B-cell stimulation by both antigens and some cytokines, particularly IL-4 and IL-13. Chronic alcoholism and alcoholic liver disease are accompanied by changes in cytokine production. Aim of the study To evaluate if IgE increase in alcoholics could be associated to a ethanol-induced imbalance of the cytokine profile. Patients and methods A total of 65 patients (53 males and 12 females, aged 47 ± 12 years), admitted to the hospital because of ethanol abstinence symptoms entered the study. On admission, total serum IgE was measured by chemiluminescent EIA and serum IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, and interferon-gamma were measured by ELISA. Data were compared with those of 40 healthy control subjects. Results Serum IgE, IL-6, IL-8, IL-10, IL-12, and IL-13 were found to be high in alcoholic patients compared with healthy volunteers. Some parallelism was observed between serum IgE and both serum IL-10 and IL-13 were increased in alcoholics. Conclusions Total serum IgE elevation in alcoholics with abstinence syndrome is accompanied by an increase of some type 2 cytokines. Ethanol-induced alterations in the cytokine profile may contribute to increased IgE levels in alcoholics.

Liver involvement in non-Hodgkin's lymphoma is relatively frequent, being found in approximately half of the post-mortem studies. However, the clinical presentation of lymphoma mimicking primary liver disease is uncommon. A case of non-Hodgkin's lymphoma (the recently described T-cell-rich B-cell lymphoma variant) is presented, where the initial and predominant manifestations were of hepatic origin, resembling non-neoplastic acute liver disease.

To analyze the clinical characteristics and diagnose of tuberculosis in patients infected by human immunodeficiency virus in our setting.We have revised the clinical, microbiological and histological characteristics of 92 cases diagnosed tuberculosis in seropositive patients, during a span time of 128 months.Of them, 71 were male and most of them (81.5%) were intravenous drugs users. The most (93.4%) were sintomatic when tuberculosis was diagnosed mainly fever and general and respiratory sintomatology. The most common signs were the presence of lymphadenopathies and hepatomegaly. The tuberculosis affected mainly pulmonary and ganglionary system. 34 cases had only pulmonary pathology, 24 extrapulmonary, 25 pulmonary and extrapulmonary and 9 miliary. The tuberculosis diagnose was based in microbiologic criteris. The most frequent source, as histologic critery, has been the ganglionary tissue.The only or associated pulmonary forms are more frequent. The most commonly extrapulmonary form is the ganglionary localization. The most of diagnose methods were obtained from respiratory tract and lymphadenopathy samples.

Cardiac arrhythmias might explain cases of sudden death in alcoholics during ethanol abstinence.To evaluate QT interval (and its outcome) in patients with alcohol withdrawal syndrome.Sixty-two patients (52 male and 10 female, mean age 43.7 years, range 18-71 years), admitted to the hospital as a result of alcohol abstinence syndrome (tremulousness in 7 cases, agitation in 12 cases, delirium tremens in 11 cases, and seizures in 32) were studied. The QT interval was measured on 12 lead ECGs performed on admission in all cases. QTc was obtained using Bazett's formula. In 27 patients a second ECG was performed during hospital stay. Results. Mean QTc interval on admission was 439 +/- 32 ms (range 350-525 ms); 29 patients (46.8%) showed a prolonged (440 ms) QTc interval. No significant differences were observed between patients with normal and high QTc values as regards to age, sex, type of withdrawal syndrome, duration of abstinence, liver function tests, serum electrolytes or blood cell counts. In cases where two ECG recordings could be evaluated (n = 27), the mean QTc interval was significantly shorter in the latter than in the former (417 +/- 26 ms versus 447 +/- 30 ms, respectively, p0.001). Eight patients found to have prolonged QTc on admission had a second ECG performed on them after complete recovery from withdrawal symptoms. In all these cases the QTc interval eventually became normal.The QTc interval is frequently prolonged during alcohol withdrawal syndrome and tends to become normal over time, along with remission of abstinence symptoms.

Erythropoietin (EPO) is a glycoprotein which appears as the primary regulator of erythropoiesis under either normal or most of the pathologic conditions. In the rat with experimentally-reduced erythropoiesis, daily administration of 1.3 IRP units can restore the function and maintain steady-state conditions of red cell formation. This important information for the programming of both physiologic and pharmacologic studies is lacking for the mouse, in spite of the fact that most of the experiments performed on the regulation of erythropoiesis have been conducted in this species. In the present study, designed to determine EPO requirement for maintenance of steady-state erythropoiesis in the adult mouse under standard laboratory conditions, adult females of the CF#1 strain were exposed to hypobaria (18 h/day) during a 3-week period for induction of polycythemia (P). At the end of the hypoxic period. P mice were maintained at sea level conditions, as were normocythemic (N) mice during the entire experimental period. P mice were daily injected with 0, 0.5, 1.0, 1.5, or 2.0 IRP units of rHu-EPO during the 4-day period that followed the hypoxic one. The rate of erythropoiesis in N and P mice were measured by RBC-59Fe uptake. The plasma 59Fe half-clearance time was also measured in other groups of N and P mice similarly treated. One-way ANOVA showed that the only non-significant difference (P0.05) between N and EPO-injected P mice was established for the 1.0 unit dose group. It is thus suggested that approximately 1.0 unit of EPO should be synthesized daily in an adult mice to maintain a normal rate of erythropoiesis.

In this report we are analysing the clinical history of 193 patients who were admitted to our medical department due to stroke during a period of two years. The patients were divided into two groups depending on wether they had ischemic or hemorrhagic pathology, analysing the presence of vascular risk factors in both groups. From the obtained results we have to point out, in both groups of patients, hypertension together with mellitus diabetes, giving clear proof of this, being the most frequent association of risk factors. We also have to point out the low percentage of patients with a lack of all the analysed risk factors, being also, that the average age was notably superior than the global.

It has been reported that chronic alcoholics show a high prevalence of hepatitis C virus (HCV) infection, with a possible role in the pathogenesis and severity of underlying liver disease. Thus, the present study was aimed to evaluate the prevalence of HCV antibodies (anti HCV-Ab) in a group of patients admitted to an Internal Medicine Department, as well as to compare characteristics of anti-HCV-Ab(+ve) respect to anti-HCV(-ve) patients. The presence of anti-HCV-Ab was prospectively studied in 180 alcoholic patients admitted during a 16-month period using a second generation ELISA. Intravenous drug abusers were excluded. Reasons for admittance were as follows: alcohol withdrawal syndrome (92 cases), complications of liver cirrhosis (mainly ascites) (54 cases), acute pancreatitis (12 cases) and miscellaneous causes (22 cases). Sixty-six patients were cirrhotics, 23 had fatty liver, 27 had liver fibrosis and 28 alcoholic hepatitis (36 patients were not evaluable concerning liver lesion). Twelve patients (6.7%) were anti-HCV-Ab(+ve). Prevalence was higher in patients admitted because of complications of cirrhosis (16.7%) than that of those admitted due to alcohol abstinence syndrome (1.1%, p0.01). Likewise, the proportion of HVC-Ab(+ve) patients was higher in patients with liver cirrhosis (16.7%) respect to those with lesser degrees of liver injury (1.3%; p0.01). In the latter group, the prevalence of anti-HCV-Ab(+ve) was similar to that of the normal population. Anti-HCV-Ab patients were older than anti-HCV-Ab(-ve) cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolated Systolic Arterial Hypertension (ISAH) is the most frequent form of AHT in the aged population, resulting in an increase of the cardiovascular risk, mainly at the cerebrovascular level. In this open non-comparative study, we analyze the effect of doxazosin, an alpha-adrenergic blocker in 40 patients older than 60 years, diagnosed of isolated systolic hypertension. After 2 weeks of lavage, the patients received treatment with doxazosin according to a monotherapy scheme, with progressive increase of the dose, from 1 to 16 mg/day during a period of 14 weeks. Doxazosin significantly reduces the systolic and diastolic arterial pressure (p0.001) with a therapeutical response in 86.5% of the cases, using an average dose of 3.4 mg/day and without observing modifications in the heart rate. This drug improves the lipidic profile, with a reduction of the plasmatic levels of total cholesterol and cholesterol linked to low density proteins (LDL) with p0.05 and a reduction of triglycerides. Among the 40 patients included in the study, 10 (25%) referred side effects; there were 2 drop-outs (5%) and the dose had to be reduced in 2 patients (5%). In conclusion, doxazosin shows its antihypertensive effectiveness in the treatment of isolated systolic hypertension in patients older than 60 years and it is well tolerated by most of the patients, improving at the same time the lipidic profile. Hence, it contributes to the reduction of the cardiovascular morbidity-mortality in this group of patients.

The erythroid response to Erythropoietin (EPO) is highly dependent on dietary protein. Its operating mechanism, however, remains unsettled. The mouse spleen is an erythropoietic organ which contains an EPO-responsive cell population that can be easily amplified by administration of the hormone. The present study was performed to determine the effect of a protein-free diet offered freely to mice up to two days after injection of r-Hu EPO (1000mU/200 ul) on the response of the above population. Splenic cell suspensions from control and experimental mice were prepared in microwells containing 400 mU r-Hu EPO and appropriate medium. The response to EPO was evaluated in terms of 3H-thymidine uptake. The results obtained indicate that acutely induced protein restriction suppressed the response of the EPO-responsive splenic cell population to EPO when it was imposed on mice immediately after hormone injection, and suggest the appearance of deficient rates of differentiation of erythropoietic units by protein restriction.

We present the case of a patient with refractory arterial hypertension, during the study of which a renal mass was discovered and diagnosed after the surgical intervention of an oncocytoma. We review the clinical, diagnostic and therapeutic characteristics of this entity. In addition, the lack of a clear association between renal oncocytoma and arterial hypertension is stressed.

The present study was designed to provide direct information on the protein requirement of 12-month-old-female rats for maintenance of the circulating red cell mass (RCM). Different groups (7) of rats were fed during 30 days one of seven isocaloric diets containing graded levels of casein, from 0% to 10%. RCM was determined by the radio-iron-labelled red cell dilution method at the end of experimental period. Casein requirement level for maintenance of RCM, predicted as the point on the regression line where the value of the dependent variable (delta RCM/100 g body wt) was 0, was 3.6%. This value was identical to that predicted for the maintenance of body weight, which suggests that both are interrelated and that RCM is a function of the body weight. The relation also suggests that the anaemia developing in the adult rat in response to protein depletion could be a type of physiologic adaptation between the body oxygen transport system and the body mass.

The case of a patient with the diagnosis of essential thrombocythemia is presented. Following treatment with melphalan during three years the patient presented clinical and radiologic data of pulmonary fibrosis. Thoracotomy with lung biopsy histologically proving fibrosis was performed. The patient developed a true histiocytic lymphoma afterwards. The rarity of pulmonary fibrosis induced by melphalan and the exceptional association of essential thrombocythemia and histiocytic lymphoma is emphasized. The characteristics of the latter disease, diagnostic difficulties and possible treatment are commented upon.

A case illustrating the infrequent association of sarcoidosis and lymphoma which was also a secretor of a monoclonal IgM paraprotein is described in a 68 year old woman. The first entity manifested by dyspnea corresponded with a bilateral interstitial pneumopathy with restrictive syndrome and was diagnosed by bronchoalveolar lavage and transbronchial biopsy and biopsy prescalenic fat. The lymphoma presented three years later followed by lymphadenopathies and a monoclonal IgM peak being diagnosed by biopsy of an axillary lymph node. In order to relate both entities it has been suggested that prolonged stimulation of the lymphocytes peculiar to the sarcoidosis would cause its malignant transformation.

Seventy one mild to moderate essential hypertensive patients receiving out-patient treatment with Captopril--inhibitor of the conversion enzyme--during a period of six months, are studied. The therapeutic goal (DAP less than 95 mm Hg.) was reached in 88% of the cases, with just a single Captopril dose of 50 mg/day in 42 patients (59.1%). AP decreased from 174.2/100.2 mm Hg. to 149.2/84.0 mm Hg. (p less than 0.001). Any significant changes in heart rate nor in body weight were observed. Side effects were rare (just in two patients), although their intensity determined in both cases the interruption of treatment. Finally, and improvement in the metabolic profile of patients was observed, with reduction in glucose, cholesterol, triglycerides and uric acid at the end of the study.

We present a case of pneumatosis cystoides of the stomach and intestine, secondary to peptic pyloric ulcer with duodenal stenosis. Clinical symptoms consisted of abdominal pain and intense vomiting; diagnosis was suspected in the radiologic examination of the abdomen (plain film), which showed and abnormal pattern of gas distribution, and later confirmed by barium contrast. The surgical correction of the underlying cause made the lesion disappear. We also review the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of this rare condition.

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.

The biological and clinical features and prognostic factors of 65 patients affected by alcoholic hepatitis were studied. All patients had an ethanol intake higher than 80 gr/day during at least 3 years. 22 patients were female and 43 male with a mean age of 45 +/- 11.7 years. 19 had acute hepatitis (29.2%), 2 had acute hepatic insufficiency (3%), one had acute cholestasis (1.5%), 14 had chronic hepatopathy (21.5%). 29 patients had the diagnosis (44.6%) confirmed by histologic analysis. All patients had liver enlargement, 25 had jaundice and 4 had fever. The hepatic biopsies showed steatosis in 53 cases, centrilobular sclerosis in 32 cases and cirrhosis in 19.8 patients developed hepatic encephalopathy, 3 had renal insufficiency, and 4 died. The levels of albumin (P = 0.0043), total bilirubin (P = 0.0003), prothrombin (P = 0.0001) and the development of hepatic encephalopathy or/and renal insufficiency were the parameters to define the group of patients with bad evolution, the IgA also being significant. The low mortality of our studied (6.1%) can be justified by the diagnosis at non-symptomatic stage. We recommend a liver biopsy in all patients with chronic alcoholism and liver enlargement, or biologic markers suggesting alcoholic hepatopathy.

A comparison of the erythropoietic restoring capacity of colony-forming units (CFU) found in the liver of adult mice recovering from a single high dose of cyclophosphamide (CY) with that of CFU derived from fetal liver and from adult bone marrow and spleen was made. In this respect CFU in the liver of adult mice differ notably from CFU in fetal liver but have a striking similarity with adult splenic CFU.

A comparative study of clinical and biological features and of the immediate prognosis was made in 46 patients with alcoholic hepatitis and 19 patients with alcoholic hepatitis with liver cirrhosis. The presence of cirrhosis has different clinical manifestations and a more intense alteration of albumin, prothrombin, total bilirubin and immunoglobulins (p less than 0.01). The development of ascites, encephalopathy and hepatorenal syndrome (p less than 0.05) and albumin, prothrombin and total bilirubin values at admission (p less than 0.01) were the best parameters to identify the patients with a poorer prognosis. There were no significant differences between both groups in mortality, frequency of encephalopathy or renal failure.

19 patients diagnosed as non-tuberculous infectious spondylodiscitis (NTIS) have been studied retrospectively over the last 10 years in three general hospitals. The etiology of 13 cases was confirmed (there were nine cases of Staphylococcus aureus, two of Brucella, one of Pseudomonas aeruginosa and another of Salmonella typhi), and the diagnosis of the remaining cases was based on clinical and radiological data as well as on the evolution with antibiotic treatment. The age of the majority of these patients ranged between 40 and 60 years (p less than 0.05), showing a clear predominance of males (p less than 0.05). The most frequently appearing symptom at the beginning of the disease was local pain which was observed in nine patients; the rest presented mixed symptoms which led to misdiagnosis at admission; an exploratory laparotomy was carried out in one patient. The interval from the symptoms' onset to diagnosis ranged between two and sixteen weeks, with an average of 6.8 weeks. The VSG had values between 22 and 148 mm during the first hour, with an average of 83.3 mm. Seven patients underwent surgery, six of them presenting paraparesis-paraplegia, while another presented cervical spondylodiscitis. One patient passed away, two persisted with paraparesis-paraplegia as an irreversible sequela and one with persistent local pain.

Cachorros radioyodotiroidectomizados a las 3 semanas de vida mostraron un descenso del 32% en la concentracion de hemoglobina y el valor hematocrito. El volumen de la masa roja circulante disminuyo un 27% y el volumen plasmatico mostro un aumento del 33%. La sobrevida de los eritrocitos no fue afectada por la tiroidectomia. La magnitud de sintesis hemoglobinica disminuyo en un 45%. Estos resultados indican 1) que la influencia de la tiroidectomia sobre el sistema eritropoyetico es independiente del periodo de la vida en que se la realiza, y 2) que la anemia post-tiroidectomia puede ubicarse entre las anemias no proliferativas, siendo su causa probablemente un descenso de la estimulacion eritropoyetica.

La administracion de 2 mg/kg/dia de hidrocortisona durante 40 dias en perros adrenalectomizados 4 meses antes produjo elevacion del volumen de la masa roja circulante y de la sintesis de hemoglobina. El tratamiento con la hormona en la dosis de 4 mg/kg/dia durante los siguientes 40 dias produjo mas aumento de la actividad eritropoyetica de la medula osea, una gran proporcion de la cual fue inefectiva en terminos de produccion de eritrocitos, produciendose un descenso de la masa roja circulante.