Fixed drug eruption in a mother and her son.

Two cases of fixed drug eruption, occurring in a mother and son, are presented. The eruption in the mother occurred after she ingested dimenhydrinate or acetylsalicylic acid and in the son after ingestion of either of the above drugs or with "junk" food (cheese crisps). Apart from the drugs, anxiety was found to be an essential factor in the manifestation of the mother's disease. A genetic predisposition would seem to link these cases.     

Optical purity determination, conformer populations and 1H NMR spectral simplification with lanthanide shift reagents--part IX. A method for improved analytical precision for "DOEt", 2,5-dimethoxy-4-ethylamphetamine

The 60 MHz (1)H NMR spectra of the potent hallucinogen 2,5-dimethoxy-4-ethylamphetamine ("DOEt"), 1, have been studied in CDCl(3) at 28 degrees with the achiral shift reagent, tris(6,6,7,7,8,8,8-heptafluoro-2,2-dimethyl-3,5-octanedionato)europium(III), 2, and the chiral reagents tris[3-(trifluoromethylhydroxymethylene)-d-camphorato] europium(III), 3, and tris[3-(heptafluoropropylhydroxymethylene)-d-camphorato] europium(III), 4. Distinct enantiomeric shift differences, DeltaDeltadelta, were observed for the amphetamine CH(3) and the adjacent CH resonances using either 3 or 4 that permit direct optical purity determinations. A novel use of an external computing integrator as an accessory to a basic NMR is described; interfacing these instruments permits improved analytical precision for the reported optical purity determinations using nonracemic mixtures of known compositions. Relative abundances of the different conformers with respect to C(alpha)C(beta) bond rotation in the arylethylamine moiety is discussed based on coupling constants. Results are compared with the related hallucinogen, 3,4-methylenedioxyamphetamine.     

Reconstructing and predicting the hepatitis C virus epidemic in Greece: increasing trends of cirrhosis and hepatocellular carcinoma despite the decline in incidence of HCV infection

In this study, a comprehensive methodology for modelling the hepatitis C virus (HCV) epidemic is proposed to predict the future disease burden and assess whether the recent decline in the incidence of HCV may affect the future occurrence of cirrhosis and hepatocellular carcinoma (HCC) cases. Using the prevalence of HCV, the distribution of chronic hepatitis C (CHC) patients within the various transmission groups and their infection-onset times, it was possible to reconstruct the incident infections per year in the past that progressed to CHC in Greece. The natural history of the disease was simulated in subcohorts of newly infected subjects using transition probabilities derived either empirically between fibrosis stages 0-4 or from literature review. Annual estimates of the incidence and prevalence of CHC by fibrosis stage, HCC and mortality in Greece were obtained up to 2030. HCV incidence peaked in the late 1980s at five new infections/10,000 person-years. Under the assumption of 20-100% decline in HCV incidence after 1990, the cumulative number of incident cirrhosis and HCC cases from 2002-2030 was projected to be lower by 9.6-48.2% and 5.9-29.5%, respectively, than that estimated under the assumption of no decline. However, the prevalent cirrhotic/HCC cases and HCV-related deaths are predicted to decline in the next 30 years only under the assumption of complete elimination of new HCV infections after 1990. Despite the progress in the reduction of HCV transmission, primary prevention does not seem adequate to reverse the rise in the incidence of cirrhosis and HCC.     

Distal Biliary Stent Migration in Patients with Irretrievable Bile Duct Stones: Long-Term Comparison Between Straight and Double-Pigtail Stents

Digestive Diseases and Sciences - Prolonged biliary stenting may be considered in high-risk patients with irretrievable bile duct stones (IBDS). Distal stent migration (DSM) is a known...     

A prospective, randomized comparison of 10-Fr versus 7-Fr bipolar electrocoagulation catheter in combination with adrenaline injection in the endoscopic treatment of bleeding peptic ulcers

OBJECTIVES: Our study compared the efficacy of bipolar electrocoagulation (gold probe) with 10-Fr (group A) versus 7-Fr (group B) catheter after adrenaline injection in the treatment of bleeding peptic ulcers. METHODS: A total of 77 consecutive patients with endoscopic evidence of peptic ulcer with active bleeding or a nonbleeding visible vessel were randomly assigned to one of the above protocols. Thirty-nine patients (31 male, eight female, mean age 62 yr) were included in group A and 38 (28 male, 10 female, mean age 61 yr) in group B. RESULTS: The initial hemostasis rate, rebleeding rate, duration of hospital stay, volume of blood transfused, number of operations needed, and number of deaths were not significantly different between the two groups. The mean number of electrocoagulations and the subsequent mean duration of electrocoagulations were significantly higher in group B patients (7.0 +/- 3.8 and 14.1 +/- 7.6 s, respectively) compared with those of group A (4.6 +/- 2.6 and 9.3 +/- 5.3 s, respectively) (p < 0.01). Multivariate stepwise logistic regression analysis revealed that among sex, age, location of bleeding, ulcer size, endoscopic severity of bleeding, and the size of the gold probes, lesser endoscopic severity of bleeding (chi(2) = 31.1, p < 0.01), large size of the gold probe (chi(2) = 23.9, p < 0.01), and small ulcer size (chi(2) = 13.4, p < 0.01) were the only factors significantly associated with a smaller number of electrocoagulations. CONCLUSIONS: In this study, the use of large-size gold probes was significantly associated with a lower number of electrocoagulations, resulting in the reduction of electrocoagulation duration. However, the clinical relevance of these findings is questionable because the efficacy of both sizes of gold probe after adrenaline injection in the treatment of bleeding peptic ulcers was similar.     

The association of the 174G > C polymorphism of interleukin 6 gene with diabetic nephropathy in patients with type 2 diabetes mellitus

AimsTo evaluate the association of 174G > C polymorphism on interleukin-6 (IL-6) gene with diabetic nephropathy in patients with type 2 diabetes.MethodsA total of 393 Greek subjects with type 2 diabetes (mean age 66.5 ± 10.0 years, men n = 203, women n = 190) were examined. Diabetic nephropathy was defined as presence of microalbuminuria and/or proteinuria. The IL-6 174G > C polymorphism was detected by polymerase chain reaction and appropriate restriction enzyme digestion. High sensitivity C-reactive protein was assayed by particle-enhanced immunonephelometry.ResultsThe genotype distribution (%) was GG: 49.1, GC: 26.8 and CC: 24.1, with no gender difference. The CC homozygotes had lower albumin excretion (mg/24 h) in comparison with the GC genotype [CC: 8.9 (4.0–20.9) vs GC: 21.95 (9.1–53.35), P = 0.004]. Participants with the GC genotype tended to have more frequently nephropathy than those with the GG or the CC genotype [GC: 44.55% vs GG: 35.1% and CC: 28.3%, P = 0.07)]. The CC homozygotes in comparison with GC heterozygotes had lower odds to have nephropathy (odds ratio: 0.51, 95% confidence intervals = 0.28–0.91, P = 0.02), even after adjustment for sex, age, duration of diabetes, body mass index, smoking, hypertension, lipids and glycated hemoglobin, (P = 0.01).ConclusionIn type 2 diabetes states, CC homozygotes have lower albumin excretion and are protected from nephropathy in comparison with GC genotypes.     

Combined effects of fibrinogen genetic variability on atherosclerosis in patients with or without stable angina pectoris: Focus on the coagulation cascade and endothelial function

Background

Fibrinogen is a coagulation/inflammatory biomarker strongly associated with atherogenesis. Data have reported that the genetic variability on fibrinogen chains may affect the atherosclerotic process and the risk of coronary artery disease (CAD). We examined the combined effects of the G455A and the G58A fibrinogen genetic polymorphisms on prothrombotic profile, endothelial function and the risk of CAD in a Caucasian population.

Methods

We recruited 422 patients with angiographically documented CAD and 277 controls matched for age and gender. The two polymorphisms were genotyped by polymerase chain reaction and restriction endonuclease digestion. Fibrinogen and D-Dimers levels, as well as factors' (f) V, X activity were measured by standard coagulometry techniques. Endothelial function was assessed by the flow mediated dilatation (FMD) of the brachial artery.

Results

The two polymorphisms had no significant effect on the risk for CAD. Although the 58AA subjects had not significantly different levels of fibrinogen compared with the 58GG + GA in both groups (p = NS), we importantly found that the 455AA homozygosity was associated with increased fibrinogen levels not only in the control group (p = 0.035), but also in the CAD group (p < 0.001) compared to the G allele carriers. Moreover, both the 58AA (p = 0.016) and 455AA homozygotes (p = 0.022) presented with higher levels of D-Dimers in the CAD group. Interestingly, the 455AA homozygotes had increased fV activity in the CAD group (p = 0.048). However, no significant effects were observed on fX activity and FMD.

Conclusions

Both fibrinogen polymorphisms are capable to modify the atherosclerotic process via their effects on the coagulation cascade.