Ochratoxin A and other mycotoxins in cereals from an area of Balkan endemic nephropathy and urinary tract tumours in Bulgaria.

The etiology of Balkan endemic nephropathy and urinary tract tumours in the rural population of the endemic regions remains unknown. As one hypothesis involves mycotoxins, a survey was carried out to investigate the possible involvement of the nephrotoxic mycotoxins ochratoxin A and citrinin. Recently, this survey was extended to screening for the presence of other mycotoxins--aflatoxins, citrinin, sterigmatocystin and zearalenone. A total of 524 samples of home-produced and home-stored beans and maize from the harvests of 1984, 1985, 1986, 1989 and 1990 were analysed. Ochratoxin A was found in samples from both endemic and nonendemic areas, but more of the samples from affected families were contaminated, and at higher levels, than those from unaffected households. Citrinin and aflatoxins B1 and G1 were also found more frequently in samples from endemic areas. These results support the theory that mycotoxins are involved in the etiology of Balkan endemic nephropathy and urinary tract tumours.     

Pharynx and cervical esophagus reconstruction with pectoralis major flap

Among numerous myocutaneous flaps, pectoral major flap is most frequently used in oncological head and neck surgery. It is specially frequent in oral cavity reconstruction, but quite rare in hypopharynx and cervical esophagus reconstruction. Nine patients had squamous cell carcinoma of the oropharynx or hypopharynx with propagation to hypopharynx and/or external larynx. Resection of malignant tumor and defect reconstruction of the pectoral major flap were done in one act. Two patients had the entire oropharynx, hypopharynx, and the cervical part of the esophagus reconstructed, whereas another seven patients had only the hypopharynx and cervical part of the esophagus reconstructed. The pectoral major flap reconstruction was done in three ways: by making a parasternal skin island with tubulous in situ formation (N = 4), with spiral formation of tubulous--Ryan method (N = 1), and by distally making a skin island in the rectangular form and tubulous in situ formation (N = 4). The procedure of flap formation with skin island in the rectangular form was successful, without complications. Much poorer results were achieved with the parasternal skin island formation. The failure rate of the reconstructive surgical procedure was 11.1% (N = 1), using Ryan operative method. Best result were achieved by flap tubulous in situ formation and rectangular skin island creation on the distal part of the muscle.     

Directly administered antiretroviral therapy for HIV-infected drug users does not have an impact on antiretroviral resistance: results from a randomized controlled trial

BACKGROUND: Directly administered antiretroviral therapy (DAART) is an effective intervention that improves clinical outcomes among HIV-infected drug users. Its effects on antiretroviral drug resistance, however, are unknown. METHODS: We conducted a community-based, prospective, randomized controlled trial of DAART compared with self-administered therapy (SAT). We performed a modified intention-to-treat analysis among 115 subjects who provided serum samples for HIV genotypic resistance testing at baseline and at follow-up. The main outcomes measures included total genotypic sensitivity score, future drug options, number of new drug resistance mutations (DRMs), and number of new major International AIDS Society (IAS) mutations. RESULTS: The adjusted probability of developing at least 1 new DRM did not differ between the 2 arms (SAT: 0.41 per person-year [PPY], DAART: 0.49 PPY; adjusted relative risk [RR] = 1.04; P = 0.90), nor did the number of new mutations (SAT: 0.76 PPY, DAART: 0.83 PPY; adjusted RR = 0.99; P = 0.99) or the probability of developing new major IAS new drug mutations (SAT: 0.30 PPY, DAART: 0.33 PPY; adjusted RR = 1.12; P = 0.78). On measures of GSS and FDO, the 2 arms also did not differ. CONCLUSION: In this trial, DAART provided on-treatment virologic benefit for HIV-infected drug users without affecting the rate of development of antiretroviral medication resistance.     

Status of diabetes in Ethiopia as a contribution to tropical diabetes mellitus

On the basis of own experiences with the care of diabetes in the northern highland of Ethiopia the particularities of the tropical diabetes mellitus are described. In the light of the control score according to Noviks and co-workers the quality of the metabolic management of 100 patients is estimated as above all unsatisfactory, from which the conclusion is to be deduced more than up to now to include the diabetes mellitus into the health care system of Ethiopia and to improve thoroughly the conditions for the diagnostics, the therapy, education and dispensary care.     

Metabolic studies on the possible mode of action of isoniazid tumorigenicity

Summary Data on tumorigenicity and mutagenicity of INH show that INH is tumorigenic in mice but not in rats. The metabolic studies on the two species denote that rats are rapid inactivators whereas mice are slow inactivators of INH. Rats are also resistant to the immediate inhibitory effect of INH on DNA biosynthesis. Using Ames test it was observed that INH is mutagenic to salmonella typhimurium strains TA 100 and 1535 and this effect is abolished in presence of 59 mixture. In vivo and in vitro studies on INH interaction with macromolecules reveal that there is a greater interaction with RNA than with DNA and the site of interaction is the cytidine and deoxycytidine, respectively. A preliminary study is undertaken to see if healed TB cases have a higher risk for cancer. It is found that cancer incidence in this group is higher as compared to noncancer patients.     

Successful gemcitabine-nedaplatin therapy in a hemodialysis patient with ureteral carcinoma after bilateral nephroureterectomy

A 79-year-old male, who received hemodialysis due to bilateral nephroureterectomy and cysto-prostateurethrectomy. Five months later, an enlarged lymph node was found in the left of inguinal area. Abdominal computed tomography revealed a low density mass from the para-aortic lymph node to the left of inguinal area, suggesting lymph node metastasis of ureteral carcinoma. After 3 cycles of gemcitabinenedaplatin therapy, the size of lymph node metastasis decreased. This is a report of successful treatment of ureteral carcinoma with hemodialysis.     

Thumb carpometacarpal osteoarthritis: trapeziectomy versus pyrocarbon interposition implant (Pi2) arthroplasty

We retrospectively compared the short-term outcomes of 18 thumbs that had a trapeziectomy and 18 that had a pyrocarbon interposition implant (Pi2) arthroplasty in 33 patients. We measured the Disability of the Arm, Shoulder, and Hand (DASH) and Short Form 36 (SF-36) scores at a mean of 20 months. Pain severity was assessed using a visual analogue scale (VAS), and level of patient satisfaction was assessed using a 5-point scale. The mean DASH scores at follow up were 27 for those that had a trapeziectomy and 35 for those that had a Pi2 arthroplasty (p = 0.001). There was no difference in the VAS for pain, SF-36 scores, or other parameters assessed. Six out of 18 (33%) thumbs in the Pi2 group had multiple operations, usually for dislocation or subluxation of the implant. The early results of Pi2 arthroplasty show a high complication rate compared with trapeziectomy and no identifiable benefit.