Undifferentiated carcinoma of the jejunum with extensive rhabdoid features . Case report and review of the literature

Malignant rhabdoid tumor, first described in the kidney of young infants, is a rare and highly aggressive neoplasm of controversial histogenesis that has been reported at many other sites, including the gastrointestinal tract. However, malignant rhabdoid tumor of the small intestine is very rare, with only seven cases published to date. We report a 70‐year‐old man who presented with abdominal pain and weight loss, and showed a perforated jejunal mass with disseminated metastases by imaging. The patient underwent partial jejunectomy and biopsy of a liver metastasis. Microscopically, the tumor was characterized by neoplastic cells with vesicular nuclei, large nucleoli and abundant eccentric cytoplasm with hyaline globular intracytoplasmic inclusions. Immunohistochemically, the neoplasm coexpressed vimentin and epithelial antigens (AE1/AE3, Cam 5.2, CK34βE12, CK19 and EMA), most of them showing a peculiar immunostaining pattern in relation to the globular inclusions. Ultrastructurally, the inclusions corresponded to paranuclear whorls of intermediate filaments. The patient received postoperative chemotherapy but died 9 months after surgery. In summary, we report the exceptional case of an undifferentiated carcinoma of the jejunum with rhabdoid phenotype. As with tumors at other sites, recognition of rhabdoid morphology in small intestine neoplasms is of significance because the prognosis is extremely poor.     

MODIFICATION OF THE PROPERTIES OF BOVINE PANCREATIC RIBONUCLEASE A BY COVALENT ATTACHMENT OF D-GLUCONYL-GLYCINE RESIDUES*

Bovine pancreatic ribonuclease A was reacted with D-gluconyl-glycine azide in aqueous solution at pH 8.9, in absence of phosphates. Five out of 11 amino groups can be reproducibly modified and the penta D-gluconyl-glycinated ribonuclease A had greater than 70% of the enzymic activity of the unmodified enzyme toward cytidine 2′, 3′-cyclic phosphate as well as uridine 2′, 3′-cyclic phosphate and yeast RNA. The kinetic parameters K_m and k₂ of the modified enzyme were calculated from double-reciprocal Lineweaver-Burk plots, using cytidine 2, 3′-cyclic phosphate as the substrate. The native and chemically modified protein exhibited identity in their reversible thermal transitions at neutral pH, with midpoint at about 60°. Circular dichroism measurements indicated that the overall conformation of the D-gluconyl-glycinated enzyme is not significantly different from that of the unglycosylated parent enzyme. The modified protein was less sensitive than the native ribonuclease A to attack by chymotrypsin, pepsin and elastase, indicating a protecting effect of the D-gluconyl-glycine units. Similar properties are shown by the glycosylated bovine pancreatic ribonuclease B.     

Catheter-Mediated Electrical Ablation: The Relation Between Current and Pulse Width on Voltage Breakdown and Shock-wave Generation

Barotrauma from arc induced shock waves may result in dangerous sequelae during ablatian of arrhythmogenic foci. In this report, maximum pulse amplitude and pulse width determinations were made to assess, avoidance of shock-wave generation using rectangular constant current pulses. Energy delivery appears to be optimal between 80–100 microseconds. If higher energies are required, multiple pulses will be needed to avoid barotrauma.     

Dapsone for refractory chronic idiopathic thrombocytopenic purpura

Summary. Fifteen patients with refractory chronic idiopathic thrombocytopenic purpura (ITP) were treated with dapsone (lOOmg/d) for 1-31 months. The overall response rate to dapsone was 40%. Five patients responded in 1 month and one patient in 2 months. No pretreatment characteristics -sex, age, platelet count or duration of ITP - were correlated with response to dapsone. Treatment was well tolerated. The most frequent adverse effect was dose-related haemolytic anaemia. In our experience, dapsone provides an inexpensive and well-tolerated alternative for patients with ITP who had inadequate reponses to conventional therapy.     

Cyclic analogues of wasp kinins from Vespa analis and Vespa tropica

Syntheses are described of two bradykinin-like kinins isolated from Vespa analis (G-R-P-P-G-F-S-P-F-R-V-I, VSK-A) and Vespa tropica (G-R-P-Hyp-G-F-S-P-F-R-V-V, VSK-T) and of their cyclic analogues. Linear dodecapeptides were prepared by the solid-phase procedure based on Fmoc-chemistry, and cyclization was carried out by the diphenyl-phosphorazide method. Peptides were characterized by amino acid analysis, optical rotation, analytical HPLC and FAB-MS. The conformational features of the cyclic and linear kinins were determined by circular dichroism measurements in water, 95% trifluoroethanol and 8 M guanidinium chloride. Consistent with previous findings, preliminary pharmacological experiments on smooth muscle preparations showed that cyclic wasp kinins were 50–100 times less potent than their linear analogues. Moreover, cyclo-VSK-A and cyclo-VSK-T behave like kininase inhibitors by preventing the degradation of straight kinins.     

Trends in ischaemic heart disease mortality and its determinants in Spain, 1940-1988

Trends of ischaemic heart disease (IHD) mortality and of manyof their determinants in Spain from 1940–1988 resemblethose of other Mediterranean countries and some Western countrieswith a lag of 10 years. Mortality from IHD Increased from 1955to 1975 and then declined. This trend affected both sexes andalmost all age groups. Tobacco smoking increased from 3.2 gper capita per day in 1940 to 8 g per capita per day in themid-1970s and then levelled off. The prevalence of smoking hasdecreased in all ages among men but has Increased among womenover the last 15 years. Since 1940 there has been a steady increasein the intake of meat and dairy products and a moderate riseof eggs, fish and sunflower oil. Consumption of olive oil hasremained relatively constant. These trends have been translatedinto an increase of total lipid intake and of saturated, monounsaturatedand polyunsaturated fatty acids and cholesterol over the period1940–1988. The number of physicians, primary health carecentres, cardiac function diagnostic facilities, heart operationsand the consumption of cardiovascular drugs have also Increasedsince the mid- 1970s. The authors conclude that the reductionin smoking among men and the improvement of the health caresystem may have contributed to the decline in IHD mortalityrates in Spain since 1975.     

Effect of the application of the new diagnostic criteria of diabetes mellitus in the prevalence estimates and diagnostic level in the general population

Background: The objective was to study the effect of the applicationof the new diagnostic criteria for diabetes mellitus on itsprevalence in Galicia (northwest Spain). Methods: Analysis using‘old’ and ‘new’ criteria (diabetes undertreatment and/or fasting glycaemia 140 mg/dl or 126 mg/dl respectively)was performed in a cross-sectional study (1,275 participants)in the general population aged 40–69 years. Results: Prevalenceof diabetes rose from 7.5 (95% Cl: 6.1–9.1) to 10.4% (95%Cl: 8.8–12.2) with the new criteria. The proportion ofnon diagnosed diabetes rose from 22.2 to 37.8%. Conclusions:The new diagnostic criteria for diabetes mellitus make it necessaryto increase previous prevalence estimates by 30–35% Inmiddle age (40–69 years).