Chronic functional somatic symptoms: a single syndrome?

BACKGROUND: Reliable longitudinal data of patients with functional somatic symptoms in general practice are lacking. AIMS: To identify distinctive features in patients with chronic functional somatic symptoms, and to determine whether these symptoms support the hypothesis of the existence of specific somatic syndromes. DESIGN OF STUDY: Observational study, with a comparison control group. SETTING: Four primary care practices affiliated with the University of Nijmegen in the Netherlands. METHOD: One hundred and eighty-two patients diagnosed between 1998 and 2002 as having chronic functional somatic symptoms and 182 controls matched by age, sex, socioeconomic status, and practice were included. Data on comorbidity, referrals, diagnostic tests, and hospital admissions over a period of 10 years prior to the diagnosis were collected. Medication use and number of visits to the general practitioner (GP) were extracted from the moment computerised registration was started. RESULTS: In the 10 years before the diagnosis of chronic functional somatic symptoms, significantly more patients than controls presented functional somatic symptoms in at least two body systems, and used more somatic and psychotropic drugs. They visited the GP twice as much, statistically had significantly more psychiatric morbidity, and were referred more often to mental health workers and somatic specialists. The number of patients undergoing diagnostic tests was higher for patients with chronic functional somatic symptoms than for controls, but hospital admissions rates were equal. CONCLUSION: Patients with chronic functional somatic symptoms have a great diversity of functional somatic symptoms. They use more somatic and psychotropic drugs than controls in the years before diagnosis. Moreover, they show high rates of referrals and psychiatric morbidity. The diversity of symptoms of patients with chronic functional somatic symptoms supports the concept that symptoms do not cluster in well defined distinct syndromes. Therefore, patients with chronic functional somatic symptoms should preferably not be classified into medical subspecialty syndromes.     

A trial use of lenses of human placental collagen in epikeratoplasty procedures

Epikeratoplasty is a refractive surgery procedure described by Werblin and Kaufman which is simple, effective and reversible. However its development is hampered by the need of human corneas. We evaluated this procedure in rabbits and monkeys using lenticules of human collagen. The collagen is obtained from frozen human placentas, washed and subjected to pepsin digestion; it is contained in the supernatant of centrifugation and can be isolated by a physico-chemical treatment. 15 days after surgery the lenses of 14 rabbits were completely covered with a layer of epithelial cells. 6 months after surgery, the eyes of 14 monkeys were quiet and the lenses were covered with an epithelium made up of 2 to 5 layers of cells. The lens exhibited no inflammatory infiltration and there was no inflammatory reaction around the lens. These studies are still preliminary and longer term tests are necessary. These initial results are very encouraging, prompting us to develop the use of this type of material in refractive surgery.     

Immunolocalization of factor V in adult and fetal rat liver

Immunolocalization of the factor V was performed in adult and fetal rat liver by means of an indirect peroxidase labelling. This could be done owing to the production in our laboratory of a monospecific antiserum anti rat factor V. In all the cases (perfused and non-perfused adult liver and fetal one) the observation of the sections has revealed an intense circular or granular labelling into all the hepatocytes whatever was their localization in the hepatic lobule. Hepatic endot helial cells seemed to be negative for factor V and this aspect of our results was discussed.     

Pathogenic molecular mechanisms in non-alcoholic steatohepatitis

Non-alcoholic steatohepatitis is a chronic disease that occurs in persons without significative consumption of alcohol, characterized by macrovesicular steatosis, mixed inflammatory infiltrate, and diverse degrees of fibrosis. It can progress to cirrhosis and its evolution to hepatocellular carcinoma has been described. It principally occurs in patients with obesity, diabetes mellitus, and hyperlipidemia, and is at present considered a manifestation of metabolic syndrome with insulin resistance. In pathogenesis, diverse factors, fundamentally insulin resistance as a mechanism that determines hepatic steatosis, have been described. Later, alteration of signalling cascades, oxidative stress, and other mechanisms occur that lead to inflammation, necrosis, and finally to hepatic fibrosis, the details of which will be described in this review.