Distal nephron function in Bartter's syndrome: abnormal conductance to chloride in the cortical collecting tubule?

Five patients with the clinical patterns of Bartter's syndrome underwent a series of clearance studies in order to characterize the underlying tubule defect. Free water generation during maximal water diuresis (CH2O), expressed as percentage of the distal delivery (CH2O + CCl), was lower in the patients (72.5 +/- 3.2%) than in controls (84.4 +/- 5.5, p < 0.0001). During maximal water diuresis and furosemide administration (40 mg i.v. as bolus), NaCl reabsorption along the diluting nephron segments could be separated into 2 components, that occurring in the loop of Henle (DRNaHL) and that occurring in tubule segments beyond the macula densa (DRNaDT): DRNaHL was normal, while DRNaDT was reduced (3.1 +/- 0.8 vs. 6.2 +/- 2.5 ml/min in controls, p < 0.015). Thus, according to this furosemide protocol, our patients had normal solute reabsorption in the loop of Henle but reduced NaCl reabsorption in tubule segments beyond the macula densa. During 0.9% saline infusion (2 liters in 2 h, after stimulation of distal Na reabsorption with fludrocortisone) fractional excretion (FE) of K showed a linear rise with the increase of FECl-FEK, however, was much higher in the patients than in controls for every FECl level. In contrast, the infusion of Na2SO4, after fludrocortisone administration, induced similar FEK increases in patients and in controls. Thus, in these patients Na reabsorption in the distal nephron (possibly the cortical collecting tubule) was associated with the generation of a higher than normal electric potential gradient in the presence of Cl but not of another poorly reabsorbable anion, such as SO4(2-). These observations indicate that, in our patients, Henle's loop function is normal, while the collecting tubule function is abnormal. We suggest that NaCl wasting and enhanced tubular secretion of H+ and K in our patients might result from an abnormally low conductance to Cl in distal nephron site(s) where Na reabsorption is electrogenic, possibly the cortical collecting tubule. A larger than normal transtubular electric gradient would be generated by Na reabsorption, causing: (1) a direct stimulation of tubular secretion of K and H+ (leading to hypokalemia and alkalosis) and (2) inhibition of the reabsorption of Na ('trapped' into the tubular lumen by electric forces), with consequent extracellular volume contraction, hyperreninemia and hyperaldosteronism.     

P64Shoe contact dermatitis

Because of its numerous etiologies, foot dermatitis can be difficult to diagnose despite of thorough history and physical examination. The differential diagnoses are challenging and include allergic contact dermatitis, dyshidrosis, juvenile plantar dermatosis, atopic dermatitis, lichen planus.
Methods:  In the Cutaneous Allergology Unit of the Department of Dermatovenereology of Pedro Hispano Hospital, between 1999 and 2003, 804 patients were observed with suspicion of contact dermatitis. In 9,3% there was a history of recurrent foot dermatitis. All these patients were patch tested with GPEDC standard and shoe series and shoe fragments.
Results:  Twenty‐five patients revealed shoe contact dermatitis with positive reactions to the series tested, with an average age of 40 years. The dermatitis involved the dorsal aspect of the foot in 20 patients and the volar aspect in 8, the lateral aspects in 4, typically sparing the instep and flexural creases of the toes. The most common allergen were para‐tertiary‐butylphenol formaldehyde resin – PTBFR (12 patients‐48%), mercapto mix (7 patients‐28%), potassium dichromate (24%), mercaptobenzothiazole (24%).
Conclusions:  The most common causes of shoe contact dermatitis were glues, followed by rubber components and chromated leather. As in other studies the most common allergen in shoe dermatitis in Portugal is PTBFR in neoprene adhesives. Rubber components (accelerators) were the second more frequent allergen in this study, probably a direct result of improved fixation of chrome and a change in footwear style and chrome sensitivity explains leather allergy. Other causes of foot contact dermatitis are iatrogenic complication, clothing (socks), cosmetics, adhesive tape and professional etiology.     

Top-down and bottom-up processes in the extrastriate cortex of cirrhotic patients: an ERP study.

OBJECTIVE: This study aims to evaluate the efficiency of top-down and bottom-up processes in the extrastriate cortex of cirrhotic patients without overt hepatic encephalopathy (HE). METHODS: Reaction times (RTs), accuracy and event-related potentials (ERPs) were recorded during the execution of a visual Simon task in 17 cirrhotic patients and 10 healthy controls. Amplitude and latency of the P1 and N1 (indexes of bottom-up processes) and of the N2pc (index of top-down processes) were measured. RESULTS: Patients were slower than controls, and patients with minimal HE (MHE) were slower than patients without MHE. The distribution analysis of RTs showed that the Simon effect decays with slower RTs in all the groups and that the shape of the distribution was different in MHE patients. No differences were found between cirrhotic patients and controls for P1 and N1 amplitude and latency. In contrast, N2pc latency was delayed in cirrhotic patients compared to controls independently of MHE. CONCLUSIONS: In the extrastriate cortex of cirrhotic patients without HE, top-down processes are altered whereas bottom-up processes are preserved. SIGNIFICANCE: The analysis of exogenous and endogenous visual components of ERPs provides a model to study the functional dissociation between top-down and bottom-up processes inside the extrastriate cortex.     

Successful heterotransplantation of human colon cancer cells to athymic animals is related to tumor cell differentiation and growth kinetics and to host natural killer cell activity

Six established human colon carcinoma cell lines with distinct degrees of cell differentiation were inoculated into infant (less than 4 weeks) and adult (greater than 8 weeks) nude rats. The most differentiated tumor cells (group I) had nearly a 100% rate of tumor takes whether inoculated subcutaneously, intraperitoneally, or intracerebrally into adult rats; subcutaneous growth continued unabated for a 120-day observation period. Cells with intermediate differentiation (group II) had nearly an 80% incidence in tumor takes when injected subcutaneously and 14-60% when injected intraperitoneally. Subcutaneous growth continued only for about 30 days, after which time growth declined, and tumors regressed completely. Intracerebral inoculations of group II cells resulted in 64-83% tumor takes. Subcutaneous injections of cells from groups I and II into 5- to 10-day-old rats resulted in 100% tumor takes; tumors induced by group II did not regress, and after about 60 days reached volumes comparable to those originated by cells from group I. No tumors developed when cells from group III (undifferentiated) were injected either subcutaneously or intraperitoneally (and even intravenously) into adult rats. Only when the intracerebral route was employed was there a 60-71% incidence of tumor takes. Also, for one of the cell lines in this group, subcutaneous injection into infant rats resulted in 100% tumor takes. NK cell activity of infant rats against all of the colon cells (measured by the 51Cr release assay) was negligible; in adult rats, the activity varied according to the cell type, being usually highest against the less differentiated tumors. Our data on the incidence of tumor takes, and on the dynamics of tumor growth and decline suggest that successful heterotransplantation of human colon carcinoma cells into nude rats depends on the activity of host NK cells. In turn, this activity seems related to the degree of cell differentiation and the growth kinetics of the xenografted tumor cells. These observations highlight important differences in biological characteristics of human colon carcinoma with important implications for their intrinsic ability to grow and metastasize, and, possibly, their response to biological response modifiers.     

Prognostic value of the equivalents of transitory myocardial ischemia evaluated by exercise thallium-201 myocardial scintigraphy in an ambulatory population of 367 patients with a maximum 5-year follow-up

From 1-1-1981 to 3-31-1985, 367 subjects (227 males and 140 females) were examined by means of TL-201 myocardial scintigraphy for diagnostic purpose. A follow-up period, 5 years maximum, was run in order to assess the prognostic value of the three equivalents of transient myocardial ischemia which can be demonstrated by the test (angina, reversible hypoperfusion, and ST-T segment changes). The end points were myocardial infarction and/or sudden death. Three-hundred fifty-four patients complied (96%). During the observation period 9 severe ischemic events (SIE) occurred: 5 myocardial infarctions and 4 sudden deaths. As far as the predictivity of SIE is concerned, the "t" test for independent samples showed a statistically significant difference between the group of patients with no signs of ischemia and the group with positive scintiscan (p less than 0.05) and with the three equivalents of ischemia all together (p less than 0.05). Moreover, in the sub-group of patients with pathological scintigraphic results the probability for SIE to occur was statistically different in the patients with no hypoperfusion in the region supplied by the anterior descending coronary artery and in those with pathological scintigraphic findings in that region (p less than 0.05). In our opinion, the above data demonstrate the pathological signs noticeable with stress myocardial TL-201 scintiscan to have prognostic value.     

Myocardial scintigraphy using 99m-technetium pyrophosphate in the diagnosis of acute myocardial infarct. Comparison of planar and tomographic imaging

The aim of the study was to compare the effectiveness of planar and single photon emission computed tomography (SPECT) imaging with 99mTc-pyrophosphate in the verification of acute myocardial infarction. The study was performed on 39 patients (26 males, 13 females) aged between 41-76 years (mean 61 +/- 9) admitted to CCU for acute myocardial infarction. Patients underwent planar and SPECT imaging using a double-head-camera with a 360 degrees rotation arc within 6 days of admission. Planar images were obtained in three standard projections (anterior, LAO 45 degrees, LAO 75 degrees) with acquisitions of 500000 counts each. To obtain SPECT images ninety projections, each lasting 20 seconds, were taken; subsequently images reconstruction was performed using an iterative algorithm. Positive planar images were found in 21 out of 39 patients; SPECT images were positive in 33 patients. In "Q wave" myocardial infarctions planar images were positive in 13 out of 15 patients, whereas SPECT images were positive in all subjects; in "non-Q wave" myocardial infarctions planar images were positive in 6 out of 22 patients whereas SPECT images were positive in 16 patients (p less than 0.005); in 2 patients with left bundle branch block both planar and SPECT images were positive. A bidimensional echocardiogram was carried out on 38 patients: an alteration of left ventricular regional wall motion was present in 30 subjects; in one patient diffuse hypokinesia was present.(ABSTRACT TRUNCATED AT 250 WORDS)