Cardiopulmonary transplantation: experience of a lung transplant group

Cardiopulmonary transplantation (CPT) is indicated for patients eligible for heart transplantation (HT) or lung transplantation (LT) who have severe concomitant lung or heart disease. Only 2 groups perform CPT in Spain. We report our experience with 18 CPTs representing 8.2% and 5% compared with LT (220) and HT (362), respectively, from February 13, 1990 to October 15, 2002. The mean time on a waiting list was 138 days. The current number of surviving patients is 7 (39%), with a mean follow-up of 602 days (range, 3 to 4627 days). They all remain asymptomatic with normal respiratory function in 4 patients. No cardiac graft rejection has been detected. Two patients experienced sustained gastroparesis during the first year with spontaneous resolution. Death occurred within the first 3 months in 9 patients. These outcomes contrast with the early mortality associated with LT and HT in our series, namely 10.6% and 11%, respectively. The different causes of death were as follows: sepsis and multiorgan failure in 5 patients, hemorrhagic shock in 3 patients, and suture dehiscence and fungal aortic perforation in 1 patient. Late mortalities were recorded in 2 cases. Overall patient survival in our series is lower than that reported by the International Registry (IR), with an early mortality rate of 50% (30% IR). Nevertheless, our survival rate at 10 years after transplantation is 30% (26% IR). We conclude that CPT should be considered despite the greater early morbidity and mortality.     

Asystolias in the acute phase of brain stroke. Report of a case

Brain areas involved in heart autonomic control are not well characterized. Insulae have been proposed as control centers. A lesion in these areas may induce a cardiac autonomic dysfunction (arrhythmias, atrioventricular conduction abnormalities). Asystolia has not been previously reported. A 65-year-old man suffered an acute ischemia of the right middle cerebral artery (MCA) territory. NIHSS score was 19 points. Brain CT scan was normal. Transcranial Doppler (TCD) showed occlusion of the right MCA. Fibrinolysis was initiated 135 minutes after stroke onset with TCD monitoring. Twenty minutes later he suffered cardiac arrest with asystolia trace in the ECG monitor. Fibrinolysis was stopped during resuscitation. Four minutes later, he recovered with the same NIHSS score. Aggressive resuscitation maneuvers were not necessary. A repeated brain CT scan showed infarct signs in the whole MCA territory and a new TCD did not show any change. Serial blood analyses including cardiac nzymes were normal. The patient experienced four brief cardiac arrests in the next nine hours, so a temporary cardiac pacemaker was placed for four days. He was treated with aspirin and was discharged 14 days after admission. He has not experienced recurrences during a 6-month follow-up. We could not diagnose the etiology of the cardiac arrests. All the episodes occurred in the acute stroke stage and arrhythmia, atrioventricular block, myocardial ischemia or structural lesions were not found in the cardiac study. We propose that ischemia in the right insula induced sudden and transitory interruptions of the sympathetic cardiac tone.     

Opsoclonus: an early sign of neonatal herpes encephalitis

Preferential involvement of certain central nervous systems areas by specific viruses provides a valuable guide to the selection of antiviral agents. We report a neonate that developed opsoclonus 7 days prior to the diagnosis of herpes simplex type 2 cerebellitis. The course of the opsoclonus paralleled the clinical course and radiologic evolution of the infection. The purpose of this report is to describe opsoclonus as a possible early sign of herpes simplex type 2 central nervous system infection.     

Immunohistochemical markers of cell proliferation in laryngeal carcinoma

Although several clinicopathological factors may contribute to the prognosis of laryngeal carcinoma, these factors are still uncertain because the carcinogenesis process and malignant behavior are not well known. Immunohistochemical methods using two important markers, PCNA and Ki67 antigen, were used to assess proliferative activity in malignant laryngeal lesions. We studied the correlation between expression of these markers and clinical factors in 72 patients with carcinoma of the larynx: age, sex, occupation, smoking, alcohol consumption, marital status, etc. We also analyzed other known biological and histopathological prognostic factors (tumor stage, histological grade, lymph node metastases, and local invasion). PCNA and Ki-67 expression differed significantly in relation to histological grade and lymph node involvement. No associations were seen between the expression of PCNA and Ki-67 antigens and other study parameters.     

Effects of early postnatal gonadal steroids on the successive conditional discrimination reversal learning in the rat

In the present study the existence of sex differences in the acquisition, retraining and reversal of a successive conditional discrimination learning (Experiment 1) and the role of the early postnatal gonadal steroids on these discrimination tasks (Experiment 2) were investigated. In Experiment 1 two groups of experimentally naive rats (males and females) were exposed to a black-white successive conditional discrimination task in a T-maze. No sex differences were found in the acquisition or retraining. However, in the reversal phase females made fewer errors and reached the discrimination criterion (90% of correct choices) sooner than males. In Experiment 2, the absence of sex differences in the acquisition or retraining phases and the existence of sexual dimorphism in the reversal period were confirmed. In addition, female androgenization and male orchidectomy, on day one after birth, reversed the direction of the sex differences found in the successive conditional discrimination reversal learning.     

One-stage correction of the spastic dislocated hip. Use of pericapsular acetabuloplasty to improve coverage.

We performed a combined one-stage approach for the treatment of eighteen spastic subluxated or dislocated hips in eleven children who had cerebral palsy. All patients were between five and thirteen years old and had spastic subluxation or dislocation of the hip and severe acetabular dysplasia. The operation consisted of release of the adductors, psoas, and proximal hamstrings; a femoral-shortening varusderotation osteotomy; and a pericapsular pelvic osteotomy. The pelvic osteotomy was designed to increase superolateral coverage of the femoral head in the elongated acetabulum, which had erosion of the superior and lateral aspects. At the latest follow-up (mean duration, six years and ten months), seventeen of the eighteen hips remained anatomically reduced.     

Effects of indorenate on food intake: a comparison with fenfluramine and amphetamine

Indorenate (TR3369, 5-methoxytryptamine b-methylcarboxylate HCl) is a 5-HT₁-like receptor agonist with hypotensive activity. Here, we describe that indorenate also decreases food intake (ED₅₀ 26.1 mg/kg) without an appreciable effect in water intake (the estimated ED₅₀ for water was 589.8 mg/kg). The anorectic activity of indorenate was compared to the effects of amphetamine and other serotonin agonists; the effect of indorenate was smaller than those of the other compounds; however, the effect of indorenate was specific to food, whereas all the other drugs also produced significant decrements in water intake. The serotonin antagonists cinanserin, cyproheptadine, methergoline and methysergide effectively prevented the decrease in food intake produced by indorenate and fenfluramine. Haloperidol, a dopaminergic antagonist, was ineffective in preventing the effect of indorenate although it prevented the anorectic effect of amphetamine. The present results suggest the participation of serotoninergic, but not dopaminergic mechanisms, in the decrease in food intake produced by indorenate.     

In vitro activity and selectivity of glucosidic SP(6-11) analogues

The relative potencies of a series of substance P (6-11) analogues have been determined for spasmogenic activity in the guinea pig ileum in vitro and for potentiation of electrically evoked contractions in the rat vas deferens in vitro. ED50 values were determined for the new analogues. Substance P and its methyl ester were used as standard agonists. Substitution of Gly9 by Pro on [Glu6]SP(6-11) increased four times the activity on the NK-1 receptor. The glycosilation of [Glu6]SP(6-11) by the incorporation of a beta-D-glucopyranosyl amide residue on the gamma-carboxyl group of Glu6 reduced both the activity and selectivity. The simultaneous substitution of Gly9 by Pro and the incorporation of a monosaccharide moiety on the gamma-carboxyl of Glu6 on [Glu6]SP(6-11) yielded an analogue with 60-fold enhanced selectivity relative to substance P for the NK-1 receptor. These results may indicate that the critical factor providing potency to SP(6-11) analogues is mostly related to conformational rather than hydrophilicity aspects of the molecular structure.     

Epithelioid sarcoma

Three cases of epithelioid sarcoma are reported. Local recurrences after excision were commonly observed. In one case, metastatic skin lesions appeared several years after removal of the primary tumor. An early and complete removal by surgical excision is essential if local recurrences and eventual metastasis are to be avoided.