T-cell characterization in chronic allergic eye disease

Chronic allergic eye disease encompasses several disorders, but it is vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) that have sight-threatening sequelae. T cells, eosinophils, and mast cells are all found in the conjunctiva, and are thought to play a role in disease pathogenesis. Recently, the conjunctival epithelium has also been considered to play a key role. New and effective therapeutic strategies for the future for these patients depend on achieving a greater understanding of the roles and interactions of the cell populations in these sight-threatening disorders.     

Congenital arteriovenous fistula between an intercostal artery and the left brachiocephalic vein

Congenital arteriovenous fistulas between the thoracic arteries and the systemic veins are rare, and in clinical terms may mimic patency of the arterial duct. We present a neonate with a large arteriovenous fistula between the left sixth intercostal artery and the left brachiocephalic vein, to the best of our knowledge a unique site of drainage. To our knowledge, ours is also the earliest presentation and treatment of a thoracic arteriovenous fistula.     

Cutaneous reactions due to diltiazem and cross reactivity with other calcium channel blockers

BackgroundThe spectrum of cutaneous eruptions in association with calcium channel blockers is extensive, varying from exanthemas to severe adverse events. Reactions due to diltiazem occur more frequently than with other calcium channel blockers. Patch testing has been used as confirmatory testing in patients with extensive cutaneous reactions. Cross-reactivity among these drugs have not been established.MaterialWe present 3 patients: 1) A 54-year-old man developed a generalized eythema-multiformelike reaction followed by erythrodermia and exfoliative dermatitis 6-7 days after starting on diltiazem. The drug was stopped and remission was obtained with emollients and systemic corticosteroids and antihistamines within 12 days. 2) A 80-year-old woman experienced a pruritic exanthematous eruption on her trunk which evolved to generalized erythrodermia and superficial desquamation. This reaction appeared 10 days after taking diltiazem, and gradually improved in 10-12 days after discontinuation of this drug.3) A 79-year-old man presented with erythema and pruritus initially on the back, and then affecting thorax, extremities and face. He had started treatment with diltiazem three days before. Diltiazem was stopped and steroid and antihistamine therapy was given. His skin condition improved, but 3 days later the patient received verapamil with worsening of previous situation. He recovered within 7 days.Methods and resultsTwo to six months after the reaction, we carried out epicutaneous tests with calcium channel blockers from different groups. Diltiazem proved positive (at 48 and 96 hours) in the three patients; nifedipine was also positive in patient 2, and verapamil in patient 3. Controlled administration of verapamil was well tolerated in patient 2 after the reaction, and the patient 1 has taken nifedipine without problems.Conclusions1) We report 3 cases of cutaneous reactions due to diltiazem. 2) Epicutaneous tests have been useful for diagnosis. 3) As one of patients had positive patch tests to diltiazem and nifedipine, and other one with diltiazem and verapamil, more studies are needed to demonstrate cross reactions among calcium channel blockers.     

Failure of endoscopic therapy in upper gastrointestinal hemorrhage due to duodenal ulcers.

OBJECTIVES: to evaluate the efficacy of endoscopic treatment in patients with upper gastrointestinal (UGIH) due to duodenal ulcer with high risk of persistent or recurrent bleeding and to determine the associated failure factors of this procedure. PATIENTS AND METHOD: three hundred and thirty-six patients with UGIH due to duodenal ulcer requiring endoscopic treatment were analyzed between January 1992 and December 2001. The patients were classified according to the endoscopic findings: a) patients with limited bleeding; and b) patients with persistent and/or recurrent bleeding due to therapeutic failure. The clinical guidelines followed in patients with endoscopic treatment failure were previously established in the internal protocol. The variables that obtained statistical significance in the univariate analysis were included in the logistic regression model to identify those with an independent predictive value for failure of the endoscopic treatment. RESULTS: mean age of the patients was 60 +/- 17 years, 271 (81%) were male. Bleeding with severe hemodynamic affectation was detected in 82 patients (24%). The most common location of the duodenal ulcer was on the anterosuperior part of the duodenal bulb (227 patients, 68%). In 43 patients (13%) the ulcer was larger than 2 cm. The bleeding stigmata were classified as: Forrest I in 125 (38%) and Forrest II in 211 (62%). It was initially reached in 297 patients (88%). Twenty-two patients required emergency surgery (6,5%) and the global mortality rate was 3%. Severe hemodynamic affectation at admission (OR 11.8, p>0.001), ulcers exceeding 2 cm (OR 6.95, p = 0.019) and the presence of active bleeding during endoscopy (Forrest I) (OR 3.55, p = 0.08) were the variables included in the multivariate analysis independently associated to endoscopic therapy failure. CONCLUSION: endoscopic therapy is an efficient treatment of upper gastrointestinal bleeding due to duodenal ulcer. By means of a clinical variable, the hemodynamic status and two endoscopies, bleeding stigmata and the size of the ulcer, a group of patients with high risk of endoscopic treatment failure can be selected.     

Transdermal Transport of India Ink by Electromagnetic Electroporation in Guinea Pigs: An Ultrastructural Study

Transdermic administration by electroporation has developed over recent years for applying drugs in a variety of pathological processes. However, mechanisms are still not finally settled. India ink was applied to the backs of guinea pigs and for the transdermic transport short, high-voltage pulses (TDES, Dencort Dell) were administrated. Punch biopsies (4 mm) immediately taken after 24, 48, 72, 96 and at 26 days were studied by light and electronic microscopy. The ultrastructural characteristics and image pigment particles were reported. Particles of India ink were observed in the stratum corneum and in the epidermic keratinocytes of samples studied immediately after treatment. Particles were also seen in the epidermic and folicular keratinocytes, and in the papillary and reticular dermis (among collagen fibers, vessel walls, and macrophages) in all the subsequent biopsies; but not in the controls, which were conducted with electromagnetic waves alone. No tissue alterations were observed. The efficacy and noninvasive nature of electroporation for the transdermic administration of macromolecules is confirmed.     

Facial Emotion Recognition after Bilateral Amygdala Damage: Differentially Severe Impairment of Fear

Although the amygdala is widely believed to have a role in the recognition of emotion, a central issue concerns whether it is involved in the recognition of all emotions or whether it is more important to some emotions than to others. We describe studies of two people, DR and SE, with impaired recognition of facial expressions in the context of bilateral amygdala damage. When tested with photographs showing facial expressions of emotion from the Ekman and Friesen (1976) series, both DR and SE showed deficits in the recognition of fear. Problems in recognising fear were also found using photographic quality images interpolated (“morphed”) between prototypes of the six emotions in the Ekman and Friesen (1976) series to create a hexagonal continuum (running from happiness to surprise to fear to sadness to disgust to anger to happiness). Control subjects identified these morphed images as belonging to distinct regions of the continuum, corresponding to the nearest prototype expression. However, DR and SE were impaired on this task, with problems again being most clearly apparent in the region of the fear prototype. An equivalent test of recognition of morphed identities of six famous faces was performed normally by DR, confirming the dissociability of impairments affecting the recognition of identity and expression from the face. Further two-way forced-choice tests showed that DR was unable to tell fear from anger, but could tell happiness from sadness without difficulty. The finding that the recognition of fear can be differentially severely affected by brain injury is consistent with reports of the effects of bilateral amygdala damage in another case (Adolphs, Tranel, Damasio, & Damasio, 1994, 1995). The recognition of facial expressions of basic emotions may therefore be linked, to some extent, to specific neural substrates.     

An insight into recent consanguinity within the Basque area in Spain. Effects of autochthony,industrialization and demographic changes

Background: The importance of studying the genetic kinship of those human groups characterized by a deeply rooted ethnicity has traditionally been and still is an interesting goal of anthropological and population genetic studies. However, only a few surveys have aimed to learn about the impact of industrial development on the consanguinity of these populations and even those have concentrated on industrialized regions. This approach is worth analysing in Spain, where industrialization was late in relation to other western European countries.

Aim: In this work we analyse the characteristics of inbreeding in Guipúzcoa from 1951 to 1995. This Basque province underwent industrial and tourist development earlier than other Spanish regions. It has the highest density of Basque speakers and has always occupied a central position within the map of distribution of the Basque language. Guipúzcoa is geographically placed in the core of the Basque area.

Subjects and methods: Data on consanguineous marriages recorded in the province of Guipúzcoa between 1951 and 1995 were taken from Roman Catholic dispensations stored in the Diocesan Archives of San Sebastián, the province's capital city. Over the whole time period, a total of 1152 consanguineous marriages were registered.

Results: The high frequencies of first cousin (M22) (F = 1/16) and uncle-niece/aunt-nephew (M12) (F = 1/8) consanguineous marriages distinguish Guipúzcoa from the rest of Iberian populations. The M22/M33 ratio (with M33 being second cousins) has never dropped below 0.67, which represents a significant deviation from the expectation value of 0.25. When consanguineous marriages are classified according to marriage partner birthplaces interesting results emerge. Provincial endogamy shows the highest consanguinity rates (57%) and the proportion of M22/M33 is also rather high (0.63). However, a major contribution to the consanguinity levels and mean inbreeding coefficient recorded in Guipúzcoa over recent decades has been made by immigrant relative groups coming from other geographical areas of Spain. In this segment of population the observed M22/M33 rates are 1.44.

Conclusions: This study shows again how important preferentiality (or avoidance) is in human consanguinity, and also how human groups, in spite of being spatially settled in the same territory, present differential attitudes for given consanguinity patterns.

Hintergrund: Die Analyse genetischer Verwandtschaftsgrade zwischen jenen menschlichen Gruppen, welche ethnisch tief verwurzelt sind, ist traditionell und noch heute ein interessantes Ziel anthropologischer und populationsgenetischer Studien Allerdings haben nur einige Studien darauf abgezielt, die Auswirkung der industriellen Entwicklung auf die Verwandtschaft dieser Populationen zu untersuchen und selbst diese haben sich auf industrialisierte Regionen konzentriert. Es lohnt sich, dies am Beispiel Spaniens zu untersuchen, wo die Industrialisierung im Vergleich zu anderen westeuropäischen Ländern spät stattgefunden hat. Ziel: In dieser Arbeit werden die Charakteristiken von Consangunität in Guipúzcoa von 1951 bis 1995 analysiert. In dieser baskischen Provinz fand die industrielle und touristische Entwicklung früher als in anderen spanischen Regionen statt. Diese Provinz hat die höchste Konzentration von Angehörigen der baskischen Sprachgruppe und hat immer eine zentrale Stellung innerhalb der Verteilung der baskischen Sprache eingenommen. Guipúzcoa befindet sich geographisch im Kern des Baskenlandes. Material und Methoden: Die dieser Arbeit zugrunde liegenden Daten bezüglich von Ehen zwischen Blutsverwandten, welche in der Provinz von Guipúzcoa zwischen 1951 und 1995 geschlossen wurden, stammen aus den römisch-katholischen Archiven der Diözese von San Sebastián, der Provinzhauptstadt. In diesem gesamten Zeitraum wurden insgesamt 1152 Verwandtenehen registriert. Ergebnisse: Die große Häufigkeiten von Verwandtenehen zwischen ersten Cousins (M22) (F = 1/16) und Onkel-Nichte/Tante-Neffe (M12) (F = 1/8) unterscheiden Guipúzcoa vom Rest der iberischen Population. Das Verhältnis M22/M33 (wobei M33 der zweite Cousin ist) liegt nie unter 0,67. Dies stellt eine deutliche Abweichung vom Erwartungswert von 0,25 dar. Wenn Verwandtenehen entsprechend den Geburtsorten der Ehepartner eingestuft werden, zeigen sich interessante Resultate. Bei provinzieller Endogamie ist die Verwandtschaftsrate am höchsten (57%) und der Anteil M22/M33 ist auch ziemlich hoch (0,63). Die Verwandtschaftsrate und der mittlere Consangunitäts-Koeffizienten, welcher in Guipúzcoa in den letzten Jahrzehnten registriert wurde, wird jedoch wesentlich von Verwandtengruppen, welche aus anderen Regionen Spaniens eingewandert sind, bestimmt. In dieser Bevölkerungsgruppe beträgt die M22/M33-Rate 1,44. Schlußfolgerungen: Diese Studie zeigt wieder, wie wichtig Sympathien (oder Antipathien) in der chlichen Verwandtschaft sind, und auch, wie menschliche Gruppen trotz räumlicher Trennung innerhalb eines Landes, unterschiedliche Einstellungen zu existierenden Verwandtschaftsbeziehungen haben.

Arrière-plan: l'étude de la consanguinité des groupes humains caractérisés par une identité ethnique anciennement formée, est une vocation traditionnelle mais toujours valide de l'anthropobiologie et de la génétique des populations. Cependant, peu de travaux ont cherché à évaluer l'impact du développement industriel sur la consanguinité de telles populations. Cette approche vaut la peine d'être analysée en Espagne, où l'industrialisation s'est produite tardivement par rapport aux autres nations ouest-européennes. But: ce travail étudie les caractéristiques de la consanguinité en Guipúzcoa de 1951 à 1995. Cette province basque a connu un développement touristique et industriel antérieurement aux autres régions espagnoles. Elle a la plus forte densité de locuteurs basques et a toujours occupé une position centrale dans la carte de répartition de la langue basque. La Guipúzcoa est au cur géographique de l'aire basque. Sujets et méthodes: pour l'ensemble de la période étudiée (1951 à 1995), on a relevé les données de 1152 mariages consanguins dans les archives des dispenses de mariage de l'église Catholique Romaine, conservées dans les Archives Diocésaines de Saint Sébastien, la capitale de la province. Résultats: les fréquences élevées de mariage consanguins entre cousins germains (M22) (F = 1/16) et oncle-nièce/tante-neveu (M12) (F = 1/8), distinguent la Guipúzcoa des autres populations ibériques. Le rapport M22/M33 (M33 étant les cousins issus de germains) n'est jamais tombé au-dessous de 0,67, ce qui représente une déviation significative par rapport à la valeur attendue de 0,25. Lorsque les mariages consanguins sont ordonnés en fonction des lieux de naissance des intéressés, apparaît un résultat intéressant. L'endogamie provinciale est associée aux plus niveaux de consanguinité (57%) et la proportion de M22/M33 est aussi plutôt élevée (0,63). Une contribution majeure aux taux de consanguinité et coefficient moyen de consanguinité observés en Guipúzcoa au cours des décennies récentes, provient cependant des groupes d'immigrants apparentés provenant d'autres régions d'Espagne. Dans ce segment de population, le rapport M22/M33 est 1,44. Conclusions: cette étude montre encore l'importance des préférences ou de l'évitement dans la consanguinité humaine et aussi comment les groupes humains présentent des attitudes différentielles pour certains modèles de consanguinité en dépit du fait qu'ils occupent les mêmes territoires géographiques.     

Leuprolide acetate induces structural and functional recovery of injured spinal cord in rats

Gonadotropin-releasing hormone (GnRH) and its synthetic analog leuprolide acetate, a GnRH agonist, have neurotrophic properties. This study was designed to determine whether administration of leuprolide acetate can improve locomotor behavior, gait, micturition reflex, spinal cord morphology and the amount of microglia in the lesion epicenter after spinal cord injury in rats. Rats with spinal cord compression injury were administered leuprolide acetate or saline solution for 5 weeks. At the 5^th week, leuprolide acetate-treated rats showed locomotor activity recovery by 38%, had improvement in kinematic gait and exhibited voiding reflex recovery by 60%, as compared with the 1^st week. By contrast, saline solution-treated rats showed locomotor activity recovery only by 7%, but voiding reflex did not recover. More importantly, leuprolide acetate treatment reduced microglial immunological reaction and induced a trend towards greater area of white and gray matter in the spinal cord. Therefore, leuprolide acetate has great potential to repair spinal cord injury.     

Autoimmune hepatitis in pediatric patients]

BACKGROUND: Autoimmune hepatitis (AIH) is an inflammatory disease of unknown origin that is responsible for progressive liver necrosis and ultimately cirrhosis. OBJECTIVE: Our aim was to evaluate the characteristics of autoimmune hepatitis presenting in the pediatric age. MATERIAL AND METHODS: We conducted a retrospective study of all patients diagnosed with AIH in our hospital department during the last 10 years. Variables analyzed included age, sex, clinical presentation, hepatic function, immunoglobulins, autoimmunity markers, histology, treatment, need for transplant, and clinical evolution. According to the positive level of auto-antibodies, AIH patients were classified as type I AIH (ANA and/or smooth-muscle antibodies) and type II (anti-LKM-1). RESULTS: Seven patients were diagnosed in this period -5 girls (71.5%) and 2 boys (28.5%). Five patients presented with type-I serological markers, and two with type-II markers. Age range at diagnosis was from 21 months to 12 years. In the type-I group, 3 patients presented with acute hepatitis while 2 other patients were diagnosed from laboratory findings while asymptomatic. Elevated aminotransferase (10 times the normal level) was observed in 71.5%, and 85% had elevated immunoglobulins. Treatment with azathioprine and prednisone was started after diagnosis with an average time to remission of 14 months. Two patients relapsed following steroid withdrawal. CONCLUSION: AIH can have different forms of clinical presentation, and is sometimes indistinguishable from viral hepatitis. AIH must be ruled out in patients presenting with concomitant elevation of aminotransferases and immunoglobulins. The commonly accepted treatment is a combination of azathioprine and corticosteroids. A high percentage of patients experience a relapse of disease after steroids are withdrawn. Therefore, some patients will need to stay on combined therapy with minimal doses of steroids.