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A response surface model was developed to describe the effects of temperature (35 to 55 degrees C), pH (3.5 to 5.5), and water activity (a(w), 0.960 to 0.992) on germination of Alicyclobacillus acidoterrestris spores. Germination and growth or viability loss depended, to varying extents, on the interactions among the independent variables and the complexity of the medium. In particular, maximum growth was achieved at temperatures between 35 and 42 degrees C and at pH values from 3.5 to 4.5. The model was validated against data not used in its development. Bias factors of 0.999 and 0.817 for 2- and 7-day models, respectively, were obtained, indicating that the models were "fail safe." Results indicated that the model provided reliable predictions of growth of A. acidoterrestris spores.

Hermansky-Pudlak syndrome (HPS; MIM 203300) is a genetically heterogeneous disorder characterized by oculocutaneous albinism, prolonged bleeding and pulmonary fibrosis due to abnormal vesicle trafficking to lysosomes and related organelles, such as melanosomes and platelet dense granules. In mice, at least 16 loci are associated with HPS, including sandy (sdy; ref. 7). Here we show that the sdy mutant mouse expresses no dysbindin protein owing to a deletion in the gene Dtnbp1 (encoding dysbindin) and that mutation of the human ortholog DTNBP1 causes a novel form of HPS called HPS-7. Dysbindin is a ubiquitously expressed protein that binds to alpha- and beta-dystrobrevins, components of the dystrophin-associated protein complex (DPC) in both muscle and nonmuscle cells. We also show that dysbindin is a component of the biogenesis of lysosome-related organelles complex 1 (BLOC-1; refs. 9-11), which regulates trafficking to lysosome-related organelles and includes the proteins pallidin, muted and cappuccino, which are associated with HPS in mice. These findings show that BLOC-1 is important in producing the HPS phenotype in humans, indicate that dysbindin has a role in the biogenesis of lysosome-related organelles and identify unexpected interactions between components of DPC and BLOC-1.

Objective: To test the effect of zinc supplementation on the nutritional status of patients on continuous ambulatory peritoneal dialysis (CAPD)., Material and Methods: Double-blinded randomized controlled clinical trial. Twenty-five patients with end stage renal disease (ESRD) on CAPD program, from 16 to 60 years old were studied. Two weeks before the beginning of the study all the drugs with a known effect on zinc absorption were withdrawn. Patients were randomly allocated into one of two groups. The control group consisted of 12 patients receiving placebo, and the intervention group of 13 patients receiving 100 mg/day of elemental zinc for 3 months. The diet was individually adjusted to 35 kcal/kg/day, and 1.5 g/day of proteins. Subjective global assessment (SGA), anthropometric measurements, electric bioimpedanciometry, measurements of albumin, prealbumin, and transferrin, and evaluation of energy, proteins, carbohydrates, and lipids consumption were done to classify the nutritional status at the beginning and at the end of the study. Therapeutic compliance was assessed by measuring plasma zinc levels and by capsule counting., Results: There were no statistically significant differences between groups regarding age, gender, time on CAPD, and ESRD causes. The proportion of patients classified as well nourished, or with mild or moderate malnutrition by SGA did not show significant differences between the group receiving Zn supplementation and the group receiving placebo. Anthropometric measurements and body composition assessed by bioelectric impedance were similar in the two groups. In the control group, serum levels of albumin (3,621 +/- 838 vs. 3,068 +/- 842 mg/dL), prealbumin (49 +/- 14 vs. 44 +/- 12 mg/dL), and transferrin (238 +/- 94 vs. 195 +/- 79 mg/dL) decreased significantly at the end of the follow-up period respect to the baseline values (p < 0.05). In the intervention group albumin (3,320 +/- 910 vs. 2,696 +/- 964 mg/dL), prealbumin (43 +/- 9 vs. 38 +/- 8 mg/dL), and transferrin (236 +/- 99 vs. 193 +/- 66 mg/dL) also decreased significantly (p < 0.05). In the control group baseline zinc level was low (60 +/- 5 micrograms/dL) and remained stable along the follow-up period, while in the intervention group it increased from 52 +/- 5 (baseline) to 92 +/- 9 micrograms/dL (end of the follow-up, p < 0.05)., Conclusions: Zinc supplementation did not improve the nutritional status in patients on CAPD.

The biosynthesis of the majority of biologically active peptides ends with an obligatory alpha-amidation step that is catalyzed only by peptidylglycine alpha-hydroxylating monooxygenase (PHM). The utility of two mechanisms proposed for this copper- and ascorbate-dependent monooxygenase was examined using site-directed mutagenesis and intrinsic tryptophan fluorescence. Retention of full activity by PHMccGln(170)Ala and -Asn eliminates a critical role for Gln(170) in a substrate-mediated electron transfer pathway. The 20-fold reduction in V(max) observed for PHMccGln(170)Glu and -Leu is consistent with a key role for conformational changes in this region. Mutation of Tyr(79), situated near Cu(A), to Trp reduced V(max) 200-fold. Measurement of changes in intrinsic fluorescence allowed determination of a K(d) for copper (0.06 microM) and for a peptidylglycine substrate, Phe-Gly-Phe-Gly (0.8 microM). Although the peptidylglycine substrate bound more tightly at pH 7.0 than at pH 5.5, V(max) decreased 25-fold at neutral pH. Total quenching of the signal from Trp(79) in apoPHMccTyr(79)Trp along with its greatly reduced V(max) defines a critical role for Cu(A) in the rate-limiting step of the reaction. Taking into account our data and the results of kinetic, spectroscopic, and crystallographic studies, we propose a mechanism in which substrate-mediated activation of molecular oxygen binding at Cu(A) completes a pathway for electron transfer from Cu(B).

Objective: To report 2 cases of acute tumor lysis syndrome (ATLS) associated with hydroxyurea treatment., Case Summary: A 79-year-old woman diagnosed with chronic lymphocytic leukemia presented with an acute blastic transformation. She was promptly hydrated, started on allopurinol, and treated with hydroxyurea. About 24 hours later, her biochemistry panel showed parameters consistent with ATLS when compared with pretreatment levels. The second case was a 76-year-old man newly diagnosed with acute myeloid leukemia presenting with high blast fraction. He was given appropriate hydration and allopurinol prophylaxis, and was started on high-dose hydroxyurea treatment. He became symptomatic after 12 hours and results of his blood work were consistent with ATLS., Discussion: ATLS is a well-known metabolic disturbance that occurs after cell destruction of rapidly growing tumors. In standard doses, hydroxyurea leads to cell death in the S phase and is not thought to cause significant cell lysis. However, in large doses, it possibly acts by a different mechanism and had a direct cytolytic effect associated with ATLS in our patients., Conclusions: Although ATLS caused by hydroxyurea appears to be rare, patients at risk should be closely monitored for this complication. An objective causality assessment using the Naranjo probability scale revealed that the adverse drug reaction was probable between ATLS and hydroxyurea therapy in these 2 patients.

Objective: Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti-Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD)., Design: Single-cohort, prospective observational study., Setting: Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico., Patients: A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied., Primary Outcome: Mortality., Methods: Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart., Results: Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status., Conclusion: These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.

Background/aims: High atrial natriuretic peptide (ANP) serum levels are seen in acute renal failure (ARF) due to impaired ANP clearance, but the response of ANP to blood volume expansion is blunted. ARF-associated hypothyroidism influences ANP clearance but it may also play a role in the synthesis and release of ANP because in primary hypothyroidism both mechanisms are disturbed. The aim of this study is to analyze whether thyroxin (T4) supplementation improves the synthesis and release of ANP in ARF., Methods: Four groups of rats were studied: group C (control); group ARF; Group ARF-T4 (ARF supplemented with T4), and group Tx (thyroidectomized). Serum creatinine (SCr), creatinine clearance (CrCl), total T4, total triiodothyronin (T3), plasma ANP, ANP response to acute saline load and atrial content of mRNA-ANP were measured 5 days after ARF induction with potassium dichromate., Results: CrCl was 1.8 +/- 0.4 ml/min in group C, and it significantly dropped to 0.6 +/- 0.5 in ARF (p < 0.01), T4 improved it (1.7 +/- 0.7 in ARF-T4, p < 0.01) and Tx did not change it. Plasma ANP was higher in ARF as compared with C (152 +/- 23 vs. 52 +/- 21 fmol/l, p < 0.01). In ARF-T4, ANP was higher than in C but lower than in ARF (85 +/- 28 fmol/l, p < 0.01). No changes were observed in Tx rats (48 +/- 17 fmol/l). The atrial content of mRNA-ANP was 0.06 +/- 0.025 mRNA-ANP/mRNA-beta-actin ratio units in group C, it was higher in ARF (0.13 +/- 0.025, p < 0.01) and lower in Tx (0.04 +/- 0.01, p < 0.05) as compared to C. Supplementation with T4 increased the mRNA-ANF content (0.18 +/- 0.2 mRNA-ANP/mRNA-beta-actin ratio units, p < 0.05) over ARF. Plasma ANP response to saline load was 45 +/- 7% in C, but it was reduced in ARF and Tx (20 +/- 10 and 26 +/- 10%, p < 0.01). In ARF-T4 the response was restored (36 +/- 9%, p < 0.01 vs. ARF)., Conclusion: Thyroid hormones modulate the synthesis and release of ANP in ARF. Although the effect is probably direct, T4-induced amelioration of renal damage may also play a significant role by improving the uremic milieu., (Copyright 2003 S. Karger AG, Basel)

Chronic lymphocytic leukemia (CLL) is recognized as a unique lymphoproliferative disorder of CD5(+) B cells. However, many published series of CLL included a subgroup of CD5(-) cases. CD5(-) B cell CLL is a topic of controversy and its nature and true incidence remain unclear. We in this study performed a retrospective analysis of a total of 128 consecutive patients with a diagnosis of CLL and available immunophenotypic record. Of these, 14 cases were previously considered CD5(-) CLL. From a further analysis of clinical, hematological and immunophenotypic results, we have reclassified seven of the patients as having weak or dim expression of CD5 and four patients as being monoclonal B lymphocytosis of undetermined significance (MLUS). The remaining three cases had clinical and morphological features consistent with prolymphocytic leukemia (PLL) or mixed CLL/PLL. Our results suggest that the CD5(-) phenotype probably does not qualify for CLL. Previous CD5(-) CLL may include false negatives due to heterogeneity of the intensity of CD5 expression, CD5(-) MLUS and variant CLL; the latter likely represents CLL in transformation. All the patients with MLUS were found to have a mild and non-progressing lymphocytosis with CD5(-) phenotype. These features may be used to differentiate them from CLL.

Background: Our objective was to assess the relationship of hormones such as cortisol and dehydroepiandrosterone-sulfate (DHEA-S) with insulin resistance and overweight., Methods: We designed and conducted a cross-sectional, observational survey consisting of home visits within a previously defined area of Mexico City. The study included 303 apparently healthy volunteers from a middle-class socioeconomic urban community. We measured glucose, cholesterol, triglycerides, insulin, cortisol, and DHEA-S. Insulin resistance (IR) was defined as belonging to the first quartile of fasting glucose/insulin ratio (G/IR) distribution or fourth quartile of IR (HOMA). Overweight was defined as body mass index (BMI) > or =25 kg/m(2)., Results: To predict IR in women < or =35 years of age, principal component analysis (PCA) disclosed three components: 1) cholesterol, BMI, and diastolic blood pressure (DBP); 2) cholesterol, triglycerides, and cortisol, and 3) dehydroepiandrosterone-sulfate [DHEA-S]. Solely the latter (DHEA-S) was significantly associated with IR (odds ratio [OR] = 1.80, confidence interval 95% [CI 95%] 1.11-2.91, p = 0.015). For men < or =35 years of age, there were two components: 1) cholesterol, triglycerides, BMI, and DBP, and 2) DHEA-S, cholesterol, and cortisol. Component 1 was significantly associated with IR (OR = 5.65; CI 95% 1.62-19.65, p = 0.006). To predict overweight in women >35 years of age, there were three components, including 1) cholesterol and triglycerides, 2) cortisol, and 3) DHEA-S and G/IR. Component 2 was significantly associated with overweight (OR = 0.38, CI 95% 0.23-0.64, p = 0.000)., Conclusions: In women < or =35 years of age, high DHEA-S levels were associated with insulin resistance, which suggests that in young women DHEA-S exerts anti-estrogenic action, perhaps caused by its competitive binding with the estrogen receptor. Additionally, in women >35 years of age, low cortisol levels were associated with overweight. These associations were not identified for the male subgroup.

Small-solute clearance targets for peritoneal dialysis (PD) have been based on the tacit assumption that peritoneal and renal clearances are equivalent and therefore additive. Although several studies have established that patient survival is directly correlated with renal clearances, there have been no randomized, controlled, interventional trials examining the effects of increases in peritoneal small-solute clearances on patient survival. A prospective, randomized, controlled, clinical trial was performed to study the effects of increased peritoneal small-solute clearances on clinical outcomes among patients with end-stage renal disease who were being treated with PD. A total of 965 subjects were randomly assigned to the intervention or control group (in a 1:1 ratio). Subjects in the control group continued to receive their preexisting PD prescriptions, which consisted of four daily exchanges with 2 L of standard PD solution. The subjects in the intervention group were treated with a modified prescription, to achieve a peritoneal creatinine clearance (pCrCl) of 60 L/wk per 1.73 m(2). The primary endpoint was death. The minimal follow-up period was 2 yr. The study groups were similar with respect to demographic characteristics, causes of renal disease, prevalence of coexisting conditions, residual renal function, peritoneal clearances before intervention, hematocrit values, and multiple indicators of nutritional status. In the control group, peritoneal creatinine clearance (pCrCl) and peritoneal urea clearance (Kt/V) values remained constant for the duration of the study. In the intervention group, pCrCl and peritoneal Kt/V values predictably increased and remained separated from the values for the control group for the entire duration of the study (P < 0.01). Patient survival was similar for the control and intervention groups in an intent-to-treat analysis, with a relative risk of death (intervention/control) of 1.00 [95% confidence interval (CI), 0.80 to 1.24]. Overall, the control group exhibited a 1-yr survival of 85.5% (CI, 82.2 to 88.7%) and a 2-yr survival of 68.3% (CI, 64.2 to 72.9%). Similarly, the intervention group exhibited a 1-yr survival of 83.9% (CI, 80.6 to 87.2%) and a 2-yr survival of 69.3% (CI, 65.1 to 73.6%). An as-treated analysis revealed similar results (overall relative risk = 0.93; CI, 0.71 to 1.22; P = 0.6121). Mortality rates for the two groups remained similar even after adjustment for factors known to be associated with survival for patients undergoing PD (e.g., age, diabetes mellitus, serum albumin levels, normalized protein equivalent of total nitrogen appearance, and anuria). This study provides evidence that increases in peritoneal small-solute clearances within the range studied have a neutral effect on patient survival, even when the groups are stratified according to a variety of factors (age, diabetes mellitus, serum albumin levels, normalized protein equivalent of total nitrogen appearance, and anuria) known to affect survival. No clear survival advantage was obtained with increases in peritoneal small-solute clearances within the range achieved in this study.

Monoclonal B lymphocytosis of undetermined significance (MLUS) is a benign condition of clonal lymphocytosis. Because of its clonal small lymphocytes and indolent clinical course, MLUS resembles and may be indistinguishable from an early stage of chronic lymphocytic leukemia (CLL). In this study we characterized the immunophenotype of MLUS. The clonal B lymphocytes from three patients of typical MLUS were shown to be CD5(-) and CD23(-) phenotype. Their immunophenotypic features remained unchanged during the clinical course. The results indicate a distinct immunophenotype of MLUS that can be useful for its diagnosis and differentiation from CLL., (Copyright 2002 Wiley-Liss, Inc.)

Aim: Fetal intrauterine growth retardation (IUGR) is one of the most common obstetric problems, with a frequency of 12% in Mexico. In the past, investigations have focused on extrinsic causes of IUGR. More recent studies have examined the intrinsic factors that cause fetal intrauterine growth. Maintenance of fetal growth has been attributed to insulin-like growth factor (IGF), epidermal growth factor (EGF) and transforming growth factor beta (TGF-beta). The objective of this study was to assess the levels of these growth factors during pregnancy and to determine whether or not low concentrations are associated with IUGR., Methods: Nine women whose pregnancies were complicated by IUGR and a group of nine women whose pregnancies exhibited normal fetal intrauterine growth were studied. IUGR was determined by sonography and confirmed by weight at birth. Venous blood samples were taken from both groups of pregnant women at the end of each trimester. Enzyme-linked immunosorbent assays, immunoradiometric assays and radioimmunoassays were used to process samples, and the results were analysed by anova., Results: IGF-I levels increased in both groups during pregnancy, but the increase was lower (p < 0.001) in the IUGR group throughout pregnancy and at delivery. EGF did not show any significant changes during pregnancy. Blood TGF-beta levels varied only during the first trimester of pregnancy. The differences were not statistically significant. However, TGF-beta concentrations were higher in the pregnancies with IUGR. Women in the IUGR group were smaller than in the control group (p < 0.05), and, using the covariance test (p < 0.05), this was found to be correlated with IGF-I levels but not with EGF or TGF-beta levels., Conclusions: Changes in fetal weight might be explained by the different concentrations of IGF. The structural homology between IGF-1 and insulin could mean that the presence of higher levels of IGF would result in a increased energetic metabolism that could contribute to fetal growth. EGF levels were not related to IUGR, and TGF-beta levels increased only during the first 3 months in the IUGR group. This observation correlates with the in vitro action of TGF-beta as a negative factor of growth, but as a positive support for sustaining early pregnancy. Our data illustrates that low height represents an increased risk factor for IUGR. These data also correlate with the studies involving extrinsic factors.

Gelatinous marrow transformation is characterized by marrow hypoplasia, fat atrophy, and gelatinous material deposition, and usually develops as a hematologic complication of chronic wasting disorders. Most of the cases associated with severe nutritional deficiency were seen in anorexia nervosa due to a depletion of protein or fat. This report describes a case of gelatinous transformation attributed to a specific restriction of carbohydrates in diet. The hematologic deficiency was eventually recovered after the patient resumed a regular starch-containing diet. This brief report illustrates the potential side effect of the compulsive dietary behavior on the hematologic system., (Copyright 2001 Wiley-Liss, Inc.)

To evaluate the relationship of nasal or skin Staphylococcus carrier status with identical strains and the development of staphylococcal peritonitis, 59 consecutive peritonitis episodes in patients using a twin-bag system for continuous ambulatory peritoneal dialysis from a single dialysis center were prospectively studied. Dialysate samples and exit-site, nose, and nail swabs from patients and their dialysis partners were obtained on the same day for culture. When bacteria belonging to the same species of the Staphylococcus genus were isolated from dialysate and at least one extraperitoneal anatomic site, pulsed-field gel electrophoresis typing was performed. The bacterial strains isolated from catheter exit site, nose, or nails of each patient and his or her dialysis partner were classified as identical or different. Twenty-seven of the 59 peritonitis episodes (46%) were caused by staphylococci. Nineteen of these 27 patients carried the same Staphylococcus species causing the peritonitis episode at the exit site, nose, or nails, but only 17 patients (63%) carried an identical strain. Four of 5 dialysis partners carried the same Staphylococcus species causing the peritonitis episode at nose or nails, but the strain was identical for only 3 dialysis partners (60%). Four patients and 1 dialysis partner carried unrelated strains of the Staphylococcus species causing the peritonitis episode. The most frequently colonized site with strains identical to that causing the peritonitis episode was the catheter exit site, followed by nose and nails. This finding may be clinically relevant because eradication of Staphylococcus aureus colonizing the catheter exit site may be more important and have a greater likelihood of success than maneuvers directed to more distant locations.

Hematopoietic progenitor cells in 2 myeloproliferative disorders, juvenile chronic myelomonocytic leukemia and polycythemia vera, are known to be hypersensitive to cytokines that control normal progenitor cell proliferation, differentiation, and survival in their respective granulocyte/macrophage and erythroid lineages. Because thrombopoietin controls these functions in the normal megakaryocytic lineage, we asked the question: Are megakaryocytic progenitor cells in the myeloproliferative disorder essential thrombocythemia (ET) hypersensitive to thrombopoietin? Peripheral blood mononuclear cells from patients with ET, or secondary (reactive) thrombocytosis (2 degrees T), or healthy volunteers were grown in strictly serum-free agarose culture containing interleukin 3 (IL-3) and all-trans-retinoic acid, with various concentrations of PEG-rHu megakaryocyte growth and development factor (MGDF). The concentration of cytokine at half-maximum colony number served as a measure of progenitor cell sensitivity. Hypersensitivity to PEG-rHu MGDF was found in circulating progenitors from 18 of 20 (90%) informative patients with presumptive diagnosis ET, 1 of 8 (12.5%) 2 degrees T patients, and none of the 22 healthy volunteers. Median MGDF sensitivity ratio in ET patients was approximately 53 times greater than in the controls. This hypersensitivity, which was also directed to rHu thrombopoietin, was highly specific with respect to cytokine, disease, and cell lineage. We propose that, despite their single pluripotential cell origin, the different clinicopathologic phenotypes in different chronic myeloproliferative disorders are determined by lineage-restricted hypersensitivities of hematopoietic progenitor cells to endogenous cytokines. This work emphasizes the importance of stringent serum-free conditions for revealing true sensitivities to cytokines. The findings also offer a basis for evolving a positive test for ET, a diagnosis now made essentially by exclusion.

Background: Patients with pheochromocytoma have been reported to show high plasmatic atrial natriuretic factor (ANF) levels. Its source may not be the atrium because blood volume, the most important physiological stimulus for ANF release, is usually reduced in these patients., Methods: To evaluate ANF secretion functional integrity, we studied three patients with pheochromocytoma before and after surgical removal of the tumor. Extracellular fluid (ECF) volume, plasmatic ANF levels, and plasmatic renin activity (PRA) were measured. ANF was measured before and after an acute saline load of 1.5L in 90 min., Results: Before surgery, ECF volume was normal or reduced, and PRA was normal but decreased after the saline load. By contrast, ANF was elevated and did not change after the saline load. After surgery ANF decreased, ECF volume rose, and the saline load induced a significant increase of plasma ANF and reduction of PRA. ANF was present in significant amounts in tumoral tissue homogenates., Conclusions: These data suggest that the tumor was the source of ANF in these patients with pheochromocytoma because high levels of ANF, despite reduced or normal ECF volume, as well as unresponsiveness to acute saline infusion, were found before surgery with subsequent normalization after tumor removal.

Background: Ehlers Danlos syndrome (type IV) and kidney and liver cyst disease can present a common factor: anomalous biosynthesis of structural collagen and elastic tissue. We present an exceptional case., Case Report: A 62-year-old man complained of pain in the upper left quadrant of the abdomen. Ultrasonography, magnetic resonance imaging and arteriography evidenced an aneurysm of the splenic artery, an aneurysm of the hypogastric artery, multiple cysts in the kidney and liver, and mitral valvulopathy. Treatment was splenectomy with resection of the splenic aneurysm and resection of the iliac aneurysm and iliac-iliac bypass., Discussion: The association of kidney and liver cyst disease with venous gastrointestinal and cardiovascular complications is well known. The simultaneous presence of cysts and peripheral and visceral aneurysms with anomalies of the arterial wall resembling Ehlers Danlos syndrome (type IV) would suggest that these two diseases might result from a common connective tissue anomaly. The underlying mechanism(s) remain unknown.

Objective: To assess the cost-effectiveness ratio of ceftriaxone and cefotaxime to treat moderate to severe community acquired pneumonia (CAP)., Methods: A clinical trial was done in five hospitals of the Instituto Mexicano del Seguro Social, at the metropolitan area of Mexico City. Ceftriaxone and cefotaxime were compared to treat moderate to severe CAP, and the costs of purchasing, preparation, administration, hospitalization, and therapeutic success were quantified. Cost-effectiveness ratio was calculated, and sensitivity analysis and incremental analysis were done., Results: The main isolated germs were Streptococcus pneumoniae (23.6%) and Staphylococcus aureus (18.5%). Most of the microorganisms were sensitive to ceftriaxone, ceftazidime, and cefotaxime, and were resistant to penicillin, ampicillin, and erythromycin. Therapeutic success was 98% in the ceftriaxone group and 83% in the cefotaxime group (p = 0.0091). Cost-effectiveness ratio for per cent unit of success was $19,458.62 Mexican pesos in the ceftriaxone group and $29,218.08 in the cefotaxime group. Sensitivity analysis showed consistently a lower cost-effectiveness ratio in the ceftriaxone group. Incremental analysis based on the treatment of 55 patients showed that using ceftriaxone instead of cefotaxime resulted in saving $35,170.79 per each additional cured patient., Conclusions: Ceftriaxone has a lower cost-effectiveness ratio than cefotaxime to treat patients with CAP and bad prognosis criteria requiring hospitalization.

Background: A significant association of cola beverage consumption and increased risk of bone fractures has been recently reported. The present study was carried out to examine the relationship of cola soft drink intake and bone mineral density in ovariectomized rats., Methods: Study 1. Four groups of 10 female Sprague-Dawley rats were studied. Animals from groups II, III, and IV were bilaterally ovariectomized. Animals from groups I and II received tap water for drinking, while animals from groups III and IV each drank a different commercial brand of cola soft drink. After 2 months on these diets, the following were measured: solid diet and liquid consumption; bone mineral density; calcium in bone ashes; femoral cortex width; calcium; phosphate; albumin; creatinine; alkaline phosphatase; 25-OH hydroxyvitamin D, and PTH., Results: Study 2. Two groups of seven ovariectomized rats were compared. Group A animals received the same management as the group III animals from study 1 (cola soft drink and rat chow ad libitum), while rats from group B received tap water for drinking and pair-feeding. After 2 months plasmatic ionized calcium, phosphate, creatinine, albumin, calcium in femoral ashes, and femoral cortex width were measured. Study 1. Rats consuming cola beverages (groups III and IV) had a threefold higher liquid intake than rats consuming water (groups I and II). Daily solid food intake of rats consuming cola soft drinks was one-half that of rats consuming water. Rats consuming soft drinks developed hypocalcemia and their femoral mineral density measured by DEXA was significantly lower than control animals as follows: group I, 0.20 +/- 0.02; group II, 0.18 +/- 0.01; group III, 0.16 +/- 0.01, and group IV, 0.16 +/- 0.01 g/cm(2). Study 2. To rule out the possibility that these calcium and bone mineral disorders were caused by decreased solid food intake, a pair-fed group was studied. Despite a lower body weight, pair-fed animals consuming tap water did not develop bone mineral reduction or hypocalcemia., Conclusions: These data suggest that heavy intake of cola soft drinks has the potential of reducing femoral mineral density.

To determine the correlation between pregestational body mass index and certain body composition parameters measured by bioelectric impedance (percentage of fat weight, fat mass, and lean weight) and to compare the body composition of women in immediate puerperal period with non-pregnant women, a cross sectional study was done including 86 women in physiologic puerperal period and 90 healthy non-pregnant women, from the Instituto Mexicano del Seguro Social, in Chihuahua, Mexico, aged 16 to 40 years old. The variables considered were the body mass index (BMI) before pregnancy, percentage of fat, fat mass, lean weight, total water and bio-resistance. Body composition was measured by bioelectric impedance (BIO) from 4 to 12 hours after delivery. Correlation coefFicient for BMI and percentage of fat was r = 0.66 (p < 0.01), and for BMI and fat mass, it was r = 0.74 (p < 0.01). In non-pregnant women the total water was 35.5 +/- 5 L and in women in the immediate puerperal period 38.5 +/- 5 L (p < 0.01). In conclusion, BMI before pregnancy is a suitable predictor for body composition in the puerperal period. However, it does not discriminate important variables such as total body water, so it may be convenient to use BIA for surveillance of body composition during pregnancy.

Malignant clear cell hidradenoma is an uncommon tumor of eccrine sweat gland origin. In contrast to the benign form, malignant clear cell hidradenoma tends to invade the surrounding tissue and has a high incidence of distant metastases. For these reasons a wide surgical excision associated to a locoregional lymph node dissection should be performed alter the initial diagnosis. The case of a 17 year old female with this rare lesion is reported; the literature is reviewed and surgical treatment discussed.

Objective: To determine changes in intraperitoneal pressure (IPP) when dialysate fill volume is increased from 2.0 L to 2.5 L to 3.0 L per exchange, and to evaluate the relationship with subjective discomfort perception., Design: Cross-sectional survey., Setting: Seven Mexican hospital-based dialysis centers., Patients: Eighty-one adult patients on continuous ambulatory peritoneal dialysis (CAPD) without restriction criteria for age, gender, or time on dialysis, were studied. Patients seropositive for HIV or hepatitis B, and those with cancer or receiving immunosuppressive drugs were excluded. Participants were studied as outpatients., Main Measures: Blindly and in random order, 2.0-, 2.5-, and 3.0-L volumes of dialysate were infused consecutively. Body surface area (BSA) was calculated from patient height and weight. IPP was assessed with the patient lying supine, measuring the height of the dialysate column inside the peritoneal dialysis bag tubing. Blood pressure and subjective discomfort perception (using a visual analog scale of 0-100 mm) were also evaluated and registered after each of the three exchanges., Results: The IPP rose with each increase of dialysate volume and was higher in males than in females for each fill volume level. For males IPP was 18.9 +/- 6.9, 20.8 +/- 7.1, and 22.9 +/- 7.5 cm H2O; and for females it was 16.5 +/- 5.7, 18.4 +/- 5.5, and 19.7 +/- 6.2 cm H2O for 2.0-, 2.5-, and 3.0-L fill volumes respectively (p < 0.01 among fill volumes and between genders). Intraperitoneal pressure showed significant negative correlation with the fill volume corrected for patient body size as reflected by the dialysate volume/ BSA ratio (r= -0.393, p < 0.01; r= 0.319, p < 0.01; and r= -0.274, p < 0.02 for 2.0-, 2.5-, and 3.0-L fill volumes respectively). Discomfort score rose as fill volume rose, with a median of 0, 2.5, and 13.0 for 2.0-, 2.5-, and 3.0-L fill volumes respectively (p< 0.001). It is interesting, however, that with 2.5-L and 3.0-L dialysate infusion volumes, 64% and 44% of the patients, respectively, had no discomfort at all., Conclusion: Dialysate volume increase is associated with higher IPP, which is modulated by the gender and body size of the patients. Although the mean discomfort score was higher with larger dialysate volumes, there was no significant correlation between discomfort and IPP or the dialysate volume/BSA ratio. Many patients had no discomfort with 2.5-L or even with 3.0-L dialysate infusions; theoretically, they can be treated with larger volumes.

Objective: The aim of this study was to analyze the correlation between the peritoneal equilibration test (PET) and the dialysis adequacy and transport test (DATT) for peritoneal transport type characterization, and the degree of patients' acceptance for each test., Design: Cross-sectional, observational multicenter study., Setting: Five referral (tertiary) dialysis centers of institutional practice., Patients: The study included 107 adult continuous ambulatory peritoneal dialysis (CAPD) patients with a prescription of four exchanges of 2 L per day, irrespective of age, gender, cause of end-stage renal disease, time on dialysis, nutritional status, or residual renal function. Patients on immunosuppressive therapy and those with cancer, hepatitis B, or HIV, and those having a peritonitis episode within the previous 30 days, or three or more episodes during the previous 12 months, were excluded., Main Measures: Peritoneal transport type as classified by creatinine and urea dialysis-to-plasma (D/P) ratios by PET and DATT., Results: Correlation coefficients between D/P ratios for creatinine and urea, obtained for the PET and the DATT, were 0.73 for D/P creatinine and 0.96 for D/P urea. Patients were classified into high, high-average, low-average, and low transport categories according to the mean and standard deviation of D/P creatinine values obtained from the PET at 4 hours. These values showed excellent concordance with those generated from the DATT data (alpha = 0.82, 95% confidence interval 0.67 - 0.93). Nineteen percent of patients showed discordance in their category when classified according to the PET versus the DATT. Patients' acceptance was better for the DATT than for the PET, as evaluated with a questionnaire., Conclusion: The DATT is an easy, inexpensive, and reliable test to assess peritoneal transport type, and it also provides information about peritoneal clearance of solutes and ultrafiltration. The DATT has better patient acceptance than the PET. Since the DATT has only been validated for patients on a fixed CAPD daily schedule of 4 x 2 L, the results should be confined only to patients receiving such a prescription.

Peritoneal mesothelioma is a rare disease, especially when it arises in a cystic form with tardive and often nonspecific symptoms. While diffuse neoplasms have an unfavorable prognosis, cystic forms are usually benign. An accurate diagnosis can only be made only with electron microscopy and immunohistochemical studies. A 92-year-old woman with an ultrastructurally ascertained cystic peritoneal mesothelioma was admitted to the hospital's emergency ward, and was considered to be unusual because of the size of the mass and the patient's age. A review of the literature is made, and the clinical and diagnostic aspects of this disease are also discussed.

Objective: To assess the role of polyclonal antibodies to basic fibroblast growth factor (bFGF) in inhibiting myointimal hyperplasia after insertion of polytetrafluoroethylene (PTFE) grafts in rats., Design: Experimental study., Setting: University laboratory, Italy., Animals: 24 inbred Lewis rats., Interventions: A segment of PTFE I cm long was interposed in the abdominal aorta. The animals were randomised in two groups, n = 12 in each. The first were given polyclonal antibodies to bFGF at the time of operation, and for the first two postoperative days; and the second were given non-specific IgG at the same time periods., Main Outcome and Measures: Two animals died during the immediate postoperative period of anaesthetic complications. 12 animals (6 in each group) were killed 7 days postoperatively (24 hours after injection of 5-bromo-deoxyuridine BrdU) to assess smooth muscle cell proliferation. The remaining 10 animals (5 in each group) were killed after 1 month to assess the degree of anastomotic myointimal hyperplasia., Results: Antibodies to bFGF resulted in less smooth muscle cell proliferation at the anastomoses as well as anastomotic myointimal hyperplasia. Smooth muscle cell proliferation was reduced to about half in animals treated with anti-bFGF antibodies. Neointimal thickness was reduced in treated animals., Conclusions: We conclude that after PTFE arterial grafting there is increased production of bFGF at the anastomotic regions that leads to smooth muscle cell proliferation and formation of myointimal hyperplasia. Agents that reduce the production of bFGF may also reduce the development of myointimal hyperplasia after PTFE arterial grafting.

The authors report a case of true isolated atherosclerotic aneurysm of the profunda femoris artery. On the basis of a careful search of the literature some aspects of this rare disease are illuminated in terms of its low incidence, pathologic background and treatment; the last should always be aggressive due to the high possibility (about 50%) of major complications mainly represented by rupture. Simple aneurysmectomy without flow re-establishment may be allowed only if the femoropopliteal tract is normal

A case of non-functioning parathyroid cyst is reported, in which the preoperative diagnosis was missed. A careful review of the pertinent literature allows to outline the correct approach to this rare pathology as for the diagnosis and the treatment; as well, to enlight the current controversies about the physiopathology and the pathology.

The authors report a case of isolated mesenteric fibromatosis un associated with familial adenomatous polyposis or Gardner's syndrome or prior abdominal surgery. These neoplasms are usually asymptomatic until when the compression of the small or large bowel or the ureter causes symptoms; although they are benign lesions without metastases, local recurrences are very frequent. Surgical removal is the primary treatment; until now no satisfactory results have been obtained with other therapeutic modalities.

Background: Recently, disconnect systems for CAPD that are associated with a reduced frequency of peritonitis have been introduced. Our objective was to compare the incidence of peritonitis using three current CAPD systems in a high-risk population with low educational and socioeconomic levels, and high prevalence of malnutrition., Methods: In a prospective controlled trial, 147 patients commencing CAPD were randomly assigned to one of three groups: 29 to the conventional, 57 to the Y-set, and 61 to the twin bag systems. The number of peritonitis episodes was registered, and patients were followed up for an average of 11.3 months., Results: The average peritonitis-free interval for the conventional group was 6.1 months, for the Y system was 12.0 months, and for the twin bag was 24.8 months (P < 0.001). By multivariate analysis, the only factor associated with peritonitis was the CAPD system. Peritonitis-related hospitalization was 5.3 +/- 2.0, 2.7 +/- 1.0, and 1.5 +/- 0.9 days/patient/year in the conventional, Y system, and twin bag groups, respectively. The cost per bag was similar for the conventional and Y system, but higher for the twin bag. However, the total costs of treatment (pesos/patient/year) were lower for twin bag (62,159 for the conventional, 70,275 for the Y system, and 54,387 for the twin bag), due to the lower peritonitis incidence and associated hospitalizations., Conclusions: Y system and twin bag use was associated with a reduction of 50 and 75% peritonitis incidence, respectively, in patients on CAPD. The cost of the twin bag was actually lower, because of savings from a decreased usage of antibiotics and fewer hospitalizations.

Two cases in which a severe form of intestinal angina was cured by revascularization of an isolated hepatic artery were studied. The collateral pathways to the hepatic artery may serve, in a retrograde fashion, to assure an acceptable blood supply to the splanchnic organs, even when the disease of the 3 main vessels is so extensive that the commonly used techniques of revascularization cannot be applied.

Background: The management of severe Gaucher's disease was dramatically improved by the development of enzyme replacement therapy. However, this treatment is very costly (currently about $21,000 per infusion for adults at the starting dose recommended by the manufacturer). The goal of this study was to determine how enzyme replacement therapy was being prescribed and financially supported in various parts of Canada. In addition, demographic and outcome information was elicited., Methods: Prescribing physicians were identified through professional associations and with the help of the manufacturer of the enzyme preparations used for the treatment of Gaucher's disease. The physicians were surveyed by questionnaire in July 1995. The study included all patients in Canada who had received enzyme replacement therapy for Gaucher's disease before July 1, 1995., Results: A total of 25 patients (15 children and 10 adults) with type 1 Gaucher's disease, the common nonneuronopathic variant of the disease, were receiving enzyme replacement therapy by the end of 1995. The indications for treatment included massive splenomegaly, growth failure, and severe bony, hematologic and pulmonary complications of the disease; no patients with mild disease were receiving treatment. Treatment regimens varied markedly (from 12 to 160 units of enzyme/kg per month). All the patients were reported to have responded well to therapy, based on serial measurements of hematologic indices, liver and spleen volumes, and numbers of bony crises as well as patients' subjective impressions. Financial support for therapy varied markedly from one province to another. None of the reporting physicians was aware of any patients with severe Gaucher's disease who were denied therapy as a result of inability to pay for the medication. Various agencies provided financial support for therapy, including both federal and provincial governments, private insurance carriers and the commercial supplier of the enzyme. In Ontario provincial health care officials accepted the development, by a multidisciplinary panel of medical experts, of formal guidelines for determining eligibility, on the basis of objective medical criteria, for reimbursement for enzyme replacement treatment., Interpretation: Although some differences were found across the country with respect to the details of treatment, the indications for enzyme replacement therapy and the selection of severely affected patients were similar in the various provinces. However, financial support was inconsistent and varied among provinces and patients. This will prove to be a challenge in future, not only with respect to this disease but also for other diseases for which effective, expensive therapy has been developed.

We evaluated whether type of response to the migraine-induction test with a nitroglycerin ointment applied to the frontotemporal head region could predict the efficacy of antimigraine therapy. Forty-two patients with migraine without aura underwent the test before and 2 months after antimigraine therapy. Two and 4 months after treatment withdrawal, most subjects with a negative response to the post-treatment test maintained treatment benefit, whereas benefit was lost in patients with an early onset migraine response.

The authors report an unusual case of retroperitoneal haemorrhage following the application of a Greenfield modified titanium filter: haematoma due to the lesion of a lumbar vein was favoured by anticoagulant therapy and complicated by infection, ending in frank disruption of the vein wall. A review is made of the modalities of caval penetration and perforation with the Greenfield filter.

The authors report a case of DFSP with one true and one successive false recurrence. The characteristics of this tumour are reviewed together with the current trends of therapy.

Objective: To test the acute effects of the intake of a phosphoric acid containing soft drink on acid-base balance and on calcium and phosphate metabolism., Material and Methods: We studied 14 young adult male Sprague-Dawley rats aged 90 days, and 14 immature animals aged 30 days. Half of the animals in each group were randomly assigned to receive either tap water (controls), or Coca-Cola ad libitum for seven days. After this period, the rats were individually placed in metabolic cages to collect 24 hours urine, and they were exsanguinated by aortic puncture. Immediately, pH and ionized calcium were measured in whole blood. Creatinine, phosphate and total calcium were determined in the urine and plasma. Plasma levels of PTH, 1 alpha, 25 (OH)2 D3 and 25 OH D3 were measured by IRMA and RIA commercial kits., Results: The animals receiving the soft drink, both adults and immature, developed significant hypercalciuria and hyperphosphaturia. In immature animals, the plasma pH dropped from 7.45 +/- 0.04 to 7.33 +/- 0.02 (p < 0.05) but did not change in adult animals. Ionized calcium dropped significantly from 1.06 +/- 0.04 to 0.80 +/- 0.06 meq/L (p < 0.05) in immature animals but not in the adult animals. Only immature rats developed significant reduction of 1 alpha, 25 (OH)2 D3 and 25 OH D3, whereas only the adult rats developed significant hyperparathyroidism. Immature animals showed more severe derangement of calcium and phosphate metabolism related to soft drink intake.

Hermansky-Pudlak syndrome (HPS) is a rare, autosomal recessive disorder in which oculocutaneous albinism, bleeding, and lysosomal ceroid storage result from defects of multiple cytoplasmic organelles-melanosomes, platelet-dense granules, and lysosomes. As reported elsewhere, we mapped the human HPS gene to chromosome segment 10q23, positionally cloned the gene, and identified three pathologic mutations of the gene, in patients from Puerto Rico, Japan, and Europe. Here, we describe mutation analysis of 44 unrelated Puerto Rican and 24 unrelated non-Puerto Rican HPS patients. A 16-bp frameshift duplication, the result of an apparent founder effect, is nearly ubiquitous among Puerto Rican patients. A frameshift at codon 322 may be the most frequent HPS mutation in Europeans. We also describe six novel HPS mutations: a 5' splice-junction mutation of IVS5, three frameshifts, a nonsense mutation, and a one-codon in-frame deletion. These mutations define an apparent frameshift hot spot at codons 321-322. Overall, however, we detected mutations in the HPS gene in only about half of non-Puerto Rican patients, and we present evidence that suggests locus heterogeneity for HPS.

Unlabelled: Prolactin (PRL) has been involved in the pathogenesis of systemic lupus erythematosus (SLE) and hyperprolactinemia has been connected with systemic activity. However, the clinical significance of PRL has not been investigated in lupus glomerulonephritis (GN)., Methods: We studied SLE patients (ACR criteria) with biopsy-proven renal disease. Renal histology was classified according to World Health Organization (WHO) criteria. Renal function tests, albuminuria, complement levels (nephelometry), anti-DNA antibodies (C. luciliae) and serum and urine PRL concentrations (RIA) were determined at baseline and at 4-month intervals for one year. Renal activity was defined as mild, moderate or severe according to serum creatinine, creatinine clearance, albuminuria, red blood cells (RBC), and casts., Results: There were 26 patients with mean age 28.5 y and mean disease duration 47.9 months. Twenty patients had diffuse proliferative glomerulonephritis (GN), four had focal GN and two had membranous GN with proliferative changes. Renal activity was mild in ten patients, moderate in ten and severe in six. Mean serum (24.7+/-5.3) and urine (0.90+/-0.36) PRL levels were higher in patients with severe renal activity (P < 0.05 compared with mild group). PRL levels decreased after treatment, but this trend was not uniform during the follow-up period., Conclusion: Hyperprolactinemia was prevalent in SLE patients and high levels of PRL in the serum and urine could be related to severe renal disease.

Unlabelled: Chemokinesis and chemotaxis were measured in polymorphonuclear cells (PMN) from 51 children aged 1 to 8 years old, of either sex. Case group--41 non-allergic asthmatic children with chronic relapsing upper airways infections, diagnostic criteria were history of wheezing associated to an upper airways infection episode and negative skin tests., Control Group: 10 healthy children. A sample of 10 ml of peripheral venous blood was drawn. PMN were incubated with Hank's solution to measure chemokinesis and with C5a and Staphylococcus aureus extract to measure chemotaxis. Chemokinesis values in healthy control children and in patients with non-allergic bronchial asthma were of 46.0 +/- 7.1 vs 23.8 +/- 6.1 microns (p < 0.01). C5a-stimulated chemotaxis values in healthy control children and in patients with non-allergic bronchial asthma were of 91.0 +/- 21.3 vs 92.3 +/- 21.0 microns (ns), and Staphylococcus aureus extract-stimulated chemotaxis values in healthy control children and in patients with non-allergic bronchial asthma were of 97.0 +/- 22.4 vs 92.0 +/- 23.0 microns (ns). These results suggest that PMN from children with non-atopic asthma have reduced chemokinesis. After a chemotactic stimulus with C5a and bacterial extract, leukocyte motility is corrected and reach similar values to that present in healthy children.

A 48-year-old woman presented with chronic myeloid leukemia six years after beginning repeated radioiodine treatments for papillary carcinoma of the thyroid gland. The literature on the association of radioiodine and chronic myeloid leukemia is reviewed.

Objective: To analyze published papers about soft drinks use, and to describe possible health benefits, risks, and damages related to soft drink consumption. INFORMATION SOURCE: A search was done in the MEDLINE compact disks, from January 1970 to January 1997, with the keywords soft drink, beverages, carbonated beverages, cola, Coca-Cola and sweetening-agents., Study Selection: Ninety nine papers reporting health-related damages or benefits in clinical or experimental studies were reviewed., Data Extraction: All articles with a clear description of at least one beneficial or harmful effect related to soft drink consumption were considered., Results: There were reports on 25 harmful effects and of 7 possibly beneficial effects. Data are classified in prophylactic and therapeutic uses, dental caries and other dental disorders, mineral metabolism disorders, acid-peptic disease, neoplasm, risk factors for cardiovascular disease, effects on central nervous system, reproduction, allergy, and miscellaneous., Conclusions: High prevalence of exposure and excessive consumption of soft drinks may represent a public health problem in Mexico. Data analysis shows that soft drink consumption may not be as harmless as generally believed. Many of the reports are anecdotal, without a suitable methodological design. A wide field for research is present in this area.

We describe two brothers with an autosomal recessive syndrome characterized by neonatal onset, severe impairment of cognitive and motor functions, abnormal ocular movements and slight dystonic postures. Brain MR and CT scan showed a reduction in size of the cerebellum and to a lesser extent pons, accompanied by cerebral and cerebellar white matter abnormalities. These data suggest that they have a particular phenotype of pontocerebellar hypoplasia. Extensive laboratory investigation excluded known metabolic causes of pontocerebellar hypoplasia. We discuss the nosological status of pontocerebellar hypoplasia in relation to other early-onset pontocerebellar disorders.

Objective: To assess whether apparently healthy subjects with a family history of systemic hypertension have a higher risk of presenting the insulin resistance syndrome., Subjects: Three hundred and eighty-six subjects aged 20-65 years., Setting: A middle socio-economic class urban community from Mexico City., Method: All subjects and, when necessary, their first-degree relatives, answered a questionnaire and underwent a physical examination with measurement of height, weight and blood pressure. Serum insulin, glucose, cholesterol and triglycerides were measured during fasting and 2 h after an oral load of 75 g glucose., Results: A family history of systemic hypertension was present for 167 (43%) of the subjects, of whom 123 (31%) were obese. Subjects with a family history of hypertension had higher systolic blood pressures than did those without such a history (120 +/- 15 versus 115 +/- 10 mmHg). In the logistic regression model, the body mass index and age showed statistically significant effects on the fasting glucose:insulin ratio and on serum insulin levels after an oral load of glucose. When men and women were analysed separately, only in men were higher systolic and mean blood pressures and lower glucose:insulin ratios observed. In the logistic regression analysis the body mass index was a significant predictor of the glucose:insulin ratio and serum insulin levels after an oral load of glucose, especially in men., Conclusion: Apparently healthy male offspring of hypertensive parents have higher blood pressure levels and lower insulin sensitivities than do offspring of normotensive parents. Insulin resistance was related to obesity, but not to a family history of hypertension, as had previously been reported by other research groups.

Two clinical studies in donor sites and deep partial-thickness burns treated with banked cultured human epidermal allografts are described. Ten burn patients were subjected to donor split-thickness skin harvesting. The study was controlled, side-by-side comparative, blind, and randomized. Banked cultured epidermal allografts promoted a faster reepithelialization of the wounds; they epithelialized in an average of 6.9 days, whereas controls healed in an average of 11.1 days, giving a reduction of 37.8 percent in time to heal (p < 0.005). Allografted sites were less erythematous as compared with controls (p < 0.01), with more tendency to normopigmentation. In the deep partial-thickness burns study, 10 patients with 18 burned wounds were treated. Wounds treated with cultured allografts showed complete reepithelialization in about 3 to 6 days. The two clinical studies showed that banked cultured epidermal allograft promotes a significantly faster epithelialization of donor sites and deep partial-thickness wounds. These results support the idea that cultured allografts should be used routinely to improve treatment of burn patients and reduce their therapy time.