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Simultaneous chemoradiation is used in unresectable pancreatic cancer for palliation. It is not known if the use of adjuvant surgery will benefit this group of patients. From November 1991 to September 1998, 47 patients with unresectable pancreatic cancer were treated with simultaneous preoperative radiation therapy (45 Gy) and chemotherapy. Chemotherapy followed three different protocols: cisplatin, 5-fluorouracil +/- paclitaxel; cisplatin, 5-fluorouracil (protracted infusion); and docetaxel and gemcitabine. Whipple pancreatoduodenectomy was performed 1 month after the end of radiation in patients selected for resection. Twenty-three unresectable tumors after preoperative treatment (47%) received an additional dose (10-12 Gy) of radiotherapy using intraoperative or external radiation therapy. Twelve patients (26%) were considered to have clinically resectable tumors after the preoperative treatment. Nine patients had surgery (19% of the total number of patients), and 2 of them had complete pathologic response. After chemoradiation, two patients died of pneumonia and gastrointestinal bleeding, respectively, and another two patients died in the postoperative period. Local recurrence was observed in 22% of the patients and 57% had distant metastases. Three-year survival rates for patients with unresectable and resectable tumors was 0% (median survival 10 months) and 48% (median survival 23 months), respectively (p = 0.0004). Preoperative treatment with chemotherapy and radiotherapy in patients with unresectable pancreatic cancer is feasible. In some patients, the tumor can be resected, and in addition some cases of complete pathologic response were found. Long-term survivors were observed in the group of resected tumors. More effective chemotherapy regimens are needed because the majority of the patients died of metastatic disease.

The production of the bundle-forming pilus subunit BfpA was investigated in 44 enteropathogenic Escherichia coli (EPEC) diarrheal isolates after growth on several conventional bacteriological media. In all, the use of brucella agar supplemented with 4.5 mM sodium bisulfite resulted in a higher detection of BfpA-producing EPEC.

Genomic diversity among 34 strains of Escherichia coli belonging to different serotypes of the O26 serogroup -- encompassing strains from different geographical origins and Shiga toxin-negative Brazilian strains -- was evaluated through random amplified polymorphic DNA (RAPD) analysis. Our results indicate that Brazilian and non-Brazilian O26 strains fall under distinct but closely related differentiation clusters. RFLP-PCR analysis of the fliC gene sequence was done in order to identify the H(-) serotypes and served to confirm the clustering pattern obtained in the dendrogram generated from RAPD data. The epidemiological significance of these data is discussed.

We present the midterm results and complications of 101 low contact stress total knee replacements performed in 94 patients and reviewed at an average follow-up of 5.2 years (range, 4-8 years). The mean age at the time of surgery was 66 years (range, 53-76 years). Meniscal bearings were used in 83 knees and a rotating platform in the remaining 18 cases; cemented fixation was used only for 16 tibial components. At most recent follow-up, average knee and function scores were 93 and 78 points. None of the knees was revised because of loosening. Five knees showed distal femoral stress shielding. Complications included infection, supracondylar fracture, patellar component dislodgment, meniscal dislocation (2 cases), catastrophic wear of polyethylene, and progressive osteolysis (2 cases).

The genetic population of Triatoma sordida group 1, a secondary vector of Chagas disease in Bolivia, was studied by multi-locus enzyme electrophoresis. A total of 253 nymphal and adult specimens collected from seven neighbouring localities in the Velasco Province, Department of Santa Cruz, were processed. The relatively low genetic variability was confirmed for this species (rate of polymorphism: 0.20). The absence of genetic disequilibrium detected within the seven localities was demonstrated. A geographical structuration appears between localities with distances greater than 20 km apart. Although T. sordida presents a relatively reduced dispersive capacity, its panmictic unit is wider than compared with T. infestans. Genetic distances between T. sordida populations were correlated with geographic distance. Gene flow between geographic populations of T. sordida provides an efficient framework for effective vigilance and control protocols.

Triatoma sordida is the second species of Triatominae considered of epidemiological significance in Bolivia. Associated with Triatoma infestans in various regions, it is as yet the only triatomine species established in human dwellings in localities of Velasco province, Department of Santa Cruz. This domestication is considered as primary. Flagellate parasites were detected in 16.2% of domiciliary T. sordida and the kDNA-PCR confirmed the presence of Trypanosoma cruzi. Frequencies of T. cruzi clonets 20 and 39, common clonets in Bolivian domestic cycle (T. infestans), were established by their direct detection in feces using PCR and hybridization. These clonets present low frequencies in T. sordida and synanthropic mammals. Forty-six stocks were isolated and analysed by multilocus enzyme electrophoresis (MLEE). The MLEE showed a higher clonal diversity than in T. infestans domestic cycle and the genotypes were clustered in the two principal lineages of T. cruzi. Within each lineage, a broad variability was observed. Mixture of genotypes was mostly observed in mammals. The large diversity of T. cruzi in this cycle should be related to its sylvatic origin. Moreover, the current limited sample of stocks suggests a lineage association with specific hosts.

The role of Triatoma sordida in the domestic transmission of Trypanosoma cruzi was assessed in 7 rural localities in Velasco Province, Department of Santa Cruz, Bolivia. Tri. sordida, the only triatomine species identified in these localities, was found inside 58.0% of houses but not in large numbers (3.1 bugs per infested house on average). A total of 220 faecal samples from domiciliary bugs was examined microscopically and by the polymerase chain reaction for the presence of trypanosomes: 21.4% were infected. Analysis of blood meals of domiciliary Tri. sordida showed that humans were the commonest host (70.4%), followed by chickens and dogs. Four of 418 persons tested were seropositive for Tryp. cruzi. Only 2 of a second group of 62 persons living in dwellings infested by Tri. sordida were seropositive. Tryp. cruzi infection was demonstrated in dogs and domestic rats. Three other species of small mammals were found to be infected with trypanosomes. In our study area, domestic Tri. sordida are mainly incriminated in the transmission of Tryp. cruzi to synanthropic animals, whereas transmission to humans is very rare. The presence in houses of small populations of Tri. sordida infected with Tryp. cruzi is therefore currently insufficient for this insect to constitute a major epidemiological risk factor.

The effect of three commercial proteases (pronase E from Streptomyces griseus, aspartyl proteinase from Aspergillus oryzae and papain) on protein breakdown and the sensory characteristics of dry fermented sausages was investigated. Water soluble, non-protein, 5% phosphotungstic acid soluble, 5% sulphosalicylic acid soluble and total volatile basic nitrogen contents increased during fermentation, stabilizing later until the end of ripening (26th day). Nitrogen values were always greater in the aspartyl proteinase added batch in comparison with the other protease added batches. Total free amino acid changes showed a similar pattern to those observed for the 5% sulphosalicylic acid soluble nitrogen. The electrophoretic studies demonstrated that proteolysis of high molecular weight myofibrillar and sarcoplasmic proteins was more prominent in protease added batches. It was especially intensive in papain one. The dominant amino acids at the end of ripening were similar in all batches. Tyramine and histamine increased throughout ripening. No significant differences in sensory properties were found between control and pronase E and papain added batches, but they were significantly different (p < 0.01) from the sausages containing aspartyl proteinase, due to an excessive softening. The effect of exogenous enzyme addition on the flavour potentiation of dry fermented sausage is discussed.

Improved cardiovascular morbidity and mortality have been observed in several clinical studies of dietary supplementation with coenzyme Q10 (CoQ10, ubiquinone). Several mechanisms have been proposed to explain the effects of CoQ10. One attractive theory links ubiquinone with the inhibition of platelets. The effect of CoQ10 intake on platelet surface antigens, and certain hemostatic parameters was examined in 15 humans and 10 swine. Study participants received 100 mg of CoQ10 twice daily in addition to their usual diet for 20 days resulting in a three-fold increase of total serum CoQ10 level. We observed a decline in plasma fibronectin (-20.2%), thromboxane B2 (-20.6%), prostacyclin (-23.2%), and endothelin-1 (-17.9%) level. Significant inhibition of vitronectin receptor expression was observed consistently throughout ubiquinone treatment. Inhibition of the platelet vitronectin receptor is a direct evidence of a link between dietary CoQ10 intake, platelets, and hemostasis. These findings may contribute to the observed clinical benefits by a diminished incidence of thrombotic complications in such patients.

Two studies were conducted in Latin America, one in Venezuela and one in Argentina, using a common protocol to investigate the efficacy of a single s.c. injection of doramectin in the prevention and control of field infestations of Cochliomyia hominivorax in newborn calves and post-parturient cows. In both experiments, pregnant cows were paired on the basis of their calving time. The first cow that calved was assigned to a medicated group, and both cow and calf were treated with doramectin. The cow received a dose of 200 micrograms kg-1 and the calf 1 ml of a 1% doramectin solution. The second cow and calf were assigned to a saline-treated group, and the cow received saline at 1 ml per 50 kg and the calf 1 ml. The procedure was repeated until all animals were allocated to the two treatments. Animals were examined on the treatment day and at 2, 4, 6 and 12 days post-treatment. At each observation day, the navel of newborn calves and external genitalia of the cows were inspected and the presence of C. hominivorax infestations was recorded. Doramectin was 100% effective in the prevention and control of screwworm strikes in newborn calves and in post-parturient cows exposed to continuous field challenge of C. hominivorax. Over the 12 day duration of the studies, 48% and 57% of the saline-treated calves had screwworm navel strikes in the studies in Venezuela and Argentina, respectively. Infested animals required repeated therapeutic treatment, whereas none of the doramectin-treated calves were affected (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

The differences in the chemical and fatty acid compositions between the meats of five Spanish wild rabbits (Oryctolagus cuniculus) and five Spanish wild hares (Lepus europaeus) for foreleg, loin, hindleg and perirenal fat have been studied. Only significant differences (P < 0.05) in the meat chemical composition were observed between rabbits and hares for dry matter and fat in loins, and for ash in hindlegs. Significant differences (P < 0.05) between saturated fatty acids in foreleg and perirenal fat and between unsaturated C-18:1 and C-18:2 fatty acids in loins were observed.

The effects of rabbit diets with four different levels of barley and sugar-beet pulp on the dressing percentage, chemical and fatty acid composition of meat from rabbits slaughtered at a liveweight of 2000 and 2500 g have been studied. Results revealed detectable (P < 0·05) effects of the total substitution of barley by sugar-beet pulp for carcass weight, dressing percentage and dry matter from animals slaughtered at a liveweight of 2000 g. No significant differences (P > 0·05) among batches were observed when slaughter weight was 2500 g. No influence of the diet on the total lipid fatty acids was found. In general, similar results were found when rabbit diets were formulated with 50% barley and 0% sugar-beet pulp, 30% barley and 0% sugar-beet pulp or 15% barley and 15% sugar-beet pulp.

To evaluate the role of erythropoietin (Epo) in the erythroid abnormalities often found in athletes, Epo was evaluated by radioimmunoassay in endurance runners (ER). In a first study, 46 experienced ER, 11 with iron deficiency (ID group), were studied during a training period. In ID and non-ID runners, serum Epo (SEpo) levels were similar to sedentary controls (ID = 19.1 +/- 4.9 U/L, non-ID = 19.7 +/- 5.5 U/L and controls 19.7 +/- 9.2 U/L). In a second study, serum and urine erythropoietin (UEpo) levels were evaluated in 17 ER during a 6-hour race. Samples were taken before the race (pre-race), immediately following (6-hour) and 4 days after (post-race). No differences were observed in SEpo levels (pre-race = 19.8 +/- 4.1 U/L, 6-hour = 21.2 +/- 4.9 U/L and post-race = 21 +/- 4 U/L), but UEpo increased following the race (pre-race = 15.4 +/- 9.6 U/L, 6-hour = 26.1 +/- 6.2 U/L and post-race = 14.1 +/- 6.5 U/L) (p < 0.0001) and this UEpo increase was related to urine creatinine changes (rs = 0.79, p < 0.00001). In conclusion, SEpo in ER does not differ from sedentary values and does not vary with competition; however, UEpo increases during a long-distance race. These data may be important for a correct evaluation of Epo abusers and sports anemia.

Screening urine for microhematuria as an indicator of serious disease is controversial because of the low positive predictive value of such screening and the costs and risks of the associated evaluation. To further evaluate test properties, we retrospectively examined the outcomes of 20,571 men aged > or = 35 years and women aged > or = 55 years who voluntarily had a Personal Health Appraisal in 1980 as members of a large prepaid health plan. Hematuria was detected by dipstick in 876 cases (4.3%); 278 were excluded because of evidence of previous urological disease which could cause hematuria. Review of the medical records of 598 patients with asymptomatic microhematuria as shown by a positive dipstick result indicated that 99% had a follow-up evaluation within 3 months of positive test results for hematuria and had various levels of urological evaluation thereafter. However, urological cancers (2 prostate, 1 bladder) developed in only 3 patients within the next 3 years. On the basis of San Francisco-Oakland Surveillance, Epidemiology, and End Results program data, rates of urological cancer were evaluated among patients whose test results were negative for hematuria, and these cancer rates were found to be almost the same as the rate among patients with asymptomatic microhematuria. Sensitivity of a single dipstick urinalysis result using microhematuria to indicate urological cancer within 3 years was 2.9%; specificity was 96.7%; and positive predictive value was 0.5%. Multivariate analysis which adjusted for age, gender, and race showed that the relative risk of 2.1 (95% confidence interval, 0.7-6.6) for urological cancer was not significantly elevated among patients with asymptomatic microhematuria compared with patients who had negative test results. These findings based on a single test are consistent with the current lack of recommendations for screening for microhematuria among asymptomatic adults.

Patients with nephrotic syndrome (NS) are believed to be at increased risk of atherosclerosis and coronary heart disease (CHD), although existing evidence for this association has not been persuasive. The risk of CHD among 142 persons with NS documented by protein-uria > or = 3.5 g daily was compared with that among 142 matched controls randomly selected from the membership of a large Northern California health plan. Controls were matched for sex, year of birth, and presence in the health plan when the referent case was diagnosed. No diabetics were included in this study. Mean follow-up for nonfatal CHD events was 5.6 years for NS subjects and 11.2 years for controls. Among the NS subjects myocardial infarction (MI) developed in 11, and there were 58 deaths, seven because of CHD. Among the controls, there were four MIs and 10 deaths, three because of CHD. In matched-pair analysis, there were 11 MIs among NS subjects and none among controls [P = 0.001, lower bound of 95% confidence interval for relative risk (CI), 2.8]. In an unmatched analysis adjusted for hypertension and smoking at diagnosis of NS, the relative risk of MI was 5.5 (95% CI 1.6 to 18.3) and the relative risk of coronary death was 2.8 (95% CI 0.7 to 11.3). Omitting data of NS subjects with minimal change disease and systemic lupus erythematosus yielded similar results. These data suggest that persons with NS are at increased risk of CHD.

Reported herein is the case of a 45-year-old woman with knee involvement due to rheumatoid arthritis. She had a total knee arthroplasty with a rupture of the quadriceps tendon 1 month later. Surgical repair of the rupture was performed following the Scuderi technique plus reinforcement with Dacron (Lig Aid, Levallois, Cedex, France) tape cerclage. An above-knee walking-plaster cast was applied with the knee in full extension for 6 weeks. The functional result was good 1 year after surgery.

The phospholipid contents (and their fatty acid composition) of the meat of two rabbit breeds (New Zealand white and the commercial hybrid HYLA) fed with two commercial diets of different protein and fibre contents, have been determined. The phospholipid contents in the meat of both rabbit breeds ranged from 9% to 19% total lipid. In this fraction seven different phospholipid classes were detected but phosphatidylcholine (PC) and phosphatididylethanolamine (PE) had average percentages of 50 and 20 of the total phospholipids. The major fatty acids of both phosphatidylcholine and phosphatidylethanolamine were C-16:0, C-18:0, C-18:1 and C-18:2, these together representing more than 70% of the total fatty acids. In general, the PC had an higher saturated fatty acid content than PE, which had a lower percentage of C-16:0 but higher C-20:4. Although differences in the fatty acid composition of the phospholipid fractions of the rabbit meat were observed, the only clear influences of age, sex, breed, and/or feeding were found with the C-16:0, C-18:0 and C-18:2 fatty acids., (Copyright © 1990. Published by Elsevier Ltd.)

Ten long distance runners were enrolled in a 6-hour competitive race. Immediately after the race technetium-99m-albumin gated blood pool scans were performed and indium-111 antimyosin was injected. Forty-eight hours later antimyosin scans were obtained and control gated blood pool scans were performed. Left ventricular ejection fraction was higher after the race (65 +/- 5 vs 60 +/- 7%, p less than 0.01) due to a decrease in end-systolic counts. Right ventricular ejection fraction was lower after the race (42 +/- 7 vs 54 +/- 12%, p = 0.03) due to an increase in both end-diastolic and end-systolic counts. A longer systolic period was observed after the race (53 +/- 5% of the RR interval vs 39 +/- 3%, p = 0.005). No significant differences were observed in peak filling or peak emptying rates after the race. An increase in pulmonary blood volume (116% of control) was observed after the race. Antimyosin scans were normal in 7 athletes and minimal antimyosin myocardial uptake was seen in 3. Transient alterations in biventricular performance present after the race correspond to function adaptation to strenuous exercise and are not due to irreversible myocyte damage.

The combined effect of ultrasonic (20 KHz, 150 W) and heat treatment on the survival of two strains of Bacillus subtilis in three suspending media (distilled water, glycerol and milk) has been studied. When spores suspended in water or milk were subjected to ultrasonic waves before heat treatments a little or no decrease of the heat resistance was observed. However, both sporicidal agents applied simultaneously (thermo-ultrasonication) decreased by 63% (B. subtilis, var. niger-40) and 74% (B. subtilis ATCC 6051) the decimal reduction times for the heat treatment when the spores were suspended in glycerol and by 79% and 40%, respectively when suspended in milk. The thermo-ultrasonication of spores in water markedly reduced the heat resistance of them (between 99.9% and 70%) in the range 70-95 degrees C but the effect of the thermo-ultrasonication significantly diminished as the temperature of the treatment was approached to the boiling point of the water.

The effect of two combinations, reverse sequential and monophasic, with cyproterone-acetate, have been studied in a group of 14 women suffering from idiopathic hirsutism. The results obtained prove that both combinations have ovulation blocking properties, by decreasing the FSH, LH, progesterone and oestrogen levels, but also have favourable effects in the treatment of hirsutism. The reverse sequential combination showed an increase in the prolactin figures, although these figures were within normal limits.

The combined destructive effect of ultrasonic waves and heating on micro-organisms has been investigated using as a model two species of thermoduric streptococci. Ultrasonic and heat treatments applied simultaneously were much more destructive than the additive effect of the two agents considered independently. Compared with heat alone, the simultaneous application of ultrasonic vibration and heat reduced the resistance of the organisms 6-11 fold.

The oxidation of the lipids and myoglobin of ground pork meat stored in oxygen- and carbon dioxide-enriched atmospheres at 1 °C has been studied. Elevated oxygen levels (80-100%) depressed myoglobin oxidation, increasing the time to 50% metmyoglobin formation from four to about thirteen days. Twenty per cent carbon dioxide greatly reduced the rate of lipid oxidation, extending the time to reach a TBA number of 5 from five to about twelve days. Tocopherol and ascorbic acids were efficient inhibitors of lipid oxidation but citric acid was not., (Copyright © 1980. Published by Elsevier Ltd.)

The combined effect of ultrasonic waves (20 kHz, 150 W) and heat treatment applied simultaneously (thermoultrasonication) on the survival of a strain of Staphylococcus aureus was studied in 0.05 M-phosphate buffer pH 6.8 and ultra-heat-treated whole milk. This combined process decreased by 63% the decimal reduction times for the heat treatment when the organism was suspended in buffer and by 43% when suspended in milk. These effects were much greater than the additive effect of the two agents considered independently.