The 24 h urinary excretion of paracetamol and its metabolites following a single oral dose of 1.5 g was compared in two ethnically different Spanish populations: 39 volunteers from the Basque country and 32 from Alicante. The urinary concentrations of unchanged paracetamol and its glucuronide, sulphate, cysteine, and mercapturic acid conjugates were determined by high-performance liquid chromatography. Statistically significant differences in the urinary excretion of unchanged paracetamol and the fractional urinary recovery of each conjugate between subjects from Alicante and subjects from the Basque country were not found. In both populations, an inverse relationship between glucuronide and sulphate conjugation following a bimodal frequency distribution pattern was found. In contrast to paracetamol oxidation, intersubject variation in paracetamol conjugation was negligible. The urinary excretion of unchanged paracetamol was higher in smokers than in nonsmokers. As compared with other studies, the urinary excretion of oxidation-derived paracetamol metabolites in both Spanish populations was intermediate and significantly different than that found in Caucasians from Scotland and West Africans (Ghana). This may determine a susceptibility to paracetamol hepatotoxicity following overdosage in the Spanish population.

Acetaminophen↗

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Heterogeneity of paracetamol metabolism in Gilbert's syndrome.

Gilbert's syndrome (GS) is an inherited bilirubin UDP-glucuronosyl transferase deficiency. The object of this study was to investigate the possible effects of this disorder on the metabolism of a drug, such as paracetamol, which is basically eliminated by hepatic glucuronidation. We studied 32 healthy volunteers and 18 people with GS, all of whom were given 1.5 g of paracetamol orally. In the 24 h urine collected, we determined the elimination of free paracetamol, the conjugates (glucuronide, sulphate) and the oxidation products (cysteine, mercapturic acid) by high pressure liquid chromatography (HPLC). The results are given as a percentage of the total quantity of paracetamol eliminated. The patients with GS were divided into 2 subgroups (GS-I and GS-II) according to whether glucuronidation was more or less than 50%. The overall results of the GS group showed no significant difference in the urinary elimination of metabolites as compared to the control group. However, in subgroup GS-I, a reduction in glucuronidation (P = 0.0012) and an increase in oxidation (P = 0.0051) was seen, as compared with the other 2 groups. There was inverse correlation between the glucuronide produced by conjugation and the oxidation products (r = -0.8718; P<0.005). People with GS are a heterogeneous group with respect to the metabolism of paracetamol. In one subgroup this was normal. In the other subgroup there was a marked reduction in glucuronidation and an increase in oxidation. These changes could mean that people in this subgroup are more liable to liver damage after an overdose of paracetamol.

Acetaminophen↗

PubMedDate not supplied

[Validity of the diagnostic criteria of the acute respiratory distress syndrome].

Acute respiratory distress syndrome (ARDS) is defined according to the criteria of the 1994 consensus conference. These criteria aim to < >. However, the histological criteria that correspond to ARDS are the criteria of diffuse alveolar damage described in 1976 by Katzenstein et al., which are still valid at present. In the last decade, different studies have been published that have tried to correlate the clinical syndrome with the histological findings. These studies have been basically done in experimental animals, but also by the description of the pulmonary biopsy findings and post-mortem study findings. The present article aims to show discrepancy between clinical and histological diagnosis of the acute pulmonary lesion, basically having an effect on the difficulty of the ARDS diagnosis when its origin is pulmonary and the implications of this discrepancy in the clinical practice and research.

Animals↗

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[Multifocal motor neuropathy].

INTRODUCTION: The multifocal motor neuropathy is an immunological disease that courses with an asymmetrical distal weakness, usually predominant in the upper limbs. DEVELOPMENT AND CONCLUSIONS: It is not rarely misdiagnosed as a motoneurone disease because of the frequent occurrence of fasciculations and cramps and the absence of sensory symptoms. Neurophysiological studies are essential for the proper diagnosis, disclosing the presence of conspicuous alterations of the nerve conduction that are mainly of demyelinating type and occur exclusively in the motor fibers. The nerve conduction blocks characteristically found in this disease are long lasting, multifocal but preferentially proximal, and they are out of the typical levels of the compression neuropathies. High titers of IgM antibodies, mainly anti-GM1, are frequently observed although their pathogenetic significance has not still been completely established. In many cases, even in those with very prolonged evolutions, treatment with high doses of parenteral immunoglobulins has been effective.

Antibodies, Anti-Idiotypic↗

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[Brainstem lesion in multiple sclerosis, blink reflex, and brainstem auditory evoked potentials].

Blink reflex (BR) and brainstem auditory evoked potentials (BAEP) were recorded from 168 patients with several diagnostic categories of multiple sclerosis, from which 98 complained brainstem symptoms (BSS+). From the whole group, the BR showed a higher degree of abnormality (45.75%) than BAEP (27.95). This range increased in the group BSS+ (52.15% for the BR and 34.9% for the BAEP) and even more when sings or symptoms of brainstem were present at the time of exploration (BSS+P) 60.4% for the BR and 41.3% for BAEP. Among patients who never complained brainstem symptoms, the BR disclosed a subclinical lesion in the 33.3% and the BAEP in the 16.9%. The combination of BR and BAEP were more useful than an isolated test. The localization of the lesion both clinically and in the BR were mostly on the pons. Light correlation between the presence of isolated or multiple symptoms and the disorder in the BR were present. Facial myokymia and internuclear ophthalmoplegia were most often associated with disorder in the BR, in both, the commonest localization was on the pons, and in the former about the motor nucleus of the facial nerve.

Adolescent↗

PubMedDate not supplied

[Bacteremia caused by Streptococcus agalactiae in adults. Presentation of 6 cases].

The incidence of Streptococcus agalactiae (SA) bacteremia in adults has increased in recent years, particularly in patients with severe underlying diseases. However SA is still an unusual pathogen in adults. We report 6 cases of SA bacteremia in adults, seen during 18 months. The microorganism was only isolated from the blood in 3 cases, and from blood and other locations in the remaining three cases. The age of the patients ranged from 35 to 70 years. Both sex were affected in the same proportion. In all cases except in one there was a previous underlying disease.

Adult↗

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[Post-radiation brachial plexus disease. Clinical and neurophysiological study].

Nine patients who developed 11 brachial plexopathies after a radiation therapy for cancer have been studied. They clinically showed heterogeneity in the common criteria used to establish the differential diagnosis between post-radiation and tumoral brachial plexopathies (PRBP and TBP) and specially within the period free of symptoms from the end of radiation, and the presence and intensity of pain. Neurophysiological studies showed a diffused neurogenic lesion with muscular denervation associated to motor and sensory nerve conduction impairment on proximal segments of the arm. Somatosensory evoked potentials were frequently abnormal with absence of N9 potential in 6 out of 7 explored plexuses. The most characteristic findings were, however, the presence of fasciculation potentials and myokymic discharges in 73 per cent of cases, and the motor nerve conduction blocking with proximal -supraclavicular and cervical spine- stimulation in all of them. Both of these phenomena, when analyzed in the same neuromuscular territory, were highly correlated, supporting a probable causal relationship. The neurophysiological data may contribute to the proper differentiation between brachial plexopathies of radiation or tumoral origin. The also would permit to consider a similar physiopathological basis of PRBP with some other infrequent neuropathies where they have been described as relevant features.

Adult↗

PubMedDate not supplied