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Tracheobronchial amyloidosis is the most common form of localized bronchopulmonary amyloidoses, although its diagnosis is not very frequent in daily practice. We present a case of localized tracheobronchial amyloidosis presented as hemoptysis. The diagnosis and treatment were performed with rigid bronchoscopy and resection with an Nd-YAG laser.
In a 14-day test with 50 probands, the effects of a heat-curing resin and a self-curing resin on the palatal mucosa of the test persons were tested by means of exfoliative cytology. It was shown that the keratinization index increased considerably during wearing the plates. It was not possible to demonstrate differences in the effect of heat-curing resins and that of self-curing resins. The different isolation with alginate film or tinfoil did not, in general, have any influence on the cytogram either. Roughness of the surface resulted in a slight increase of the intermediary cells.
BACKGROUND: The HOT study is a multicenter international trial which included 19,193 patients and whose goal was to assess the optimal target diastolic blood pressure to achieve by antihypertensive treatment. PATIENTS AND METHODS: Patients were recruited in 26 countries. Spain contributed with 806 patients (4.3%) who were randomized to achieve three target DBP: < or = 90; < or = 85; and < or = 80 mmHg, respectively. Baseline characteristics, blood pressure achieved by treatment and cardiovascular events are described and compared with the whole HOT sample. RESULTS: Mean age of the 806 Spanish patients was 61.9 +/- 7.3 years (range 50-80), 58.2% being women. About 55.6% were on pharmacological antihypertensive treatment and not controlled at inclusion. There were significant differences in gender, higher number of females (p > 0.001), less prevalence of tobacco consumption (p = 0.014), and a fewer number of patients with angina (p > 0.001) and myocardial infarction (p > 0.04) between the Spanish sample and the whole HOT population. The percentage of patients reaching the randomized target blood pressure was 76.5% at the end of the study. Average systolic and diastolic blood pressure reduction was 28.5 mmHg, and 23 mmHg respectively. The average number of drugs required per patient was 1.7 (57.6% needed two or more antihypertensive drugs) and the number of cardiovascular events in the Spanish population was 40 (4.96%), a similar incidence to the observed (687 events) in the whole study population (3.65%; p = 0.06). CONCLUSION: Strategies of intensive treatment with current antihypertensive drugs are capable to achieve blood pressure control in the great majority of Spanish essential hypertensive patients without significant side effects, thus being responsible for a very low rate of cardiovascular events in these patients.
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The results obtained in measurements of the dimensional behavior of U-shaped specimens correspond to the dimensional behavior of dentures. Part of the dimensional changes found in U-shaped specimens are not observed to the same extent in dentures, but produce interior tension in the denture. The bigger the dimensional changes in the U-shaped specimen, the bigger the dimensional changes in the denture or the tensions in its interior. Thus, the results of the measurements of U-shaped specimens demonstrate the behavior of a clinically used denture. Corresponding guidelines for testing purposes are proposed.
Advances in scientific research over the last century have permitted the recognition and characterization of the structure and function of an enzymatic pathway involved in cardiovascular homeostasis and blood pressure control, namely the renin-angiotensin-aldosterone system. This system may be reversibly blocked by drugs acting at different levels: renin inhibitors, angiotensin converting enzyme inhibitors and AT1 angiotensin II receptor antagonists. Lacking clinical experience with effects of AT1 angiotensin II receptor antagonists on the cardiovascular system are practically identical to those observed with angiotensin converting enzyme inhibitors. The efficacy and safety of drugs blocking the renin-angiotensin-aldosterone system in the reduction of blood pressure, the regression of cardiovascular remodeling, the prevention of progression of diabetic nephropathy to end-stage renal failure, and the prevention of cardiovascular morbidity and mortality is well established. These hemodynamic effects of AT1 angiotensin II receptor antagonists treatment are achieved with less adverse effects than with angiotensin converting enzyme inhibitors. Furthermore, the association of angiotensin converting enzyme inhibitors and AT1 angiotensin II receptor antagonists allows a more effective renin-angiotensin-aldosterone Systems blockade and improves the hemodynamic and non-hemodynamic effects. This possibility opens up new perspectives in the treatment of cardiovascular diseases, the most common cause of death at the end of the millennium in developed countries.
Mutations in the the glaucoma gene GCL1A, also known as trabecular meshwork glucocorticoid response (TIGR) or myocilin (Myoc), have been shown to be associated with juvenile-onset primary open-angle glaucoma. Very little is known about the pattern of expression of the TIGR gene in human ocular tissues. In-situ hybridization experiments demonstrated the localization of TIGR mRNA in cells throughout the iris, ciliary muscle, and the filtering portion of the trabecular meshwork of normal eye donors. The expression of TIGR protein was investigated by Western blot using an epitope-directed antibody to the carboxy terminus region of TIGR. This antibody was able to distinguish a recombinant TIGR fusion protein from a truncated TIGR form containing the naturally occurring Gln(368)-->stop mutation. In tissue extracts from the iris, ciliary body, and trabecular meshwork, the antibody recognized a major protein band of 57-kDa molecular mass. Deglycosylation treatment with PNGase F, NANase II, and O-glycosidase indicated that the 57-kDa protein in these tissues was unglycosylated. In agreement with this observation, in coupled in-vitro transcription/translation systems, the 57-kDa TIGR protein was unaffected by the presence of the processing and glycosylation activities of canine pancreatic microsomal membranes. These findings support the view that the expression of TIGR mRNA in cells of the iris, ciliary body, and trabecular meshwork correlates with that of TIGR protein, and that the 57-kDa TIGR protein was unglycosylated. These results, which are in contrast with earlier reports, raise the possibility that the TIGR protein might be processed into distinct forms in a tissue-specific manner.
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Up to 40% of ceftriaxone is excreted unchanged into the bile and, due to its high calcium-binding affinity, it may form a salt that can provoke biliary lithiasis. Echography revealed that biliary lithiasis was present in 12-45% of patients treated with ceftriaxone as early as the second day of treatment. Lithiasis is usually asymptomatic and disappears in less than 2 months. Symptomatic cases and patients requiring cholecystectomy have been described in the literature. We present four children, evaluated in 1999, who presented asymptomatic cholelithiasis between the second and fourth day of ceftriaxone treatment. Biliary lithiasis was found after 2-4 days of treatment, with resolution of the lithiasis between 1-4 months after the end of therapy.
This study aims to evaluate the clinical and biochemical profile associated with the presence of microalbuminuria in a group of essential hypertensive patients referred to a hypertension clinic. A total of 188 non-diabetic, untreated essential hypertensive patients (100 men, 88 women) aged 55.8 +/- 11.7 years are studied. Urinary albumin excretion was determined in two 24-h urine collections. Clinical and biochemical evaluations and 24-h ambulatory blood pressure (BP) monitoring were performed at baseline. Forty-two patients (22.3%) showed an increased urinary albumin excretion rate (20-200 micrograms/min). These patients showed significantly higher values (P < 0.01) for 24-h, daytime and night-time systolic and diastolic BP, compared with essential hypertensives with normal urinary albumin excretion. However, nocturnal reduction in BP did not differ between the groups. Furthermore, patients with microalbuminuria showed significantly higher (P < 0.01) creatinine, serum uric acid and triglycerides, as well as lower high-density lipoprotein (HDL)-cholesterol. In a multiple logistic regression analysis, a 24-h systolic BP > 140 mmHg (odds ratio: 3.19; 95% confidence interval [CI 95%]: 1.44-7.06) and a serum creatinine > 88 mumol/L (odds ratio: 3.08; CI 95%: 1.39-6.84) were the two factors associated independently with increased urinary albumin excretion. We conclude that, in essential hypertensive patients, the presence of microalbuminuria is associated with elevated BP, but not with its circadian pattern. Likewise, microalbuminuria is associated with the degree of renal impairment, and with increased uric acid and triglycerides and decreased HDL-cholesterol.
Basaloid-squamous cell carcinoma is a rare tumor characterized by Wain et al in 1986 as a separate pathological entity. In head and neck more than 100 cases have been reported, with a strong predilection for hypopharynx, base of tongue, and supraglotic larynx. This entity also has been described in nasal cavity, oesophagus, tonsils and oral cavity. Only 14 cases has been reported arising in the floor of the mouth, and none in our literature. We present a new case in floor of the mouth and clinicopathological features are emphasized. We have undertaken moreover a bibliographic review of this uncommon and aggressive neoplasm.
To evaluate the long term results of telescopically retained overdentures, 92 patients with a total of 106 overdentures on 236 teeth were examined after two to eleven years. Thirty-three teeth were lost during the follow-up period. A higher tooth survival rate of the double-crowned teeth was found under mandibular overdentures (92%) than under maxillary overdentures (86%) after five years. The palladium-silver-alloy used seemed to be more suitable for telescopic crowns than the use of precious gold-copper-alloys because of tarnishing the latter alloys.
The aim of the present study was to evaluate the effects of the level of salt intake on endothelium-derived factors in a group of patients with essential hypertension. A group of 50 patients with essential hypertension who had never been treated for the condition were placed on a low-sodium (50 mmol/day), low-nitrate (400 micromol/day) diet, which was supplemented, in a single-blind fashion, with placebo tablets for the first 7 days and then with NaCl tablets (200 mmol/day) for a further 7 days (total sodium intake 250 mmol/day). At the end of both periods, 24-h ambulatory blood pressure monitoring was performed. In addition, plasma levels and 24-h urinary excretion of nitrites plus nitrates and cGMP were measured, along with plasma levels of endothelin. A high salt intake promoted significant decreases in plasma levels of nitrites plus nitrates (from 41.0+/-2.1 to 32.8+/-1.8 nmol/ml; P<0.001), 24-h urinary nitrate excretion (from 417+/-36 to 334+/-37 micromol/24 h; P=0.045) and plasma endothelin levels (from 5.6+/-0.3 to 4.6+/-0.3 pg/ml; P=0.007). The plasma concentration and 24-h urinary excretion of cGMP were not altered significantly by a high salt intake. We did not find any relationship between endothelium-derived products and 24-h mean blood pressure, at either low or high salt intakes, or between changes induced by the high-salt diet. A high salt intake also induced significant decreases in plasma renin activity, angiotensin II and aldosterone, and a significant increase in atrial natriuretic peptide. We conclude that a high salt intake decreases the plasma concentration and urinary excretion of nitrates and plasma levels of endothelin in patients with essential hypertension, suggesting that the level of salt intake may affect endothelial cell function. However, these alterations are not correlated with changes in blood pressure induced by the high salt intake.