[Hemispheric functional specialization and anxiety. Focus on an evaluation procedure]. Observations of brain-lesioned patients and experimental psychology studies have shown that the influence of the specific functioning of the two hemispheres of the brain on the regulation of emotional behaviour appears to be unequal and suggests a functional specialization of the right hemisphere for the expression and comprehension of the affective components of behaviour. However, the extension of this hypothesis to include all emotional experiences remains controversial. The observed superiority of the left hemisphere in the perception of positive emotions and the predominance of the right hemisphere in the treatment of negative emotions would appear to favour a joint and complementary participation of both cerebral hemispheres in emotional experiences. In the case of affective disorders, and particularly in anxiety symptoms, the hypothesis of a dysfunctioning of the right hemisphere is similarly questioned: while all metabolic studies corroborate this hypothesis, experimental psychological studies suggest the existence of a preferential involvement of one or the other hemisphere in relation to individual differences such as the "trait" anxiety score. Moreover, the few studies which have been undertaken with healthy volunteers raise the problem of their extrapolation to pathological situations. In view of the potential interest in the neuropsychological evaluations of subjects with different forms of pathological anxiety, we have developed an experimented with two tests aimed at evaluating the differential activity of the two hemispheres of the brain. These two tests, constructed on a "mirror-image" model from the specifications of a functional hemispheric specialization, are supposed to involve cognitive strategies pinpointing preferentially one hemisphere or the other.(ABSTRACT TRUNCATED AT 250 WORDS)


[Sensation seeking and mood dimensions in depressive states]. This study presents the investigation of the relations between dimensions of depressive mood and sensations seeking in 55 hospitalized depressed subjects. The concept of sensation seeking, identified by M. Zuckerman as a personality dimension, has been defined as the need for the subject to reach his optimal level of activation. The four subscores of sensation seeking, relatively independent, are identified in the sensation seeking scale; they stand at different levels on the dimensions of activation and pleasure which are emotional dimensions. These emotional dimensions are investigated in the exploration of the emotional components of depressive mood; the different symptomatic regroupings, such as blunted affect or impulsivity, do not have the same relations with these dimensions. The sensation seeking concept appears fruitful to investigate the different troubles of affective dynamic, which stand on the expressive and behavioral level, and on the subjective level. As in several studies with normal populations, we find again the same inverse relation between age and sensation seeking, and men obtain higher scores on the Thrill and Adventure seeking factor and on the Desinhibition factor. Globally, depressed subjects have lower scores of sensation seeking than normal subjects (paired by age and sex); but the weakness of sensation seeking is not proportional to the intensity of depression (Hamilton Depressive Scale) and to the the intensity of anxiety (Covi Brief Anxiety Scale). Interesting relations appear with the depressive mood factors, which agree with previous studies of sensation seeking in psychology and psychopathology.(ABSTRACT TRUNCATED AT 250 WORDS)


[Efficacy of tianeptine in the treatment of psychasthenia. A study versus placebo]. Tianeptine is an effective antidepressant with original neurochemical properties. Tianeptine increases the serotonin (5-HT) reuptake after acute and chronic treatment. The efficacy of tianeptine (T) versus placebo (P) was evaluated in the treatment of psychasthenia, because of the role of 5-HT in obsessive-compulsive disorders, the last state of psychasthenia in term of severity. Patients were recruited using the psychasthenia scale; then, their MADRS scores limited those who turned out to the depression. Mean inclusion MADRS scores where 12 (T) and 11.8 (P). Tianeptine is an effective treatment for patients suffering from psychasthenia. Tianeptine is more effective than placebo in global score and in sub-scores (asthenia and somatic symptoms) of the psychasthenia scale. In spite of weak inclusion scores in MADRS, patients taking tianeptine also showed significant improvement, greater than with placebo. The percentage of patients with a reduction equal to or greater than 50% of their MADRS score was significantly more important in tianeptine group. These results could be the illustration of the decrease in associated depressive symptoms or the result of an improvement of symptoms common to MADRS and psychasthenia scales. The same favorable results were obtained in symptoms of anxiety scored by HARS. In term of safety, tianeptine is equivalent to a placebo if we consider somatic complaints expressed by the patients, global improvement evaluated by the patient and the investigator, weight and blood pressure. Interruption of treatment for side-effects concerns the placebo group only (3 versus 0). This excellent safety is particularly well-adapted to the treatment of these out-patients.


[Neuropsychologic function of the depressive patient. A lexical decision investigation in major depression]. According to the Resource Allocation Model, it is logical to think that emotional mood states modulate the allocation of capacity, most cognitive tasks require some allocation of capacity, and in many instances there is a positive correlation between effort and memory. In cognitive science, the experimental paradigm of lexical decision task is used to investigate visual words recognition and lexical access. According to the Resource Allocation Model, we postulated that depressed patients take more time to recognize items from an affective loaded list. In order to compare their behavior in lexical decision task in this study, depressed patients and healthy controls were studied. We hoped to find an interaction between the mood state of subjects and the categories (affective or neutral) of words. This kind of interaction is expected to figure among the cognitive markers of depression. Two groups of right-handed adults served as subjects in our experiment. The subjects were living in the north west region of Quebec. The first group consisted of 11 depressed patients (mean age: 40.2; SD: 6.8). All of them met the DSM III criteria for major depressive disorder and the RDC. Patients were rated using the 24-item Hamilton Depression Rating Scale (HDRS). All depressed patients were without medications. The control group was composed with 24 subjects (mean age: 32.7; SD: 7.9). We built a depressive word-list (Mood-list) and a neutral word-list (Neutral-list) and used a computer for the lexical-decision task. We noted a significant interaction [F(1.33) = 10,035, p < 0.001] between the subjects group (depression vs control) and the words category (Moodlist vs Neutral-list).(ABSTRACT TRUNCATED AT 250 WORDS)


[Nonulcerative dyspepsia associated with Helicobacter pylori]. 30 patients with non ulcer dyspepsia (NUD) were evaluated to find out if there was a relationship with Helicobacter pylori (HP) infection. Gastric biopsies from the antrum were taken and two of them sent to pathology to be stained with H&E and Warthin-Starry. The other three were sent to Microbiology, for urease-test, culture and frotis with Gram stain. To diagnose HP was necessary to get it at least in two of the performed test. This was possible in 20 (66.66%). Chronic active gastritis was observed in 15/20 (75%) and in the 3/10 HP negative patients none had histological alteration shown. Normal aspect of gastric mucosa did not predict Helicobacter pylori infection. The presence of the bacteria could not be correlated to any kind of symptoms and always was associated with chronic gastritis.


[A morphological study of the liver in the acquired immunodeficiency syndrome. An analysis of 69 cases]. The morphologic findings in the liver of 69 autopsy cases with had died of AIDS are presented. The morphologic changes were represented by the presence of opportunistic germs (Histoplasma capsulatum, Mycobacteria, Cryptococcus neoformans and CMV). Other alterations found were fatty changes, portal fibrosis, dilated and congested sinusoids. We did not find Kaposi's sarcoma in the liver and only one case of lymphoblastic lymphoma was seen observed.


[A comparative study of cisapride versus metoclopramide in the treatment of symptomatic hiatal hernia]. Comparative study of the therapeutical effects of cisapride and metoclopramide in 50 patients with symptomatic hiatal hernia was performed. Behaviour of media before and after treatment, of resting pressure and relaxation lower esophageal sphincter, pressure of the primary wave and the number of reflux episodes with pH < 4. The group of patients treated with cisapride had a considerably higher beneficial effect (p < 0.01) than the metoclopramide-treated group. A total of 4 patients were dropped-off the study because of undesirable side effects (diarrhea 2, headache 1, and somnolence 1).


[The Alagille syndrome. Apropos 3 cases]. The clinical, biochemical, and histopathological characteristics of three patients who had jaundice and other findings suggestive of the syndrome are reported. Studies showed the presence of hypoplasia of the intrahepatic biliary ducts associated with facial, vertebral, cardiovascular, and eye abnormalities and a delay in the weight-height development. This group of abnormalities establish the Alagille syndrome, an entity which has not, until now, been extensively studied in our country.


[Terminal jaundice in progressive disseminated histoplasmosis associated with AIDS. A report of an autopsy case]. The case of a 58-years-old patient with AIDS is discussed. He presented a progressive disease with discomfort, abdominal pain, hiporexia, fever and weight loss. At the time of admittance in our hospital he had hepatosplenomegaly. The patient worsened and presented asthenia, fever, oedema, ascites, pulmonary congestion and finally jaundice and died. Autopsy findings were indicative of disseminated histoplasmosis with pseudotumoral appearance of the adrenal glands.


[Gastroduodenitis and Helicobacter pylori in uremic patients]. We studied 26 patients (p) with end stage renal failure (RF) and 26 healthy volunteers (HV) to investigate the prevalence of Helicobacter pylori (Hp) and its relation with chronic gastritis (CG) and chronic duodenitis (CD). We analyzed 312 gastric and duodenal mucosal biopsies stained with H & E and Giemsa. Categorical data were assessed by the X2 and Fisher's exact test. Probability values of p < 0.05 were considered significant. Endoscopic lesions correlated with histological gastritis and duodenitis and Hp was positive in antrum of 6/8p (75%) (p < 0.05). The prevalence of Hp was 54.5% (15/26p) in RF and 47.2% (12/26s) in HV. Hp was found more frequently in pathological mucosa (p < 005.). CG of the antrum and CD were more commonly in RF (88.5% vs 69.5% and 42.3% vs 23.1% respectively). HP was more frequently located in the antrum than in body and duodenum in both groups (p < 0.05). Chronic gastritis of the body was more frequently in HV (p < 0.05). Active chronic antral gastritis and superficial gastritis were more frequently associated to Hp. Hp was associated to chronic inflammatory gastroduodenal diseases in both groups and may be a cofactor in its pathogenesis. We recommended Hp treatment before renal transplantation.


[Jejunal leiomyosarcoma. A case report]. Jejunal leiomyosarcoma, is an uncommon neoplasm. Diagnosis can be difficult because symptoms may be vague and nonspecific. We report the case of a 33-years-old patient, which was diagnosed and operated of this infrequent pathology.


[Bacterial translocation. Its role in the etiology of sepsis and multiple organ failure]. Under certain conditions or diseases the microorganisms that normally inhabited in the gastrointestinal tract reach the mesenteric lymph nodes, the portal circulation, the intra and extraperitoneal organs and the systemic circulation creating the possibility of infection, sepsis and multiple organ failure. This phenomenon has been termed bacterial translocation and although was described few decades ago, today it has regain critical importance due to the association to the multiple organ failure syndrome in critical and severely injured patients. In this review a series of pathologies where the translocation of bacteria has been demonstrated are described as well as the possible therapeutics maneuvers.


[Mucinous papillary cystadenoma of the pancreas]. The case of a 15-years-old female patient is presented, who referred pain and presence of a mass in the left upper quadrant of the abdomen. Diagnostic imaging showed a 9 cm diameter cystic lesion in the tail of the pancreas which was removed surgically. Histology demonstrated a pancreatic mucinous cystadenoma with borderline biological behaviour. A review of the literature related to cystic neoplasms of the pancreas is realized.


[Prolonged total parenteral nutrition in surgery. A case report of severe malnutrition]. We present a 15-years-old female patient severely malnourished due to complications of abdominal surgery, who received total parenteral nutrition during 118 days. The clinical and laboratory parameters are analyzed and a photographic sequence is presented. During the treatment period nitrogen balance was positive and her weight increased in 50%.


[Colonic polyps: an analysis of the endoscopic and histopathological aspects]. The present study is a retrospective analysis of the endoscopic and histologic features of 728 polyps resected from 422 patients during the years 1980 to 1991. Mean age of the patients was 52 years (5 to 87), 63% male and 37% female. The histology of the lesions showed: adenoma: 60.3%, hyperplastic: 31.7; juvenile: 2.3% and miscellaneous: 5.7%. The 439 adenomas where found in 270 patients of which 151 (55.9%) were male and 119 (44.1%) female. The 231 hyperplastic polyps where found in 113 patients: 66 (58.4) male and 47 (41.6) female. All the hyperplastic polyps where less than 20 mm in diameter. Of the adenomas, 385 (87.7%) where less than 20 mm in diameter and had macroscopic appearance similar to the hyperplastic polyps. Of the 439 adenomas, 218 (49.6) where pediculated and 221 (50.4%) sessile. Of the hyperplastic polyps 53 (22.9%) where pediculated and 178 (77%) sessile. Of the adenomas, 351 (80%) where tubular and 88 (22%) had a villous component, most of the tubular adenomas where less than 15 mm in diameter and the villous component was more frequent as the polyps increased in size. Of the adenomas, 139 (30%) had dysplasia and of these 10% had cancer which represents a total of 3% of all the adenomas in this series. The grade of dysplasia was more severe as the adenomas was larger in size or had villous component. The polyps were located: 69.6 in the distal colon at the reach of the flexible sigmoidoscope and 30.4% in the proximal colon.(ABSTRACT TRUNCATED AT 250 WORDS)


[Acute pancreatitis: the value of ultrasonography in its prognosis]. As acute pancreatitis is a disease of unpredictable outcome, we wanted to use an available diagnostic method such as ultrasonography, in order to establish the prognosis of this problem. There are some published papers using CT scan as prognostic value of this disease but none about ultrasonography. We evaluated 34 patients with clinical diagnosis of acute pancreatitis based on abdominal pain, nausea, vomits and absence of abdominal sounds plus an elevation of amylases of at least three times above the normal value. An abdominal ultrasound was performed at admission and every 4 days or even sooner if complications were suspected. Acute pancreatitis was classified by clinic and ultrasound in mild, moderate and severe. From 34 patients studied, 27 were clinically and by ultrasound correlated (79%) giving a sensibility of 100% and a specificity of 85%, without false positives. There were some cases in which ultrasound detected abnormalities before clinical manifestations, so a close follow up was done and this allowed us to be ready if any complications showed up. Follow up with ultrasound examination was very useful, permitted us to detect early complications with or without clinical manifestations and also emphasized that a single ultrasound examination is not enough as a prognostic or diagnostic method.


[Sickle-cell anemia. The liver lesions. A clinical, morphological and ultrastructural study of 21 cases]. Liver changes in patients with sickle cell anemia, for some authors, is a common finding and is hot in relation with the severity of the anemia. The grade of liner disfunction or malfunction is related with ischemia and, there exists probable, slowing of intrahepatic circulation secondary to sinusoidal obstruction due to masses of sickle cells and to the hypertrophy of Kupffer cells. In this paper, clinical morphologic and ultrastructural findings of 21 cases of SS and SA, hemoglobinopathies are presented. Sixty percent were females and forty percent were males with ages between 18 and 46 years. The most frequent microscopic findings were sinusoid distention followed by hypertrophy of Kupffer cells and inflammation. Areas of necrosis, fatty changes and iron deposits were also seen.


[Duodenal duplication cyst].

[Duodenal duplication cyst]. The duodenal duplication cyst is an uncommon inherited anomaly. Its etiology is related to malformations of the canal in the gastrointestinal duct during the formation of the embryo. It develops in the infancy period or during childhood, it is uncommon in adults. The most frequent finding, is abdominal mass, although it might appear along with obstructive symptoms, recidivante pancreatitis and digestive bleeding. The diagnosis is based on image methods (ultrasonics, radiology, computed tomography, CPRE), nevertheless its identification through ultrasonics is of great value. Therefore we consider important the introduction of a 72-year-old woman case, whose pre-surgery diagnosis was performed with ultrasonics and reaffirmed by all other image methods. We also mention the usefulness of inner-surgery ultrasonics, in the surgery case of this pathology.


[Propranolol in children and adolescents with portal hypertension: its dosage and the clinical, cardiovascular and biochemical effects]. An adequate propranolol dose to reduce 25% the initial heart rate was searched in 19 children with portal hypertension. 13 were pre-hepatic and 6 hepatic hypertension, mean age: 6.96 +/- 3.48 years, range: 2-14 years. Treatment was started with 0.5 mg/kg/day increasing 0.25 mg/kg/day every third day, needing an average of 26 +/- 13 days (range: 6-54 days) to obtain the response. Daily dose ranged from 1 to 5.25 mg/kg/day (mean: 2.69 +/- 1.16). The highest daily dose was 175 mg, the lowest 23.4 mg (mean: 58.27 +/- 36.6 mg/day). Some parameters were evaluated before and after achieving the dose. There was a significant reduction of mean blood pressure (p < 0.01) and peripheral venous pressure (p < 0.05) in 68.4% of patients. A significant elevation (p < 0.001) of 24 hour urinary catecholamine levels occurred in 94.7%. Side effects were minimal. Propranolol could be considered a safe pharmacological option in these patients.


[Hepatitis B (HBV) and C (HBC) virus infections in Down's syndrome and in neuropsychiatric patients without Down's syndrome]. Hepatitis B virus (HBV) markers are found with high frequency in immunocompromised individuals. In order to find out if this is also true for the hepatitis C virus (HCV), we have analyzed a group (G.1) of 46 patients (pts.) with Down syndrome, situation known to be associated with immunodepression G. 1. We compared them with a G. of 310 mentally retarded pts. without Down syndrome G. 2 and without evidence of immunological disfunction. All of them were studied for infection with HBV. All pts. in G. 1 and G. 2 were also tested for HCV. The pts. have been hospitalized in a specialized medical institution for mentally retarded on a long term basis and were followed during 1 year. Finally G 3 was composed of 5454 voluntary blood donors. In all pts. search for HBV infection markers (anti-HBc, HBsAg, HBeAg by EIA test and HBV-DNA by nucleic acids hybridization) were performed. Search for HCV markers was done by a second generation EIA kit (Abbott Hepatitis C (rDNA) (Antigen). HBsAg was found to be positive in 12/46 (26%) of G. I and 25/310 (8%) of G. II (p < 0.001). HBeAg was positive in 8/12 (67%) of G. I and in 2/25 (8%) of G. II (p < 0.001). All HBeAg positive pts. had elevated values of DNA-HBV. In G. I, 4/12 (33%) pts. lost HBeAg during the observation period, one of them remained HBV-DNA positive and none become HBsAg negative.(ABSTRACT TRUNCATED AT 250 WORDS)


[Hepatic glycogenosis: the clinical, biochemical and enzymatic aspects in a group of pediatric patients]. Nine children with clinical diagnosis of glycogenoses were studied, types were confirmed through determination of levels and structure of glycogen, stimulation with glucagon and enzymatic defect analyses. Eight patients suffered glycogenoses type III and one, type VI. The major age group un type III was 1 to 2 years old (62.5%), the type VI was diagnosed in a preschool boy. Mean clinical features were: hepatomegaly, doll-like facies and short height. Major biochemical alterations were: transaminases elevation in both types, hypertriglyceridemia, hyperglycemia, metabolic acidosis and hyperuricemia only in glycogenoses III. One III type patient presented cardiovascular alterations. All patients showed increased concentrations of erythrocyte glycogen, with normal structure in type VI and abnormal in 75% of type III. Tree fourths of type III patients had a positive response to glucagon stimulation. No one presented glucose 6 phosphatase deficiency.


[Sporadic non-A, non-B hepatitis in Argentina. The responsibility of the hepatitis E virus?]. Sporadic non A, non B hepatitis non related to blood transfusions or parenteral exposure is present in India and various countries of southeast Asia and Africa. We present the experience in a northeastern region of Argentina from January 1987 to September 1990. During this period twenty one patients where identified with acute hepatitis without serologic evidence of infection with HAV, HBV, HCV, toxoplasmosis, infectious mononucleosis nor clinical evidence of Herpes virus infection. Clinic and biochemical parameters were analyzed and showed a considerable elevation of transaminases and cholestasis. Of the 21 patients diagnosed as having acute non A non B hepatitis of probable enteric transmission (NANBE), 10 where male and 11 female. Mean age was 24.7 years. In all cases the disease was self limited and follow up during more than one year after the acute episode did not demonstrate signs of reactivation nor evidence of chronicity.


[The diagnostic efficacy of ultrasonography-guided puncture cytology in hepatic masses]. The aim of this work was to evaluate the diagnostic reliability of fine needle cytology guided by ultrasonography in hepatic masses. One hundred and fifty nine patients underwent this procedure. The final diagnosis was confirmed by histology obtained by percutaneous biopsy, surgery, laparoscopy and necropsy or adequate clinical follow-up in 139 cases. Twenty cases were excluded since no final diagnosis was available. In 102 cases the method was applied on an outpatient basis, while the remainder were hospitalized. There were 9 (6.4%) false negatives, whose final diagnosis were hepatocarcinoma in 4, adenocarcinoma in 3, cholangiocarcinoma in 1 and in a non Hodgkin lymphoma. The global sensitivity of the method was 93.5%, the specificity 100% and the efficiency 93.5%. In hepatocarcinomas the sensitivity was 73.3%, the specificity 100% and the efficiency 73.3%. In metastatic adenocarcinomas the sensitivity was 96.2%, the specificity 100% and the efficiency 73.3%. Except for a single hepatocarcinoma patient who developed hemoperitoneum and 2 patients who required parenteral analgesics, complications were entirely lacking. Fine needle cytology guided by ultrasonography in hepatic masses is a highly efficient method to confirm, rule out and stage liver malignancy and benign lesions in a fast low-cost fashion. The low sensitivity in hepatocarcinomas is attributable to tumor size and histological differentiation.


[Endoscopic resection in early gastric cancer]. Development of therapeutic endoscopy has permitted the treatment of early gastric cancer (EGC) in its different macroscopic forms. In this paper we present 9 cases of EGC treated endoscopically in our Institution. We describe the criteria we follow to perform this procedure. The patients selected were of advanced age and high surgical risk. Seven cases were macroscopically Type I and two were Type IIa. According to localization six were proximal tumors (body and fundus) and three were located in the antrum. Six of the nine patients are alive after resection, one more than 6 years and 3 more than 3 years. Three patients died of ailments no related to cancer.


[Hemobilia. Its clinical presentation and diagnosis]. Hemobilia is a rare cause of upper GI bleeding that must be suspect in order to make an early and precise diagnosis, that permits to decrease the high rate of mortality. We present our experience in three cases and analyze the clinical manifestations, diagnostic methods and follow-up.


[Chronic caustic esophagitis in childhood. A functional study]. The purpose of this study was to investigate the motor function of the esophagus in patients with chronic caustic esophagitis. We evaluated 7 patients between 2 and 10 years of age, who had ingested caustics between 15 months and 3 years of age. The method we used was radiology with fluoroscopy vision and manometry. There was no correlation between radiologic and manometric findings. Esophageal transit was normal in all patients, even in those that had small stenosis while manometry showed motor disfunction in patients with severe esophageal damage.


[The usefulness of biofeedback in children with encopresis. A preliminary report]. Children with encopresis (costiveness) have a social problem, and (BFB) offers them a valid therapeutic alternative. The present prospective study compares the advantages of this technique with conventional treatment in 21 patients, with average ages of 10.13 and 8.54 years in each group. The patients were studied by clinical, manometric and electromyographic parameters. Those treated with BFB showed clinical improvement, with manometric significant enhancement (p < 0.001) of the percentage of internal anal sphincter (IAE) relaxation, relaxation interval of the IAE and rectal sensation threshold (RST), on the other hand, patients treated by conventional therapy only improved the RST (p < 0.01). Biofeedback seems useful in the treatment of the child with encopresis.


[Biometry in the echosonography of the biliary tract and large abdominal vessels in normal children]. We evaluated children younger than twelve years old with abdominal ultrasound in order to obtain normal dimensions of abdominal vessels, gallbladder and biliary tree. The measures in 183 cases increased with age in all groups.


[The recurrence of duodenal ulcer after treatment for Helicobacter pylori. A randomized, double-blind, placebo-controlled study]. We studied 63 duodenal ulcer (DU) patients (p) diagnosed by upper gastrointestinal endoscopy (UGE) and Helicobacter pylori positive (HP). Patients were randomized, double-blinded to receive placebo (PG) 30p or Amoxicillin plus Metronidazole 33p (TG). All of them took Famotidine for six weeks and at this point UGE was performed. DU healing was similar in both groups. HP eradication was possible in 14/24p of TG and 4/23 of PG (58.33% vs 17.39%) difference was statistically significant. DU recurrence at 3 months was 68.75% in PG vs 11.76% in TG (p = 0.001). At the end point of the study global recurrence of DU was 3/24p in TG vs 19/23 in PG (p = 0.000001). Our findings suggest that DU recurrence is related to the presence of HP. Definitive treatment to permanently eradicate the bacteria is to be evaluated.


[The relationship between intestinal metaplasia and gastric carcinoma: a study of 722 biopsies]. Intestinal metaplasia has been shown by many investigators to be a premalignant state. Considering this fact, 722 gastric biopsies were studied, a 24% of association was found between gastric carcinoma and intestinal metaplasia and 27% of the cases with metaplasia were found in "apparently normal" or with benign stomach lesions. The group most affected was males over 61 years. Control endoscopy and biopsy was practiced in 17 patients with previously diagnosed intestinal metaplasia and in 11.7% gastric carcinoma with metaplasia was found. Therefore, it cannot be concluded that intestinal metaplasia is a premalignant condition, but its frequent association with gastric adenocarcinoma advises periodical examination by endoscopy in every patient over 40 years in which it is determined by biopsy.


Model curriculum in Medical Crisis Counseling. Linda Pollin Foundation/NIMH Workshop. This document describes a curriculum model for a year-long fellowship training program in Medical Crisis Counseling designed for health care professionals selected as Linda Pollin Fellows. The document was developed at the Second Annual Workshop, cosponsored in 1990 by the National Institute of Mental Health and the Linda Pollin Foundation. Conference participants included experts in the field of mental health--representing psychiatry, nursing, psychology, and social work--who were divided into task forces focusing on various content areas: clinical, sociocultural, managerial and administrative, liaison/educational, and research and evaluation. The document develops the content in these areas. Although designed for Pollin Fellows, the curriculum, once implemented and evaluated, may be modified for use in the basic education of a variety of health professionals. The philosophy upon which the curriculum is based incorporates the following core concepts: 1) each Fellow must have a skilled supervisor (Mentor), 2) the supervisor-trainee relationship should embody the essence of the future relationship between trainees and their patients, and 3) Medical Crisis Counseling is essentially a multidisciplinary enterprise.


Psychosocial interventions in adult patients with coronary heart disease and cancer. A literature review. A growing body of evidence suggests that chronic medical illness is associated with an increased prevalence and incidence of psychiatric and psychological disturbances. The present literature review is based on two theses: first, that chronic illness is viewed as a stressor and is associated with increased psychological distress, and secondly, that interventions can minimize the distress. A review of the studies conducted with adult patients diagnosed either with coronary heart disease or cancer suggests that psychosocial interventions are, in general, efficacious in relieving self-reported psychological distress. The review also recommends psychosocial interventions for high-risk patients rather than all patients, and that researchers need to identify other outcomes such as health care costs, disability, days in hospital, morbidity, and mortality in order to convince policy makers that these interventions are worthwhile. Recommendations for future research are also discussed.


The need for multidisciplinary training in counseling the medically ill. Report of the training committee of the Linda Pollin Foundation. Training for medical counselors requires that medicine and psychiatry give up the position that counseling is only a negligible offshoot that almost any professional can readily do. Instead, counseling can be considered a generic concept that covers a wide variety of interventions designed to help patients cope with the complications and consequences of their chronic illness. This report outlines the principles and scope of training for consideration in the area of counseling the medically ill and reviews the current status of training programs in the fields of psychiatry, psychology, social work, and nursing. Recommendations are made for future directions, including role clarification for disciplines, building a credible research base, provision of guidelines and possible accreditation, and incorporating medical counseling into training fellowships.


Psychosocial interventions in chronic medical illness. An overview of outcome research. Previous studies have shown that psychopathology is common in the medically ill, affects the course of medical illness, and is associated with increased health care costs. Recent controlled trials have demonstrated that psychosocial interventions in the medically ill can improve both psychosocial and medical outcomes. Although an important aim of current research is to assess the cost effectiveness of such interventions, the meaning and significance of "cost effectiveness," "cost benefit," and "cost offset" are frequently misunderstood. An overview of outcome research will be used to illuminate the promise and the limitations of such studies, with special attention to bias in research design.


[Alagille's syndrome in Cuba. A report of 9 cases]. Alagille's syndrome or arteriohepatic dysplasia has been described in Cuba in nine patients between nine months and 12 years of age (8 males and one female). Among the clinical features we found five major abnormalities: chronic cholestasis with neonatal jaundice (9/9), peculiar facies (9/9), peripheral pulmonary artery hypoplasia associated with cardiac murmur (6/9), butter-fly-like arch defects (4/9), and posterior embryotoxon (6/7). Two children had a severe xanthomatosis. Laparoscopy showed green hepatomegaly depending on the degree of cholestasis, and only one patient had incipient signs of micronodular cirrhosis. Liver histology showed a paucity of interlobular bile ducts. Survival was of 60%. One patient survived more than 30 years. Four patients died of liver carcinoma (unique report in infants), broncho-pneumonia, acute renal failure, and sudden death respectively. Among the minor features were mental retardation (5/9), a peculiar voice (3/9), growth retardation observed in some of our patients. This is the first report on Alagille's syndrome in Latin America, because so far reports have come only from Europe and North America.


[Primary adenocarcinoma of the duodenum: a report of 2 cases and a review of the world literature]. We presented two cases of adenocarcinoma of the duodenum diagnosed at the Gastroenterology Unit of the General Hospital of Lidice Dr. Jesús Yerena and reviewed retrospectively the pathology cases from 1980-1990. We review the world literature and found that the most common clinical presentation was as obstructive type. In our cases perforation and jaundice were the presentation.


[Squamous cell carcinoma of the colon. A case report]. A case of primary squamous-cell carcinoma (epidermoid carcinoma) of the colon is presented located in the hepatic flexure. It seems to be the first case registered in Latin America. The pathogenesis, natural history, and treatment of the disease are reviewed.


[Leiomyosarcoma of the vena cava inferior. The correlation: ultrasound and fine-needle puncture biopsy]. The leiomyosarcoma of the inferior vena cava is a non-frequent tumor, mesenchymal, that has its origin in the smooth muscular tissue of the vascular wall. Its growth is slow and expansive, more frequently found on females. The symptomatology is related to the cava segment where it is located. The diagnosis is performed by ultrasonics, computed tomography and cavography, actually magnetic resonance acquires more and more importance. The treatment is specifically surgery along with radiotherapy and chemotherapy. A case of leiomyosarcoma of the inferior vena cava is presented in which diagnosis was performed using ultrasonics, tomography and cavography confirmed before surgery by biopsy punction with thin needle. In the diagnosis of this pathology it is described the use of intro-surgery ultrasonics.


The ActionAid disability programmes: experiences in early identification and early intervention. The World Health Organisation (WHO) estimates that about 10% of the world's population has some form of disability, while statistics from different sources show that about 3.8% of India's population has locomotor, visual or communication disabilities or mental retardation. The Disability Division of ActionAid-India supports 38 non-governmental organisations involved in disability programmes in India. This paper touches upon the experiences of some of its project partners in the areas of early identification and early intervention.


The UPANAYAN' early intervention programme. The Upanayan programme is a product of Indchem Research and Development Laboratory, a scientific association recognized by Government of India, Ministry of Science and Technology. The objective of the project was to develop a computer assisted programme for the training of persons with mental retardation. The project was executed by an inter disciplinary team of experts. The focus of the training programme is the mother who is the intervening agent. The programme, developed in the first phase of the project, is an expert system for the infant stimulation and early intervention process for children below 2 years of age with the disability. The system comprises of: (i) a development check list of skills for assessment and programming, (ii) a profile to record the observations, (iii) intervention strategies in the form of activities to acquire all the skills in the check list. The programme is designed for the Indian socio-economic conditions and is available in the form of a printed manual, and also as a computer software. The two can be used independently of each other. The programme has been translated into Hindi, Tamil, Malayalam and Marathi. With this programme as the basis, a centre for early intervention, Madhuram Narayanan Centre for Exceptional Children--was set up in Madras about 3 years back. Presently 210 children are receiving training there. The Centre has evolved intervention strategies based on parental involvement, with salutary effect on the parents as well as on the children.


Neurosurgical intervention during resistant phase of motor development of cerebral palsied. Positive neurological phenomena of cerebral palsied, especially spasticity are best relieved by neurosurgical procedures. But the procedures are indicated only in those cases who have developed resistance to nonsurgical therapies, especially rehabilitative therapy. However, surgical procedure cannot teach a child how to perform motor functions. Therefore, rehabilitative therapy plays immense role in development of motor functions which can be improved best during the physical developmental and learning ability age of the child. Therefore, it is recommended to start neurodevelopmental therapy at a few weeks age of the child, and perform the neurosurgical procedure as soon as the child develops resistance to the therapy. The child has to resume back to therapy following the surgery for further motor development. There are various neurosurgical procedures for the relief of positive neurological phenomena. The present article includes brief description of the procedures and review of the literature. The authors feel that the selective posterior rhizotomy is perhaps the best procedure among all other ablative procedures for the relief of diffuse spasticity of both the lower limbs in strictly selected cases.


Bacterial meningitis in Saudi children.

Bacterial meningitis in Saudi children. During the four years period from 1988 to 1991, 50 pediatric patients were diagnosed to have bacterial meningitis, out of a total number of 9057 pediatric admissions at Qatif Central Hospital, Qatif, Saudi Arabia, and 82% were less than two years of age. The causative organisms were isolated in 27 (54%) patients. The bacteria grown included Haemophilus influenzae type B in 8 patients (29.6%), Neisseria meningitidis in 8 patients (29.6%), Streptococcus pneumonia in 6 (22%) patients, and other bacteria in 5 patients (18.5%). Cerebro spinal fluid cultures from twenty three patients (46%) showed no organisms, however their clinical and C.S.F. findings were compatible with bacterial meningitis. One case of H. influenzae type B was resistant to ampicillin. Six patients died with an over all mortality of 12%, and 10 patients (20%) developed some kind of C.N.S. sequelae. Partially treated meningitis formed a large percentage of our sample.


Cerebral palsy--an etiological study.

Cerebral palsy--an etiological study. Five hundred and forty four cases of cerebral palsy were studied to find the etiology. Male to female ratio was 1.9:1. Prenatal, natal and postnatal factors were found in 42 (7.72%), 238 (43.75%) and 142 (26.1%) cases respectively. Only 79 (14.52%) cases were found to have more than one factor which could have contributed to brain damage. In 43 (7.9%) cases the prenatal, natal and postnatal history were normal and the cause was not known. Toxemia (1.29%) cases and microcephaly (1.84%) cases were the most common etiological factors in the prenatal category. Among the natal causes, birth anoxia was the most common etiological factor and was observed in 24.45% cases. Infections of the central nervous system comprised the major etiopathogenetic factors of the postnatal causes--11.95% cases had encephalitis, while 5.15% cases had meningitis. In cases where more than one etiology was present, the most frequent causes were a combination of prematurity or birth anoxia in association with toxemia, antepartum hemorrhage, prolonged labour, twins, forceps or caesarean delivery. Anoxia was consistently the most common etiological factor in those cases of monoplegia paraplegia, quadriplegia, diplegia, and ataxia, i.e. in 0.55%, 1.29%, 11.76%, 6.07% and 0.55% cases respectively. The present study reveals that majority of the cases were found to have natal or post natal etiology.


A study of phenobarbital and dilantin in neonatal seizures. A total of 40 cases of neonatal convulsions of different nonmetabolic aetiological factors were studied. Patients with kernicterus were included in the study. Peak plasma phenobarbital concentrations after incremental loading doses of phenobarbital i.e. 10 mg/kg, 15 mg/kg, and 20 mg/kg were determined. Diphenylhydantoin was added if phenobarbital alone was unable to control seizures. In three patients, a combination of phenobarbital and diphenylhydantoin was used as the initial loading therapy. Increase in the loading dose of phenobarbital was associated with an increase in its peak plasma concentration. Despite increase in the plasma phenobarbital concentration beyond the 'therapeutic' levels suggested by the Western studies, doses of 15 mg/kg and 20 mg/kg of phenobarbital were unable to score over the traditional regimen of 10 mg/kg. Convulsions were controlled in 50% of the patients with any of these three regimens, irrespective of the aetiology. Convulsions were controlled in 7 out of the 9 cases where diphenylhydantoin was added, because of the failure of phenobarbital in controlling the convulsions as a single drug. Convulsions of all the three patients, in whom a combination of phenobarbital and diphenylhydantoin was used by random selection as the initial bolus, were controlled. Seizure effects were difficult to distinguish from drug effects but major side effects were not encountered despite the fluctuating drug levels in the sick neonate.


Persistent pulmonary arterial hypertension of the newborn. Persistent pulmonary hypertension of the newborn (PPHN) characterised by right to left shunting with intense cyanosis is difficult to manage, and in the best of centres carries a 40-60 percent mortality. We report our one year's experience of managing six neonates with PPHN. There were 5 males and 1 female with mean birth weight of 2.59 +/- 0.487 kg and gestation period 39 +/- 2.0 wks and 1 minute Apgar score 2.8 +/- 2.1. Four to six babies were born by cesarean section and 3-6 babies had aspiration pneumonia. All babies presented within 12 hours of age (mean 5.08 +/- 5 hrs) with intense cyanosis and respiratory distress. Diagnosis were confirmed in all by (a) hyperoxia test, (b) simultaneous determination of preductal and postductal paO2 (c) contrast echocardiography and (d) hyperoxia-hyperventilation test. Babies were managed with hyperventilation using mean ventilatory rates of 100 +/- 45 per minute, an inspired oxygen concentration of 100%, peak inspiratory pressures 27 +/- 9 cm of H2O, and expiratory pressures 5 +/- 1.6 cms of H2O, and mean air way pressures of 10.4 +/- 2.7 cms H2O. Alkali therapy was used in 3 of the six babies whereas low dose dopamine was infused in all six babies. Inspite of aggressive ventilatory therapy, only 3 out of 6 babies could be salvaged.


Risk factors for recurrence of febrile convulsions. A cohort of hundred children with febrile convulsions, in the age group of 3 months to 5 years were followed up prospectively for one year to study the natural course of the illness, and to determine if specific factors would increase the risk of recurrence of febrile convulsions. The risk factors studied were age of onset under one year, long duration of convulsion (more than 15 minutes), family history of febrile convulsion or epilepsy and combination of two or all of the above factors. Four groups of children with different risk factors were followed up for recurrence of convulsion, after the first attack. A group of children without any risk factor was considered as control and they were also followed up for recurrence of convulsions. Though all the groups with the risk factors, showed a trend towards a higher recurrence rate when compared to controls, the difference observed clinically was not significant statistically. This could be due to the small sample size of each group. A larger study could throw light on the predictive value of these risk factors and narrow down the use of long term anticonvulsant prophylaxis.


Benzathine penicillin G for rheumatic fever prophylaxis: 2-weekly versus 4-weekly regimens. Rheumatic fever is still one of the major public health problems in Egypt and the developing countries. It is characterized by a high tendency to recur following streptococcal infections. The use of long acting penicillin for prophylaxis against strep infections was a good achievement in this field, yet, recurrences have been reported in patients following monthly prophylactic programs. Clinical experience in Alexandria have shown for a long time that giving penicillin every 2 weeks is followed by less recurrences of rheumatic fever. Recently, reports came showing that effective penicillin levels are not maintained except for 2 to 3 weeks after the injection. In the present study, we compared two regimens of prophylaxis with 190 patients in the 2-weekly regimen, and 170 patients in the 4-weekly regimen being followed up for 2 consecutive years. Two hundred and sixty nine streptococcal infections occurred during this period. Although the streptococcal infection rate was equal in both groups, the rheumatic fever recurrence rate and the RF attack rate were significantly higher in the group of patients on the 4-weekly schedule. The results of this study have shown the superiority of the 2-weekly schedule in the adequate control of RF recurrences. We suggest that this schedule should be implemented for secondary prophylaxis of rheumatic fever in Egypt and other areas with severe RF.


Synthesis of genetics into community-based nursing practice. Scientific knowledge in the field of clinical genetics is increasing rapidly. To address the need for genetic information at the community level, the Michigan Department of Public Health coordinates a statewide program that provides genetic and newborn screening services. Services including genetic diagnosis, counseling, and outreach education are provided in five geographic regions by major genetic centers. Nurses in a variety of primary pediatric care settings also work with families affected by genetic disorders and birth defects; they serve as an important part of the team providing comprehensive genetic health care to children and their parents. For those families, the nurse must utilize a knowledge of genetics to provide appropriate family-centered assessment.


[Tuberculosis in patients with lymphomas]. In a period of ten years (1980-1989) 6 patients, out of 506 cases of lymphoma, presented an active tuberculosis (1.18%). Five of them had Hodgkin disease in an advanced stage, with predominance of the nodular sclerosis histologic subtype; one had a non Hodgkin lymphoma. Clinical presentation of TBC was mostly focal with a predominance of extra pulmonary involvement (cervical tuberculous lymphadenitis); disseminated disease only appeared in the non Hodgkin lymphoma patient. There was no difference in the severity of the infection when it appeared either before or after multiagent therapy of the hematologic malignancy. There was clinical suspicion of TBC in all of the pulmonary forms of the disease; lymph node tuberculosis, without drainage of caseous material, was a finding related to the routine culture of lymphatic tissue. In biopsy material, in which Mycobacterium tuberculosis was isolated, neither epithelioid cell granulomas with caseation necrosis nor acid-fast bacilli were histopathologically documented. No mortality due to tuberculous infection was registered in this group. TBC prevalence in these lymphoma patients was 1185.7 per 100,000; compared with the prevalence of this disease in the general population (52.3 per 100,000) a significant difference is demonstrated (p < 0.0001) and it is related to Hodgkin lymphoma.


Parent gender, victim gender, and family socioeconomic level influences on the potential reporting by nurses of physical child abuse. In 1974, the Federal Child Abuse Prevention and Treatment Act required reporting of child abuse in all states. Although nurses have since this time been designated as mandated reporters of abuse, only recently have nurses begun to hold positions where they are directly responsible for abuse reporting. This study investigated whether the gender of the victim, the gender of the abusing parent, or the family's socioeconomic level influences the potential reporting of child abuse by nurses. Participants were shown three vignettes of children being admitted to an emergency room with symptoms of possible abuse. When asked if they would or would not report the incident as child abuse, participants indicated they were significantly less apt to report abuse when the victim was female rather than male, and when the family was perceived as being from a middle rather than a low or high socioeconomic background. The implication of this finding is that female children from middle-class backgrounds may be left less protected than others as nurses become more actively involved in child abuse reporting.


A clinical assessment strategy for maternal acquaintance-attachment behaviors. The Acquaintance-Attachment Assessment Strategy for Maternal Behaviors (AASMB) is a strategy for assessing maternal attachment in the clinical area. The strategy is based on an eclectic conceptual framework and reflects the progressional nature of the attachment process. A review of the literature summarizes the phases of the attachment process--acquaintance, attachment, and bonding--and the maternal behaviors associated with each phase. The acquaintance and attachment phases are found during the first year of the infant's life and are of interest to the nurse who is assessing the maternal-infant relationship. These phases form the basis for constructing the Opportunity and Proximity-Seeking subscales of the AASMB. The AASMB can be easily utilized by nurses in clinical settings to assess mother-infant dyads for which early maternal-infant separation during the first year is common, such as occurs with premature or ill infants.


[Cyclosporin interactions in kidney transplants]. Treatment with Cyclosporine has resulted in improved allograft survival. Cyclosporine metabolism occurs in the liver via hepatic cytochrome P-450IIIA microsomal enzyme. Pharmacokinetic drug interactions usually involve drugs which induce or inhibit the cytochrome P-450 system. We reviewed the Medical Charts of 53 renal transplant recipients immunosuppressed with Cyclosporine between 1985 and 1991. We analysed the relationship between Cyclosporine concentration, its dose and the change induced by concomitant administration of different drugs. Until December 1988, Cyclosporine was measured by solid-phase radioimmunoassay (RIA) using a polyclonal antibody. This method measures Cyclosporine and some of its metabolites. Since January 1989, Cyclosporine was measured in whole blood by radioimmunoassay (RIA-Kit Sandimmun, Sandoz), which used a specific monoclonal antibody which binds Cyclosporine and a non-specific monoclonal antibody which binds Cyclosporine and its metabolites. The therapeutic range recommended by Sandoz in whole blood using the specific monoclonal antibody is 100 to 400 ng/ml. We present 3 cases of probable pharmacokinetic drug interactions with Cyclosporine. The first patient received concomitantly isoniazide (150 mg/day). Cyclosporine levels were between 600 and 2085 ng/ml despite the dose reduction from 10 to 1.5 mg/kg/day (Fig. 1). The dose reduction of isoniazide to 100 mg/day resulted in reduction of Cyclosporine levels. Until December 1988 with the polyclonal antibody the median was 320 ng/ml (range: 185 to 760 ng/ml; n = 11).(ABSTRACT TRUNCATED AT 250 WORDS)


[An evaluation of transesophageal atrial pacing for studying the use-dependence effect of anti-arrhythmia drugs]. Use-dependent effect is characteristic of certain antiarrhythmic drugs, mainly those included in Group I of Vaughan-Williams classification. There is an increasing interest in the study of this phenomenon in order to correlate it with the potential arrhythmogenic effect of currently used antiarrhythmic drugs. Use-dependent effect produces widening of the QRS ECG complex as the heart rate is increased. Thus, to produce the necessary changes in heart rate to clinically disclose this phenomenon, endocardial stimulation of the right ventricle is usually done both in control condition and under the effect of the tested drug. As this is an invasive method, the amount of information collected on this important aspect of the antiarrhythmic drug effects has been limited. Hence, we decided to confirm whether transesophageal cardiac pacing is a suitable method to produce controlled changes of the heart rate in order to analyse the use-dependent phenomenon. In this study we included 14 patients, 9 women and 5 men aged 47.85 +/- 13.91 years and ejection fraction of 54.64 +/- 7.19%. Transesophageal stimulation was performed up to the Wenckebach point and the previous rate producing 1:1 A-V response was considered. ECG was recorded in an ink-jet three-channel electrocardiograph at 100 mm/sec chart speed and QRS duration was measured. All patients were studied in the basal unsedated state, free of any medication and after the administration of 3.13 +/- 0.74 mg/kg of flecainide during 4.07 +/- 1.4 days. Atrial capture was obtained with pulses of 15 mA and 18 msec. Heart rate attained before treatment was 150 +/- 21.83 bpm and 144.28 +/- 19.88 bpm under the effect of flecainide (p = NS) (Table 1).(ABSTRACT TRUNCATED AT 250 WORDS)


Early abnormalities of left ventricular function in essential hypertension induced by exercise. In order to assess their ventricular function at rest and during exercise, 42 essential hypertensives (164 +/- 2/98.7 +/- 2 mmHg) and 12 normotensives (131.7 +/- 4/81.2 +/- 1 mmHg) were studied. Ejection fraction (EF), peak filling rate (PFR) and peak ejection rate (PER) were measured by means of gated radionuclide ventriculography. At rest, no differences in EF, PFR and PER between hypertensives and normotensives were found. During exercise, hypertensives showed lower PFR (5.3 +/- 0.2 EDV/s) and EF (67.7 +/- 1%) than normotensives (PFR 7 +/- 0.5 EDV/s, p < 0.005 and EF 79.4 +/- 2%, p < 0.001). Likewise, hypertensive showed a lower increase from rest to exercise in PFR and in EF than normotensives p < 0.001. In addition, hypertensives showed a great individual variability in EF response to exercise, where 23 patients increased EF more than 5% and 19 patients failed to increase it during stress. Moreover, the last group of patients had higher systolic blood pressure (SBP) both at rest and during exercise than patients who increased EF, p < 0.01. In addition, there was a significantly negative correlation between resting SBP and the variation of Ef (r = 0.47 y: 163.1-0.79X, p < 0.01). Left ventricular mass (LVM) was similar in the two groups of hypertensives. On the other hand, there were no differences in any of the variables analyzed between the hypertensives with LV hypertrophy and those with normal LVM. These findings suggest that abnormalities in both systolic and diastolic LV during exercise may be found in hypertensive patients even before myocardial hypertrophy can be detected.


Reduction of risk factors for osteoporosis among adolescents and young adults. Osteoporosis is the most common of all skeletal disorders. The most commonly accepted definition of osteoporosis is a decrease in the amount of calcified bone tissue to the point that fractures occur with minimal trauma. Researchers have shown that peak bone mass at skeletal maturity may be the single most important factor in the development of osteoporosis. At present, no satisfactory way to replace lost bone exists, and the ideal treatment for osteoporosis is prevention, which must begin early in life. The most promising approach in the primary prevention of osteoporosis is to help each person achieve as high a peak skeletal mass and bone density as genetically possible prior to skeletal maturity. Furthermore, identifying those adolescents and young adults at risk is of clinical value for prediction and counseling purposes. Recommendations for achieving the maximal bone mass prior to skeletal maturity, as well as methods of assessing and minimizing the risk factors for osteoporosis, will be discussed.


[The prevalence of risk factors for coronary arteriosclerosis in the urban areas of the Argentine Patagonia. A multicenter study]. It is important to know the prevalence of risk factors for coronary atherosclerosis in the urban south area of Argentina in order to implement the prevention of this disease. In 330 males and 322 females of Viedma and Cipolletti (Province of Rio Negro), and Comodoro Rivadavia (Province of Chubut), we determined total cholesterol (CT), triglycerides (TG), HDL cholesterol (CHDL), LDL cholesterol (CLDL), uric acid (AcU), systolic pressure (PS), diastolic pressure (PD), cigarette smokers (Cig), and body mass index (BMI). Laboratories were coordinated as to methodology and quality control. Between 30 and 50 years of age, the prevalence of risk factors was greater in males than females; 27.3% of males vs 16.0 of females had CT > or = 240 mg/dl (p < 0.05), 30.5% vs 19.7%, had CLDL > or = 160 mg/dl (p < 0.05), 10.3% vs 5.9%, had CHDL < 35 mg/dl, 8.9% vs 4.2% had PS > 145 mmHg, 9.0% vs 5.9%, had PD > 90 mm Hg, 33.6% vs 23.4%, had Cig > or = 10/d (p < 0.05), 26.0% vs 13.8% had TG > 170 mg/dl (p < 0.05), 30.5% vs 22.4%, had BMI > 27 Kg/m2 (p < 0.05) (Figs. 2-3). This difference between sexes was not significant over 50 years of age, when the prevalence of factors increased in both sexes. In Figure 4, 41.5% of males and 34.5% of females had one primary risk factor, 13.0% of males and 9.9% of females had two factors and 1.5% of males had three. The following main combinations of two primary risk factors was observed: between 30 and 50 years of age, 10.3% of males and 3.7% of females had CLDL > or = 160 mg/dl and Cig > or = 10/d (p < 0.01); over 50 years, 19.5% of females and 11.8% of males had CLDL > or = 160 mg/dl and PS > 145 mm Hg (NS). We suggest that operatives of education for the prevention of high cholesterol, no smoking and control of high blood pressure, are needed specially in young men.


Nurses, children, and play.

Nurses, children, and play. A child's play is recognized as a useful tool for nurses in the diagnostic process of making judgments about a hospitalized child's compliance with medical procedures, adjustment to the hospital environment, degree of pain, and level of psychosocial functioning. However, the knowledge base that is required to effectively help a pediatric patient "play" in a therapeutic mode appears to be extremely limited for most nurses and is rarely addressed in a substantive manner in nursing education. Educational programs must be willing to incorporate a "developmentally appropriate, culturally sensitive, and family-centered approach" using clinical experiences and professional role models in their nursing curricula. The end product should be nurses who are competent in a much wider range of medical technological and psychosocial issues than has been necessary in the past. In short, nurses must learn to play.


[The immunohistochemical determination of hormonal receptors in breast cancer. A retrospective study in 322 cases]. A study of 322 patients with infiltrating ductal carcinoma of the breast, followed from 6 to 20 years, is presented. Pathological characteristics including immunohistochemical determinations of estrogen and progesterone receptors are shown, as well as interrelations of the different factors between themselves and with the follow up. Results showed significant relations between positive estrogen receptors and low nuclear grade (p < 0.001), histological low grade (p = 0.06) and positive progesterone receptors (p = 0.001). In addition, progesterone receptors were associated with stage I (p = 0.02); tumors with less than 2 cm in diameter (p = 0.01); low nuclear grade (p < 0.001) and positive estrogen receptors (p < 0.001). The univariate Cox regression analysis of prognostic factors revealed an association between positive lymph nodes and high nuclear grade with a more frequent tumoral recurrence. On the other hand, overall survival was significantly affected by cases in stage II, positive lymph nodes, tumors with diameter greater than 2 cm, and high nuclear grade. Stepwise Cox regression analysis showed that a high nuclear grade, positive lymph nodes and absence of estrogen receptor, were associated with a higher risk for recurrence and that tumor size and the state of lymph nodes were predictive for overall survival. This paper demonstrates that histochemical determination of hormonal receptors is useful because together with other known prognostic factors it contributes to a better management of patients with breast carcinoma.


[S hemoglobinopathies in Argentina].

[S hemoglobinopathies in Argentina]. Hb S is among the most prevalent abnormal hemoglobins, its distribution being related to areas where malaria is or was once endemic. In order to establish the characteristics of sickle cell hemoglobinopathies in Argentina, all cases diagnosed in a 30-year period in the Hematology Unit of R. Gutiérrez Children's Hospital were revised. Hb S diagnoses were based minimally on a positive sickling test; in most cases, RBC and reticulocyte counts, Hb concentration, and PCV were also performed, and red cell indices were obtained according to standardized procedures. Concentrations of Hb A2 and Hb S were calculated by elution of cellulose acetate strips following electrophoresis, and Hb F was measured by alkali denaturation. Of the 925 hemoglobinopathies diagnosed, Hb S was found in 116 (12.5%): sickle-cell trait (AS) in 75, sickle-cell disease (SCD) in 8, S/beta-thalassemia (s/beta-thal) in 23, SCD or S/beta-thal in 8, S/D in 1; beta-thalassemia syndromes accounted for 785 cases (84.9%). Major findings in AS were: (a) all cases came from northern and central areas of the country, neighboring countries, and other countries (Italy and Arabic nations); (b) black ancestry was found in 15 out of 75 (20%); (c) mean hematological values were normal (Table 3), and mean Hb S level was 37.1%; (d) of 57 AS patients whose blood smears were examined, 18 showed red cell abnormalities (microcytosis and/or hypochromia); (e) AS cases with altered erythrocyte morphology had significantly lower Hb, PCV, MCH, and MCV levels when compared with those with normal morphology (Tables 5, 6).(ABSTRACT TRUNCATED AT 250 WORDS)


[The prevalence of anti-hepatitis virus C antibodies in chronic hemodialysis patients]. Liver involvement with a variety of viral diseases is a frequent finding in chronic renal failure patients on regular hemodialysis treatment. We evaluated the prevalence of IgG anti-hepatitis C virus antibodies (HVC) in our dialysis unit, looking for risk factors associated with seropositivity and we assessed the type and degree of liver involvement by means of a liver biopsy in those patients with biochemical abnormalities of liver function test. We studied 50 patients aged 13 to 77 years, and performed serial determinations of serum ALT (UI/L). IgG anti HVC was determined by a second generation ELISA Kit (Abbot). We retrieved information from chart review and patient interview, regarding: time on hemodialysis, number of blood transfusions and intravenous IV drug use off dialysis. Liver biopsy specimens were stained with H.E. and Masson and findings were classified as chronic persistent, chronic active hepatitis or cirrhosis, according to Schewer. We compared the findings with those of other patients with liver dysfunction and positive IgG anti HVC who did not have renal failure. Anti-HVC prevalence in our hemodialysis patients was 44%. Anti-HVC seropositive hemodialysed (HD) patients were not different from seronegative HD patients, with regard to age, sex, i.v. drugs usage and peak ALT values. Twelve of 22 HVC positive patients had peak ALT values higher than 40 UI/L (Table 2). Time in HD (75.5 +/- 42.8 m) and number of blood transfusions received (35.3 +/- 28) were clearly different in HVC positive patients, compared to HVC negatives. Histologically, 11 seropositive patients showed chronic persistent hepatitis as the most frequent finding.(ABSTRACT TRUNCATED AT 250 WORDS)


[The correction of anemia with a high requirement for transfusion in patients on maintenance hemodialysis by conventional and reduced doses of recombinant human erythropoietin]. The hematologic findings of chronic renal failure are consistent with hypoproliferative anemia; the pathogenesis of the anemia is primarily due to decreased erythropoietin production by the diseased kidneys. There are aggravating factors (AF) contributing to this primordial cause: inhibitors to erythroid marrow function, shortened red cell survival, nonevident chronic blood loss (owing to uremic platelet dysfunction), iron and/or folate deficiency, aluminium toxicity, hemolysis (acute or chronic), etc. Ten patients with end stage renal disease, treated with maintenance hemodialysis and high transfusional requirement (more than 300 ml/month) are presented; in five the AF were discarded by a previously presented protocol (Table 1) and they were treated with human recombinant erythropoietin (r-HuEPO) intravenously, in conventional schemes (three times a week) and doses (195 +/- 41 Units/Kg)-Group A-. The AF were not studied in the other five and the r-HuEPO treatment employed different doses (125 +/- 70 U/K/W) and protocols (1.7 +/- 0.5 times a week)-Group B-(Table 2). The transfusional requirement disappeared and the hematocrit and the hemoglobin rose significantly in both groups (more in group A) (Table 3). The significant drop in ferritin levels (147 +/- 30 ng/ml vs 27.5 +/- 11 ng/ml at the 12th week) and the stabilization in reticulocyte count (1.4% at start vs 2% at 12th week) indicate iron consumption; in the meantime, the persistent increment in reticulocyte production index (1 at start vs 3 at 12th week) revealed a continuous stimulation of the erythropoiesis (Fig. 1). No clinical and/or vascular complications were observed; arterial pressure and serum potassium levels did not rise significantly so that r-HuEPO treatment was not canceled in any case.(ABSTRACT TRUNCATED AT 250 WORDS)


[Intensified insulin therapy in the management of gestational diabetes]. A total of 35 pregnancies in 28 Pregestational Diabetic Patients (PDP) were followed with the goal of achieving and maintaining near normoglycemia (as many pre-postprandial glycemias as possible between 60-140 mg/dl); 13 patients (16 pregnancies) were assigned to Subcutaneous Continuous Preprogrammed Insulin Infusion (SCII) because of high risk pregnancies (HRP) (at least one of the following: former history of spontaneous abortions, stillbirths, premature deliveries and/or sterility). The remaining 12 PDP's (15 pregnancies with no past history of the above nature) were treated with Multiple Conventional Insulin Injections (MCII). Both groups were comparable regarding the following clinical parameters: age, time of onset and class of diabetes. All patients were instructed in performing 3 to 7 daily Self Capillary Blood Glucose controls (SCBG). Mean follow-up observation period was (mean +/- SEM) 28.5 +/- 2.5 weeks for SCII and 3.2 MCII and 28.8 +/- 3.2 weeks for MCII. All the 3 PDP drop out's (4 pregnancies) belonged to the CMII group. No drop out's were recorded in the SCII group. Both insulin therapy approaches were similarly effective in improving metabolic control in that comparable levels of mean blood glucose (MBG) and HbA1 were attained by SCII and MCII (Fig. 1). Compliance, as evidenced by average of daily SCBG was also similar in both groups (Fig. 2). Such satisfactory metabolic control was achieved mostly because of an increase in the percentage (65%) of "fair" glycemias (60-139 mg/dl) and not because of an increase in hypoglycemias (< 60 mg/dl) which could have canceled out an undesirable degree of hyperglycemias thus rendering "false satisfactory" MBG's and HbA1 (Fig. 1). With the above degree of metabolic control obtained there occurred no severe hypoglycemic episodes requiring medical intervention. All newborns to the PDP's who remained under treatment showed an adequate APGAR (X +/- SEM, 9.5 +/- 0.2) regardless of the modality (SCII or MCII) of insulin delivery used (Tables 1, 2). The single malformed baby found in this series was born to a patient on SCII who happened to start on the intensified insulin treatment rather late in her pregnancy (21st week) and, in addition, the patient self medicated with high doses of chlorpromazine because of recurrent vomiting episodes. Incidence of neonatal hypoglycemia (HY) or macrosomy (MS) was comparable in both groups (Tables 1, 2). It is to be pointed out, however, that PDP's who bore the babies with no HY or MS had presented a larger number of low glycemic values than mothers who bore the babies with HY and/or MS.(ABSTRACT TRUNCATED AT 400 WORDS)


[The endovascular treatment of hemoptysis]. We studied 18 patients, 9 women and 9 men, ranging in age from 18 to 76 years. The main symptom was hemoptysis and the underlying pathology was tuberculosis, actinomycosis, lung cancer, metastatic carcinoma and systemic lupus. Nonsurgical patients, with recurrent hemoptysis or massive bleeding were selected. The embolization substances were spongostan, avitene (R) and PVA; they all produce temporary as well as persistent hemostasis. The procedure was successful in 16 patients. In two patients the embolization was not performed, one for technical reasons and the other because the vessel to be treated was the source of an anterior spinal artery. It is considered that the endovascular treatment constitutes an alternative for hemoptysis, even during the acute period, mainly in the management of nonsurgical patients.


Modifications of antitumor defenses by tumor derived factors and by superantigens. There is ample evidence that tumor development can be affected by the interactions between the growing neoplasms and the immune system. The balance of these interactions is tilted in favor of tumor growth in many cases due to the production of cytokines and other factors by the tumor cells. These factors can modulate the immune system either by direct interactions with immune cells or by indirect means, which include downregulation of the synthesis of other cytokines or products necessary for the activity of a given effector cell. In addition, endogenous retroviral superantigens, with their capacity of eliminating part of the T cell repertoire and possibly by other effects on cells of the T and B cell lineages, may provide the tumor cells an escape from the otherwise efficient antitumor host defenses.


[The selection of resident physicians. The evaluation of their cardiology knowledge and of their pregraduate experience]. The purpose of this work was to assess the level of cardiological knowledge in a population of recently graduated physicians and to compare the examination results with pregraduation experiences. The results of the residency entrance examinations of 230 physicians from different universities were analyzed (Table 1). The examination consisted of 70 questions (69 by multiple choice and 1 of professional competence). The cardiovascular area was explored through 28 questions including basic and clinical subjects (Fig. 1). A qualitative and quantitative analysis of the examination was made based on difficulty and discrimination levels (Annex 1-2). A danger level was established when the answer involved a potential risk of death for the patient. Thirty percent of applicants passed the exam (60% of correct answers). Informative questions were easier than those of application and interpretation. A greater difficulty was evidenced with respect to questions in the clinical area (Fig. 3). A higher performance was noted in men, graduates from the University of Buenos Aires and those applicants with assistance and teaching experience. A remarkable positive correlation between average marks during the students career and the level of marks obtained in this exam (Fig. 2) was noted. Twenty-six percent of the physicians who failed gave potentially dangerous answers (Fig. 4). The examination results give us the opportunity to obtain information regarding features of university education.


[The pharmacokinetic study of a daily dose of theophylline]. Theophylline pharmacokinetics, administered in tablets containing 600 mg in a sustained-release hydrophilic matrix for a once daily intake, was evaluated after being administered to 6 healthy volunteers during 7 days at 8 pm. Plasmatic levels at -2, 0, 2, 3, 4, 6, 8, 10, 12, 14, 18 and 24 hours in relation with 8 pm intake, were obtained at the 7th day of administration. A plasmatic curve was obtained with a maximum concentration at 12 hours of 10.18 mcg/ml, a minimum concentration of 3.27 mcg/ml and an area under the concentration/time curve of 198.4 mcg.h/ml. These data make it evident that the tablet studied shows a release profile without excessive peaks and an average concentration at steady state within therapeutical range, and suggests its use in asthma.


[Acute paraplegia and intramedullary cavitation in a patient with pulmonary tuberculosis]. This 42-year-old male patient voluntarily discontinued treatment for lung TBC and twenty days later developed acute paraplegia. Magnetic resonance imaging (MRI) demonstrated a large intramedullary cavity extending from T2 to the conus medullaris. Having resumed anti-TBC treatment, the patient progressed favourably, despite any change in cavity size. Tuberculous meningitis may be complicated by the appearance of intramedullary cavities by two distinct mechanisms: 1) adhesive arachnoiditis at the skull base with obstruction of Luschka and Magendie foramina, followed by hydrocephalus and hydromyelia; and 2) spinal cord arachnoiditis with the development of arachnoidal and intramedullary cysts. In either case, symptoms are of late presentation. To the best of our knowledge, this is the first report in the literature of lung tuberculosis associated with syringomyelia but without basal arachnoiditis. Acute clinical presentation with paraplegia is exceptional.


Role of electromyography in the diagnosis of motor neuron disorders. Programming of electromyographic examination in motor neuron diseases is discussed taking into account application of appropriate techniques. The difficulties of correct interpretation of results are stressed. The stages of disintegration and reintegration of affected motor units are described as well as compensatory changes of surviving motor units. A detailed description of EMG dynamics of amyotrophic lateral sclerosis, late post-polio syndrome and of childhood spinal muscular atrophy is given.


Inclusion body myositis (IBM). Morphological study. Among the chronic idiopathic inflammatory myopathies inclusion body myositis (IBM) has emerged as a clinicopathologic variant. Slowly progressive weakness of the distal and the proximal muscle groups, the presence of rimmed vacuoles with basophilic granules as well as 15-18-nm filamentous inclusions in affected muscle confirm the clinical and histopathological distinction between inclusion body myositis and chronic polymyositis.


Asymmetric damage of the CA1 sector of Ammon's horn after short-term forebrain ischemia in Mongolian gerbils. The studies were carried out on 98 three-month-old Mongolian gerbils, submitted to short-term (5 or 7.5 min) forebrain ischemia induced by bilateral ligation of common carotid artery. After 5-day survival animals were sacrificed by transcardiac perfusion with 10% formaldehyde. Paraffin brain sections were stained with cresyl violet and according to Klüver-Barrera method. Pickworth benzidine method was also applied to evaluate hippocampal vascular network. Varying susceptibility of individual animals to the ischemic incident was found. This was expressed by differences in the intensity and extent of structural lesions of CA1 pyramidal neurons. No abnormalities were found in 41.7% of animals, total neuronal loss in the CA1 sector was observed in 33.3% of cases, while the partial neuronal loss appeared in the remaining 25% of animals. Asymmetric distribution of the neuronal changes observed in 18.4% of cases was a very striking feature. Differences of the angioarchitectonics of CA1 sector as compared with neighbouring parts of Ammon's horn were found. In the pyramidal cell layer very scarce fragments of the blood vessels were present. In adjacent cortical layers (stratum oriens and stratum radiatum) relatively dense capillary network was characterized by appearance of specific vascular loops and tangles localized on the border of stratum pyramidale. It is supposed that particular spatial arrangement of the vascular network in pyramidal layer of CA1 sector, favouring appearance of local hemodynamic and rheologic abnormalities after temporary brain ischemia, may play an essential pathogenic role in both, selective vulnerability of this neuronal population and individual variations in the intensity and distribution of the neuronal changes.


Immunoreactivity of astroglia in the hippocampus of the Mongolian gerbil during short survival following brief ischemia. Mongolian gerbils subjected to 5-min cerebral ischemia by common carotid artery ligation were decapitated after 24, 48, 72 and 96 h of survival to investigate the immunoreactivity of astroglia in the hippocampus. The sections from formalin-fixed, paraffin-embedded brains were stained histologically and with ABC method (Hsu et al. 1981). Control animals (normal and shame-operated) presented positive GFAP immunostaining in corpus callosum, in subventricular regions, in temporal subcortical white matter, in fimbria hipocampi and perivascularly in stratum lacunosum-moleculare. Experimental animals, independently of postischemic survival time showed various individual GFAP reactivity. Differences concerning the number and localization of immunoreactive astrocytes in both cerebral hemispheres of the same animal stressed the asymmetry of the reaction. The authors did not observe any accumulation of reactive astrocytes in the area of synaptic terminals of glutaminergic fibers (mossy fibers, Schaffer's collaterals) or in the neighbourhood of CA1 and CA3 sectors. In particular, there was complete lack or only sporadic reactive astrocytes among pyramidal neurons of CA1 and among granular cells of dentate gyrus in all examined animals.


Hippocampal damage in vitro after different periods of oxygen deprivation. The dynamics and pattern of postanoxic ultrastructural changes in organotypic culture of rat hippocampus was studied. The experiments were performed on 14-day-old cultures of rat hippocampus exposed to pure nitrogen atmosphere for 10- and 20-minutes and processed for electron microscope 2 and 24 h, 3 and 7 days post anoxia. The earliest changes following 10-min anoxia consisted of marked swelling of mitochondria and Golgi complex of neurons. The presynaptic terminals were preferentially affected. The protoplasmic astrocytes revealed swelling of the cytoplasm whereas the fibrous ones were relatively well preserved. Longer, 20-min anoxia resulted in profound ultrastructural changes even after short survival time. The tissue culture model of anoxia allow to study the direct effect of oxygen deprivation on cell morphology independently of any vascular and/or vasogenic factors.


Astrogliosis in the temporal lobe of newborn infants who died in the perinatal period. The normal distribution of astrocytes in the temporal lobe of the newborn and that occurring as consequence of perinatal pathology was compared. The astrocytes were revealed by immunohistochemical visualization of glial fibrillary acidic protein (GFAP). The intensity of positive reaction correlates well with the maturation of various white structures. In the group with hypoxic encephalopathy the GFAP-positive reaction was clearly related to the observed neuropathological changes. Intensive reaction in the area of U-fibers confirmed the susceptibility of this region to hypoxic damage. The presence of GFAP-positive cells within Ammon's horn indicates that the degree of reaction depends on the intensity and duration of the lesions.


The breakdown process of human brain infarction in middle-aged and senile cases. The material comprised 15 cases of ischemic brain stroke at the age of 45 to 101 years. Six brain of subjects deceased at the age of 45 to 57 years and 9 brains of those deceased at the age of 80 to 101 years were studied. Phagocytic cell immunoreactivity in both age groups during the first 5 days and on the 11th and 12th were compared. Phagocytic reactivity in cases of patients who died on the 6th, 15th and 35th days after stroke onset was also estimated. Colliquative necrosis with cavitation was observed in middle-aged cases from the 3rd infarction day. In the senile group the beginning of tissue breakdown was noted on the 5th day, but colliquative necrosis with cavitation was found on the 11th infarction day. Senile alterations in the biochemical components in various brain tissue elements are probably the cause of the different course and dynamics of the pathological process.


The possible role of endothelium in prevention of rebleeding in experimental subarachnoid hemorrhage (SAH). Experiments were performed on six male cats under nitrous oxide in oxygen anesthesia. Animals were paralysed and artificially ventilated. Subarachnoid hemorrhage (SAH) was produced by basilar artery puncture following clivectomy. After 10 minutes (3 cats) and 60 minutes (3 cats) the basilar artery was dissected and fixed for electronmicroscopic examination. Ultrastructural examinations revealed in the cytoplasm of the endothelial cells on the side of the vessel lumen, the presence of spherical or flattened cylindrical structures identified as Weibel-Palade bodies. In the endothelium of the proximal segment, 10 and 60 minutes after puncture, the number of these electron-dense bodies increased, and was higher than in the corresponding distal segment. The possible role of the Weibel-Palade bodies in SAH after-effects is discussed.


Ultrastructural pattern of brain aging in normal rabbit and in pt mutant. The aim of the study was to compare ultrastructural brain changes in aging normal rabbits and in pt mutants with CNS hypomyelination. The study was performed on material of pt and healthy 3- and 4-year-old rabbits and on the control group of adult rabbits aged up to 2 years. Ultrastructural changes in both aging normal and pt rabbits included lipofuscin accumulation in glial and nerve cells, wide extension of astrocytic processes around vessels and in neuropil, thinning of capillary endothelial and their lumen distension, neuroaxonal dystrophy and incidence of degenerated dendrites and synaptic terminals. These changes, especially degeneration of axons and dendrites were much more frequent in the pt mutants than in normal rabbits. Moreover, myelin sheath abnormalities, similar as in younger pt rabbits were a characteristic feature in the aging mutants, whereas, the myelin in aging normal rabbits was well preserved, probably because the white matter changes are rather a later event in senescence. It is concluded, that with the exception of white matter affection in mutants, the age-related changes do not vary much qualitatively between pt and normal rabbit, although they are distinctly enhanced and develop earlier in mutants. Further studies are needed for evaluation of the influence of the aging process on the white matter changes in association with pt mutation and under normal conditions in animals of more advanced age.


Creutzfeldt-Jakob disease with tubulovesicular structures: an ultrastructural study. Tubulovesicular structures (TVS) have been consistently observed in brain tissue of the transmissible spongiform virus encephalopathies such as natural and experimental scrapie, bovine spongiform encephalopathy and experimentally induced Creutzfeldt-Jakob disease (CJD). TVS were recently demonstrated in 3 cases of naturally occurring CJD. We report here the presence of TVS in another human brain with CJD, as detected in all 3 specimens by thin section electron microscopy. Their occurrence in all types of spongiform encephalopathies, irrespective of the affected host and the strain of infectious agent, emphasizes their biological significance.


beta-Amyloid deposits within the cerebellum of persons older than 80 years of age. The cerebellum, frontal cortex, hippocampal and parahippocampal regions of 100 patients older than 80 years, most of whom had died of stroke, were examined. Eighteen percent were diagnosed as clinically demented. On the specimens labeled previously with Thioflavin S and Bielschowsky method, immunohistochemical studies were performed with Fab (antigen-binding fragment) of the anti beta-amyloid antibody 4G8. Positive amyloid immunoreactivity was observed in the cerebrum in 71 of 100 cases, Cerebella of 31 subjects of 71 with cerebral amyloidosis also revealed amyloid deposits. They appeared in various morphological forms, such as diffuse plaques and focal subpial deposits, as well as classical and primitive neuritic plaques. Cases with amyloid in the cerebellum alone were not observed. Beta-amyloid deposits in the cerebellum were associated with a significant number of beta-amyloid plaques in the cerebrum, which showed other Alzheimer-type pathology, also in individuals without clinical symptoms of dementia. There was no correlation either between cerebellar amyloid deposits and clinical cerebellar symptoms or between the presence of diabetes mellitus, arterial hypertension, and neuropathological changes. A clear association of microglial cells with amyloid deposits in the cerebellum was demonstrated. In our experience, LN-1 and RCA-1 were not as suitable for formalin-fixed paraffin-embedded tissue, as was anti-ferritin. Negative staining for tau-1 and positive staining for anti-ubiquitin characterized neurites within primitive and classical plaques. No neurofibrillary pathology was detected in the cytoplasm of cerebellar neurons when we used anti tau-1 labeling.


Damage of maturing brain in the course of toxoplasmic encephalitis. The aim of the study is to present the damaging influence of toxoplasmic encephalitis on newborn brains. The material consisted of six cases of toxoplasmosis who died during the first months of life. The neuropathological picture indicated indirectly the mechanism of spread of the inflammatory-necrotic process. In the first stage of pathologic process intensive inflammatory infiltrations in the periventricular white matter were seen. In the next stage the necrotic changes involved the majority of the hemispheric white matter. Further development of the disease transformed the brain hemispheres into thin-walled sacs composed of meninges and remnants of the nervous system. Finally, the inflammatory process resulted in hydranencephaly. Proliferation of subependymal glia evident in all cases and blocking the pathways of the cerebro-spinal fluid circulation, may have played a role in this process.


Anaplastic temporal lobe ganglioglioma. Case report. Clinical, histological and histochemical features of anaplastic temporal ganglioglioma in a 30-year-old woman are described. Short clinical course (preoperative 2 years, postoperative 6 months), anaplastic features of glial astrocytic component with scarce GFAP and negative vimentin immunostaining indicate aggressive character of the tumor. Ganglionic component is confirmed by the strong Con A affinity and discrete FN and NSE immunostaining.


Impairment of vertebral canal nervous structures after intrathecal prophylaxis in non-Hodgkin's lymphomas. Neuropathological analysis of spinal cord and spinal roots as well as spinal leptomeninges after intrathecal methotrexate (MTX) therapy was performed in 44 cases of non-Hodgkin's lymphomas of high malignancy. It was showed that MTX applied according to the program applied as a prophylaxis against lymphomatous infiltrations in the central nervous system, caused demyelination of spinal roots and fibrosis of leptomeninges and their blood vessels. However, it does not affect spinal cord structures. Described morphological changes remained clinically mute, therefore they do not seem counterindicate prophylactic intrathecal MTX application.


Morphology and morphometry of the cervix uteri of female albino rats in the estrus and diestrus phases. The morphological aspects of the cervix uteri of twelve albino rats, six in estrus and six in diestrus were studied. Micrometry of the epithelium thickness was performed and it was observed that the epithelium is significantly thicker during the estrus phase of the cycle than in diestrus. The major causes for this are discussed and the findings are correlated with the estrogen and progesterone levels present in each of the mentioned phases.


Chromosome variability in Brazilian populations of Drosophila buzzatii (Diptera, Drosophilidae). Analysis of 28 strains of Drosophila buzzatii from six different localities revealed that populations from southern Brazil apparently differ from northeastern populations in chromosome structure. Of the 16 polymorphic chromosome inversions detected in this species, only two (2j and 5c2) were present in southern populations. The Northeastern populations were the first of this species found not to have the 2j inversion. This suggests that the populations of Drosophila buzzatii may have lost chromosome polymorphism during dispersion, supporting the idea that the current geographic distribution of this species in South America is due to active dispersion.


[Total paralysis of the brachial plexus caused by supra-clavicular lesions]. From 1983 to 1987, 50 adult patients who suffered total palsy of brachial plexus were operated on. The average follow up was 39 months. They suffered severe supra-clavicular lesions of all the roots. All the roots damaged in the scalenic area were grafted, the avulsed ones were not. One root was grafted in 23 patients, two roots in 9 patients, three roots in 5 patients, four roots in 1 patient. No root was grafted in 12 patients. An active flexion of the elbow (over M3+, M4) was recovered in 39 patients (76 per cent). An active adduction of the shoulder (m. pectoralis major) was recovered in 24 patients (48 per cent), and an active abduction (supraspinatus or deltoid) in 13 patients (26 per cent). Twenty seven patients had severe pain before surgery. After grafting, pain decreased in 17 (62 per cent. At follow-up, 31 of the 50 patients had no pain or mild pain. These results justify for the authors nerve repair in total palsy of brachial plexus by supra-clavicular lesions.


[Treatment of post-traumatic swan-neck deformities of the fingers. Apropos of a series of 43 patients]. Thirty three patients with 51 swan neck deformities were reviewed with a mean follow up of 35 months (6 to 86 months). 8 fingers presenting some stiffness necessitated a first step of splinting before operation giving nevertheless 5 excellent and good results. Among the other fingers with full range of passive motion surgery was performed in 38 cases with 81.5 per cent of excellent and good results. According to etiology, articular or extrinsic, excellent and good results were respectively 71 per cent and 94 per cent. The most frequently used operations were Littler type II (12 cases) and Littler type III (S.O.R.L. 11 cases) giving respectively 75 per cent and 82 per cent of excellent and good results, despite frequent minor complications. Tenodesis with translocation of a lateral extensor band gave in half the cases some extension lack at DIPJ (less than 20 degrees in 62.5 per cent). Finally direct surgery of mallet finger complicated by a swan-neck deformity led constantly to good correlation at the PIP level.


[Epineural layer of the median nerve in carpal tunnel syndrome]. The different factors influencing a nerve compression have been studied regarding to the anterior epineurium modifications. Depending on the interstitial collagen sclerosis 3 histological groups have been separated in 55 patients. There is no influence on the epineurium layer depending on the pre-operative electrologic neuro-stenosis and denervation data. The macroscopic status of the nerve and the epineurium sclerosis have no parallelism. The age and the number of corticoid injections have no influence on the epineurial sclerosis. The only influencing factor on the histological aspect of the epineurium is the long term duration that precedes the surgery.


[Surgical treatment of isthmic spondylolisthesis. A comparative study of 3 types of arthrodesis]. The authors present a series of 186 cases of spondylolisthesis treated using 3 different types of arthrodesis: 84 by anterior arthrodesis, 35 by postero-lateral arthrodesis and 67 by combined arthrodesis. Slippage reduction was sought only in combined arthrodesis. The elimination of pain or a significant improvement were noted in 95 per cent of cases treated by anterior arthrodesis, in 74 per cent of those treated by postero-lateral arthrodesis and in 97 per cent of those treated by combined arthrodesis. The work resumption or professional rehabilitation rate was 89 per cent for anterior arthrodesis, 46 per cent for postero-lateral arthrodesis and 90 per cent for combined arthrodesis. Analysis of the clinical results according to the criteria of Stauffer and Coventry shows that good results were noted in 69 per cent of cases treated by anterior arthrodesis, in 43 per cent of those treated by postero-lateral arthrodesis and in 74 per cent of those treated by combined arthrodesis. A fusion rate of 86 per cent was achieved after anterior arthrodesis, 69 per cent after postero-lateral arthrodesis and 95 per cent after combined arthrodesis. Reduction had no effect on either clinical results or spinal statics in spondylolisthesis of less than 50 per cent. In the reduction of spondylolisthesis of more than 50 per cent, better results were obtained with the R. Louis technique than the Harrington technique in the restoration of spinal statics and maintenance of long-term clinical results.


[Cotrel-Dubousset instrumentation in the treatment of thoracolumbar and lumbar spine fractures]. Thirty-three thoracolumbar and lumbar spine fractures have been operated on using Cotrel-Dubousset instrumentation. Most were thoracolumbar burst fractures. Regional kyphosis at follow-up was 4 degrees, vertebral kyphosis was 8 degrees. Secondary loss of regional kyphosis was 1 degree, and 10 degrees of vertebral kyphosis. This construct with screws varies according to the level (thoraco-lumbar or lumbar); it seems reliable, as compared with other kinds of internal fixation. Restoring the height of the vertebral body is essential and is the key to a good final result. Addition of a postero-lateral fusion and or a brace did not improve the results.


[Bipolar prosthesis in femoral neck fractures. Results and long-term acetabular tolerance of 36 bipolar arthroplasties]. The authors present the long-term results of 36 SEM cemented bipolar hip prostheses for femoral neck fractures with a mean observation time of 7.4 years. The objective was to study the acetabular tolerance of these prostheses comparing with Moore's and Thompson's conventional hemiarthroplasties. The average age of the patients was of 69 years. According to the Merle d'Aubigné's classification, clinical results were better than those results reported in the literature with conventional hemiarthroplasties. At long term, acetabular deteriorations were nevertheless frequent (41.6 per cent pinchings and 25 per cent protrusions), but with no clinical significative correlation. They seem to be favoured by technical errors (drilling, size of the cups) and acetabular morphology. The part of the intermediary joint's mobility is difficult to demonstrate and is far being univocal. The authors conclude, to the superiority of the bipolar hip prosthesis actually totalizable (long term clinical results and middle term acetabular tolerance) in comparison with the conventional hemiarthroplasties, and recommend the use of those implants in sub-capital displaced femoral neck fractures for elderly patients with no arthrosis.