[Sequelae of osteoarthritis of the hip in growing children. Apropos of 72 cases]. The authors reviewed a series of 72 hips in 60 children with sequelae of septic arthritis of the hip to evaluate the long term evolution. The average follow up was 7 years 8 months (Range 1Y-17Y). 40 hips were operated and 32 were not. The results were analysed according to clinical and radiological criterions in an attempt to propose a guide for treatment. Sequelae might also occur after both initial treatment with open drainage or aspiration. The study of sequelae according to the factors of severity (organism, age when infected) showed that the evolution of these cases of arthritis cannot be forecast. The authors noticed that very severe roentgenographic lesions could be well tolerated clinically, at least on a medium term basis. They advise great care before operating on dislocated hips when they are clinically well tolerated. Finally the authors insist on 2 little known lesions: caput valgum and caput antetorsum.


[Hip-shelf procedure in children and adolescents]. Forty-six hips treated by a shelf operation in childhood and adolescence have been reviewed. The mean follow-up was 8 years 1 month (4Y-26Y) after operation. The indications were residual dysplasia of the acetabulum, neurologic hips and sequelae of osteochondritis. All patients were operated after the age of 8.5 years except 2. In poliomyelitis and sequelae of osteochondritis the results were good. In dysplasia we had two bad results in 18 cases (1 painful hip after operation and 1 ankylosing hip) and in cerebral palsy 4 bad results in 13 cases, due to difficulty of maintaining a correct reduction for a long period. After a review of the literature to compare the results of this intervention with pelvic osteotomies we conclude that the shelf procedure is beneficial in childhood and adolescence, due to the quality of acetabular cover, to its improvement in time and to ease of intervention.


[Resection of the tip of the lateral malleolus by Ibister's method in the treatment of painful sequelae of calcaneus fractures]. Persistent pain below the tip of the lateral malleolus may occur after comminuted fractures of the calcaneus. The pain is the result of compression of the peroneal tendons or abutment between the calcaneus and the lateral malleolus. Computerized tomography clearly shows the etiology. In these cases, the excision of the tip of the lateral malleolus, procedure described by Isbister, was performed. The clinical results of fifteen procedures in thirteen patients who had persistent pain below the tip of the lateral malleolus after fracture of the calcaneus are reported. All the patients were completely relieved of lateral pain. Subjectively, for nine patients, the results were excellent (7) or good (2). 4 patients are not satisfied. In these cases, pain arising from the subtalar joint was the main complain.


[Stress fractures of the tarsal navicular. Apropos of 20 cases]. Twenty cases of tarsal navicular stress fractures were observed in 17 patients. These fractures are rare, often go unrecognized, and are reputed to unite with difficulty. A clue to diagnosis was given by the description (young athletic person in sports involving sudden starts and stops). The lesion was not always visible on X-rays of the foot in supination and dorsal flexion (only 10 out of 20 in this series). Use of tomography and tomodensitometry was essential. Treatment was based on compressing the fracture with a screw without grafting or freshening, followed by immobilization of the foot with a cast and no weight bearing for 45 days. Union occurred in 19 out of the 20 cases. Thirteen patients were able to practice their sport without a loss of performance after a period ranging from 3 to 14 months. Treatment varied given the risk of spontaneous non union: incomplete fractures discovered early often responded to orthopedic treatment; fractures associated with large intra-osseous lytic lesions required addition of bone grafting. These fractures can be prevented through the use of inner arch supports especially if a predisposing factor exists such as a short first metatarsal bone.


[Reversibility of early stage diabetic nephropathy]. A double blind crossover trial was performed on the effect of enalapril on urinary albumin excretion (UAE) in normotensive insulin dependent diabetics. Nineteen normoalbuminuric (UAE < 30 mg/24 h) and 17 microalbuminuric patients (UAE > 30 and < 300 mg/4 h) were studied; all patients had post prandial blood glucose levels < 180 mg/dl, HbA1 < 11% and none had chronic diabetic complications. Both groups had similar age, years of diabetes, body mass index and protein ingestion (70 g/day). Fifty percent of patients in each group received 5 mg/day of enalapril or placebo during one year, and during the second year the therapy was switched. No changes were observed in blood pressure, post prandial blood glucose, HbA1 and plasma electrolytes during the study period. A reduction in creatinine clearance, within normal limits, in both groups of patients treated with enalapril and no modifications with placebo were observed. UAE decreased significantly in normo and microalbuminuric patients initially treated with enalapril from 19 +/- 8 to 8 +/- 2 and from 71 +/- 19 to 39 +/- 12 mg/24 h respectively. These values increased during the placebo period to 23 +/- 6 and 47 +/- 13 mg/24 h respectively. Among those initially treated with placebo, UAE increased only in normoalbuminurics from 19 +/- 7 to 28 +/- 9 mg/24 h. During subsequent treatment with enalapril, UAE decreased in both groups. It is concluded that, in this group of patients, enalapril decreases UAE, possibly preventing the progression to severe forms of diabetic nephropathy.


[Gallbladder cancer: immunohistochemical expression of CA-19-9, epithelial membrane antigen, dupan-2 and carcinoembryonic antigen]. The immunohistochemical expression of CA19-9, epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA) was studied in 103 tissue samples of gallbladder cancer and 25 samples of non tumoral gallbladder lesions. CA19-9 and EMA were positive in over 90% of cancers and non tumoral lesions. Dupan-2 expression was observed in 100% of non tumoral lesions and 78% of cancers. CEA expression was observed in 12% of non tumoral lesions and 89% of cancers. The magnitude of immunohistochemical staining was moderate or intense for all antibodies, except Dupan-2. No differences were observed in the location of positive staining in superficial or deep parts of the tumor. In these lesions the positive staining was cytoplasmatic with a granular and irregular pattern; on the contrary, in the non tumoral lesions, staining was seen in the apical parts of the cell. Calculated sensitivity, specificity and positive predictive value for CEA was 89%, 88% and 96% respectively. If future studies disclose a good correlation between serological and immunohistochemical detection of this antigen, its determination would be potentially useful in clinical grounds.


[Correlation between ultrasound and pathology of the gallbladder]. Ultrasound is a sensible and specific method for the diagnosis, study of natural course and follow up of medical treatment of gallstones. Thus it is important to specify the concordance between echographic and pathological findings of the gallbladder. Ninety one patients were subjected to an ultrasound gallbladder examination immediately before elective surgery and the excised organ was pathologically examined right after the operation. The number and size of stones, the diameters and wall thickness of the gallbladder and the presence of polyps and septa were compared with both methods. The correlation was fair for the number or size of the stones considered separately; however the correct diagnosis of both parameters was obtained in only a third of the cases. Diameters of the gallbladder were underestimated by ultrasound; wall thickness measurement showed a very good correlation with both methods. No correlation was found for polyps or septa. Although ultrasound is excellent for the diagnosis of gallstones, its precision, is insufficient to determine the exact number and size of the stones.


[Assessment of knowledge of cardiopulmonary resuscitation]. The knowledge about standardized CPR of 41 physicians and 30 7th grade medical students was evaluated using a written multiple choice test. Results showed a severe lack of information about CPR in both groups; the test was approved by 39% of physicians and 10% of medical students. Among physicians, the lower achievements were obtained by traumatologists and the best by internists. The basic level of questions were approved by 63% of physicians and 43% of medical students. The principal deficiencies were on pharmacological management and CPR in trauma. It is concluded that education programs on CPR, similar to those given by the American Heart Association, are urgently needed among physicians and medical students.


[Anticardiolipin antibodies in rheumatic autoimmune diseases. Correlation with clinical and laboratory findings]. The prevalence of anticardiolipin antibodies (ACA) was determined using an Elisa method in sera of 60 patients with autoimmune diseases. ACA were correlated with clinical manifestations of the antiphospholipid syndrome and other serological markers of autoimmunity. Sixty three percent of sera had ACA IgG (+) and 50% ACA IgM (+). Nine patients, five of them with systemic lupus erythematosus, had a history of arterial or venous thrombosis and all had positive ACA (IgG (+) in 7 and IgM (+) in 2). In patients with rheumatoid arthritis, no association was found between the presence of ACA and thrombosis. Patients with a history of spontaneous abortion had non significantly higher levels of ACA. There was a significant correlation between ACA levels and rheumatoid factor (ACA IgG r = 0.374, ACA IgM r = 0.676), no other association was found between ACA and other autoantibodies. It is concluded that ACA are found frequently in patients with autoimmune diseases and its clinical significance may be different in patients with lupus than in patients with rheumatoid arthritis or other connective tissue diseases.


[Value of electrocardiogram in localization of the coronary artery occlusion in acute inferior wall myocardial infarction]. Early EKG changes may contribute to predict the site of coronary artery occlusion during acute inferior myocardial infarction (MI). Its interpretation is relevant to therapeutic clinical decisions. We have prospectively evaluated early EKG changes of 40 consecutive patients with acute inferior MI and correlated them with the site and location of the coronary artery culprit lesion. Proximal right coronary artery occlusion was characterized by negative ST-T wave changes in leads D1 and aVL and ST segment elevation in leads D3 > D2. However the most distinctive EKG pattern of proximal right coronary artery occlusion was ST segment elevation with positive T wave in V4R (specificity 96%, predictive value 89%, p < 0.001). Distal right coronary artery occlusion was characterized by a positive T wave without ST segment elevation in V4R. Finally circumflex coronary artery occlusion was defined by a positive R/S > 1 relationship in V1, ST segment elevation in V5 and V6. Again lead V4R with flat or negative ST-T wave morphology had the highest predictive value for circumflex coronary artery occlusion (100%). Thus early EKG changes may contribute to precise the site and location of coronary artery occlusion and may help to implement clinical therapeutic strategies in patient with inferior MI. Right precordial leads are most useful in the EKG interpretation of inferior MI.


[Accidental exposure to health care workers of blood and body fluids from patients]. Due to the growing concern of Health Care Workers (HCW) regarding the possibility of acquiring blood borne infections through accidental occupational exposure and the fact that HIV and Hepatitis B infections have occurred in that setting, an evaluation of the frequency of accidents and their circumstances, suffered by HCW with blood or body fluids from patients was carried out. 1,340 self administered questionnaires were given to HCW with direct contact with patients in a general 800 beds hospital, requiring information of accidental percutaneous, mucosal or cutaneous (it not intact) exposures to blood or certain (risky) body fluids ever and/or in the last 6 months. Sixty five percent of HCW referred some exposure ever and 46% in the last 6 months. The rate of exposure ever ranged from 36.6% in medical students to 69.5% in doctors, 78.5% in nurses to 100% in dentists. Seventy seven percent of the exposures were seen during routine care, 28.5% were perceived as due to personal carelessness, 19.9% due to patient agitation, 33.5% as inherent to the procedure and 8.9% to abandonment of material. Exposures were mostly to blood. One hundred eleven out of 331 (33.5%) exposures were produced during handling of syringes; 33.2% during invasive procedures and 13% during cleaning of material. Sixty out of 107 (56%) non surgical doctors (NSD) and 61/67 (92.5%) of surgical doctors (SD) had had exposures ever (p < 0.01), 16.8% and 65.6% had had one or more in the last 6 months respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


[Computed tomography guided fine needle aspiration biopsies]. Computed tomography (CT) allows the performance of fine needle aspiration biopsies in situations in which ultrasound or conventional X rays do not correctly visualize the lesion or the needle tract. One hundred four patients with a clinical suspicion of neoplasia were subjected to CT guided percutaneous aspiration biopsies in a lapse of 6 years. The most frequently biopsied organs were the lung (39.5%), liver and gallbladder (20.2%) and pancreas (15.4%). Forty nine percent of procedures were performed in the thorax and 51% in the abdomen. Of 51 patients with suspicion of thoracic cancer, there was only one false negative and no false positive results, with an overall accuracy of 98%. For abdominal procedures, there were no false positive results, although there were 6 false negative results, specially for pancreatic or retroperitoneal lesions. Overall accuracy for abdominal procedures was 88%. It is concluded that CT guided fine needle biopsy is a safe and accurate method for the diagnosis of thoracic and abdominal lesions.


[Shigellosis in children of the IX region of Chile: clinical and epidemiologic aspects and antibiotic sensitivity]. Ninety four children with diarrhea and a positive stool culture for Shigella, hospitalized at the Hospital Regional de Temuco, were studied. Forty six percent of patients were less than two years old. Forty two percent of microorganisms were resistant to Ampicillin, 45% to trimethoprim/sulfamethoxazole, 8% to tetracycline and none to chloramphenicol. Isolated species were Shigella flexneri 83% and Shigella sonnei 17%. Seventy nine percent of patients had fever, 60% dysentery and 21.3% seizures. Ninety two percent of symptomatic family contacts had a positive stool culture for Shigella. Due to the high incidence of resistance to ampicillin and trimethoprim/sulfamethoxazole, these antimicrobials are not recommended as the first choice treatment of Shigellosis in the Ninth region of Chile.


[Identification and sensitivity of acinetobacter sp isolated from clinical specimens and hospital environment]. One hundred thirty two strains of acinetobacter isolated between october 1989 and march 1991 at the San Juan de Dios Hospital, Santiago de Chile were included in this study. One hundred twelve isolates were obtained from patients and 20 from the hospital environment. Among the 112 clinical isolates, 108 (96.4%) were identified according to the new classification proposed by Bouvet and Grimont in 1986 as A. baumannii, and four as acinetobacter genospecies 3. The 20 strains obtained from the hospital environment corresponded to A baumannii. No differences in the activities of the antimicrobial agents were found between clinical and environmental strains of A baumannii. Imipenem was the most active antimicrobial drug against A baumannii followed in descending order by sulbactam ampicillin and ceftazidime. The other antimicrobials tested showed poor activity against these strains as revealed for the MICs 50 and 90 in the resistance range.


Severe hemorrhagic syndrome secondary to active circulating inhibitors of the intrinsic phase of blood coagulation in 3 patients. The study of three adults with severe bleeding due to the presence of acquired anticoagulants that inhibit procoagulant action of Factor VIII and to a lesser degree of factors IX and XI, is described. In one case, this phenomenon occurred during the course of a rheumatoid arthritis, in one case coincided with a megaloblastic anemia (pernicious anemia) and the last case did not have any coexisting disease. Corticosteroids were useless, intravenous cyclophosphamide improved one patient and given orally failed in other patient. The circulating inhibitor disappeared in the patient successfully treated with cyclophosphamide and persisted and was the cause of death in the other two patients. In one patient, column fractioning demonstrated that the anticoagulant was an G immunoglobulin, with higher activity at pH 6.5.


[Acute renal insufficiency secondary to the use of angiotensin converting enzyme inhibitors in 2 patients without renal artery stenosis]. Two female patients who developed acute renal failure secondary to the use of angiotensin converting enzyme (ACE) inhibitors for hypertension are presented. None had renal artery stenosis on angiography or duplex doppler ultrasound examination. A 66 year old patient with a single functioning kidney recovered basal renal function; the other patient, aged 77 years, remained with a permanent severe renal damage. Risk factors were advanced age, mild chronic renal failure due to nephrosclerosis and diuretic use. We conclude that acute renal failure related to ACE inhibitors may be severe and can occur even in patients without renal artery stenosis. Diuretics, associated to ACE inhibitors, should be prescribed with caution, specially in older hypertensive patients with pre-existing chronic renal failure. Diabetic patients are at special risk due to the high incidence of small vessel disease in them.


[Polymorphic reticulosis: a type of lymphoma? Report of 3 cases]. Three patients seen at the Medicine Department of Del Salvador Hospital between 1986 and 1990 are reported. All had a history of purulent or bloody nasal discharge and recurrent sinusitis, before the appearance of progressive and painful destructive phenomena that affected the rhino faucial region. The diagnosis was made with the histopathological study that disclosed and angiocentric polymorphic infiltrates and perivascular necrosis. The three patients received similar treatment consistent in prednisone 1 mg/kg/day per os, cyclophosphamide 2 mg/kg/day per os and local radiotherapy. The response to therapy was bad and survival was less than three months. It is concluded that although this entity is infrequent, its severity requires and aggressive workup and management by a multidisciplinary team. Notwithstanding the mortality remains to be high.


[Clinical significance of platelet antigens]. During the last years, platelet immunology has shown an accelerated progress associated with the development of new highly specific and sensitive techniques. This progress has allowed the description of many new "platelet specific" alloantigens. In 1990, an International Workshop on Platelet Serology of the ISBT and ISH grouped the accepted alloantigens into five systems, named HPA-1 to HPA-5. Recent progress in molecular genetics techniques has also enabled the definition of the primary molecular structure of platelet glycoproteins which carry the specificity of the platelet-specific antigens. From the clinical point of view, the role of immunization against platelet-specific alloantigens has been established in neonatal alloimmune thrombocytopenia and in posttransfusion purpura, with anti-PIA1 (anti-HPA-1) being the antibody most frequently involved. An adequate diagnosis and management of these conditions can avoid devastating consequences like severe bleeding and even death. Associated with an increase in the administration of platelet transfusions, immunological refractoriness to platelet transfusions limits the benefits of such therapy, in most cases associated with HLA antibodies. Refractoriness can be efficiently prevented to large extent by using leucocyte-poor blood components in multitransfused patients.


[Female physicians: work and family].

[Female physicians: work and family]. One hundred female physicians were surveyed to describe features of their family, social and academic lives and obstetric history. Most outstanding findings were that 8% of women were divorced or separated, a trend to have few children and a mean day's work of 9.2 hour. Sixteen percent of women had a history of premature delivery and 22% premature labour symptoms (higher than the frequency found in the general population). Mean age at first childbirth was 26 years, significantly higher than the average of the general population (22.8 years). Prenatal leave was partially or not used by 50% of women, while postnatal leave was not benefitted by 12%. Breast feeding had a mean lapse of 3.8 months (shorter than advised). Sixty seven percent of women found scarce the length of time devoted to their children and 67% felt satisfied with their mate relationship. Fifty three percent performed 4 or more spare time activities a month and 55% declared to be satisfied with their professional performance. A mean of 0.89 scientific papers/year/woman were published or presented to meeting. Thirty percent believed that their professional work had a negative impact on their family life.


[A psycho-spiritual model for the physician-patient relationship]. The recent advances in Medicine, specially during the last years, have been important in the fight against disease. However, the dimension of patients as human beings has been forgotten. In this article, some ideas about the physician-patient relationship are exposed. Some case histories are depicted to clarify this issue. The importance of an emotional and spiritual support of patients and relatives in situations of emotional breakdown in emergency rooms, terminal disease and cardiopulmonary resuscitation in emphasized.


[Adult morbidity consultations in rural medical centers]. A sample of 823 adult morbidity consultations in four rural medical centers in the VI Region in Chile were studied according to age and group of diagnosis. There was a reduction in the number of consultations with age. The following were the most frequent diagnoses: respiratory disorders 17.3%, infections and parasitic infestation 10.2%, circulatory diseases 10.6%, gastrointestinal diseases 9.8%, genitourinary diseases 8.9%, musculoskeletal disorders 8.6% and mental illnesses 8.0%. No differences were found between this pattern of morbidity and that found in similar studies in urban areas. Important differences were found between the rural centres included in the study and these should be analysed in more detail, as they may reveal different risk factors for these populations.


[Brief history of nephrology in Chile].

[Brief history of nephrology in Chile]. The development of nephrology in Chile is described. The advances in the study and treatment of acute renal failure, urinary tract infections, hypertension, glomerulopathies and other areas are analyzed. The present state of dialysis and transplantation programs is highlighted and the activities of Pediatric and Internal Medicine nephrology branches are summarized.


[Frequency of platelet specific alloantigens HPA-1a (P1A1) and HPA-4a (Pen(a)) expression in Chilean population]. The phenotype frequency of platelet-specific alloantigens has been reported to vary with the ethnic composition of the population under study and the only two HPA-4a negative individuals found in the United States were of Hispanic origin; therefore, the aim of this work was to define the frequency of expression of these systems in the Chilean population. Using an ELISA with captured antigen by monoclonal antibodies, 604 blood donors were typed for the platelet-specific antigen systems HPA-1 and HPA-4. Eight samples typed negative for HPA-1a (1.32%) and 596 typed positive (98.68%). The calculated gene frequencies were 0.88 for HPA-1a (gene frequency > 0.99). Since these antigens are involved in thrombocytopenic disorders such as neonatal alloimmune thrombocytopenia and post-transfusion purpura, their frequency in a population is of clinical relevance. The gene frequency found for HPA-1a is higher than in Europeans (0.85) and lower than in Mapuche Indians (0.99), which is to be expected from the ethnic origin of our population. The absence of HPA-4a negatives in this study does not support our original hypothesis of a higher polymorphism of this system among hispanics.


[Colonic fermentation in humans: effect of the ingestion of meat associated to milk]. The amount of breath H2 produced for 6 h following the ingestion of 240 ml of milk was used as an index of the rate of colonic fermentation of undigested lactose in 8 lactase non-persistent Guatemalan adults. Treatments in separate days included milk alone, milk with 400 g cooked beef, lactose pre-hydrolyzed milk with the same amount of beef, beef alone and fasting for 6 h. Excess excretion of H2, calculated as the mean area under the curve were 178 +/- 31 ppm h with milk alone, 50 +/- 17 with milk plus beef, -1 +/- 26 with prehydrolyzed milk (p > 0.001). Peak increments of breath H2 followed the same trend: all 8 subjects over 20 ppm with milk alone, 2 with milk plus beef and none with hydrolyzed milk, beef alone or fasting. Thus, cooked beef significantly reduces the rate of appearance of intact lactose in the large bowel of lactase deficient adults.


[Pre S2: a marker for chronicity and/or liver damage in hepatitis B infection?]. Pre S2 was investigated using a monoclonal ELISA in 100 samples from 52 patients with different forms of infection with Hepatitis B virus. Pre S2 was present in 18 of 19 patients with acute hepatitis. Its persistence for more than 150 days after beginning of symptoms was associated to a chronic hepatitis state. It was also present in 11 patients with chronic hepatitis or cirrhosis, 15 asymptomatic Hepatitis B carriers and 3 of 4 patients with hepatic carcinoma. Pre S2 became negative in only 1 of 3 patients treated with interferon who had a positive response according to HBe and HBs antigens. Thus, Pre S2 is present in patients with evidence of viral replication. It is more a marker of persistent Hepatitis B infection than of chronic liver damage.


[Prevalence of dental fluorosis in Chile: a pilot study]. The prevalence of enamel fluorosis and its severity was studied in 118 young men of 2 socio-economic levels. The subjects were born and resided for at least 6 years in Chilean communities with different natural levels of fluoride in drinking water. There was a high prevalence of enamel defect overall (54%) most of it of mild degree (36%). This was not related to the level of fluoride in drinking water, however further studies are needed since Chilean children are receiving fluoride from other sources. A national program to supplement drinking water with fluoride should take this information into account.


[Intermittent negative pressure ventilation in patients with chronic air flow limitation: criteria for selection of patients]. To determine clinical and functional predictive criteria for use of intermittent negative pressure ventilation we evaluated 9 patients with severe chronic air flow limitation. Arterial blood gases, lung volumes, maximal inspiratory pressures and transdiaphragmatic pressure during quiet breathing were measured. patients were then ventilated once or twice a week for 3 to 10 weeks and improvement was evaluated through changes in quality of life, dyspnea, PaO2, PaCO2 and maximal inspiratory mouth pressure (PRMAX). Result was considered good when 4 or more of these indices improved. 5 patients benefitted from intermittent negative pressure ventilation. Compared to non responders, patients who improved had significantly lower PRMAX (39.4 +/- 11.6 VS 73.5 +/- 13.8 CMh20, p < 0.025), and higher percentage of their maximal inspiratory pressure during quiet breathing (31.2 +/- 7 vs 12.2 +/- 5%, p < 0.025>). Other indices were not different between groups. We conclude that a severe impairment of inspiratory muscle function characterizes patients with chronic air flow limitation who may benefit from intermittent negative pressure ventilation.


[Microscopic colitis and collagenous colitis. An entity not yet reported in Chile]. Collagenous and microscopic colitis have been described as causes for abundant watery diarrhea with a normal radiologic and endoscopic aspect of the colonic mucosa. Microscopic colitis is characterized by diffuse intraepithelial lymphocytic infiltration and collagenous colitis by thickening of subepithelial collagen layer greater than 15 microns with or without inflammatory changes of the mucosa. Here are reported 5 patients with microscopic colitis and 4 with collagenous colitis. The mean age was 52 years (range 40 to 68) with an equal sex distribution. Diarrhea was of longstanding duration without weight loss, anemia or hypoalbuminemia. Occasionally the volume of diarrhea was over 1 L a day. One patient had steatorrhea that proved resistant to a gluten free diet. Endoscopic and radiologic findings were normal in every patient and the diagnosis was based on typical histology. Azulfidine therapy was successful in 7 patients and prednisone in another. Colonic biopsy should be performed in every patient with chronic diarrhea.


[Percutaneous puncture thyroid cytology: cyto-histologic correlations in 136 nodular goiter surgical patients]. Percutaneous puncture for cytologic study was performed in 136 patients with nodular goiter. All patients were operated on and correlation of cytologic and histologic findings was obtained. Echographic study revealed a solid aspect in 72%, cystic aspect in 10% and mixed in 18%. The cytologic findings were classified as: benign--hyperplasia--, chronic thyroiditis, follicular neoplasm (adenoma and carcinoma), oxyphilic neoplasm (adenoma and carcinoma), papillary cancer, medullary cancer, anaplastic cancer and insufficient material. Surgery revealed cancer in 36 patients (26.5%). There were 3 false positives for cancer in the cytologic study. Percutaneous cytology was able to detect 88% of patients with cancer and 83% of patients with neoplasms. False negatives for cancer (n = 5) were due to insufficient sample (2), topographic error (2) and cytology error (1). No follicular cells were obtained in 13 patients with cystic follicular adenoma and the diagnosis was missed. Surgery confirmed that 24 of 25 patients with cystic aspect on echography had a basic underlying lesion. Thus, percutaneous cytology of the thyroid is useful in the evaluation of patients with cold nodules. Main limitations of the technique are found in patients with cystic lesions and follicular neoplasms.


[Respiratory complications in severe acute pancreatitis]. Respiratory complications are important causes of mortality in severe acute pancreatitis. We analyzed the pleuropulmonary complications that occurred in a series f 63 patients with severe acute pancreatitis. The most frequent were respiratory failure (52.4%) and bronchopulmonary infection (33.3%), both associated with sepsis and a high mortality rate. The initial laboratory workup included serial arterial blood gases and chest roentgenogram within the first 24 hours. The latter was useful to predict mortality. The tracheobronchial cultures isolated only enteral bacteriae. We conclude that pleuropulmonary complications are clearly related to the outcome of severe acute pancreatitis, specially when associated to sepsis.


[Neonatal autoimmune purpura: laboratory study of 5 cases]. Maternal alloimmunization against fetal platelets can cause fetal and neonatal thrombocytopenia. We report our experience in the study of five cases with severe neonatal-thrombocytopenia. Using an ELISA with antigen capture and other serologic tests on platelets, we investigated the sera of the five mothers. Sera from four mothers contained a platelet-specific alloantibody, anti-HPA-1a (PlA1) whereas the platelets typed as HPA-1b/b. In one case despite extensive serological investigation and clinically unequivocal diagnosis of AINT, no antibodies were demonstrated. The use of monoclonal antibodies for antigen immobilization, showed to be a reliable and sensitive test for the detection and identification of platelet antibodies in AINT. These techniques could also be used in the follow-up of patients at risk (e.g. pregnant HPA-1b/b women) and in the screening of blood donors lacking of certain antigens, whose platelets are collected to be transfused in patients with platelet-specific antibodies.


[A kinetic model for heparin dosing in patients on chronic hemodialysis]. The quality of anticoagulation was evaluated in 5 patients receiving heparin during chronic hemodialysis. 50 kinetic studies were performed using 2 monitoring tests, TTPK and TCK. Basal and intradialysis measurements were used to estimate sensitivity and the elimination constant according to formulae described by Milthorpe. Mean basal TTPK time was 27.3 sec and TCK time was 211 sec. Mean initial intradialysis TTPK time was 107.5 sec and after correction applying the kinetic model it was 62 sec. Intradialysis TCK time varied from 806 to 683 sec after correction. At the end of the study, mean intradialysis TTPK time was 61 sec not significantly different from the target time of 55 sec. TCK time, however, was significantly greater than target (684 vs 434 sec).


[Miliary tuberculosis as a complication of BCG immunotherapy in cancer of the bladder. Case report]. Intravesical administration of BCG may be used as an ancillary immunotherapy after endoscopic resection for cancer of the bladder. Local side effects are usually mild. Here is reported a patient who developed miliary tuberculosis after this form of therapy. Radiologic studies of the thorax and liver biopsy confirmed the diagnosis. The patient recovered after treatment with anti-tuberculosis drugs (TA-81 scheme). Epithelial trauma may be invoked as an alteration facilitating this complication. Although it develops infrequently, patients with bladder cancer treated with BCG must be monitored for this complication.


[Hypomagnesemia associated with hypokalemia, hyponatremia and metabolic alkalosis. Possible complication of gentamycin therapy]. Hypomagnesemia is a serious abnormality with different causes and usually associated to other disorders of electrolyte metabolism. We report a female patient developing hypomagnesemia after administration of gentamycin. This was associated to severe hypokalemia, hyponatremia and metabolic alkalosis. Possible pathogenetic mechanisms and therapeutic measures are discussed.


[Laparoscopic appendectomy: 2 cases at a regional hospital]. The surgical technique for removal of the appendix has remained unaltered for many years. Recently, laparoscopic surgery has been introduced with advantages for many patients. We report 2 patients with acute appendicitis who were operated on with laparoscopic surgery at a regional hospital in southern Chile. This technique may become routinely available to general surgeons in the near future.


[Traumatic pancreatic pseudocyst, 2 cases]. Two patients with traumatic pancreatic pseudocyst are presented. One patient was treated with percutaneous drainage and the other was operated on to perform a cystoenterostomy. Both patients recovered successfully. Diagnosis and treatment of this condition is discussed.


[HTLV-I clinical pathological spectrum]. HTLV-I has been revealed as the etiological factor of the Tropical Spastic Paraparesis (TSP) and of the T-cell leukemia-lymphoma of the adult (ATLL). Recently, it has also been associated to some forms of polymyositis, polyarthritis, polyneuropathies, Sjögren's syndrome, thrombocytopenia and lympho-alveolitis. The clinical and pathological spectrum of this retrovirus is analyzed taking into account the Chilean cases and those reported by the international medical literature.


[Proposal of a new table of weight increase for undernourished children under the age of 6]. All children (n = 447) under 6 years of age attending an outpatient facility during 1988 were evaluated for weight increase according to the current table. Recovery of undernutrition was estimated at a mean of 45%. A new table, based on the fact that undernourished children have a greater potential for weight increase was developed and applied prospectively during 1989 (n = 307). Recovery from undernutrition was 60%, especially high in preschool children who improved from 35% en 1988 to 56% in 1989 (n < or = 0.01). This was attributed to an individualized educational program as an additional measure to the National complementary feeding program. Better controls for children who failed to attend may help improve recovery from undernutrition which is relatively stagnant since 1982.


[150 Years of the University of Chile School of Medicine (1842-1992)]. The development of medical education during colonial times was slow due to problems analyzed elsewhere. In 1833, the first Medical School of the Republic was founded at the National Institute. The first four physicians graduated in 1842. The University of Chile was founded on november 19; 1842, Andres Bello being its first Rector. Medicine was among the first 5 Faculties. Two Chileans, Luis Ballester and Francisco Javier Tocornal and 6 foreigners, the Britishmen Thomas Armstrong, Nathaniel Cox, Juan Blest and Guillermo Blest and the Frenchmen Lorenzo Sazie and Julio Lafargue were the first Faculty members. Sazie was named Dean in 1943 with Tocornal as Secretary. A new curriculum was developed in 1845. The University of Chile and its Faculty of Medicine, as state supported non confessional and national institutions have played a fundamental role in the cultural and medical development of the country. Graduates from these institutions were instrumental in the development of social medicine during the XXth century.


[Significance of investigating viral DNA in serum from patients with hepatitis B]. The DNA-HBV was investigated in 109 serum samples from 75 patients with different forms of infection with the HB virus, using an RIA hybridization technique (Genostic-Abott). DNA-HBV was present in 12 of 18 cases of acute hepatitis, 1 of 3 patients with fulminant disease, 11 of 14 patients with chronic hepatitis and/or cirrhosis, 2 of 10 patients with hepatoma and 6 of 30 asymptomatic chronic carriers. Presence of DNA-HBV beyond 60 days in 7 patients with acute hepatitis established the chronic state. The highest levels were found in patients with chronic hepatitis or cirrhosis (mean 41 +/- 11 pg/ml) and the lowest in chronic carriers and patients with hepatoma. High levels of DNA-HBV denote persistent viral replication and would support antiviral treatment. Thus, investigation of DNA-HBV has diagnostic, prognostic and therapeutic implications in patients with Hepatitis B.


[Diagnosis of activity in Crohn's disease and ulcerative colitis: scintigraphy with TC-99m glucoheptonate labelled leukocytes]. We evaluated a pre-tinning leukocyte labeling technique using Glucoheptonate-Sn lyophilized kit, in the detection of activity in 15 patients with clinical and laboratory signs of active inflammatory bowel disease (IBD). 25 patients, without gastrointestinal disease were the control group. In 7/8 patients with Crohn's disease and in 7/7 with Ulcerative Colitis the study was positive. The negative study corresponded to a patient who has only involvement of the duodenum, an area of difficult evaluation due to the high liver uptake. 3/25 patients of the control group had activity in the intestine at 4 hour images. In spite of the small group evaluated, we believe that this labeling technique is a promising procedure for evaluation of activity in patients with IBD (Sensitivity 93.3%, Specificity 88.0%).


[Early renal dysfunction after elective surgery of the infrarenal aorta: incidence and predictive factors]. Renal dysfunction was investigated in the early postoperative period in 223 patients subjected to surgery of the infrarenal aorta. Dysfunction was diagnosed as an elevation of creatinine plasma levels above 2 mg/dl in patients with normal preoperative renal function, or a 50% increase over abnormal preoperative levels, within the first 5 postoperative days. The overall incidence was 5.68% (13 patients), and 2 patients required hemodialysis. Predictive variables were chronic hypertension and preoperative creatinine levels above 1.5 mg/dl. Two patients died from causes other than renal failure. No hemodynamic renal failure could be identified in 7 patients. The possibility of atheromatous renal embolization cannot be excluded in these patients. In patients with elevated risk for renal failure, delaying surgery after angiography, careful hemodynamic monitoring and surgical techniques may help decrease the incidence of this complication.


[Symptomatic profile of the climacteric female. Clinical experience]. To describe the symptoms of the climacteric female, 287 climacteric patients had their symptoms evaluated according to the criteria of Blatt-Kupperman for menopause. The median age was 50 years (P10 = 43 and P90 = 58). The main complaint was flushing in 46%, psychiatric symptoms in 17.8% a health examination in 14.6%, osteoporosis in 11.1%, menstrual problems in 6.3%, and other symptoms in 4.5%. Asthenia was a prominent symptom in 82% of patients, followed closely by headache, irritability and depression. Flushing was present in 77% of patients. Symptoms not usually associated to menopause, such as vertigo, palpitations and bone pain were quite prevalent. Only 69% of females were sexually active. Among them, 45% complained of dyspareunia and 58% of decreased or absent libido. The median Blatt index was 27. Working capacity was affected in 87% of patients. The menopausal period is associated to many symptoms which may motivate females to consult an internist.


[Early diagnosis of phenylketonuria. Follow up of 2 cases]. A screening program for the early diagnosis of phenylketonuria was initiated 24 months ago in the Servicio de Salud Metropolitano Central. Since then, 2 cases with phenylketonuria have been early diagnosed. These patients started their nutritional treatment, consisting of a phenylalanine restricted diet at 14 and 17 days of age. The children are submitted to periodic medical, anthropometric, neurologic, biochemical and psychometric analysis. With a strict control they maintain phenylalanine plasma levels between 2 and 6 mg%. Both patients have a normal psychomotor development at 4.5 and 6.5 months of age and an anthropometric development at p50 of NCHS.


[Cutaneous infection by mycobacterium marinum: case report]. A 45 year old male who manipulated tropical fish ponds developed painless nodular plaques in both hands. Biopsy showed mononuclear infiltrate of the dermis with few granulomata. Repeated cultures revealed M. marinum (diagnosis confirmed at the WHO/PAHO Reference Center in Canada). Good initial results were obtained with single agent therapy with ciprofloxacin. The patient suspended therapy after 11 month and a relapse was observed. Definite cure was obtained with oral cotrimoxazole and topic kanamycin.


[Mixed myelocytic and lymphocytic acute leukemia. Case report]. A patient with acute mixed myelocytic and lymphocytic leukemia is reported. The patient showed two populations of malignant myeloid and lymphoid cells with predominance of myeloid lineage. According to the present knowledge, it is hypothesized that its origin is at a pluripotent transformed stem cell which has the capability of differentiating through myeloid and lymphoid lineages. Its maturation is arrested at certain level, thus raising two monoclonal populations simultaneously in the same patient. The treatment should be combined with drugs used in acute myeloblastic and lymphoblastic leukemia. The response to chemotherapy is generally poor.


[New concepts on the pathogenesis of uveitis]. The pathogenesis of uveitis is not entirely clear. Diverse clinical and experimental findings support the participation of immunologic mechanisms. In fact, uveitis may appear along with many immunologic systemic diseases. In this article, possible etiologic agents of uveitis are described and experimental models discussed. The immunologic mechanisms are analyzed and a unifying hypothesis is presented.


[The need for autopsy].

[The need for autopsy]. A generalized decrease in the number of autopsies has been observed in hospitals worldwide, including Chile. A significant number of discrepancies between clinical and pathologic diagnosis persists in spite of the increasing sophistication of diagnostic methods. The teaching value of the autopsy, recognized by students, is stressed. Some lessons obtained in the personal practice of over 4500 autopsies are commented upon. The intimate experience of autopsies practiced in relatives and the speculation upon the attitude of the pathologist himself facing an autopsy are discussed.


[Drug surveillance].

[Drug surveillance]. Premarketing clinical studies of drugs have several limitations with respect to adverse reactions. Information obtained from postmarketing studies is important for determining drug safety. Drug surveillance has been developed to detect, evaluate and classify information related to adverse reactions to drugs. In this article different methods and strategies adopted in different countries for drug surveillance are described. Finally, the situation in Chile is analyzed and the need for a National Center of Drug Surveillance is stressed.


[Study of absenteeism in hospital workers]. The sick leaves from hospital workers involved in health care or in administrative positions at a hospital center in Santiago were analyzed. Absenteeism was 3.59% for health personnel and 2.25% for administrative staff. Absenteeism was higher in females, 5.1 and 2.7% respectively, compared to figures below 2% for males. Work accidents and professional diseases cause 0.5% absenteeism. Prevalence of absent workers amounted to 11% in females and 7% in males (15.8% and 8.4% among health workers, 6.5% among administrative staff). The mean duration of sick leaves was 7.3 days, 2 days higher in females compared to males. Diagnosis underlying the sick leaves were not different between health workers and administrative staff.


[The Expulsion of the Jesuits (1767) and its impact on Chilean medicine in colonial times]. In the mid XVIII century medical education was started in Chile with the foundation of the University of San Felipe. However, King Charles the Third expelled the Jesuits from the Spanish Empire in 1767 resulting in clear deterioration of medical development. Jesuits concentrated the cultural elite of the country and had the best professionals and libraries. A restrictive intervention from the Spanish government led to the establishment of a "Protomedicato" whose first director was Dr Jose Antonio Rios who remained in office for 40 years. At the end of the Colonial period, only 4 latin physicians and 3 bachelors in Medicine had graduated from the Universidad San Felipe, from an initial enrollment of 38 students in half a century. Only 5 among 25 doctors practicing in Chile in the first half on the XIXth century had been born in this country. This shortage was a severe handicap in the fight against smallpox and other plagues. Only the foundation of 2 hospitals (San Borja and Valparaíso) can be mentioned as positive actions coming from the Spanish government, and this was possible by using funds confiscated from the Jesuits. It was only after the establishment of the Republic and the foundation of the University of Chile, that medical development could again flourish in this country.


[Insulin secretion and sensitivity in patients with secondary failure to oral hypoglycemic drugs]. Secretion and peripheral sensitivity to insulin was investigated in diabetic patients with secondary failure to oral hypoglycemic drugs. 8 patients with secondary failure (non responders), 7 non insulin dependent diabetic patients with good response to oral drugs (responders) and 8 control subjects were studied. Insulin secretion was determined with peptide C in urine obtained 4h after a 500 Cal breakfast; in vivo insulin sensitivity was studied by the euglycemic hyperinsulinemic clamp technique. All groups were comparable in age, nutritional status and duration of diabetes. Non responders had higher fasting blood sugar levels compared to responders (228 +/- 70 vs 136 +/- 21 mg/dl, p < 0.05). Controls had lower blood sugar levels than the other 2 groups (93 +/- 8, p < 0.05). Insulin levels were similar in non responders and responders (24 +/- 12 and 16 +/- 9 uU/ml, respectively) and higher than in controls (10 +/- 3, p < 0.05). Peptide C was lower in non responders than in responders (3.8 +/- 1 vs 5.3 +/- 1.4 nm/4h, respectively, p < 0.04), but similar to controls (4.4 +/- 1.2). No difference in secretion of insulin was noted between non responders and responders. Insulin sensitivity index was 3.67 +/- 1.41 ((mg/kg.min)/(uU/ml)). 100 in non responders and 4.20 +/- 1.14 in responders; the index for controls was 7.92 +/- 1.70 (p < 0.05). These results show that non responders have normal insulin levels, although inappropriate for the level of hyperglycemia. Insulin sensitivity in non responders is similar to responders but lower than controls.(ABSTRACT TRUNCATED AT 250 WORDS)


[Familial association of epilepsy and cleft palate: an expression of predisposed common genetic factors or a teratogenic effect of the epilepsy genotype?]. The familial association of epilepsy and cleft lip with or without cleft palate (CL (P)) is analyzed assuming both entities share common genetic predisposing factors. The genealogical data stemming from 169 CL (P) probands and 168 epileptic probands yielded information on the prevalence rates of cleft and epileptic relatives. The working hypothesis assumes that the relatives of epileptic and cleft probands should have a greater liability to CL (P) and epilepsy, respectively. The results obtained do not support the hypothesis of an etiologic association given that a greater joint prevalence of epileptic and cleft relatives is only observed when the proband is epileptic and not with a cleft proband. This situation seems to reflect a teratogenic effect of the epileptic genotype which expresses itself in those individuals which simultaneously present a greater liability to cleft.


[Typhoid fever in children: association with blood phenotypes ABO, Rh and MNSs]. The hypothesis that blood phenotype B is associated to typhoid fever either directly or interacting with other phenotypes of the Rh or MNSs blood systems was tested. 256 children from the Northern Area of Santiago (Chile) with bacteriologically confirmed typhoid fever and 329 afebrile controls matched by age and gender from the same population, were studied. Association was found between phenotype RH3 and protection against disease for the whole group (OR = 0.67; p < 0.042) and for males (OR = 0.05; p = 0.014) although the gender-RH3 interaction was at the limit of significance. RH8 and Ss phenotypes were associated to increased susceptibility (OR = 1.83; p < 0.034 and OR = 1.56; p = 0.01, respectively). Controlling RH3 and Ss phenotypes by B, increased their effects (OR = 0.26; p = 0.04 and OR = 3.42; p = 0.026, respectively), but interactions did not reach statistical significance. These results show a susceptibility cline whose implications and applicability deserve further studies. A high proportion of S. paratyphi B (23.8%) appeared in this series, which may imply sample heterogeneity. The meaning of these findings need further epidemiological and genetic studies.


[Study of the Widal test phenotypic expression of blood groups ABO, Rh and MNSs in patients with typhoid fever]. The significance of the Widal test (WT) as a phenotypical expression was investigated in a cross-sectional study of 244 children from the Northern Area of Santiago (Chile) with bacteriologically confirmed typhoid fever (TF) due to S. typhi (183 cases) and S. paratyphi B (61 cases). The working hypothesis was that if the parasite-host relationships were similar for these two agents the immune response, as measured by the Widal test, should be similar. An association between test response and etiology was found consisting of a significantly higher proportion of positive response, in cases due to S. paratyphi B as compared with those due to S. typhi, (OR = 2.13; 95 Cl% = 1.06, 4.32; p = 0.02). Stratified analysis showed that although the association between etiologic agent and Widal test response persisted within all strata, significant interactions could be shown as evidenced by the magnitude of the associations, which varied according to blood phenotypes as well as gender (Mantel-Haenszel test for heterogeneity for 0, p < 0.034; for RH5 p < 0.033; for SS, ss p < 0.056; and gender p < 0.033). These results support the hypothesis that the Widal test response is a phenotypical marker eventually useful for studying human genetic heterogeneity in typhoid fever. The implications of these findings regarding previous study results and the possible role of S. paratyphi B in typhoid fever and its related conditions are discussed.


[Are disturbances of small intestinal motility associated with hyperglucagonemia in patients with liver cirrhosis?]. Patients with liver cirrhosis develop marked abnormalities in small bowel motility and high plasma glucagon levels. Disturbances in small intestinal motor activity could be related to hyperglucagonemia. To investigate the relationship between fasting plasma glucagon levels and changes in small bowel motility in patients with liver cirrhosis, eighteen cirrhotic patients and ten controls were studied. Plasma glucagon was measured by RIA. Mouth to cecum transit time was estimated by lactulose hydrogen breath test. Fasting small bowel motility was investigated by means of intraluminal manometry. Plasma glucagon levels were significantly higher in patients with cirrhosis (61 +/- 5 pmol/l) than in controls (32 +/- 3 pmol/l); p < 0.01. In patients with liver disease, plasma glucagon levels were not significantly correlated to mouth to cecum transit time (r: -0.32), duration of migrating motor complex (r: -0.24), nor to the frequency of multiple clustered contractions (r: -0.26). The degree of small bowel dysmotility is not related to plasma glucagon levels in patients with hepatic cirrhosis. These results do not support the hypothesis that hyperglucagonemia plays an important pathogenic role in the abnormalities of gut motility in cirrhosis.


Study of interactions between Listeria monocytogenes and experimental tumors. to verify the effects of Listeria monocytogenes (LM) inoculation in the survival of animals bearing Ehrlich's tumor. KIND OF STUDY: experimental. Animals-isogenic mice, Balb/c, female, 19-21 g. Tumor-Ascitic Ehrlich's tumor, dilution of 5 x 10(5) cells/0.1 ml. Bacteria-LM serotype 4a, solution with 7 x 10(3) bacteria (standard sub-lethal dose). Intervention-a) inoculation of LM in mice bearing Ehrlich tumor at the same time as ascitic cells transplantation. b) inoculation of LM seven days before and, again, seven and fourteen days after ascitic cells transplantation. c) to study the effect of using ampicillin 100 mg/kg, im, simultaneously with the inoculation of Ehrlich tumor and LM organisms and, again, 3, 5, 7, 14, 21 and 30 days after the ascitic cells transplantation. Chi-square test; p < 0.05 LM increases significantly the survival of mice bearing Ehrlich tumor even when only one inoculum of viable LM was used, seven days before or seven days after the ascitic cells transplantation. The use of ampicillin after the inoculation of LM and tumor transplantation does not alter the survival of mice.


Fine needle aspiration biopsy in diagnosis and treatment of breast pathology. A review. Seventy-eight women with breast disease were studied aiming to evaluate the importance of the fine needle aspiration biopsy for its diagnosis and forwarding treatment. Our data showed a high diagnostic accuracy with a low level of false negative results and no false positive. The macroscopic appearance of samples is an important aspect. Clear material prevailed in benign pathology (90%) and the presence of blood was usual in malignant tumors (78.3%).


Nasoduodenal feeding of the critically ill child. Malnutrition frequently occurs among hospitalized children (19, 23, 24) and is associated with increased rates of morbidity and mortality (3, 5). Because of this hypercatabolic condition, a critically ill patient may undergo a process of acute malnutrition within a few days (7, 27, 34). The nutritional or metabolic support provided in these situations is usually by the parenteral or enteral route, depending on the presence of a functioning digestive tract. When exclusively parenteral feeding is used, prolonged fasting may deprive the intestine of specific nutrients and reduce its function of nutrient processing and absorption for lack of a substrate, with the consequent occurrence of atrophy. Clinical and experimental studies have demonstrated the advantages of the enteral route, which is more physiological, has a lower rate of complications and involves easier administration when compared to the parenteral route. Experimental studies (15, 21) have shown a hypoplastic response of the intestinal mucosa of rats after 3 days of parenteral nutrition when compared to controls submitted to enteral feeding. This response was measured in terms of mucosal weight, villus hypoplasia, DNA protein content, enzyme activity, and pancreatic function. Similar changes detected in clinical studies were rapidly reversed to normal after feeding by the digestive route (13). It is suggested that the mechanism of these alterations may involve the absence of intraluminal amino acids needed for enzyme synthesis rather than the lack of specific substrates inducing enzyme production.(ABSTRACT TRUNCATED AT 250 WORDS)


Simplified method for the analysis of cellular karyotype and phenotype in leukemias. The objective of this study was to develop a simplified method for the simultaneous analysis of cellular karyotype and phenotype which would permit the identification of cell origin. We studied 6 patients with AML, 3 with CML (one of which was in blastic transformation) and one ALL. We used a method in which the suspension of bone marrow cells was incubated in TC 199 medium with colchicine and with hypotonic solution formed from glycerol, NaCl, KCl, CaCl2, MgCl2 and sucrose. The slides were prepared from this cell suspension by cytospin and stained for peroxidase, PAS, esterases and iron. The karyotype was studied by direct method and culture. It was possible to relate the cytogenetic marker with cytochemistry characteristics in the same cell in 3 cases, showing the feasibility of cytochemistry techniques in cytogenetical preparations. The best preparations were found through peroxidase. The presence of iron granules allowed identification of erythroblastic lineage in the combined staining. Mitosis with a marker chromosome of leukemic clone in an AML cell with negative peroxidase probably showed a proliferation of more primitive precursor not sufficiently differentiated to show markers.


Correlation between free bilirubin and indirect bilirubin in normal newborn infants with non-hemolytic jaundice and effect of hemolysis on free bilirubin measurement by the peroxidase method. The present study was undertaken to determine the correlation between free bilirubin and indirect bilirubin in normal newborn infants with non-hemolytic jaundice, and the possible effect of hemolysis on free bilirubin measurement by the peroxidase method. A prospective study protocol was applied at the Neonatal Unit of the Department of Pediatrics, Escola Paulista de Medicina. Forty-three newborn infants were submitted to measurement of free bilirubin and bilirubin fractions and the extent of hemolysis of the sample was determined. Data were analyzed statistically by the Student t-test. A positive and moderate correlation (r = 0.668; p < 0.01) was detected between free bilirubin and indirect bilirubin. The linear regression equation calculated by the least squares method was as follows: f(x) = 4.562 + 0.382x. The concentration of free bilirubin was inversely proportional to sample hemolysis, the difference being greater at 50 mg/dl hemolysis. Despite these results, however, the use of this correlation is delicate due to the impossibility of establishing it in individual cases. Also, since the samples may show some degree of hemolysis, this factor should be minimized by appropriate sample collection before free bilirubin measurement.


Perinatal factors associated with neural tube defects (anencephaly [correction of anancephaly], spina bifida and encephalocele). The objective of the present study was to determine the presence of risk factors for the occurrence of neural tube defects. Data for 33,535 births which occurred at Hospital do Servidor Público Estadual de São Paulo from July 1973 to December 1986 were collected in a prospective manner as recommended by "Estudo Colaborativo Latino-Americano de Malformações Congênitas" (ECLAMC, Collaborative Latin American Study on Congenital Malformations). Twenty-six cases of neural tube defects were detected (0.77/1000 births). Of these, 11 were cases of spina bifida (0.39/1000 births), 9 of anencephaly (0.27/1000 births) and 6 of encephalocele (0.18/1000 births). We observed a higher frequency of polyhydramnios, premature labor, Apgar scores of less than 7 at the first and fifth minutes, low birth weight and intrauterine growth retardation.


Sydenham chorea: clinical and laboratory findings. Analysis of 187 cases. Sydenham's chorea (chorea minor, St. Vitus dance, rheumatic encephalitis), described by Thomas Sydenham in 1686, is considered one of the major manifestations of rheumatic fever (1, 2, 3, 4). Clinically it is characterized by involuntary movements, hypotonia, dysarthria, emotional disorders, and less frequently, by other neurological manifestations such as weakness, headache, seizures and sensory abnormalities (1,4). The motor disorders may be generalized or unilateral, in this case constituting a hemichorea (3). Chorea may present associated to other rheumatic fever manifestations during an acute episode, or in isolated form, characterizing the so-called "pure" chorea (5, 6, 7). Its etiology and pathophysiological mechanisms are still unclear, although its relation with a previous pathophysiological group A Beta-hemolytic streptococcus infection is well established (8). There is also evidence of the participation of immunological mechanisms in its pathogenesis, such as the finding of serum anti-nucleus caudatus and anti-subthalamic antibodies (9) and increase in IgG levels in cerebrospinal fluid of patients with chorea (10). In developed countries due to the reduction in rheumatic fever incidence and decrease in frequency of chorea as its manifestation (3, 11), the latter has become rare. However, in developing countries rheumatic fever remains a public health problem. In Brazil, in the last years an increase in the incidence of chorea has been observed as part of the clinical picture of rheumatic fever (12). The present study reports the clinical and laboratory findings of 187 cases of Sydenham's chorea followed-up during the period of January 1980 to December 1990 in two university centers in the city of Sao Paulo, Brazil.


A critical appraisal of the value of vaginal acid phosphatase determination for the estimation of post-coital time. A careful literature review of the use of vaginal fluid acid phosphatase levels as a means to estimate post-coital time disclosed several inconsistencies. In this study, acid phosphatase levels were determined in vaginal fluid samples obtained from 200 women whose post-coital time was known. No statistical significance (at 5% probability levels) was found when vaginal acid phosphatase levels were correlated with post-coital time.


Detection of estrogen receptor in formalin-fixed and paraffin-embedded breast carcinoma: correlation with histological patterns. The authors studied the expression of estrogen receptor (ER) in tissues of breast carcinomas which were previously fixed in formalin and paraffin-embedded. The ER expression was correlated with several histological findings, namely grade of differentiation, tumor necrosis, desmoplasia, lymphocytic infiltration and elastosis. The ER was detected in tissues using the avidin-biotin immunoperoxidase technique associated with the H222 monoclonal antibody from Abbott. All 39 biopsies were of infiltrating ductal carcinoma of breast and 16 of them expressed ER. The statistical analysis showed that the expression of ER was correlated with histological findings of good prognosis as well differentiated carcinomas, no tumor necrosis, absence or mild lymphocytic infiltration around the tumor cells and severe elastosis.


The height of the diaphragm domes in pathologies of abdominal organs of the digestive apparatus. The present study reports on diaphragmatic changes observed in 226 patients with diseases of abdominal organs of the digestive system. The group consisted of 121 males (53.5%) and 105 females (46.5%) (mean age: 44.1 +/- 4.3 years; range 15-83 years). The parameter of reference for comparisons between normal and pathological conditions was the normal average difference in height between the hemidiaphragms, which was obtained from 220 postero-anterior chest radiographs. These radiographs were obtained from 99 males (49.5%) and 101 females (50.5%) (mean age; 41.1 +/- 5.6 years; range: 15-78 years) who did not present any symptoms compatible with diseases of the digestive system. Several diseases which affect different abdominal organs were found to cause various differences in height between the left and right hemidiaphragms. The mechanism and clinical applications of the alterations observed are discussed.


Primary lymphoma of the breast.

Primary lymphoma of the breast. We describe a case of primary lymphoma of the breast which clinically mimicked a phyllodes tumor. The diagnosis and treatment of this rare neoplasm are discussed. The lymphomas, neoplasias of the immune system, comprise a large group of proliferative diseases of the lymphoreticular tissue which are classified into two histological types, i.e., Hodgkin and non-Hodgkin. Primary lymphomas of the breast are quite rare, with an incidence ranging from 0.4 to 0.53% of all malignant breast tumors (2). They are characterized by uni- or bilateral involvement of the breast, with or without homolateral axillary lymphadenopathy, and by the absence of lymphatic disease at another site (7). We report here a case of primary non-Hodgkin lymphoma of the left breast and we discuss its clinical aspects and the treatment instituted.


Intestinal anastomoses.

Intestinal anastomoses. Anastomotic dehiscence remains the main cause of morbidity and mortality of intestinal resections, mainly the colorectal (77, 95, 110). Very often in the literature the words dehiscence and fistula are misused for the same meaning. Nevertheless, attention must be paid to the fact that these two situations may be distinct. Dehiscence is defined as the failure of healing of the anastomoses, while fistula is the leakage of the intestinal content into the peritoneal cavity. So, the evidence of fistula is always accompanied by dehiscence, although a dehiscence may not develop into a fistula, should it be blocked by omentum or surrounding organs (110, 117). The incidence of overt dehiscence varies from 0.1% to 30% in the literature (13, 15, 17, 27, 31, 40, 44, 46, 76, 77, 81, 96, 113, 120, 123, 126, 133, 135). The Colon Cancer Project of the Saint Mary's Hospital in London, a multicentric study of patients submitted to bowel resections revealed a post operative mortality of 22% in patients with dehiscence and 7% for uncomplicated anastomoses. This led to the struggle various authors to achieve better results, regarding techniques and suture materials, such as the number of planes involved, inverted or everted sutures, wound healing and the influence of local and systemic factors, like infections, antibiotics, NSAIDs on sutures. Recently, surgical stapling gained importance among surgeons, due to its technical advantages. However, this is still very controversial and must undergo further investigations (93, 107, 109, 112, 115, 116). So, in order to understand the pathophysiology of the complications and to reduce morbidity and mortality, related to intestinal anastomoses, it is necessary to study the events involved in intestinal healing after resection, as well as the technique, materials used and the factors related to anastomotic failure.


Generalized smooth muscle hypertrophy.

Generalized smooth muscle hypertrophy. This report presents a twenty-year-old man with generalized digestive and urinary smooth muscle hypertrophy combined with somatic and sexual hypodevelopment. We could not find in the literature any report related to the disease of our patient. Congenital pyloric stenosis is the less rare obstructive syndrome due to smooth muscle hypertrophy. Morgagni described this syndrome in an adult patient, in the XVIII century (2). Pyloroplasty is the best treatment for this disease. Other congenital or acquired obstructive syndromes of the digestive system such as Chagas' aganglionosis and pseudo-obstruction of the small bowel are also important clinical and surgical challenges (1,3,4). Several obstructive illnesses due to smooth muscle dysfunction have been described. This report presents an apparently original syndrome urinary segmental obstruction following smooth muscle hypertrophy.


Frequency of X-chromatin in pregnant women during the second trimester of gestation. The frequency of X-chromatin was determined in pregnant women during the second trimester of gestation in order to establish possible correlations with the changes in steroid hormone levels occurring during this period and compare the curve with that for normal nonpregnant women. The mean frequency of X-chromatin in oral mucosa cells from a salivary suspension was 19.97% for the 24 patients studied, a statistically higher value than that obtained for nonpregnant women.


Cytology by capillarity and anatomopathological diagnosis of solid breast tumors. A study was conducted on material obtained by capillarity puncture (74 punctures) from 71 patients with breast tumors. The material was fixed in absolute alcohol and stained by the Papanicolaou method and the result was classified as insufficient material, or as negative, suspect or positive cytology. After tumor exeresis, the anatomopathological results of each patient were compared to the cytology data. A single false-positive case was obtained among 44 patients (97% specificity) and 9 false-negative cases were obtained among 16 patients (56% sensitivity).


Histological study of the endometrium in menopausal women with breast carcinoma. The first reference concerning the multiple primary malignant neoplasms was made by Bilroth, 1880 and since then a large number of studies have been published. Furthermore, an increasing incidence of simultaneous cancers are currently observed (16,18). At the same time, several retrospective populational studies evidenced the association between breast and endometrium carcinoma. It is well known that both uterus and breast are hormone-dependent organs and are likely to be influenced by the same oncogenic stimulus, either of endocrine nature or dietary origin (2, 3, 14). The risk of developing endometrial carcinoma is higher in patients already affected by breast neoplasm and is much more evident in older women within the first five years following the diagnosis of breast tumor. Conversely, patients with endometrial carcinoma may present a second mammary neoplasm and the relative risk is around 2.0 (1, 17). Although the existence of a correlation between these two primary malignant neoplasms is clearly observed, the absence of systematic studies directed to the screening of endometrial cancer in women with breast carcinoma is surprising. This study deals with histological analysis of the endometrium of postmenopausal patients with breast cancer and aims to determine the possible changes that might have occurred in the onset of the disease.


Arthroplasty of the knee--indications and contraindications. Total knee arthroplasty has been showed to be a satisfactory procedure mainly in relation to designs evolution of condylar or surface prostheses. In this matter, the concepts of prostheses of Gunston Polycentric (2), Freeman-Swanson (1) and the Total Condylar (3) were particularly important. The present status of development of condylar or surface arthroplasties allows to establish that in the majority of cases, arthrodesis of the knee is a salvage procedure. The alternative procedures indicated must always be considered. The conservative treatments as anti-inflammatory drugs and physiotherapy as well as arthroscopy, arthrotomy, synovectomy and osteotomies can be performed. These procedures are indicated depending on age, joint condition and type of disease. The knee arthroplasty requires skill and training of the surgeon, particularly if we consider the deformities and instabilities to be corrected and joint function to be aimed. On the other hand, the major problem may be the selection of the patient who will be operated on for a given type of total knee arthroplasty.


Semiquantitative culture in diagnosing venous catheter-related sepsis. Since Aubaniac (1) described the puncture of the subclavian vein in 1952, and specially after the standardization of parenteral nutrition by Dudrick et al. (11) in 1968, much has been published about complications caused by percutaneous central venous catheterization. Among the various complications provoked by this procedure, a very important one is "primary sepsis" or "catheter-related sepsis", both because of its frequency and because of the morbidity and mortality it causes (18,19). It is, however, difficult to diagnose this complication. The main difficulty lies in differentiating catheters that are really causing sepsis from those that, though showing "positive culture" do not cause bacteremia and are not responsible for the occasional signs of infection that a patient may show (6,7). This difficulty in diagnosing has led to the recommendation that all catheters suspected of causing sepsis be systematically removed. This procedure has the effect of exposing patients in serious condition and with limited venous access to the risks of new punctures. Usually these risks are unnecessary, since 75 to 90% of the catheters removed for this reason are not the real source of infection (3, 17, 19, 21, 22). In 1977, Maki et al. (18) proposed a semiquantitative catheter tip culture that showed considerable correlation with positive hemoculture for the same microorganisms; that is, capable of identifying which "positive catheters" were really causing sepsis. Subsequent research confirmed these results, showing that the semiquantitative catheter tip culture had specificity and sensibility over 80% (10, 15).(ABSTRACT TRUNCATED AT 250 WORDS)


The vertebral artery: its relationship with adjoining tissues in its course intra and inter transverse processes in man. The authors study the vertebral artery from its origin to termination, especially in its course inter and intra transverse process and show its relation to venous and nervous structures, as well as its behavior toward adjacent conjunctive tissue. They discuss the relation of the anatomy to the physiopathology of the vertebral artery and come to the conclusion that the vertebral artery is fixed to adjacent structures in the fibrous osteomuscular tunnel by means of a continuous lamina of collagen along its entire course and that there is considerable independence between the artery and the branches of these final nerves.


Evaluation of the physical fitness by the Bruno Balke protocol in sedentary and wheelchair trained paraplegic patients. The Bruno Balke test is one of the methods available to measure the oxygen intake in wheelchair users. The equation of the test is:intake O2 = 33+ (speed average-133) x 0.17 ml/kg x min. (-1). The average speed represents the acceleration and may be used to measure the level of physical fitness. In order to verify the efficiency of this kind of evaluation, we selected ten male, sedentary paraplegic patients, level D5-D12 in an ordinary rehabilitation program and ten paraplegic athletes. All of them were submitted to the Bruno Balke test. The results demonstrated that the average speed, the covered distance and the oxygen intake were significantly greater in athletes than in sedentary individuals.


Histologic changes in fibrocystic breast disease before and after treatment with bromocriptine. Twenty-five women with fibrocystic breast disease were investigated in a double-blind study using treatment with bromocriptine (5 to 7.5 mg/day for 3 months) or placebo. Estradiol and progesterone measurements did not show any changes before, during or after treatment. Serum prolactin levels were reduced during the use of bromocriptine. Histologic evaluation demonstrated a decrease of epithelial hyperplasia and arrest of the cystic dilation picture after treatment with bromocriptine.


Mediastinitis after cervical suppuration. The objective of this study is to decode the etiopathogenesis, the clinical feature, the diagnosis and the prognosis of the acute mediastinitis resulting of infectious processes of the cephalic segment. Three out of five patients studied presented focus of dental origin and two patients presented focus in the face area. One of them presented Ludwig's Angina before the suppurative process would spread over the mediastinum. In the others, there was fast expansion through the fascial spaces of the neck and, in two of them, besides the mediastinum, there was pleuropericardial involvement. Three patients died due to respiratory insufficiency and two survived with complications. The mediastinitis after cervical suppuration is a special and extremely serious kind of endothoracic infection. The pus reaches that area through the fascial spaces of the neck, taking the organism to an alarming toxemic feature. The rarity of the disease, the little is known about its physiopathology and the initial care of the patient in non-specialized services, which are not familiarized with this type of feature, are factors that can delay the diagnosis and worsen the prognosis.


Focal acantholytic dyskeratosis: a snare for the pathologist. Report of two cases associated to psoriasis and fibrous papule of the nose. Two specimens containing clinically inapparent histologic features of acantholytic dyskeratosis (on the base of a fibrous papule of the nose and overlying a psoriatic lesion) are presented. The authors discuss the conduct to be followed by the pathologist in similar cases. The general pathologist should be well trained in dermatopathology since cutaneous biopsies account for 10 to 25% of the specimens submitted for histologic diagnosis or, even, form the major part of the workload (Berry). There is a wall between the physician who submits the skin biopsies (who may be or not a dermatologist) and the pathologist. The clinical information provided by dermatologists is scant and incomplete and physicians who are not dermatologists seldom submit any information. The histological pictures found in skin biopsies are, often, common to several nosological entities and an adequate understanding of their meaning is desirable for a thorough evaluation. We ought to assess it with the maximum scientific severity, searching to solve the puzzle without depreciating the information received. In this report the authors analyse the histopathological approach to the cutaneous lesions of two patients. They displayed the association between acantholytic dyskeratosis (AD) and another cutaneous pathology. Findings like these may obstruct the final diagnosis to be issued by the pathologist.(ABSTRACT TRUNCATED AT 250 WORDS)


Pattern of splenic phagocytic function in Brazilian patients with sickle cell disease. The splenic function measured by the counts of "pitted" erythrocytes has been assessed in 87 patients with sickle cell disease (59 homozygotes for hemoglobin S (SS), 14 double heterozygotes for Hb S and beta zero thalassemia (S/beta zero thal), 4 S/beta+ thal and 10 SC patients) in Southeast Brazil. Results showed a progressive increase in pit counts according to age. The reduction pattern in the splenic function was similar for the SS, S/beta zero thal and S/beta+ thal patients, and over the age of 12 almost all patients presented counts compatible with severe splenic hypofunction. Patients with SC hemoglobinopathy presented slower development of hyposplenism and lower levels of pit counts even in advanced ages. Except for S/beta+ thal patients, the developmental pattern of hyposplenism was not different from that reported among patients in the United States and Jamaica.


Eclipse of the identifiable myoblast.

Eclipse of the identifiable myoblast. During development of the limb musculature there is an eclipse of the myoblasts from the time first formed until the limb musculature begins to develop. The formation of the muscles of the limb is from cells of somite origin that migrate into the forming limb bud. While it is possible to identify myogenic cells in the somite prior to when migration occurs, and to determine the time frame during which migration occurs, there is a hiatus of about 34 hours during which it is difficult to identify or culture myogenic cells from the limb. In part this is because it is difficult to distinguish myogenic cells that migrate from those that do not. There are no markers that distinguish the myogenic cells of the somite that form the axial muscles and therefore stay in place, and from the myogenic cells that migrate to form the peripheral muscles of the body. Thus it unclear if the cell commitment to different myogenic fates occurs during somite formation, or during their sojourn to the limb bud.


Actinic rectitis--the role of colostomy. From 4132 patients treated with radiation therapy due to gynecological malignancy from 1974 to 1988, 527 (12.75%) developed some grade of actinic rectitis with clinical manifestation. The authors analyzed the efficacy of colostomy in the management of 10 women with actinic rectitis grades I and II (Sherman classification) submitted to clinical treatment without response. Pelvic radiation therapy, clinical findings, proctoscopy and rectal biopsy were the basis for the diagnosis and staging of the actinic rectitis. All colostomies were made in the transverse colon and the median follow up from colostomy to last review was 53 months. Eight patients had complete remission of clinical findings after colostomy, but one had recurrence of symptoms 2 years later. One patient had incomplete remission but with clinical improvement and one patient had tumor recurrence. From 8 patients with complete clinical remission, 2 had the colostomies closed, but in 1 was restored 3 months later due to rectum-vaginal fistula.


Drosophila actin mutants and the study of myofibrillar assembly and function. The use of Drosophila mutations in the indirect flight muscle-specific actin gene, Act88F, to study actin structure/function and its assembly into thin filaments during myofibrillogenesis is described. Mutants with different phenotypic effects are discussed and attempts made to correlate the different properties of the mutants in vivo-myofibrillar structure, actin synthesis, accumulation and stability, heat shock response induction-with properties of the same mutations expressed by in vitro transcription/translation of the cloned actin genes-co-polymerisation, thermostability and protein conformation. Few of the properties show a complete correlation between the different classes of mutants. The nature of the diversity of the mutant effects is discussed. Questions as to how this will help in elucidating the molecular effects of the mutations and the assembly of thin filaments and myofibrils are considered. In addition, the efficacy of the co-polymerisation assay is examined. The post-translational processing of this actin-by N-terminal processing, methylation and ubiquitination-are described. Data is presented that inhibition of the N-terminal processing of actin in vitro affects the ability of the actin to copolymerise, and makes unprocessed actin behave as a capping protein. The possible in vivo importance of this phenomenon is discussed.


Expression of actin isoforms in Artemia. Complementary DNA clones have been isolated from the crustacean Artemia that code for four different actin isoforms. The nucleotide sequence of these clones has been determined. The four clones are about 80% identical in their translated regions but unrelated in their untranslated regions. The cloned Artemia actins are very similar in their deduced amino acid sequences to other invertebrate actins, especially in the amino terminal region. The analyses of the steady-state levels of actin mRNAs during Artemia development has shown a parallel increase in the levels of all four mRNAs between five and ten hours of development. Whole-mount embryo hybridizations have shown that one of the clones codes for a muscular actin isoform while the other three clones code for cytoplasmic isoforms.


Treatment of carcinoma in situ of the cervix experience at the Faculty of Medicine, University of São Paulo. The authors studied a total of 334 cases of carcinoma in situ of the cervix (1975-1990). The patients were 19 to 61 years old (mean age, 36.6 years). The following procedures were performed: cervical amputation in 54.5% of cases, cervical enlarged amputation with resection of the adjacent vaginal mucosa in 23.3%, abdominal hysterectomy in 15.3%, electrocauterization in 3.6%, simple conization in 2.4%, and vaginal hysterectomy in 0.9%. Recurrence rates were: 9.8% after cervical amputation, 1.3% after cervical enlarged amputation, 25% after simple conization, 5.8% after abdominal hysterectomy, and 33% after electrocauterization. Recurrences were detected before the 18th month after treatment and none of them was of the invasive type. The treatment procedure with the highest rate of complications was cervical enlarged amputation (16%), followed by simple conization (12%), total abdominal hysterectomy (3.9%), and cervical amputation (2.9%). The authors conclude that, although cervical enlarged amputation was followed by the lowest recurrence rate, it was also the treatment followed by the largest number of complications. On this basis, they recommend cervical amputation or hysterectomy. For young women who wish to have children, simple conization is recommended.


Surgical treatment of veno-occlusive dysfunction: evaluation of short-term and long-term results. The abnormal venous drainage of the penis is an important cause of erectile dysfunction. Until recently the best choice for treatment was the venous surgery. We studied 21 patients submitted to radical vein ligation due to venous leakage. Their age ranged from 27 to 69 years (mean 53 years). A total of 14 patients evaluated after a mean follow-up of 13 months showed a 64% success rate. At a mean follow-up of 25 months the success rate of the 21 patients operated on, decreased to 38%. Therefore, we concluded that in a long-term follow-up the results are not quite satisfactory, which brings us much concern about the efficacy of the operation.


Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats. Termino-lateral neurorrhaphies have been used up to the beginning of this century. After this period, they have no longer been reported. We tested the efficacy of a new type of latero-terminal neurorrhaphy and evaluated the role of the epineural sheath. A group of 10 rats had the fibular nerve sectioned and the distal ending was sutured to the lateral face of the tibial nerve without removing the epineurium. All experiments were made on the right side, the left one remaining untouched in half of the animals of each group. The other half were denervated by sectioning and inverting the endings of the fibular nerves. In this way, tibial cranial muscles were either normal or denervated in the left side and reinnervated through latero-terminal neurorrhaphy in the right side. After 7.7 months, the animals were subjected to electrophysiological tests, sacrificed, and the nerves and muscles were taken for histological exams. A response of the tibial cranial muscle was obtained in 75% of the animals. The distal ending of the fibular nerve showed an average of 498 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (mu 2):841.30 for M2n and 1798.33 for M2d. We concluded that the termino-lateral neurorrhaphy was functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The presence of the epineurium was no impediment to axonal regeneration or to the passage of electrical stimuli.(ABSTRACT TRUNCATED AT 250 WORDS)


Switches in fish myosin genes induced by environment temperature in muscle of the carp. Fish are cold blooded animals and their muscle function is expected to be greatly affected by environmental temperature. Species that live in the Antarctic ocean have evolved a different contractile system to fish that live in the tropical waters. In the case of Antarctic fish they have a higher specific myofibrillar ATPase activity but 'the trade off' seems to be a lower thermal stability. They are thus capable of a greater muscle power output at low temperatures but the lower thermal stability means they are restricted to living at temperatures below +4 degrees C. Some species, however, experience a wide range of seasonal variations in temperature. We found that these species adapt by changing their myofibrillar apparatus so that they have a higher specific ATPase which physiological studies indicate is due to a different type of myosin crossbridge for low temperature swimming. This is reversible and they develop a contractile system with a greater thermal stability and a commensurate loss of ATPase activity when their environment warms up again. There were several possibilities by which this may be achieved including expression of different isoform genes or the post- translational processing of existing proteins. To elucidate the mechanism we made a carp genomic library and screened this for myosin heavy chain gene using mammalian cDNA sequences under moderate stringency conditions. The clones were restriction mapped which resulted in 28 non overlapping sequences. This indicated that the carp had a reasonably large family of myosin heavy chain genes that is about twice the size of that in mammals. Rather fortuitously the first sequence to be identified was from the gene that is predominantly expressed in white muscle at warm temperatures. This was done by extracting the RNA from red and white muscle of fish acclimated to different 25 degrees C, 18 degrees C or 8 degrees C and carrying out Northern analysis using the gene fragment as the probe. The time course for the expression of this gene when carp maintained at a low temperature were acclimated to a warm temperature was slightly in advance of the change in myofibrillar ATPase which suggested that this strategy for adaptation is regulated at the transcriptional level. Hence these species of fish can adapt to seasonal changes in temperature by expressing different myosin heavy chain isoform genes and rebuilding their myofibrils for either warm or cold temperature swimming. At the present time we are characterising the 5' regulatory (promoter) sequence of this gene to see how a temperature switch may operate.(ABSTRACT TRUNCATED AT 400 WORDS)


Gallbladder injuries due to blunt abdominal trauma: report on five cases and review of the literature. Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of São Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature.


cDNA cloning and sequence comparisons of human and chicken muscle C-protein and 86kD protein. Thick filaments in vertebrate striated muscles are composed of myosin heavy chain (MHC) and myosin light chains (MLCs) plus at least eight other proteins: C-protein, 86kD protein (birds) or H-protein (mammals), M-protein, myomesin, titin, MM-creatine kinase, skelemin, and AMP-deaminase. Except for CPK and AMP deaminase, none have well defined functions. Analysis of cDNA clones encoding chicken C-protein and 86kD protein has revealed a high degree of shared amino acid identity, particularly in the C-terminal 40kD. To identify functionally significant regions, the human counterpart of each protein was cloned, sequenced and analysed. Two human C-protein cDNAs were isolated with significant homology to chicken fast C-protein. Clone H75, with 69% identity to chicken fast C-protein, shows the same pattern of hybridization as the chicken fast C-protein in chicken muscles. The other clone, H8 with 60% identity, shows a pattern of hybridization in chicken muscles which is consistent with the expression of chicken slow C-protein. The human 86kD protein shares 66% DNA sequence identity with the chicken 86kD protein. Assuming that essential sequences would be conserved during evolution, we compared the chicken and human proteins using PALIGN. Chicken and human fast C-proteins possess 66% peptide identity over their deduced length plus 10% conservative substitutions. Human slow C-protein and chicken fast C-protein share 44% peptide sequence identity, plus 16% conservative substitutions. Chicken and human 86kD proteins are also very similar: 54% peptide identity plus 20% conservative substitutions. This high degree of sequence identity between chicken and human C- and 86kD proteins suggests selective pressure on the primary sequence. Recent primary sequence analyses of projectin and mini-titins from Drosophila, twitchin from C. elegans, C-protein, smMLCK, 86kD protein, and M-protein from the chicken, titin from the rabbit, and skelemin from the mouse reveals that all these proteins possess multiple internal repeats of approximately 100 amino acids. These repeating domains are of two types: one is homologous to the internal repeats which define the C-2 subset of the immunoglobulin superfamily, the other is related to the fibronectin type III repeat. Both human C-proteins possess comparable internal repeats and preliminary evidence suggests the presence of the same repeats in human 86kD. This duality of repeat structure is found in many extracellular proteins and is typified by the N-CAMs.(ABSTRACT TRUNCATED AT 400 WORDS)


Multiple products of the Duchenne muscular dystrophy gene. The gene which is defective in Duchenne Muscular Dystrophy (DMD) extends over 2300 kb of the X chromosome. Its product in the muscle is a 14 kb mRNA encoding a 427 kd rod-shaped protein called dystrophin. A 14 kb transcript encoding a very similar isoform of dystrophin is produced in the brain. The brain 14 kb mRNA is transcribed from the same gene but controlled by a different promoter, located at least 75 kb upstream from the muscle dystrophin promoter. The regulation of these promoters is very stringently controlled. The muscle-type but not the brain-type dystrophin mRNA is found in cloned skeletal muscle cells and its presence is correlated with the appearance of multinucleated fibers. The brain type is expressed in neurons, while in glia cells the muscle-type promoter is active. A third DMD gene transcript which is only 6.5 kb long has been identified. It contains the sequence coding for the C-terminal domain and the cysteine-rich domain of dystrophin but not the large region encoding the spectrin-like repeats and the N-terminal domain. The cell type distribution of this transcript is also very different from that of the two 14 kb mRNA isoforms. It is the major product of the DMD gene in many nonmuscle tissues including brain. Using monoclonal antibodies we have identified a 77 Kd protein which seems to be the translation product of this mRNA. As expected from the distribution of the 6.5 Kb mRNA, this protein is the major DMD gene product detectable in brain and many other nonmuscle tissues; it is undetectable in skeletal muscle but is present in the heart and stomach (as is the 6.5 Kb mRNA).