[Gonococcal urethritis in men: clinical experience in 1978-1988]. Nine hundred thirty four samples of urethral secretion proceeding from male subjects without previous treatment were analyzed with Gram stain. These subjects consulted in Santiago Western area, and belong to medium and low socioeconomical status. In 82.5% of samples, intracellular gram-negative diplococci were found, that made the presumptive diagnosis of gonococcal urethritis. The importance of direct examination of urethral secretion for the diagnosis and immediate treatment of gonococcal urethritis is emphasized.


[Total congenital absence of left pericardium in 3 cases]. Congenital absence of left pericardium is rare. We report three adult women, mean age 48 years old, in which this diagnosis was confirmed. This condition must be suspected in patients with atypical chest pain, as in 2 of our cases, or in the presence of radiologic cardiomegaly of unknown origin, as in the third case. Physical examination may disclose a left displaced cardiac apex and electrocardiogram a right axis deviation, incomplete right bundle branch block and clockwise rotation. Chest X rays show a left displaced heart with a prominent pulmonary artery and the interposition of pulmonary flap between the aorta and pulmonary artery and between left hemidiaphragm and lower cardiac border. There is an echocardiographic impression of left chamber enlargement and the usual apical, four chamber vision is observed placing the transductor in posterior positions. The diagnosis could be confirmed with computed tomography and magnetic resonance imaging.


[Ovarian cancer and dermatomyositis. A clinical case]. Dermatomyositis (DM) is associated to malignant neoplasia in up to one third of the cases. Not considering breast neoplasia, ovarian cancer is the malignancy most frequently associated with DM in women. This study shows the evolution and outcome of a case of this association managed in our unit. The principal features of similar cases reported in the literature are summarized.


[Tuberculosis of the pancreas, an anatomoclinical case]. A 49 year old "mapuche" male patient was operated on and tuberculosis of the gallbladder was found. Later on, he developed evidence of meningeal and pulmonary involvement and elevated pancreatic enzyme levels. In spite of appropriate anti-tuberculosis therapy, the patient died. Autopsy revealed multiorgan involvement with pancreatic tuberculosis and areas of steatonecrosis. Immune deficiency related to the previous cholecystectomy may have facilitated the severe dissemination of the disease observed in this patient.


[Value of thallium-201 in the non-invasive evaluation of coronary cardiopathy]. Normal myocardial cells actively uptake the radioisotope Thallium-201 and its myocardial distribution is a reflection of the existent regional coronary artery blood flow at the moment of the examination. Thallium-201 reaches quickly a high intracellular concentration and then leaves myocardial cells in a mean time of 4 to 8 h. In the presence of significant coronary artery disease, uptake and elimination rates of Thallium-201 are delayed in ischemic tissue, compared to normal tissue. This leads to regional differences in relative concentrations which allow to identify viable areas with insufficient coronary flow in conditions of vasodilatation induced by exercise or pharmacologic means. This phenomenon does not occur in the irreversibly damaged myocardium, and affected areas fail to uptake the radioisotope. Clinical applications of this test are: 1.--Search for coronary artery disease. 2.--Assessment of patients with known coronary artery disease. 3.--Evaluation of patients after revascularization procedures. 4.--Assessment of coronary risk before peripheral vascular surgery. 5.--Detection of viable myocardium. 6.--Assessment of coronary reserve in patients with angor and normal coronary vessels.


[The fall of the Jericho walls].

[The fall of the Jericho walls]. Archeologic and medical evidence and biblical texts were analyzed in search of support for the hypothesis that the fall of Jerico walls might have been related to an epidemic caused by Schistozoma hematobium. There is evidence of the presence of Balinus trunctus, a snail acting as an intermediary host, but not of the disease itself. However, the hypothesis could still be tenable if all inhabitants left the city, which is suggested by all available evidence. The text in Re 2: 19-22 may not be taken as literary evidence of infection by the agent under discussion.


[Physical work capacity in coal miners and industrial workers]. The aerobic work capacity of 220 coal miners aged 22 to 63 years with a high physical work load and 78 industrial workers aged 19 to 58 years with a relatively light work load was measured to observe if there was a relationship between the work load of these subjects and their aerobic work capacity. All the subjects were subjected to a medical examination, spirometry, chest x Rays and anthropometric measurements. Aerobic work capacity was indirectly estimated extrapolating pulse rates obtained al submaximal work loads in a bicycle ergometer to the calculated maximal cardiac frequency for age. Aerobic work capacity was not different between coal miners and industrial workers, either measured as absolute values (2.43 +/- 0.41 and 2.5 +/- 0.49 l/min respectively) or as relative values (43.2 +/- 6.9 and 43.4 +/- 8.2 ml/kg lean body mass respectively). These values decreased with age in the same proportion in both groups (0.24 l/min per decade). Lean body mass was significantly higher in industrial workers and decreased significantly with age only in coal miners. Considering published energy requirements for mine labors, none of the studied miners should work as digger and a high proportion of the other workers would be exposed to hazardous work loads to their health. The fact that over 50% of these subjects can efficiently fulfill their jobs may indicate that they have a high anaerobic work capacity. This hypothesis needs confirmation with future studies.


[Alcohol and alcoholism: publications in Chilean journals (1950-1989)]. The review of the literature on alcohol and alcoholism published in fifteen wellknown Chilean journals shows an exponential grow of the publications in the period 1950-1989. More than 50% of the 333 articles found has been published in the 80s and 64% were published in only three journals. Biological subjects such as liver alterations induced by alcohol and metabolism of ethanol account for 36% of the papers published in the period of 1950-1989. In spite of the fact that alcoholism in a main health problem in the country, it is striking that only 3.6% of the papers show empiric results of treatment of alcoholics and only few articles dealt with psychological, psychosocial, behavioral and social subjects in relation to alcoholism. Possible reasons for the lack of such studies are difficulties researchers find to have time, funds and facilities to dedicate to research in the institutions they are working on.


[Historic perspective of cardiac catheterization]. In 1929 Forssman introduced a catheter into one of his left forearm veins and advanced it up to the right atrium, opening the possibility of cardiac catheterization in man. Since 1940, right heart catheterization was systematically performed by Andre Cournard and Dickinson Williams and many other researchers who contributed in the following decade with different approaches; at the present time the retrograde access through the femoral or brachial artery is the most widely used. Angiocardiography evolved in different countries between 1929 and 1959. Selective coronary cineangiography, developed by Sones, has been one of the most important advances in this field. Cardiac catheterization has been a valuable tool in cardiovascular research and diagnosis. Moreover, it has contributed to the progress of cardiac surgery and critical care medicine. Lately, it has derived to therapeutic procedures such as coronary angioplasty and percutaneous, dilatation of stenotic heart valves and closure of some congenital shunts. "Interventional catheterization" has become one of the most frequent indications for this procedure as long as many heart diseases are correctly diagnosed by means of non invasive technique.


[Muscular strength: an indicator of nutritional status]. A hand dynamometer was used to measure muscle strength in 207 patients admitted to the Gastroenterology service of a general hospital. Validation of international standards in a normal population of both sexes and different ages revealed that our normals perform at the 25% percentile of international values. Results were correlated with other measurements of nutritional status, namely anthropometric measurements, serum albumin level and tuberculin test. Compared to normals, muscle strength was significantly (p < 0.01) lower in patients with body mass index under 19, cutaneous tricipital folding < 85%, brachial circumference < 85%, and serum albumin < 3.5 g/dl. No difference in muscle strength between tuberculin positive or negative subjects was observed. None of the nutritional parameter was helpful to predict complications in patients submitted to surgery. Thus, muscle strength is a useful parameter to evaluate nutritional status but, similar to other measurements, is not predictive of surgical complications.


[Fascioliasis in populations of rural areas with high prevalence of animal infection]. Between January 1986 and December 1990 the prevalence of F. hepatica infection was studied in 5861 rural inhabitants of the provinces of Curico, Talca and Linares, VII Region, an hyperendemic zone of animal fascioliasis. Every one was screened by intradermal (IDR), complement fixation (CF), double diffusion (DD) counterelectrophoresis (CIEF), immunoelectrophoresis (IEP) and enzyme-linked immunoabsorbent assay (ELISA) tests. 366/1881 (9.3%) had positive IDR; 61 (1.04%) positive CF; 14 (0.24%) positive DD and 105/3838 (2.73%) positive ELISA and thus considered under suspicion to be infected. F. hepatica eggs were searched in stool in 241 of these persons. 37 cases were thus confirmed. Another 4 individuals with positive immunobiological tests and absence of the parasite eggs in stools were confirmed by duodenal intubation. 21 of the confirmed cases (51.2%) had less than 15 years of age. Women were more frequently infected than men (73.2% vs 26.8%). The 41 cases represent 0.7% of the surveyed population predicting 2000 cases among the total rural population of these provinces (300,000 persons). These results indicate that human fascioliasis is an important problem in the zone, perhaps much higher if family contacts of the index cases and symptomatic persons are included.


[Arrhythmogenic dysplasia of the right ventricle: clinical presentation and long-term course]. The clinical findings and follow up in 10 patients with arrhythmogenic dysplasia of the right ventricle were analyzed. Presentation occurred at a mean age of 35 +/- 12(SD) years and all patients presented with ventricular tachycardia and a left bundle branch block pattern. Physical examination was normal. T waves were inverted in right precordial leads in all and late depolarization were seen in 7. Global or segmental dilatation of the right ventricle was shown by echocardiogram in all patients and by right ventricular angiography in 8. After a mean follow up of 6.6 years (+/- 3), 70% had recurrence of ventricular tachycardia in spite of adequate antiarrhythmic therapy. Mortality was only 10%. Surgery was performed in 4 patients. Two patients had focal right ventricular fibrosis and resection lead to cure of arrhythmia.


[Pneumocystis carinii infection. Various aspects on its clinical and laboratory diagnosis]. P carinii is an opportunistic pathogenic agent able to produce severe infection that must be diagnosed promptly. We analyzed 138 samples from 100 patients suspected of having infection by P carinii. The ortho-toluidine blue and the methenamine stains were used to analyze the samples. Infection was demonstrated in 18 patients, 13 adults and 5 children. Underlying disease was AIDS in 7 and other immunosuppressive disorders in the rest. No immunocompetent patient was infected with P carinii. Proper sample collection is important for diagnosis. When bronchoalveolar lavage is not possible, pharyngo-tracheal aspirate in children and sputum sampling after assisted coughing in adults are recommended. At least 2 staining methods and proper controls are advisable.


[Juvenile systemic rheumatoid arthritis and adult-onset Still's disease: comparison of clinical course]. The course of systemic juvenile rheumatoid arthritis (JRA) and that of Still's disease in the adult is unpredictable. The clinical course of 14 patients with JRA and 7 adults with Still's disease 6 months after onset was classified into 4 forms according to the persistence of joint manifestations after the cessation of systemic signs. a) monocyclic systemic form (5 children and 2 adults); b) polycyclic systemic form (3 children and 1 adult); c) monocyclic chronic joint form (3 children and 2 adults) and d) polycyclic chronic joint form (3 children, 2 adults). Seven of the 21 patients (5 children and 2 adults) developed joint sequelae, 5 with the polycyclic chronic joint form and 2 with the monocyclic chronic joint form. None of the patients with systemic forms, mono or polycyclic, developed sequelae. Thus, the course of patients with JRA and Still's disease may be used to predict development of joint sequelae.


[Angiographic findings in non-Q wave infarction and their relation to ST-T changes]. Non q wave myocardial infarction has been attributed to occlusion of a vessel with no ECG representation, early reperfusion of the occluded artery or occlusion of a vessel with generous collateral flow. The coronary arteriography of 84 patients with non Q wave myocardial infarction performed at 16 + 17 (SD) days after infarction was analyzed. Main left lesion was found in 6 (17%), single vessel disease in 30 (36%), two vessel disease in 18 (24%) and 3 vessel disease in 16 (19%). The "culprit" vessel had a critical residual lesion in 38 patients (45%): 22 affected the left anterior descending artery, 10 the circumflex, and 5 the right coronary artery. No residual lesion was found in 10 patients (12%). An occluded artery was found in 32 patients (38%): circumflex in 20, right coronary artery in 9 and left anterior descending in 3 (p < 0.01). Significant collateral flow to the occluded vessel was present in 41% of cases. The ST segment was analyzed in 82 patients. Depression of ST was found in 29 (35%), elevation in 22 (27%), negative T waves in 17 (21%) and minimal alterations in 17%. There was no correlation between ST levels and coronary occlusion of the culprit artery. Depression of ST was more commonly (p < 0.01) associated with severe coronary artery disease (main left or 3 vessel disease), which may be related to the poorer prognosis in these cases.


[Psychiatric patients from general hospitals: pathways followed before consultation]. A survey of all patients who consulted at the Psychiatric Service of a general hospital during a one month period was used to evaluate factors influencing the referral of the patient to the specialist. A preponderance of young females was observed. Patients presenting with somatic symptoms, anxiety or depression were usually referred from another physician, while patients with psychotic disorders and problems related to alcohol abuse were first seen by the specialist. Almost half of the patients had been previously treated, usually with anxiolytic drugs and the median time between the first consult and the referral was 52 weeks. Better systems for derivation of these patients must be developed.


[Antihypertensive effect of isradipine: blood pressure determination with continuous ambulatory monitoring]. A 24 hr blood pressure monitoring system (Medilog ABP) was used to evaluate the efficacy of isradipine, 2.5 mg q 12 hr for 2 weeks, in 26 hypertensive patients. During a pretreatment control period of 4 weeks a diastolic pressure above 95 mmHg on non pharmacologic measures was verified in each patient. A significant decrease in systolic and diastolic blood pressures compared at 2 hr intervals was observed after treatment with isradipine. Treatment was not associated to modification of the circadian rythm in blood pressures.


[Determination of plasma concentration of amiodarone and desethylamiodarone with high pressure liquid chromatography. Preliminary experience]. A simple specific and sensitive high pressure liquid chromatography method (HPLC) to measure amiodarone and desethylamiodarone is described. The plasma sample is deproteinized with acetonitrile and a 50 ul aliquote run in the HPLC system with reverse phase column (C-18). Methanol-ammonium hydroxide is used to separate and spectrophotometric measurements are read at 254 nm.95% of the drug present in plasma is extracted with this method, with a sensitivity of 0.03 ug/ml and a day to day variation under 3%. Preliminary measurements were analyzed in 14 subjects receiving amiodarone for treatment of supraventricular arrhythmia. With a mean dose of 267 +/- 116 (SD) mg/day, plasma levels of 1.3 +/- 0.6 ug.ml for amiodarone and 0.9 +/- 0.5 mg/ml for desethylamiodarone were obtained.


[Treatment of acute secretory diarrhea with casein: an effect of beta-casomorphins?]. A patient with acute secretory diarrhea refractory to conventional therapy received calcium caseinate as sole nutrient, based on the recognized development of constipation and fecaloma in patients receiving this agent. Complete remission of diarrhea followed within 10 days. An inhibition of intestinal motility mediated by B-casomorphins released after hydrolysis of casein in the intestinal tract may be the mechanism involved in this effect. These exorphins have varying effects upon the opioid receptors of the intestinal tract.


[Bilateral Leydig cell tumor].

[Bilateral Leydig cell tumor]. A 7 year old boy presented with bilateral nodular testicular swelling, adult penis development and scrotal aspect. Laboratory studies revealed a bone age of 13 years, increased testosterone, estradiol, DHEA-S, and 17 ketosteroids levels. The GnRH test revealed puberal findings. Biopsy was consistent with Leydig cell tumor with presence of Reinke crystals. After enucleation of the tumor signs of necrosis and malignancy were shown. Orchiectomy will follow as chemotherapy and radiotherapy have been reported to be without value.


[Etiopathogenic factors of arterial hypertension]. High blood pressure of unknown etiology has been related to many pathogenetic factors, mainly dietary salt intake, mental stress, alcohol consumption, sedentary living and aging. Hypertension is more common in condition such as obesity and diabetes mellitus. Sustained elevation of arterial pressure is mediated by vasoconstriction in response to catecholamine release and activation of the renin-angiotensin-aldosterone system. In obese and diabetic subjects, insulin resistance and hyperinsulinemia have been found to be related to development of hypertension. The hypertension phenotype may correspond to many different genotypes codifying various alterations of hormone and receptor function, as well as inherited diseases linked to hypertension. An outstanding epidemiologic example of how hypertension may appear in a community is found in Easter Island. Hypertension among native adults increased from 3 to 30% in a 10 year period, in relation to influx of tourism and changes in salt intake and diet.


[Diuretics and their current role in the treatment of essential arterial hypertension]. Diuretics have been most commonly used to treat hypertension in the last 25 years. Their tolerance is good, they have been effective specially in negroes, older and obese patients and they are relatively inexpensive. The emergence of new and more potent drugs: beta blockers, calcium antagonists, and ACE inhibitors, has led to a decrease in diuretic use. Hyperglycemia and lipid disorders induced by diuretics have been invoked to explain the lack of effect on coronary mortality among treated hypertensive patients. Hypokalemia induced by diuretics has been suspected as the cause for sudden deaths. However, these effects are not sufficiently proven and do not warrant, at present, the elimination of diuretics in the treatment of hypertension.


[Ethical problems related to caring for the dying patient]. A brief historic review of the approach to death in the Western world gives some insight to deal with the ethical problems related to care of the dying patient. Many such patients are currently left without adequate care. After analyzing the psychological phases these patients go through, some recommendations for their care are outlined. The communication of diagnosis and prognosis to the patient is discussed.


[Certification of specialists and their training outside the university]. A better appraisal of the training of medical specialists has been possible since the establishment of the National Certification Board in 1984. Participation of training centers outside the university environment has been considerable. Thus, after certification of the first 4500 medical specialists, it was noted that 7.5 of all applicants and 25% of those applying for official programs have received training in one or more of 137 extra-university programs. The quality and contents of these programs is variable. Their emergence is an inevitable fact derived from shortage of training centers in university teaching hospitals. Some control of these training programs is required to ascertain minimal standards of quality.


[Hospitalization in Chile: a critical analysis]. Main features of hospital stay in Chile are analyzed with special regard to incidence, geographic, sex and age variations, main causes and trends observed in the last decades. The annual admission rate in 1989 was 107 per 1000, twice the overall Latin American rate. Wide variations are observed among geographical areas, with relatively low use of hospital beds in the capital city of Santiago. Hospital needs differ for men and women and according to age, being greater for infants, older people and women of childbearing age. Near two thirds of the needs are related to pregnancy. Admissions for traumatic, digestive, respiratory, urinary and gynecological problems are also frequent. Accidents are the main cause for hospital admission among males, while tumor is foremost among women. During the last 30 years the hospitalization rate has remained stable while the case fatality rate has decreased. Different factors influencing the frequency and features of hospital stay are discussed.


[Chronologic list of the members of the Medical School of the University of Chile (1843-1865)]. The Faculty of Medicine at the University of Chile was started in 1843. Founding professors included Tomas Armstrong, Guillermo C. Blest, Nataniel Cox, Francisco Javier Tocomal, Juan Blest, Julio Lafargue, Manuel Cortés, Luis Ballester. Further nominations, up to a number of 30, took place from 1843 to 1865, and are listed in this paper.


[Paleodemography in mummies of prehispanic populations from Africa]. Mummies' demographic information of 10 prehispanic cultures that developed in the Arica region of Chile about 7000 years ago is analyzed and related to the present population structure. A paleoepidemiological analysis supports a relationship between cultural development and demographic structure. In chronological sequence, 4 demographic patterns can be distinguished: 1) archaic, a mature population with the highest life expectancy and the lowest dependence from prehispanic populations; 2) later archaic, a population in demographic explosion with its larger fraction under 15 years of age, elevated fertility rates and the greatest prehispanic dependence; 3) andean, a transition population with moderate fertility rates and dependence index; and 4) modern, an aging population with the highest proportion over 45 years of age and the highest life expectancy. The present demographic analysis may help to understand the relationships among disease, individual and culture from the perspective of genetic epidemiology.


[The effect of body weight change on cardiovascular risk factors]. Changes in cardiovascular risk factors and body weight were correlated in 568 professional males from 17 to 57 years of age. Measurements of weight, height, body mass index, blood pressure and fasting levels of blood sugar, triglycerides, total and HDL cholesterol were obtained in 1980 and again in 1985. A significant correlation was found between body mass index and blood pressure, total cholesterol, total/HDL cholesterol, HDL cholesterol (p < 0.005), triglycerides (p < 0.001) and blood sugar (p < 0.05). Changes in body weight during the study period were correlated to changes in total cholesterol (p < 0.001), triglycerides (p < 0.05) and diastolic blood pressure (p < 0.005). Thus, obesity is correlated to the presence of cardiovascular risk factors. Its modification may influence development of atherosclerotic cardiovascular disease.


[Effect of octopamine on arterial pressure and renal function in the normal rat]. Octopamine is a beta hydroxylated phenylethanolamine which accumulates in patients with chronic liver damage. A pathogenic role of octopamine in hemodynamic and systemic alterations of advanced liver failure was investigated in normal awake rats. An infusion of octopamine (220 ug/kg/min) was associated with an increase in mean arterial pressure, urinary volume, urinary Na and K output and their filtration fractions. Glomerular filtration rate and renal plasma flow were not affected. A sudden and marked decrease in mean blood pressure and diuresis was observed after stopping octopamine infusion. Findings during the infusion differ from those observed in the hepatorenal syndrome, although the post infusion period was characterized by hypotension and oliguria. Octopamine behaves as a vasoconstrictor and may interfere with the action of physiologic neurotransmitters.


[Persistent microalbuminuria in insulin-dependent diabetics and cardiovascular risk factors]. A possible association of cardiovascular risk factors and early diabetic nephropathy was investigated in 32 patients. Microalbuminuria (radioimmunoassay), total and HDL cholesterol and triglycerides (enzymatic methods), glycosylated hemoglobin (colorimetric methods), Apo A1 and B (immunonephelometric) and LDL were measured. Microalbuminuria was present in 28% of patients. Compared to subjects with no microalbuminuria they had increased levels of cholesterol (200.2 +/- 13.5 (SE) vs 168.6 +/- 9.4 mg/dl, p < 0.025) and LDL cholesterol (171.9 +/- 14.1 vs 137.4 +/- 9.1 mg/dl, p < 0.025). Systolic blood pressure was also higher in patients with microalbuminuria (127.8 +/- 3.9 vs 114.5 +/- 2.8 mmHg, p < 0.01). Microalbuminuria was correlated to the level of diastolic blood pressure (r = 0.74, p < 0.025). Thus, persistent microalbuminuria in insulin dependent diabetic patients is associated to cardiovascular risk factors which may explain the increased cardiovascular morbidity and mortality in these patients.


[Percutaneous aortic valvuloplasty in the adult: immediate results and follow-up of 43 patients]. From June 1986 to June 1991, percutaneous balloon valvuloplasty was performed in 43 patients with severe symptomatic aortic stenosis. Their age ranged from 52 to 81 years (mean 69). The retrograde approach was used in 34 and the transseptal technique in the remaining 9. One patient died from severe tamponade, another developed a large cerebral infarct and the procedure failed in a third. The procedure was considered successful in the remaining 36 patients. Cardiac output increased from 3.5 +/- 0.6 to 4.7 +/- 0.7 l/min, (p < 0.01) and aortic valve area from 0.53 +/- 0.21 to 0.97 +/- 0.2 cm2 (p < 0.01). After a follow up period of 24 +/- 9 months 3 patients, all with initially poor results, died. 10 of 19 patients with adequate initial results experimented a deterioration of functional class. The other 9 patients have preserved the initial improvement obtained with dilatation. Thus percutaneous aortic valve dilatation in adults with severe aortic stenosis is risky and of limited clinical value.


[Peptic ulcer and endoscopic signs of portal hypertension in patients with primary biliary cirrhosis]. Controversies exist on the prevalence of peptic ulcer and on the relationship between the presence of portal hypertension associated lesions in the upper gastrointestinal tract and the histological and functional stages of primary biliary cirrhosis To evaluate the prevalence of peptic ulcer and endoscopic signs of portal hypertension in subjects with primary biliary cirrhosis. A retrospective study based on upper gastrointestinal endoscopies in 36 patients with primary biliary cirrhosis and 45 subjects with chronic active hepatitis. Gastroenterology Center, Hospital Clínico, University of Chile, Santiago. No differences were demonstrated between the two groups for the prevalence of peptic ulcer (11% in primary biliary cirrhosis vs 13% in chronic active hepatitis). Esophageal varices were found in 5 of 16 patients (31%) in prefibrotic stages of primary biliary cirrhosis compared with 10 of 20 (50%) in whom fibrosis or cirrhosis were noted; NS. Endoscopic signs suggesting hypertensive gastropathy were present in 2 patients with early primary biliary cirrhosis (13%) and in 5 (25%) in advanced stages. Peptic ulcer is not more prevalent in patients with primary biliary cirrhosis than in those suffering from chronic active hepatitis. Esophageal varices and endoscopic stigmata of portal hypertension induced changes in gastric mucosa can be observed in early stages of primary biliary cirrhosis.


[Immunologic study of lymphoproliferative diseases]. Thirty six patients with stage IV lymphoproliferative diseases, were studied with a panel of monoclonal antibodies. There were 26 B-Lymphoproliferative Diseases (BLD): 11 B-chronic lymphocytic leukemia, 15 B-cell non Hodgkin lymphoma and 10 T-Lymphoproliferative Diseases (TLD): 4 T-cell non Hodgkin lymphoma, 4 adult T-cell leukemia/lymphoma, 1 T-chronic lymphocytic leukemia and 1 Sezary Syndrome. HLA-DR and CD 19 (B4) were the most common antigens found in BLD. CD4 + CD8 was the most common phenotype in TLD. 13 out of 26 BLD and 1 out of 10 TLD, patient were alive at the end of a 4 year observation period. Our study shows that immunophenotyping is a very useful diagnostic test in lymphoproliferative diseases. Along with cytology and histopathology, it can better define different pathologic groups and lead more specific treatments.


[DDD dual chamber pacemakers. Initial experience]. Our preliminary experience with dual-chamber DDD pacemakers is reported. Technological innovations of the device, atrio-ventricular electrode stability and sequential stimulation have contributed to improve the conditions of patients previously submitted to VVI pacemaker implantation. Primary indications for DDD pacemaker implantation in our series included 7 patients with complete atrio-ventricular (A-V) block, 3 with Mobitz type II second-degree A-V block and 2 with sick sinus syndrome. In six of the 12 patients (50%) additional indications included: ventricular tachycardia in 4 patients, atrial fibrillation in one and pacemaker syndrome in one. Other cardiac conditions were diagnosed: dilated cardiomyopathy in 3 patients, ischemic heart disease in 2 patients, valvular heart disease in 2 patients, congenital heart disease in 1 patient and hypertrophic cardiomyopathy in one patient. The implanted pacemakers were: 5 Genesis, 4 Ultra CPI and 3 Versatrax. J-shaped atrial electrodes were used in 8 patients and in 4 instances a screw-in electrode was employed. Improvement of hemodynamic function was achieved by frequent follow up and reprogramming of DDD pacemaker in every patient. While 4 patients died with progressive deterioration of cardiac function, eight patients survived with adequate sequential stimulation. We conclude that DDD pacemakers are reliable and afford symptomatic relief in a broad spectrum of patients.


[Infective complications of the use of permanent central venous catheters in oncology]. We analyzed the infectious complications associated with the use of permanent central venous catheters (PVC) in pediatric and adult cancer patients. 62 patients used 74 PVC (54 external, 20 subcutaneous), which were in place for an average of 200 days with a total observation period of 14,876 days, 152 febrile episodes occurred during this period, 87 in neutropenic patients (less than 500 neutrophils/mu, FN+) and 65 in non neutropenic patients (FN-). The incidence of bacteremia was 32% in febrile episodes in the first group (FN+C+ and 41% in the second (FN-C+). Overall there were 3.7 episodes of bacteremia per 1000 catheter days. We found a statistically significant difference in the incidence of bacteremia between the external and subcutaneous PVC in favor of the latter among patients over 15 years of age but not in the pediatric group. 14 PVC had to be removed due to an infection, 8 in patients with bacteremia and 6 in patients with exit site infections. We conclude that the use of PVC in the care of cancer patients is beneficial and safe, with a low incidence of infectious complications.


[Acalculous acute cholecystitis caused by Cryptosporidium in a patient with AIDS]. We report a patient with the acquired immunodeficiency syndrome who developed acute cholecystitis. Removal of the gallbladder revealed infection by Cryptosporidium spp. The clinical course after cholecystectomy was favourable. The pathogenesis and therapy of this complication in patients with AIDS is discussed.


[Tungiasis. A clinical case].

[Tungiasis. A clinical case]. A 22 year old Chilean male presented with necrotic lesions of the 5 toes of the right foot and the heal of the left foot. He had spent 7 months traveling in the Amazona region of Brazil. Surgery was performed to clean the areas where eggs of Tunga penetrans were identified.


[Migraine caused by ergotamine tartrate dependence]. A 37-year-old patient had migraine without aura over a six year period. He developed tolerance and dependency to ergotamine tartrate defined as the irresistible and dependable use of the drug. This is contingent upon a self-sustaining, rhythmic headache/medication cycle. The diagnosis of this entity is clinical and is supported by the typical and expected evolution of the migraine in response to the sudden interruption of ergotamine tartrate use.


[Drugs and porphyric crisis].

[Drugs and porphyric crisis]. Life threatening crisis may accompany some varieties of porphyria like the acute intermittent form, coproporphyria, porphyria variegata and that associated to deficiency of porphobilinogen synthetase. Drugs are commonly involved as precipitating factors. A classification of drugs according to their proven or probable triggering effect is offered in this paper. Insufficient information precludes the classification of some drugs.


[The need for national transfusion services]. Continuing advances in medical and surgical treatment have resulted in increasing demands for blood and blood derivatives. In most developed countries and in many developing ones, the blood transfusion services are organised centrally either as National Blood Transfusion Services or under the auspices of organisations such as the League of Red Cross or Red Crescent Societies. Centrally organised services have been shown clearly to be superior to hospital based transfusion services. Although hospital based services may be a convenient alternative under certain circumstances, in most cases there is inefficient use of resources and difficulties in setting, achieving and enforcing quality standards. This is so particularly in developing countries. The need to change from a remunerated or replacement donor system is emphasised, with the ultimate goal being national self-sufficiency in blood and blood derivatives. Attention is also drawn to the importance of education and motivation of staff working in the blood transfusion services if these objectives are to be met.


[Medicine as narrative].

[Medicine as narrative]. This is and address delivered by the author on being elected Member of the Chilean Academy of Letters. It develops the notion of medicine as a metatext composed by different "texts": the physiological, the introspective and the behavioral. Each of these narratives derives its meaning from the "context" provided by the others and is articulated differently according to the social roles allotted to the participants in communicative transactions. Medicine, as communicative praxis, is a science of actions rather than objects which can be understood as process, procedure and product. In the light of these concept the distinction between illness, disease and sickness receives a new emphasis.


[Teaching of psychiatry for undergraduates]. This paper postulates that Psychiatry does not fit in the group of the so called medical specialties. It should rather be recognized as a 5th basic clinical discipline if the graduating general practitioner is to cope effectively with the community's health needs. The methodology of natural sciences has prevailed in the teaching of undergraduate medicine, the human being considered mostly as an organism with somatic aspects. To improve upon this situation, rather than introducing humanistic courses, the multidisciplinary team of the Psychiatry Department should teach "Basic Psychiatry" and "Pre-clinical Psychiatry" programs. A list of the proposed contents is included and methodological aspects are discussed.


[A 2-year follow-up of a program for the control of cardiovascular risk factors among asymptomatic workers]. In 1987, a cardiovascular risk profile was obtained on 836 workers of the National Electricity Co in Santiago. There were 714 males and 125 females, the mean age was 45 years (ES +/- 0.3). Hypertension (systolic pressure > 160 or diastolic > 90 mmHg) was present in 17% of subjects, hypercholesterolemia (> 240 mg/dl or > 220 mg/dl associated to 2 other risk factors) in 17%, obesity (> 20% above ideal weight) in 33% and 29% were smokers. An advice to stop smoking, changes in the casino menu and hypertension, obesity and hypercholesterolemia's control programs were offered. These were attended by 108 hypertensives, 141 subjects with hypercholesterolemia and 104 obese individuals with an attendance rate of 64%, 75 and 77% respectively. Measurements repeated 2 years later revealed a reduction in diastolic pressure of 3.3 +/- 1.1 mmHg (p < 0.004) only in adherent subjects. Cholesterol levels were reduced by 24 +/- 3 mg/dl (p < 0.001) with no differences for non participants, adherent and non adherent subjects. Adherent obese subjects reduced their weight by 2.2 +/- 0.4 kg (p < 0.001). There was no change in the number of smokers.


["Revista Médica de Chile": 120 years (July 1872-July 1992)]. The "Revista Medica de Chile" founded in 1872 is the second oldest medical journal in Latin America after the "Gaceta Medica de Mexico" (1864). Among medical journals in the world it is placed 24. It has been published monthly without interruption, except for the period January through December 1891, due to the revolution taking place at that time. The first Editor was German Schneider, a German physician from Bonn who came to Chile in 1850 with the immigrants that settled in the South.


Embryonic recapitulation, coenogenesis and heterochrony. An attempt at a comparative analysis of the relationships between embryogenesis and evolution. The relationships between embryogenesis and the scale of living beings have been the subject of long-dated observations. It is well known that Haeckel, going back and codifying this data, has divided it into two large groups called palingenesis and coenogenesis. He has only mentioned the concept of heterochrony to which we give much more importance nowadays. We will look over these questions and link them up with some aspects of modern genetics.


Neuronal growth and the Steiner problem. In this paper we conjecture that neuronal networks develop following an optimality principle. We point out that a neuronal outgrowth in culture may be seen as the solution of a classical optimization problem: the "Steiner Problem". A neuron might grow minimizing a "cost", which may be determined by the viscoelastic properties of the neuron cytoplasm. We then discuss the role of chemiotactic factors such as the Nerve Growth Factor (NGF) in an optimized neuronal development in vivo. Finally we suggest, with some mathematical arguments, that the optimization of the elastic forces in the growing neuron may give rise to a "fractal" structure.


Cellular and molecular regulation of odontogenesis. Developing mammalian tooth is one of the most interesting model systems to study the mechanism of morphogenetic process especially to understand problems associated with spatial organization and symmetry. In the present article we recapitulate the morphologic aspects of odontogenesis and discuss the cellular and molecular regulatory factors involved in this process. The importance of cellular aspects such as epithelial-mesenchymal interactions and the cell kinetics are described. Role of growth factors such as Transferrin, Epidermal Growth Factor and its receptor and Transforming Growth Factor is analyzed. In addition the studies on transcription factors such as c-fos and Egr-1 and on homeobox genes are discussed to understand the molecular mechanism of odontogenesis.


An experimental test of the hypothesis of formative causation. The hypothesis of formative causation predicts that as animals of a given species learn a new pattern of behaviour, other similar animals will subsequently tend to learn the same thing more readily all over the world, as a result of a process called morphic resonance. The more that learn it, the easier it should become for others. This possibility was tested with day- old chicks using a simple learned response, a conditioned aversion. The test took place in the laboratory of Steven Rose, a sceptic, following a standard procedure used routinely in his laboratory, and was carried out blind by a summer student who knew nothing of the purpose of the experiment nor of morphic resonance. The chicks were exposed either to a test stimulus, a small yellow light-emitting diode (LED), or a control stimulus, a chrome bead. Half an hour after pecking the stimulus, the control chicks received an injection of saline solution, and the test chicks an injection of lithium chloride, which made them mildly sick. They were then tested three hours later, each chick being exposed sequentially to the control and the test stimulus, when most test birds were averse to pecking the yellow LED, but not averse to pecking the control bead. The response of the chicks was measured by recording the latency, the time delay in seconds before they first pecked the stimulus. The same experimental procedure was repeated for 37 days. If morphic resonance were occurring, successive batches of chicks should have shown an increasing aversion to the yellow LED, even in the initial training procedure, by morphic resonance from their averse predecessors. The controls should have shown no such increasing aversion. I think the results are consistent with such an effect, which shows up with a high degree of statistical significance (p < 0.01) when the aversion to the yellow bead is measured relative to the control. Rose disagrees with this interpretation.


Adopting the primary health care approach in malaria control in Malaysia: lessons in community participation. The Primary Health Care approach in Malaysia was first tried out in Sarawak, East Malaysia in 1982. In 1984, the Vector Borne Disease Control Program, Kelantan decided to adopt the Primary Health Care approach as an additional strategy in its effort to control malaria in the state, which then experienced an increase in malaria cases. Much effort was directed at creating the awareness and stimulating the interest of health staff and communities to adopt the strategy. Kelantan was made the model state. The paper gives an outline of the process involved and some characteristics of PHC workers. A study was carried out among health workers, community members and health staff on their knowledge and involvement in PHC in three states, including Kelantan. In view of the overall success of this approach, and the weaknesses which have been identified possible solutions have been suggested and should be acted upon.


The role of community participation in the malaria control program in Indonesia. An operational field trial on community-based malaria control efforts in West Timor, one district in Indonesia, had been implemented since 1987. The trial investigated the utilization of Posyandu cadres in case finding and treatment of malaria. From this trial it appears feasible to utilize these cadres for malaria control. Efficacy of cadres in case finding and treatment of chills and fevers surpassed all expectations.


The role of community health workers in malaria control in the Philippines. The barangay health workers (BHWs) or government-trained health volunteers have been operating in rural villages in the Philippines since 1981. Although malaria is a consistently recognized health problem, the BHWs do not contribute optimally to control activities even in endemic areas. This is so because of inadequate training, insufficient logistic support, poorly sustained motivational schemes and lack of community support. Prospects for involvement in malaria control are numerous, however there is need to enhance the existing BHW Program.


Community participation in the malaria control program in Thailand: a review. The focus of this paper is on community participation in the Thai Malaria Control Program. Two projects concerned are reviewed. First, the Village Voluntary Malaria Collaborator Program has been established for case detection. Second, the Village Malaria Self-Reliance Project aims at malaria prevention. Both projects have been able to get community participation at a certain level. The success of the projects depend on the community, the structures of the projects and the malaria situation in the communities.


Risk behavior in malaria in Malaysia.

Risk behavior in malaria in Malaysia. The risk behavior in malaria has been identified as one of the factors contributing to malaria in Malaysia. The occurrence of malaria among illegal immigrants and indigenous groups, staying in risk prone areas where conditions are favorable for transmission, highlights the behavior pattern of these groups. In these areas the usual anti-malarial activities are less effective and thus there is a need to identify control measures suited to that particular condition and environment and to community groups. Some of the determinants contributing to the increase in malaria cases like man-vector contact, non-compliance to drugs, complications of the disease, and factors interfering with malaria control measures, factors favoring transmission and proposals to modify risk behavior, which can be applied in an endeavor to control the diseases, have been discussed.


Malaria-related social and behavioral risk factors in Thailand: a review. A review of the social and behavioral risk factors that have been implicated in malaria infection in Thailand was done as a basis for designing a conceptual framework in formulating recommendations of strategies and research needs to ensure better implementation and/or maximization of the effectiveness of existing malaria control measures in the country. These factors can be broadly divided into three categories: (1) social and behavioral risk factors favoring increased occurrence and transmission, ie population movements, irregular use or non-use of mosquito nets, partial or non-conformance with residual DDT house spraying, etc, (2) behavioral risk factors predisposing to occurrence of severe and complicated malaria, not clearly known, probably delayed treatment, (3) behavioral risk factors related to occurrence of drug resistance, ie treatment-seeking patterns, practices of drug utilization and population movements. Recommendations on research needs as well as strategies for a more effective control program are given.


Community participation and malaria control in Southeast Asia: defining the principles of involvement. Primary health care requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate.


The output and outcome of two types of formal health structures--health post and creche--for nutritional interventions for preschool children in two urban, low-income communities of Belo Horizonte, Brazil (1986). In order to observe the nutritional and health status of pre-school children, the output and outcome of two formal health services -health post and creche- for this vulnerable group in two urban slum areas of Belo Horizonte, Brazil were studied in 1986. A total of 420 children were surveyed, 254 children randomly selected from the communities and 156 from three creches. Growth monitoring was not undertaken systematically, and mothers did not have growth control charts. When a child had diarrhea, mothers preferred to apply home remedies or to buy proprietary drugs rather than to consult medical personnel. 72% of mothers reported using ORT, and 11% suspending feeding completely. After three month of life, 50% of infants were receiving some breast milk. 75% of children were immunized completely. The prevalence of health and nutrition indicators such as anemia (50% vs. 30%), parasitosis (87% vs. 70%), and stunting (28% vs. 20%) was worse in the creches than in the communities.


[Relation of fat consumption to colorectal cancer mortality in a Venezuelan population]. Epidemiologic and experimental studies have pointed to an association between fat intake and colorectal carcinogenesis. In the present work we have studied the correlation between fat intake and mortality caused by colorectal cancer in the venezuelan population. For this purpose, we have calculated the correlation coefficients between the ingestion of total fat, visible fat (vegetable oil, margarine, butter, mayonnaise) as well as non-visible fat (that contained in other foods) and the mortality rate by colorectal cancer with data from nine venezuelan states and geographical regions. The highest lipid consumption and mortality rates were observed in the more developed states. There was a positive and significant correlation between total as well as visible fat consumption and colorectal cancer mortality (r = 0.756 p < 0.02, and r = 0.958, p < 0.001; respectively). In contrast, there was no significant correlation between the consumption of non visible fats and colorectal mortality (r = 0.543, p < 0.05). More than 80% of the visible fats ingested in Venezuela are constituted by vegetable oil and margarine, which contain a high proportion of polyunsaturated fatty acids. Based on the above, is possible to infer that colorectal carcinogenesis in Venezuela is associated to the uptake of unsaturated fat, and that measures leading to the prevention of this disease should be based on the reduction in the consumption of total and unsaturated lipids.


The nutritional status of Guaymi Indians living in Chiriqui province, Republic of Panamá. Guaymi Indian children have recently been identified as a population group who are at risk for vitamin A deficiency with numerous cases of xerophthalmia with ocular perforation being reported. A four-day parasitological and nutritional clinic based survey was conducted with 335 Guaymi women and children in the towns of San Felix and Alto Caballero to identify the prevalence of parasitic infections and factors associated with malnutrition. A subsample of 79 children, under 19 years of age, from independent families was constructed for the current analysis. The results of the study indicated that 20% of the children had a plasma vitamin A concentration less than 20 micrograms/dl. Significant associations were identified between ascariasis, age, a food diversity score and vitamin A concentrations. Other indicators of nutritional status were also negatively associated with intestinal parasitic infections, and a modernization index, using multivariate regression analysis. In conclusion, this study identified several factors associated with poor nutritional status that can be used by health officers to identify Guaymi children at risk for malnutrition.


[Personnel standardization in clinical diagnosis of goiter: how to evaluate agreement among thyroid examiners?]. The use of the t Student and Cochran tests to evaluate central tendency measures, as well as the F test to evaluate variability and correlation analysis, have been incorrectly used for the evaluation of concordance between thyroid examiners. This paper presents the intraclass Kappa test (Bloch & Kraemer, 1989), as well as the experience of its use in Central America to standardize thyroid examiner personnel who participated in national surveys carried out during 1990 to determine goiter prevalence.


[Effect of nutrition on the functional capacity of a group of elderly Spaniards]. The present study analyzes the influence of the nutritional status on the functional capability of 11 institutionalized elderly living in Madrid (Spain). Nutritional status was evaluated by dietetic, anthropometric, hematological and biochemical data and functional status was evaluated considering adiposity, strength in hands and legs bent and stretched and flexibility. The most important nutritional problems that conditional functional wastages are obesity, hypercholesterolemia and protein and micronutrient deficiency. The adverse influence of obesity and hypercholesterolemia on the functional capacity of the elderly is shown by the inverse relationship between flexibility and strength in hands and legs with the adiposity degree, with the thickness of skin folds and the cholesterolemia. In reference to the diet's influence, there are positive correlations between food intake and most of the nutrients with hand and legs strength, and there are statistical significances for proteins, iron, zinc, magnesium and pyridoxine, and also for vitamin C, niacin, thiamin, folic acid and vitamin E. For blood values, the mayor correlation exists between functional parameters and iron, ferritin and vitamin C levels. Our results contribute to confirm the influence of nutrition on the functional capacity of the influence of nutrition on the functional capacity of the elderly and manifest the necessity of improving the elderly's diet, to prevent micronutrient deficiency and also the necessity of increasing their physical activity. Both measures will mean an important help for sanitary and functional improvement of the elderly.


[Content and bioavailability of carotenoids from peach palm fruit (Bactris gasipaes) as a source of vitamin A]. Four introductions of ripe peach palm fruit (Bactris gasipaes) were analyzed for ether extract, total carotenoids and their biological conversion into vitamin A. Also, edible portion in cooked fruit was estimated. Ether extract content in raw fruit ranged from 8.2 to 12.9% dry basis (DB), cooked between 5.7 to 12.4% DB and nutrient retention after cooking was 69 to 100%. Carotenoids content in raw and cooked pejibaye was similar, 4.8 to 29.6% DB and 4.8 to 29.9% DB, respectively, giving a nutrient retention after cooking greater than 85%. Average edible portion was 68 +/- 2%. The biological study showed significant differences (p < 0.05) of pejibaye carotenoids efficiency conversion in retinol, the values varied from 14 to 50%. Food efficiency results in the control and experimental diets were not statistically significant (p > 0.05). Carotenoids content was inversely related (r = -0.8, p < 0.02) with ether extract. Cooking had no significant effect in ether extract and carotenoids content, except in one introduction. Based in the results generated in the study and vitamin A Recommended Daily Allowances (RDA) it was estimated that one, in three introductions and seven in the remaining one satisfies an adult RDA's.


[Effect of the sorghum extraction process on the color of the flour and tortillas made from mixtures with lime-treated cornmeal]. The objective of this work was to study the effect of the extrusion process in the color of instant flours and its tortillas prepared with mixtures of commercial instant corn flour. In the extrusion process four flours from two genotypes of sorghum (whole and decorticated sorghum of each genotype) were used. These flours were processed in a single screw Brabender laboratory extruder. In the preparation of sorghum tortillas and sorghum-corn tortillas four flours were selected from the extrusion process. 1) genotype CMSXS 9A: Whole flour extruded with moisture content of 15% and screw rate of 130 rpm, flour from decorticated sorghum with particle size less than 0.420 mm extruded with moisture content of 15% and screw rate of 130 rpm, 2) genotype CMSXS 145: whole flour extruded with moisture content of 18% and screw rate of 170 rpm, decorticated sorghum flour extruded with moisture content of 15% and screw rate of 130 rpm. Also these flours were utilized with mixtures of commercial instant cornflour for the preparation of tortillas. The instant sorghum flours and tortillas from decorticated sorghum (20% = presented whiter color compared to instant whole sorghum flour and its tortillas. The addition of different levels of commercial instant corn flour (10, 20, 30, 40 and 50%) to the instant sorghum flours improved the color of the mixtures of flour and tortillas. This improvement was more pronounced with instant sorghum flour from whole sorghum grain.(ABSTRACT TRUNCATED AT 250 WORDS)


[Physical and chemical properties and correlations of early hybrid corn for high valleys]. The evaluation of physical and chemical properties of corn kernels permits the obtaining a wider vision of the experimental hybrids that present good yield and suitable agronomic characteristics. The objectives of this paper were: to classify 24 modern hybrids of early corn according to endosperm texture and to determine their physical and chemical properties and their relationships. The physical parameters tested were: test weight (TW), endosperm texture (TE), pearling index (IP), 1000 kernel wt (W 1000), infrared reflectance (NIR) and color (Ref). The chemical parameters tested were: protein content (Prt), lysine content (Lis) and tryptophan content (Trp). When the hybrids were classified according to IP it was possible to detect 5 hybrids with soft, 12 intermediates and 7 with hard endosperm. The hybrids with hard endosperm presented an average TW of 80.3 Kg/hl, 10.70% of Prt, 0.082% of Trp and 0.35 of NIR, these values were statistically higher than those hybrids with soft endosperm; the IP showed a negative relationship with Prt, NIR and TW; a positive relationship was observed with Ref, meaning that corn grains with soft endosperm presented lower protein content and smaller average flour particle size, larger size grain and whiter color. It was possible to detect hybrids with yields from 8.1 to 9.5 t ha-1 with soft, intermediate and hard endosperms.


[Incidence of Fusarium toxins in corn and milling byproducts]. The incidence of Fusarium toxins-trichothecenes and zearalenone in 100 samples of whole grains as well as their distribution in the by-products (arising of 32 whole corn samples) of the wet-grinding of corn were studied, the samples coming from the central and northern areas of the Santa Fe Province, Argentina. The analyses were carried out by thin-layer chromatography. A 33% of the samples was found to be contaminated by deoxynivalenol (DON), its amount ranging from traces to 1,200 micrograms/Kg; 15% of the samples contained T-2 toxin from 900 to 2,400 micrograms/Kg and only traces of zearalenone were detected in one sample. Only few samples (7%) included diacetoxiscirpenol (DAS), nivaleno (NIV) and neosolaniol (NS) and 7% of the samples evidenced contamination by more than one mycotoxin. It is worth noticing that DON was found to be contaminating only those by-products destined to human consumption. Conversely, T-2 toxin was found in by-products destined to both human and animal consumption.


[Production of a carp-based hamburger-like product by reducing the water activity]. The experimental conditions were determined in order to conserve lean fish by means of combined factors based on Aw and pH reduction as well as the addition of an antifungal. Theoretical Aw was determined in formulas containing fish, sodium chloride, glycerol and sorbitol applying a mathematic model. From the results of the prediction, 4 formulas were prepared experimentally with (Cyprinus carpio). Phosphoric acid was added to the products in order to obtain a 5.5-6.0 pH. The final formulas were packed in plastic bags and stored with a control product (100% carp pulp) at 25 +/- 2 degrees C and 38 +/- 3% R.H. during one month. Aw, water content and pH determinations were carried at weekly intervals. Results indicated a slight but significative (P < 0.025) lowering of Aw, water content and pH. Microbiological analysis showed an increase in MAB count with no growth of pathogens. A control product (100% carp pulp) was deteriorated in a five day period. Sensory evaluation of the products indicated a slight acceptance among an inexperienced panel.


[Current status of analytical methods for measuring provitamin A]. The difficulties inherent to provitamin A determination and the present state of development of the analytical methodologies are appraised. The procedures, the advantages and disadvantages and the possible sources of error of the methods involved are discussed. Open-column methods are still the most viable option in developing countries but the efficiency and reproducibility of the chromatographic separation depend largely on the analysts skill and experience. Although HPLC chromatograms are highly reproducible, the problem is to transform the peak areas to provitamin A concentrations because of the instability, varying purity and unavailability of provitamin standards. Internal standardization with the stable Sudan appears to be a promising solution. Separation of cis-isomers requires rechromatography in open-column systems. For HPLC, this problem still remains to be solved. Confirmation of the identity of the provitamins and prevention of degradation during the analysis are also dealt with. Notwithstanding the obstacles involved, reliable data can be obtained with adequate application of the analytical techniques and proper interpretation of the results.


[Characteristic, composition, and cheese-making behavior of goat's milk]. Up until now, the composition of goat's milk has not been well known. However, every day it is more and more evident that this milk is quite different from cow's and other mammal's milk. This difference depends on a major concentration in some of milk elements. Caseins, in goat's milk are found in a minor concentration (their inner components have, besides, different relative proportions). On the other hand, non-proteinic nitrogen, calcium and phosphorus exist in a major concentration and biggest micellar size in goat's milk than in other milks. All these goat's milk qualities result in a different physicochemical composition which explains some of its characteristics and its very particular technological behaviour. They prevent, also, our associating goat's milk to cow's milk, as it has been done until recently.


[Physical, technological, and protein characteristics of wild and cultivated beans (Phaseolus vulgaris L.)]. The main purpose of this work was to observe and compare some physical, technological and proteinic characteristics of four bean seed cultivars developed in Mexico, eight wild bean seed accessions collected in Mexico and four wild bean seed accessions collected in South America. All of them belong to the species Phaseolus vulgaris L. In the South American materials the seed size was very similar (mean = 10.4 g/100 seeds). Nevertheless the water absorption was variable 36-64%, the percentages of seed coat and solids were statistically alike, the protein content range varied from 23.8 to 27.2% d.b. In the Mexican wild beans were found the smallest seeds (2.8 g/100 seeds) and those in which the water absorption percentage was very small. These two variables were correlated (r = 0.83**); they have the biggest amount of seed coat and during cooking lose a small quantity of solids. The protein content range was 21.3-24.6%. The lysine quantity was low. The cultivated material had the best physical and technological characteristics, but the average protein content of the group (X = 22.3%) was the lowest, the lysine and tryptophan amounts were 1.14 and 0.36%, respectively. The linear regression coefficient between cooking time and the percentage of cooked seeds was different in the members of each group. After 200 minutes only 85% of the South American accessions were cooked, whereas in the wild Mexican accession 153 only 40% was cooked; accessions 147, 148, 153 and 175 represented a group with long and irregular cooking time; accessions 631, 882, 900 and 939, likewise the cultivated materials Bayomex and Negro Puebla were 100% cooked in 140 minutes. Jamapa needed only 100 minutes in order to be completely cooked.


[Selenium, an essential and toxic element. Latin American data]. After a brief discussion of some of the aspects of importance, sources, deficiencies and excesses of selenium the great differences of ingestion between different countries are mentioned. Breast fed children from an area in Venezuela ingest 10 times the amount compared with children from Finland. Among sesame seed samples from 20 different countries used as Se indicators, the highest and the lowest values were found in those of Latin-American origin. With very few exceptions the highest and the lowest urinary and serum Se levels reported in the literature came from this region. The performance of more studies in Latin-America on Se is recommended. Urinary excretion and analysis of finger nails or egg-white of freely foraging hens could be used as suitable indicators.


[The cholesterol profile in the city of São José do Rio Preto]. To analyze: a) the cholesterol profile in adults older than 29 years, from São José do Rio Preto (300,000 inhabitants), city located in one of the country's richest regions; b) the variables that correlated with cholesterolemia. An specialized firm was hired, and data was obtained through quantitative research, where a survey was done, using a sample stratified by sex and age; the error limits admitted was +/- 4%, for a 95% confidence interval, and Reflotron was utilized for cholesterol measurements. It was studied 672 persons (47% men), with mean age of 47.15 +/- 12.28 years; 35% were between 30 and 39 years, 25% between 40 and 49.22% between 50 and 59, and 18% were 60 or more years old. Thirteen variables were compared with cholesterolemia through simple regression; following, six of them, selected as predictors by stepwise regression, were compared with cholesterol through multiple regression analysis. a) Cholesterol levels: 192.5 +/- 48.9 mg/dl on global average, with 187.6 +/- 53.3 for men and 196.8 +/- 44.2 for women (p = 0.01, 95% CI 2.3 to 17.1); 176.5 +/- 44.7 mg/dl for people > or = 30 < 40 years old, 191.3 +/- 51.7 for those > or = 40 < 50 years (p = 0.002, 95% CI 4.6 to 24.2), 206.8 +/- 44.4 for those > or = 50 < 60 years (p = 0.005, 95% CI 4.6 to 26.4), and 208.5 +/- 47.8 for those > or = 60 years (p = 0.765,95% CI 9.5 to -12.5); 62% of the population showed < or = 200 mg/dl, and 16% > or = 240; b) through simple regression analysis, significant correlations were found between cholesterolemia and: age (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.001) arterial pressures, diet (any, the great majority hypocaloric, p = 0.001), height (inverse correlation, p = 0.003), and female gender (p = 0.011); under multiple regression analysis, significant correlations were found for age (p < 0.001), educational level (p < 0.001), systolic arterial pressure (p < 0.001), weight (p = 0.004) and height (inverse correlation, p = 0.012). In the population older than 29 years, from São José do Rio Preto: a) the mean cholesterolemia is 192.5 +/- 48.9 mg/dl, being significantly higher for women, in relation to men, and showing significant increases between 3rd, 4th and 5th decades of life; b) correlated significantly with cholesterolemia, through simple regression analysis: age, systolic and diastolic arterial pressures, diet, height (inverse), and female gender; under multiple regression analysis: age, educational level, systolic arterial pressure, weight and height (inverse).


[Valvular surgical treatment concurrent with myocardial revascularization]. To study the morbidity and mortality due to valvar surgical treatment performed concomitantly to myocardial revascularization. From 1650 patients submitted to mitral or aortic valve surgical treatment, 103 (6.24%) had it associated to myocardial revascularization. Coronary insufficiency was associated to aortic valvar lesion in 66 (64.0%) patients, group I, with mean age of 62.3 +/- 8 years; and in 37 (35.9%) patients with mitral valve lesion, group II, with mean age of 57.8 +/- 5.8 years. Diagnosis was based upon the anamnesis, physical examination and confirmed by cine-coronarographic findings. I-Complications at the immediate postoperative; a) mortality 11 (10.6%) patients, 6 (9.09%) from group I: by low cardiac output 3, uncontrolled arrhythmia 1, mediastinitis 1; acute infarction with cardiogenic shock 1, and 5 (134.5%) of group II: uncontrolled hemorrhage 2, sudden death 1, saphenous vein graft occlusion, respiratory insufficiency and sepsis 2; b) controlled intercurrences that increased the time of hospitalization: mental disorder 5 patients; CVA 7, diabetes decompensation 2, worsening of chronic renal insufficiency 1, upper level digestive hemorrhage 1 and respiratory insufficiency 3 patients. II-late postoperative complications of 77 (83.6%) patients which could be followed up during a period of 60 months: 1) mortality: 3 (3.89%) patients; 2 due to cardiomyopathy and 1 by acute myocardial infarction; 2) late evolution-functional capacity III (NYHA) by cardiomyopathy 6; I/II 68 patients; mild angina 6 patients, 2 underwent revascularization at the end of final 36-42 months. The clinical improvement and mortality indexes statistically similar to the isolate surgical acts stimulate us to keep up with such associate procedures.


[Supraventricular tachycardia due to retrograde decremental conduction over accessory pathways]. To discuss the clinical and the electrophysiologic findings, the differential diagnosis and the behaviour of concealed retrograde long conduction time accessory pathways. Seventeen patients were submitted to electrophysiologic study using programmed electrical stimulation of the heart to assess the electrophysiologic properties of the accessory pathway. In all 17 studied patients, it was possible to advance the next atrial activation by giving a ventricular premature beat during the refractoriness of the His bundle. Of 17 patients, 7 developed signs and symptoms of heart failure (tachycardia-induced cardiomyopathy) due to the presence of incessant tachycardia. Eight patients were cured surgically and 1 underwent DC catheter ablation of the AV node. Six patients were successfully treated with antiarrhythmic drugs, one die of cancer and one still presents incessant tachycardia. The electrophysiologic study is essential for the differential diagnosis of the supraventricular tachycardias with a R-P' interval longer than P'-R interval where the incidence of tachycardiomyopathy is high in this group of patients. Surgery provides definitive cure of those patients leading to the regression of the signs and symptoms of heart failure.


[The late results of fulguration of the atrioventricular node using high-energy shocks in patients with supraventricular tachycardias]. To evaluate the long-term efficacy and safety at long term after atrioventricular junction fulguration (complete AV block induction, using high energy shocks, to control drug-resistant supraventricular tachyarrhythmias. Twenty-eight patients, 17 (60.7%) men, with mean age 48.1 years, were submitted to one up to six ablation sessions with high energy shocks. The total delivered energy per patient was 1304 +/- 868 J. Each shock ranged from 100 to 400 J. After 12 months, at least, 60.6% of patients were in complete atrioventricular block; three (10.8%) were asymptomatic without complete AV block, and in five (17.8%) the ablation was unsuccessful. AV junction ablation with high energy shocks is safe and efficient in long-term follow-up.


[Primary angiosarcoma of the right atrium with a patent foramen ovale and severe hypoxemia]. A 19-years-old female with a primary right atrial angiosarcoma partially obstructing the tricuspid valve, developed severe hypoxemia due to right-to-left shunting through a patient foramen ovale. This is the first report of such clinical situation with this type of tumor. A complete resection of the tumor was attempted, and the right atrium had to be rebuilt with a bovine pericardium patch. Post-operative cranial, thoracic and abdominal CT scans and bone scintigraphy did not show metastatic spread. Chest radiation therapy was started on the third postoperative week. Chemotherapy was not used. The patient died five months after surgery due to disseminated metastatic disease but no evidence of the tumor was found in the necroscopic study of the heart.


[A congenital arteriovenous fistula between the subclavian artery and vein. Its successful surgical correction in an infant]. The case of an asymptomatic 6-month-old boy, first seen due to a right arm edema is described. A continuous murmur heard at the right infraclavicular area, cardiomegaly plus increased flow to the lungs on the chest X-ray were associated with an isolated right subclavian artery-to-vein fistula diagnosed at angiography. Successful ligation of the fistula was done at operation with normalization of the arm circumference and heart size on the chest X-ray at 4 years follow up.


[Transluminal coronary angioplasty combined with cardiomyoplasty in the treatment of coronary disease associated with dilated cardiomyopathy]. A 53-year-old white female candidate to cardiomyoplasty to control heart failure class III (NYHA). Submitted to coronary angioplasty, presented at the coronarography 75% obstruction of the left anterior descending (LAD) artery and at the left ventriculography diffuse and severe hypocontractility ejection fraction (EF) = 17%. After primary success of the coronary dilatation, she was operated on with a good surgical outcome. Six months after the surgery, she did well clinically (class II) and at the coronarography the LAD artery presented free from restenosis or progression of the disease and the left ventriculography showed improvement of the ventricular function (EF = 28%).


[Captopril in the treatment of patients with congestive heart failure. Its bicycle ergometry evaluation]. To analyze the physical performance of the patients with congestive heart failure (CHF), grades I and II of the New York Heart Association (NYHA), submitted to ergometric test: 1) under conventional treatment with digitalis and diuretic; 2) with an angiotensin converting enzyme inhibitor, captopril, associate with conventional treatment; 3) using captopril associated with digitalis or diuretic. A randomized double blind study was performed in 20 patients with CHF (I and II-NYHA) submitted to ergometric test in different therapeutic phases. The initial workload was 5 watts and load was increased until the appearance of limiting symptoms. The introduction of captopril to the conventional treatment for CHF or associated with digitalis or diuretic promotes significant increase in the duration of the physical exercise, in the oxygen consumption and in the total workload during the ergometric test. In the initial forms of CHF, captopril provides better physical performance when compared with conventional treatment and the diuretic treatment can be changed for the angiotensin converting enzyme inhibitor with equal efficacy.


Renal botryomycosis.

Renal botryomycosis. A case of visceral botryomycosis which arose in the left kidney of a 60-year-old woman is reported. This is the fifth reported case of renal botryomycosis which, in this patient, was mistaken clinically for a renal carcinoma. The lesion was composed of confluent abscesses containing 'sulphur granule-like' lesions in which irregularly lobed aggregates of Gram-negative organisms surrounded by an eosinophilic capsule were noted. Awareness of this unusual lesion is important because of its histopathological similarity to actinomycosis.


Reconstitution of agonist-stimulated phosphatidylinositol 4,5-bisphosphate hydrolysis using purified m1 muscarinic receptor, Gq/11, and phospholipase C-beta 1. We describe the reconstitution using purified proteins of the m1 muscarinic cholinergic pathway that activates phosphatidylinositol 4,5-bisphosphate-specific phospholipase C via the G protein Gq/11. Recombinant m1 muscarinic receptor was co-reconstituted in lipid vesicles with either hepatic Gq/11 or with cerebral alpha q/11 and beta gamma subunits. The rate of [35S]GTP gamma S binding to the reconstituted vesicles was stimulated 20-50-fold by agonist. Maximal receptor-catalyzed binding was 7 mol of GTP gamma S bound per mol of receptor. The m2 muscarinic receptor was a poor activator of Gq/11. The binding of [alpha-32P]GTP to [gamma-32P]GTP to m1/Gq/11 vesicles indicated that the receptor could maintain up to 40% of the total coupled Gq/11 in the GTP bound state. The rate of hydrolysis of bound GTP, 0.8 min-1, is consistent with the rate predicted from the GTP binding data but is 3-5-fold lower than rates reported for other trimeric G proteins. Agonist-stimulated photo-affinity labeling with gamma-(4-azidoanilido)-[alpha-32P]GTP indicated that the receptor catalyzed binding to both alpha q and alpha 11 with about equal efficiency. Receptor-catalyzed activation of Gq/11 by GTP gamma S, measured as the ability to activate purified phospholipase C-beta 1, paralleled receptor-catalyzed [35S]GTP gamma S binding. Co-reconstitution of receptor, Gq/11, and phospholipase C-beta 1 restored GTP gamma S-dependent carbachol-stimulated hydrolysis of phosphatidylinositol 4,5-bisphosphate. The m1 receptor, Gq/11, and phospholipase C-beta 1 are thus sufficient to initiate the hormonal inositol trisphosphate/diacylglycerol signaling pathway without additional proteins.


Recurrent tonsillitis. The role of Chlamydia and Mycoplasma. The core tissue microflora of 40 patients who underwent tonsillectomies were examined with cultures, DNA probe tests, enzyme immunoassays, and direct immunofluorescence antibody tests for Chlamydia and Mycoplasma. We believe this is the largest and most accurate prospective study that has examined the role of Chlamydia and Mycoplasma in the core tonsil tissue of patients with recurrent or chronic tonsillitis. The data strongly indicate that, unlike acute tonsillopharyngitis, Chlamydia and Mycoplasma are not involved in recurrent or chronic tonsillitis.


Effect of adenosine triphosphate on the postischemic left ventricular function of the immature myocardium. In this study, the effect of exogenous adenosine triphosphate (ATP) on the immature myocardium was evaluated. Isolated working neonatal rabbit hearts were perfused aerobically for 15 min with Krebs-Henseleit buffer (KHB) at 37 degrees C, and then arrested with St. Thomas solution (STS) in group 1 and STS containing 500 mumol/L of ATP in group 2 at 4 degrees to 6 degrees C and maintained at 10 degrees to 14 degrees C for 60 min. Hearts were reperfused with KHB aerobically at 37 degrees C for 15 min. Each heart served as its own control before and after arrest. Systolic function was significantly depressed in group 1 compared with group 2. There was a significant decrease in the peak left ventricular (LV) systolic pressure in group 1 (preischemia mean [PIM] 54 mm Hg to postischemia mean [PoIM] 42 mm Hg, Student's t test p = 0.007) than in group 2 (PIM 66 to PoIM 62 mm Hg, p = 0.5). The LV pulse pressure decreased in group 1 (PIM 72 to PoIM 54 mm Hg, p = 0.02) but not in group 2 (PIM 84 to PoIM 86 mm Hg, p = 0.9) and the rate of rise of LV pressure (dP/dT) in group 2 improved (PIM 5718 to PoIM 6926 mm Hg, p = 0.4) compared with group 1 (PIM 7021 to PoIM 4125 mm Hg, p = 0.008). The PoIM LV flow (LVF) was greater in group 2 than group 1 (LVF group 1 = 2.7 ml/min, group 2 = 4.5 ml/min). Diastolic pressures were not significantly different in the two groups. Our findings suggest that the incorporation of ATP in STS has a significant effect in improving postischemic LV systolic function in neonatal rabbit hearts.


Mucin-positive epithelial mesothelioma.

Mucin-positive epithelial mesothelioma. Mucin-positive epithelial mesothelioma is a rare, frequently unrecognized entity that should not be misinterpreted as metastatic adenocarcinoma, as each is associated with differing treatment and prognosis. Presented herein is a case of an acidic and neutral mucin-positive papillary mesothelioma of the right pleura, with cytologic, histologic, histochemical, immunohistochemical, and ultrastructural evaluation.


Experimental embolic capture by asymmetric Greenfield filters. An uncommon complication of percutaneous insertion of the titanium Greenfield filter is angulation at discharge with clustering of the limbs to one side of the vena cava. Potential adverse effects of this asymmetry were tested in a perfusion system with cadaver venae cavae. The stainless-steel Greenfield filter (SGF) was compared with the modified-hook titanium model (TGF-MH) and a percutaneous modified-hook model of the SGF (SGF-MH) with flexible plastic emboli in four sizes and varied sequences. There were 458 runs comprised of 2203 embolic events, with an overall successful capture rate of 81% despite tilting, asymmetry, and accelerated flow rates from 1.0 to 2.5 L/min. Significant differences were observed in vena cava with diameters greater than 22 mm where capture rate was 76% as opposed to 86% in venae cavae less than 22 mm (p = 0.01). Larger emboli (8 x 25 mm and 8 x 100 mm) were trapped uniformly, whereas smaller emboli (5 x 10 mm) had 59% capture (p = 0.001). Similarly, the capture rate was less when smaller emboli were released before the larger ones (71% vs 87%; p = 0.001). Capture in small versus large venae cavae was not significantly different for the SGF (75%) or TGF-MH (84% vs 87%) but differed for the SGF-MH (98% vs 67%; p less than 0.001). Logistic regression was used to develop a mathematic model for interaction of the variables and determined two first-order interactions: caval size and limb position and caval size and type of filter.(ABSTRACT TRUNCATED AT 250 WORDS)


Distribution and characterization of endozepine-like immunoreactivity in the central nervous system of the frog Rana ridibunda. The localization of endozepine-like immunoreactivity in the brain of the frog Rana ridibunda was investigated by indirect immunofluorescence, using an antiserum against synthetic rat octadecaneuropeptide (ODN). A specific immunoreaction was detected in ependymal cells lining the ventricular system of the brain and in circumventricular organs. Numerous immunoreactive cells were found covering the walls of the lateral ventricles in the telencephalon, as well as in the diencephalic and mesencephalic ventricles. In the hypothalamus, both the preoptic nucleus and the infundibular region showed numerous immunopositive cells. Ependymal cells lining the rhomboencephalic fourth ventricle and the central canal of the spinal cord were also immunoreactive. The concentration of endozepine-like immunoreactivity was measured in various regions of the brain using a sensitive and specific radioimmunoassay for rat ODN. The highest levels of ODN-like immunoreactivity were found in the infundibulum, cerebellum and preoptic area. Reverse phase high performance liquid chromatography and radioimmunoassay quantification were used to characterize endozepines in the frog brain. The elution profiles of the different brain regions revealed four major immunoreactive peaks. The present results demonstrate the presence of peptides immunologically related to the endozepine family in the central nervous system of the frog. The localization of immunoreactive endozepines in ependymal cells suggests that these peptides play important neuromodulatory functions in the amphibian brain.


Systemic lupus erythematosus valve disease by transesophageal echocardiography and the role of antiphospholipid antibodies. The aims of this study were to better characterize valve disease in systemic lupus erythematosus and to determine its association with antiphospholipid antibodies. Estimates of the prevalence of valve disease in systemic lupus erythematosus have been higher in autopsy series than in clinical studies using transthoracic echocardiography. Antiphospholipid antibodies have been suggested to be a primary pathogenetic factor. Transesophageal echocardiography was performed on 1) 54 patients with lupus erythematosus, 22 of them with (group I) and 32 without (group II) antiphospholipid antibody; 2) on 10 patients with antiphospholipid syndrome (group III); and 3) on 35 normal subjects (group IV). Patients in groups I and III had similar types and concentrations of antibodies. Leaflet thickening was found in 50% of group I, 47% of group II, 10% of group III and 9% of group IV patients (group I or II vs. group III or IV, p < 0.03). Leaflet thickening in patients with lupus erythematosus was diffuse; it usually involved the mitral and aortic valves and was associated with valve regurgitation (73%) or valve masses (50%). Valve masses were observed in 41% of group I, 25% of group II, 10% of group III and in none of group IV patients (group I or II vs. group IV, p < 0.002). Most valve masses in patients with lupus erythematosus were located near the base on the atrial side of the mitral valve or on the vessel side of the aortic valve, had variable size (0.2 to 0.85 cm2), shape and echodensity. Valve regurgitation was observed in 64% of group I, 59% of group II, 10% of group III and 20% of group IV patients (group I or II vs. group III or IV, p < 0.006). Moderate or severe regurgitant lesions were noted in 27% of group I and 25% of group II patients. Lupus erythematosus valve disease is frequent (74%) regardless of the presence or absence of antiphospholipid antibodies. Therefore antiphospholipid antibodies may not be a primary pathogenetic factor. The characteristic appearance of leaflet thickening and masses in patients with lupus erythematosus may be unique.


Improved method for coliphage detection based on beta-galactosidase induction. An improved method for coliphage detection based on the induction of beta-galactosidase in Escherichia coli is described. Upon infection by coliphages, the cells are lysed and a stable indolyl product that is dark blue becomes visible within each plaque. The improved method is compared to the proposed coliphage detection procedure described in Standard Methods for the Examination of Water and Wastewater.


Endoscopic balloon dilation of esophageal strictures following surgical anastomoses, endoscopic variceal sclerotherapy, and corrosive ingestion. Between 1987 and 1991, endoscopic balloon dilation was performed for esophageal strictures which developed after operation in 28 cases, after sclerotherapy in 9 cases, and after corrosive injury in 8 cases, for a total of 45 cases. The locations of stricture were upper third in 20 cases, mid-third in 2 cases, and lower third in 23 cases. The stricture appeared clinically 1 to 3 months after esophageal injury. Endoscopic follow-up interval was 1 week. A total of 136 dilations were done in these 45 patients with an average of 2.6 times/case (range, 1 to 8). The result of dilation was good in 9 cases, improved in 18 cases, slightly improved in 15 cases, with only 3 cases having no response. The follow-up period was 2 years on average (range, 0.5 to 4 years). The data suggest that endoscopic balloon dilation is a safe, effective, and easy method for the management of esophageal stricture caused by surgical anastomosis, sclerotherapy, and corrosive injury.


Nurse-physician collaboration: solving the nursing shortage crisis. The current severe nursing shortage in the United States has many causes and its solution requires new strategies. Collaboration among the American Association of Critical-Care Nurses (AACN), the Society of Critical Care Medicine (SCCM) and the American College of Cardiology (ACC) has provided a model for the multidisciplinary approach needed. Nurse-physician collaboration is an important strategy to address the ongoing shortage.


Transesophageal echocardiography: normal variants and mimickers. An accurate diagnosis of cardiac pathology using TEE is contingent upon the ability to recognize and differentiate normal cardiac structures and normal variants from pathologic conditions. We describe several normal cardiac structures commonly imaged using TEE of the atria, interatrial septum, aorta, valves, and extracardiac spaces that may mimic diverse pathologic states, such as intracardiac tumor and thrombus, valvular vegetations, mitral and tricuspid valve prolapse, atherosclerotic plaque, and aortic dissection. Methods to aid in the differentiation of normal cardiac structures from pathology are offered.


Effect of OK-432 on cytotoxic activity in cancer patients without tumor burden. The present study was designed to determine the optimal therapeutic protocol for OK-432, a streptococcal preparation, and to clarify the kinetics of various immunological parameters following intracutaneous administration of OK-432 in 39 disease-free postoperative patients with early cancer. These patients were randomly divided into 4 groups according to the dose (1KE or 5KE) and the frequency of administration (one or 3 times every other day) of OK-432. NK activity 3-4 days after the first injection increased significantly in patients whose pretreatment baseline activity was below the lower level of normal values (60 LU) in all study groups (P < 0.05). The elevation of post-therapeutic NK activity lasted for 2 weeks in the group of patients given repeated injections. The serum content of cytotoxic activity against L-M cells increased significantly after the injection of OK-432 at doses of more than 5 KE doses (p < 0.05). These findings suggest that repeated injections of OK-432 over a period of a week have important immunotherapeutic results.


[The effect of bretylium tosylate on ventricular arrhythmias in patients with acute myocardial infarction]. Sixty three patients with the acute myocardial infarction, aged between 34 and 85 years, admitted to the Intensive Cardiological Care Unit during the first 12 hours following the infarction were randomly divided into two groups. Patients of group I (20 subjects) were treated with nitroglycerin and additional intravenous infusions of bretylium tosylate in the dose of 5 mg/kg administered every 6 hours for 48-72 hours. Patients of group II (33 subjects) were mainly treated with intravenous nitroglycerin. A type and incidence of the ventricular arrhythmias, conduction disorders in AV node, and hemodynamic complications were analysed during the first 72 hours. It was found that bretylium tosylate reduces the incidence of ventricular arrhythmias accompanying myocardial infarction but after 2-3 hours following its administration (p < 0.05). Therefore, bretylium tosylate should be administrated to patients with the acute myocardial infarction in combination with other rapidly acting anti-arrhythmic drug. Bretylium tosylate increases also the effectiveness of electric defibrillation in patients with ventricular fibrillation or ventricular tachyarrhythmia. No evidence of the effectiveness of bretylium tosylate on atrio-ventricular conduction and hemodynamic complications of myocardial infarction was found.


Cloning of GT box-binding proteins: a novel Sp1 multigene family regulating T-cell receptor gene expression. Analysis of a T-cell antigen receptor (TCR) alpha promoter from a variable gene segment (V) revealed a critical GT box element which is also found in upstream regions of several V alpha genes, TCR enhancer, and regulatory elements of other genes. This element is necessary for TCR gene expression and binds several proteins. These GT box-binding proteins were identified as members of a novel Sp1 multigene family. Two of them, which we term Sp2 and Sp3, were cloned. Sp2 and Sp3 contain zinc fingers and transactivation domains similar to those of Sp1. Like Sp1, Sp2 and Sp3 are expressed ubiquitously, and their in vitro-translated products bind to the GT box in TCR V alpha promoters. Sp3, in particular, also binds to the Sp1 consensus sequence GC box and has binding activity similar to that of Sp1. As the GT box has also previously been shown to play a role in gene regulation of other genes, these newly isolated Sp2 and Sp3 proteins might regulate expression not only of the TCR gene but of other genes as well.


New, potent kainate derivatives: comparison of their affinity for [3H]kainate and [3H]AMPA binding sites. Newly synthesized kainate derivatives, 4-(2-hydroxyphenyl)-2-carboxy-3-pyrrolidineacetic acid (HFPA and 4-(2-methoxyphenyl)-2-carboxy-3-pyrrolidineacetic acid (MFPA), were potent inhibitors of [3H]kainate binding to the rat spinal cord synaptic membranes, comparable in their effectiveness to kainate and domoate, whereas acromelic acid A (ACRO-A) and B (ACRO-B) was much less effective than kainate. ACRO-A, MFPA and HFPA all inhibited [3H]AMPA binding. These novel kainate analogues provide new pharmacological tools for analyzing the mechanisms underlying activation of kainate/AMPA receptors.


Methyl 1,2,4,5,6,10b-hexahydro-8,9-methylenedioxy-2- oxobenzo[d]cyclopenta[b]azepine-4-carboxylate. The title compound contains the tetracyclic A-B-C-E ring system of cephalotaxus alkaloids. Unexpectedly, the five-membered-ring plane is twisted 67.2 degrees from the aromatic ring plane and, like cephalotaxine, the seven-membered ring is oriented in a boat form with the nitrogen at the prow.


C9 conformation of N-(N alpha-[(tert.-butyloxy)-carbonyl]-L-alanyl)-N,N'-dicyclohexylu rea in solid and solution. An X-ray diffraction study was carried out on a single crystal of N-(N alpha-[(tert.-butyloxy)-carbonyl]-L-alanyl)-N,N'-dicyclohexylur ea belonging to the tetragonal space group P4(1)2(1)2, having cell dimensions a = b = 10.102(3) A, c = 46.067(7) A, V = 4701.2 A3, Z = 8. The crystal structure was solved by direct methods and refined to an R value of 0.056 for 1602 unique reflections with I greater than 2.5 sigma(I). Crystal structure analysis shows the presence of an intramolecular N-H ... O=C H-bond stabilizing the molecule in a folded form similar to that of a beta turn, forming a nine-membered ring. IR and 1H-NMR studies in CDCl3 solution confirm the stable folded conformation found in the crystalline state, as well as the existence of N-H ... O=C H-bonds in the title compound, as in peptides.


Preparation of 17 alpha-iodoethynylandrosta- and 17 alpha-(2-iodoethenyl)androsta-4,6-dien-17 beta-ol-3-ones as active site-directed photoaffinity ligands for androgen-binding proteins. Unsaturated analogues of androst-4-en-17 beta-ol-3-one, each with a 17 alpha-iodoethynyl or 17 alpha-(2-iodoethenyl) substituent, were prepared, and their relative binding affinities (RBAs) for androgen-binding protein (ABP) were compared with those of 5 alpha-androstan-17 beta-ol-3-one, androst-4-en-17 beta-ol-3-one, androsta-4,6-dien-17 beta-ol-3-one, and androsta-1,4,6-trien-17 beta-ol-3-one. These binding studies indicate that the iodine[125I] analogues of 17 alpha-iodoethynyl and 17 alpha-[(E)-2-iodoethenyl] derivatives of androsta-4,6-dien-17 beta-ol-3-one and androsta-1,4,6-trien-17 beta-ol-3-one will have RBAs at least twice as great as that of 5 alpha-androstan-17 beta-ol-3-one. They can be prepared from 17 alpha-ethynylandrosta-4-en-17 beta-ol-3-one, the final synthetic step using N-[125I]iodosuccinimide, and are potential radioiodinated, active site-directed photoaffinity ligands for ABP and testosterone-binding globulin.


[Studies on the chemical constituents of Cornus officinalis Sieb et Zucc]. A new bisiridoid glucoside named cornuside was isolated from the fruits of Cornus officinalis Sieb et Zucc. The structure of cornuside has been established by spectroscopic methods (IR, MS, 1HNMR, 13CNMR).


Physiological, biochemical and molecular mechanisms of salt appetite control by mineralocorticoid action in brain. Adrenocortical hormone effects in the central nervous system depend on steroid interaction with intracellular receptors, which belong to a superfamily of ligand-activated transcription factors. Using a combination of biochemical and molecular biology techniques, we have demonstrated: 1. the localization of mineralocorticoid receptors in the brain, with highest density present in hippocampus, lateral septum and some amygdaloid nuclei; 2. the arousal of a mineralocorticoid-specific behavior such as salt appetite, coincident with inhibition of the biosynthesis/activity of (Na+K)ATPase in some amygdaloid and hypothalamic nuclei; 3. the modulation of the biosynthesis/activity of the sodium pump by glucocorticoids, although for these hormones changes are stimulatory, as shown in the spinal cord and brain; 4. the reported steroid effects on the (Na+K)ATPase constitute an important mechanism of control of nervous system function, involving behavior, changes in excitability and neurotropism.