Changes in phospholipase A2 in myometrium of the guinea pig uterus during pregnancy.

Phospholipase A2 activity has been measured in membrane and cytosolic fractions from non-pregnant and pregnant guinea pig myometrium has been studied. Enzyme activity was measured with 1-stearoyl-2- [3H]arachidonoyl-phosphatidylcholine exhibiting Michaelis-Menton kinetics with Km of 83.8 +/- 21.6 and 53.2 +/- 14.1 for membrane and cytosolic enzymes respectively. Fractionation of the myometrium from non-pregnant guinea pigs suggested that 35% of the activity was membrane associated compared with 20% (P < 0.01) in tissue from pregnant animals. In the presence of 1 mM calcium total activity rose from 3.03 +/- 0.41 to 1737 +/- 368 nmol/h per uterus between non-pregnant and late pregnancy. Calcium activated the membrane enzyme, but the effect was greater late in pregnancy with almost a 6-fold increase in activity at 1 mM calcium compared with a doubling in membrane from non-pregnant guinea pigs. The K0.5 for calcium activation was about 150 microM. Immunoblotting with anti-human-110 KDa phospholipase A2 showed in guinea pig uterus a 34 KDa form of the enzyme that, consistent with changes in activity, showed a fifteen-fold increase in quantity between non-pregnant and late pregnancy. The data are consistent with dramatic increases in the capacity for arachidonic acid release and prostaglandin production in the guinea pig myometrium late in pregnancy.


45Ca-efflux in embryonic chick heart and its modification by caffeine and ryanodine.

Ontogenic changes in the kinetics of exchangeable cellular calcium were studied in embryonic (ECV) and post-hatch (PHCV) chick ventricular tissue by monitoring 45Ca-efflux. The isolated whole ventricle (5 & 7 days ECV) or ventricular strips (12 & 18 days ECV and 1-2 days PHCV) were "loaded" with 45Ca (37 degrees C) and then passed through a series of tubes containing efflux solution (4 degrees C) to determine 45Ca-efflux. Curve 'peeling' of the efflux curve indicated existence of 3 kinetically distinct components of exchangeable cellular Ca2+ compartments: C1, C2 & C3. The size of C1, which was the largest in 5 & 7 days ECV decreased significantly to become minimum in 18 days ECV & PHCV. The rate constant of this compartment, however, reduced with the age of the embryo. In contrast, the size of C3 increased with the embryonic development to become the largest in 18 days ECV & PHCV. An increase in the rate constant of this compartment was also observed during embryogenesis. The size and rate constant of C2 remained unaltered during development. However, the increase in size of C3 during embryonic development indicates differentiation of Ca2+ storage sites, like sarcoplasmic reticulum (SR), during the later stages. Caffeine (10 mM) and ryanodine (10 microM) enhanced fractional escape rate during slow phase (ie 120-180 min) of efflux at all developmental stages. The magnitude of enhancement increased during later stages of development indicating greater prominence of SR with the age of embryo.(ABSTRACT TRUNCATED AT 250 WORDS)


The effect of maternal undernutrition on the growth and development of the guinea pig placenta.

Fetal growth is known to be correlated with the size of the placenta and the exchange surface area. Reduction in the growth of the materno-fetal exchange surface areas may be a mechanism by which the effects of maternal undernutrition on fetal growth are mediated. In the compact placenta of the guinea pig the exchange surface is equivalent to the peripheral labyrinth. The effect of a 40% reduction in maternal feed intake on the growth of the peripheral labyrinth was investigated in pregnant guinea pigs between gestational days 25 and 65. Fetal and placental weights were significantly reduced in the last trimester by 32% and 38% respectively (P < 0.01). Placental efficiency in early gestation was significantly impaired in restricted animals but equivalent to ad lib. fed controls by the last trimester. The volume of the peripheral labyrinth increased as a percentage of the total placental volume with gestational age. Restricted placentae tended to be composed of a smaller volume of peripheral labyrinth tissue in early gestation. It is suggested that maternal undernutrition results in an impaired or delayed expansion of the peripheral labyrinth in early gestation causing a reduction in placental efficiency. By the last trimester the weight of the peripheral labyrinth of restricted animals was reduced by 33% (P < 0.05). The weight of the peripheral labyrinth was also significantly correlated with fetal weight is limited by the size of the peripheral labyrinth in the later stages of gestation.


The effects of maternal undernutrition on maternal and fetal serum insulin-like growth factors, thyroid hormones and cortisol in the guinea pig.

The insulin-like growth factors (IGF-I and -II) are potential mediators of the effects of maternal undernutrition on fetal growth and muscle development. The effects of a 40% reduction in maternal feed intake on serum levels of the IGFs, the thyroid hormones and cortisol, were investigated for the last two trimesters (day 25 to birth). This level of undernutrition is known to cause a 35% reduction in fetal and placental weights, and a 20-25% reduction in muscle fibre number. Maternal IGF-I level was greater than non-pregnant levels on day 25 gestation, in both control and restricted dams, and declined with gestational age. The increase in IGF-I level in the 40% restricted group was approximately two-thirds that of control animals. Fetal serum IGF-I was also reduced in undernourished fetuses throughout gestation. Maternal IGF-II did not change with gestational age and was unaffected by undernutrition. Fetal IGF-II reached a peak at day 55 of gestation, this peak was greatly diminished by maternal feed restriction. Both IGF-I and IGF-II tended to be related to fetal, placental and muscle weights at day 65 of gestation. Thyroid hormone concentration declined in maternal serum and increased in fetal serum with increasing gestational age. Levels were not significantly affected by undernutrition. Both triiodothyronine (T3) and thyroxine (T4) were correlated with IGF-I in maternal serum (P < 0.05), but not in fetal serum. Cortisol levels were elevated by undernutrition in both maternal and fetal serum, and increased with gestational age. Cortisol was inversely correlated with serum IGF-I in both maternal and fetal serum. Maternal serum IGF-I may mediate the effects of undernutrition on fetal growth by affecting the growth and establishment of the feto-placental unit in mid-gestation. Fetal IGF-I may mediate the effects on muscle growth, whereas IGF-II seems to be related to hepatic glycogen deposition. Cortisol may play a role via its effect on the IGFs, but the thyroid hormones are unlikely to be important until the late gestation/early postnatal period.


Hemoglobin H disease in children.

One hundred and ten children with hemoglobin H (Hb H) disease who attended the hematology unit of the Department of Pediatrics at Songklanagarind Hospital from 1982 to 1988 were studied. Hb Constant spring (Hb CS) was found in 55 patients. Four patients, two with Hb CS, were diagnosed during the newborn period. Anemia and jaundice were the main symptoms in three neonates, while the fourth one was found to have anemia with hepatosplenomegaly. Nine infants were diagnosed in the first year of life with the chief symptoms of anemia with or without fever. Two of them needed blood transfusions. Hb H was found in only three infants, while Hb Bart's was the constant finding in every infant. The Hb H children with Hb CS had a more severe clinical course than the group without Hb CS. The levels of Hb at steady state were found to be lower and the reticulocyte counts, red cells with inclusion bodies and Hb H were higher in patients with Hb CS. The clinical picture of acute hemolysis in Hb H children can be found in the neonatal period and the difference in clinical severity between the two genotypes of Hb H disease seems to develop from the first year of life.


Evaluating the UVA protection of commercially available sunscreens.

Because the protection factor of sunscreens concerns only UVB protection, usually only a little is known about the protection offered in the UVA range. Photoprotection against ultraviolet A (UVA) by five commercially available sunscreens and their components was evaluated in humans, with erythema and pigmentation used as end points. Because UVA-induced tanning obscures a UVA-erythema, quantitative analysis of UVA-erythema cannot be used as the end point in this study. All products provided low UVA protection factor (1.02-1.9). The sunscreen which contain 3 per cent Parsol 1789 was the most effective product and significantly better than the other (p < 0.0001).


Transvaginal sonographic features in ectopic pregnancy.

A retrospective review of the transvaginal sonograms of 37 women with confirmed ectopic pregnancy was performed to characterize the findings from transvaginal sonography and correlate operative findings with sonographic features. Thirty-six of the 37 ectopic pregnancies were tubal pregnancies. Intrauterine findings showed an absence of gestational sac in all cases and a pseudosac in 1 case (7.14%). An ectopic gestational sac with a live embryo was documented in 2 cases (5.41%) and with embryo or yolk sac in 6 cases (16.22%) and nonspecific adnexal mass in 30 cases (81.08%). Fluid in the cul-de-sac was found in 22 cases (59.46%). Transvaginal sonography provides better access to the pelvic organ and allows a clear view of the uterus and adnexa, with no need to fill the bladder. Excellent visualization of the endometrial cavity permits the detection of even a very early intrauterine pregnancy and clearly shows the gestational sac where it is outside the uterine cavity. Blood and other fluids in the cul-de-sac can also be seen easily. This technic has reduced patients' risk by minimizing delay in diagnosis and treatment.


High-frequency flow interruption in the rescue of preterm infants with severe RDS.

High-frequency flow interruption (HFFI) was used successfully to rescue three preterm infants with severe respiratory distress syndrome (RDS) whose clinical condition continued to deteriorate while on the conventional mechanical ventilation. Had the HFFI not been used, the survival chances might have been 25 per cent for Case 1 and 2, and 45.5 per cent for Case 3. A dramatic, immediate, and sustained improvement in ventilation and oxygenation was demonstrated once the critical frequency and amplitude of HFFI were established. Bronchopulmonary dysplasia which was already evidenced in one infant before the HFFI attempt was detected in two infants. This study demonstrates that HFFI is capable of achieving adequate gas exchange and improving survival in infants with severe RDS.


Intradermal simulated rabies postexposure prophylaxis using purified chick embryo rabies vaccine.

The antibody responses of 65 volunteers receiving an i.d. regimen (0.1 ml given at two different sites on days 0, 3, 7 and 0.1 ml given at one site on days 30 and 90) were compared with a control group of 35 volunteers receiving the standard i.m. regimen. By day 14, seroconversion was observed in all vaccinees in both groups. Geometric mean titers remained higher than 0.5 IU/ml throughout the study period. At the end of the observation period on day 365, antibodies persisted in all subjects. The multisite i.d. PCEC regimen has been proved as immunogenic as the standard i.m. regimen. Both regimens were well tolerated. Thus, it would be the effective and cheapest available rabies postexposure treatment using tissue culture vaccine.


Treatment of severely head injured patients with absence of basal cisterns on initial CT scans.

Sixty-four severely head injured patients with absence of basal cisterns on initial CT scan were studied from January 1986 to March 1989. None had good recovery at 6 months follow-up period. The result from logistic regression analysis pointed to the GCS at 24 hours following injury as an independent, significant outcome predictor. Conventional treatment is not suitable for these patients. Earlier and more aggressive therapy should improve their outcome.


Lymphocyte-bearing ferritin in beta-thalassemia/Hb E.

Flow cytometric analysis of lymphocyte subsets and lymphocyte surface ferritin shows no significant difference in the number of total T-cells, B cells, NK cells, helper T-cells (CD 4), suppressor T-cells (CD 8) and CD 4/CD 8 ratio among normal subjects (n = 11) and Hb E trait (n = 6), beta-thalassemia (beta-thal) trait (n = 5), neither in normal and nonsplenectomized patients with beta-thal/Hb E (n = 10) except B cells and CD 4. There is a significant reduction in lymphocytes surface spleen-type and heart-type ferritin in patients with beta-thal/Hb E when compared to normal subjects. No difference can be seen among patients with beta-thal/Hb E, beta-thal trait and Hb E trait. This low percentage of lymphocyte-bearing ferritin suggests a negative relationship between ferritin on the cells' surface and high circulating ferritin normally associated with thalassemic patients.


True 47,XXX in a patient with premature ovarian failure: the first reported case in Thailand.

A case of triple-X female with premature ovarian failure was reported. The patient was a 23-year-old, single, Thai woman who presented with primary amenorrhea, incomplete development of the secondary sex characteristics, elevated levels of serum gonadotropins, and decreased estrogen concentration. Immunological abnormalities were not identified by antinuclear antibody, rheumatoid factor, antimicrosomal antibody and antithyroglobulin antibody studies. Cyclic estrogen-progestin was given and withdrawal bleeding occurred. The present case represents the utilization of chromosomal analysis in a patient with delayed sexual development, or primary amenorrhea and elevated serum gonadotropin levels.


Post-polio syndrome: a review and case report.

A 21-year-old Thai man presented with progressive weakness and atrophy of both hands for 2 years. His left leg was atrophic and weak secondary to poliomyelitis since he was 8 months old. Physical examination showed that there was atrophy of both hands and forearms as well as left leg. Sensation was normal. Deep tendon reflexes were normal except for hyporeflexia of left leg. EMG showed chronic denervation pattern in the recent atrophic muscles and in normal power muscles. Motor and sensory nerve conductions were normal. Biopsy of forearm muscle revealed degeneration and fibrosis of muscle fibers. These findings were compatible with post-polio syndrome (PPS) which presents in patients with late paralysis following poliomyelitis. It is not a form of amyotrophic lateral sclerosis although some clinical similarities exist. Weakness from PPS may lead to musculoskeletal pain and increased functional disability. Proper rehabilitation program is to maintain his functional status and allow him to continue to live as independently as possible by regular exercise without stressing joints and muscles.


A study of the incidence of stress and anxiety related health problems among the dependants of RAF personnel during the Gulf War.

This study set out to investigate the problems suffered by wives of RAF servicemen who were active in the Gulf War (Jan-Feb 1991). A sample of 12 women were given a semi-structured interview which sought their feelings about being separated from their husbands under such circumstances, and their views on life in the services in general. In addition, a number of health professionals who dealt with the women during this time were also interviewed. The results demonstrate that the women were suffering from the effects of severe stress, with 75 per cent at risk of developing serious illness. The effects of the stress touched many aspects of their emotional, social and family lives. Many negative aspects of life in the services were also identified. The author concludes that there is a need for formal support for these women at all times when their husbands are in the RAF, and not just in times of crisis.


Methicillin resistant Staphylococcus aureus and its implications for nursing practice: a literature review.

The subject of methicillin-resistant Staphylococcus aureus (MRSA) and its implications for nursing practice are reviewed. Resistance of Staphylococcus aureus to antibiotics, and the emergence and incidence of MRSA both in the United Kingdom and abroad, are examined. Modes of transmission of MRSA by transfer of affected patients and, specifically, cross infection by staff are reviewed with methods to prevent cross infection, including screening of staff, handwashing techniques, barrier and cohort nursing, being examined. The costs of an MRSA outbreak, both financially and psychologically, to staff and patients are discussed. Guidelines for the control of epidemic MRSA are explained in the context of the above topics, and all areas are related to improving nursing practice.


Management and leadership in Australian nursing homes.

This paper is based on the outcomes of a study undertaken by Deakin Institute of Nursing Research for the Department of Community Services and Health between 1988 and 1990 (1). The study, which looked at the relationship between skills mix and resident outcomes, involved gathering data from 200 nursing homes in four Australian states using questionnaires and a case study approach. One of the major findings related to the importance of the management and leadership style on the outcome of quality of care and life within the nursing home. The pivotal role of the senior nurse (ie the director of nursing or charge nurse) in affecting high quality is consistently reported in the literature and this was confirmed by the study. Factors drawn from the quantitative and qualitative parts of the study, which make an important contribution to the quality of care experienced by residents, included the director of nursing's attitude, commitment and interpersonal skills. Also important were the ideology of the staff, team cohesiveness and positive attitude and an overall staffing environment which adheres to an agreed philosophy and is stable, satisfied and friendly. All of these were found to be influenced by the senior nurse.


Evaluation of a computerised nursing care planning system in two small hospitals.

This paper describes an evaluation study of a computerised nursing care planning system in two small hospitals. A pre/post test design was used, incorporating a variety of measures. The results of the study do not allow any firm conclusions to be drawn about the effects of the system itself, and need to be considered within the wider context of changes occurring both within nursing and the National Health Service (NHS). Further research should be contemplated to include large sample size, the use of a control and objective independent measures of quality.


[Urinary citrate determination in normal persons and in patients with recurrent urinary calculi].

The presence of citric acid in urine and its ability to bind calcium ions forming a soluble complex are well recognized and has led to the suggestion that citric acid may play an important role in preventing renal calcium stone disease. In this study the 24-hour urinary excretion was measured with a specific enzymatic method in 48 normal subjects and in a group of 46 non selected patients with recurrent urolithiasis. Hypocitraturia was detected in 18/46 patients (39.1%) and was the unique metabolic abnormality in 6 (13%).


[Trypanosoma cruzi in the milk of women with chronic Chagas disease].

Breast milk secretion is one of the possible alternative mechanisms of transmission of the parasitosis caused by Trypanosoma cruzi, but it is still needed to define its importance in terms of public health. On this aim we searched for the presence of this protozoal organism in the colostrum and breast milk of 40 women with Chagas' disease, through direct observation, culture and inoculation. We never found parasite; perhaps it might be possible with the use of more efficient procedures and a larger number of cases.


[Functional electric stimulation (FES) in cerebral palsy].

Our study concerns a patient with cerebral palsy, submitted to conventional occupational therapy and functional electrical stimulation. The results as to manual ability, spasticity, sensibility and synkinesis were satisfactory.


[Fatal strongyloidiasis in an immunodepressed patient following renal transplantation].

Occurrence of fatal hyperinfection with Strongyloides stercoralis in an immunodepressed patient after kidney transplantation is reported. Physiopathology of the illness is discussed and the seriousness of the hyperinfection syndrome is stressed. Endoscopy with duodenal biopsy is useful for the establishment of diagnosis.


[Acute lethal intoxication caused by mercury vapor].

Nowadays mercury poisoning usually results from the oral ingestion of methylmercury or from inhalation of mercury vapor. Mercury intoxication in a gold prospector after inhalation of mercury vapor is described. The patient presented a history of fever, tachypnea and headache. Despite the treatment with dimercaprol, penicillamine and intensive supportive care the patient died with symptoms of acute respiratory distress.


[Clinical use of immunoglobulins].

This article is a review of literature about the clinical use of immunoglobulins and the main purpose of this paper is to direct those who prescribe theses products. In this review are analysed and discussed the principal indications for the use of these compounds, the complications and the safety of the immunoglobulins.


[Role of oxygen free radicals in the physiopathology of rheumatoid arthritis].

The authors present a review of the mechanisms of free radicals production and report the results of "in vivo" and "in vitro" studies correlating these agent with the physiopathologic changes of the rheumatoid arthritis. The data reviewed in this paper support the idea of the participation of free radicals in the articular lesion. However new studies are necessary to determine the contribution of free radicals on disease development, chronicity and the efficacy of antioxidant agents.


[Systemic lupus erythematosus in the aged: clinical and laboratory characteristics].

The clinical and serologic characteristics of 199 systemic lupus erythematosus patients with early and late onset of disease were compared to determine if the disease in the older age group defines a specific subset of SLE. This study demonstrated that SLE in the elderly patients exhibits peculiar clinical features with a high frequency of muscular involvement (p < 0.05) and low frequency of cutaneous manifestations (p < 0.001) and alopecia (p < 0.02). Moreover, the most frequent clinical manifestation was muscular pain and stiffness, arthritis and weight loss (over 10 kg). This condition is often hard to distinguish from polymyalgia rheumatica or underlying malignancy. The frequency of autoantibodies was similar in both groups. The absence of anti-La was surprising, however it was confirmed by "Western blotting". The symptoms of late onset SLE are not very prominent however the diagnosis should be considered in order to avoid delays in treatment.


[Medical schools in Brazil].

In the 1970-1980 period there was a considerable increase in the number of institutions of higher education in Brazil which are located mostly in the Southeast region of the country. The distribution of medical schools is not correlated with the distribution of population. In 59 out of 76 medical schools the internship has a duration of two semesters, in five schools three, and in 12 schools four semesters. The medical residence programs are, with 68% of 9,644 total vacancies, considerably concentrated in the Southeast region.


[Occurrence of Strongyloides stercoralis in patients with acquired immunodeficiency syndrome (AIDS)].

A comparative study on the occurrence of Strongyloides stercoralis larvae in 554 patients with AIDS and in 142 patients suffering from infectious diseases other than AIDS was conducted during the period from January 1987 to December 1988. The two groups was constituted by male individuals in-patients at Emílio Ribas Hospital--São Paulo. Faeces samples from 696 patients were submitted to spontaneous sedimentation method and Rugai method. The data obtained from the present investigation demonstrated a similar prevalence of Strongyloides stercoralis in both groups (p > 0.05) indicating no significant statistical differences.


First register of Biomphalaria straminea Dunker, 1848, in Santa Catarina State.

The first register of Biomphalaria straminea, vector species of schistosomiasis, in Santa Catarina State, South Brazil is described. The specimens were obtained from two ornamental aquaria of private residences. In both cases the ornamental plants and/or fishes were bought from the same supplier. The presence of this species was later confirmed in the farm where these plants and fishes are cultivated, in the city of Governador Celso Ramos, also in Santa Catarina State. The occurrence in natural environments was later detected in two different places of the Island of Santa Catarina.


[Epidemiology of latrodectism in the province of Buenos Aires, Argentina].

Epidemiological data related to Latrodectus bites over a 10-year period (1979-1988) in Buenos Aires Province, Argentina, are presented. Data on distribution of accidents by year, month, sex, residence of person bitten and general symptomatology are given. Statistical analysis showed a mean of 28.1 bites cases per year, 80% in males, most of whom were farm workers. The Latrodectus bites were localized in arms, pelvic waist and legs. Forty-six per cent of bitten persons visit the clinic within 1 to 3 hours after the incident, and only 15% capture the animal responsible for the accident.


Modulation of parasitemia and antibody response to Trypanosoma cruzi by cyclophosphamide in Calomys callosus (Rodentia, Cricetidae).

Calomys callosus a wild rodent, previously described as harboring Trypanosoma cruzi, has a low susceptibility to infection by this protozoan. Experiments were designed to evaluate the contribution of the immune response to the resistance to T. cruzi infection exhibited by C. calossus. Animals were submitted to injections of high (200 mg/kg body weight) and low (20 mg/kg body weight) doses of cyclophosphamide on days -1 or -1 and +5, and inoculated with 4 x 10(3) T. cruzi on day O. Parasitemia, mortality and antibody response as measured by direct agglutination of trypomastigotes were observed. Two hundred mg doses of cyclophosphamide resulted in higher parasitemia and mortality as well as in suppression of the antibody response. A single dose of 20 mg enhanced antibody levels on the 20th day after infection, while an additional dose did not further increase antibody production. Parasitemia levels were not depressed, but rather increased in both these groups as compared to untreated controls. Passive transfer of hyperimmune C. callosus anti-T. cruzi serum to cyclophosphamide immunosuppressed animals resulted in lower parasitemia and mortality rates. These results indicate that the immune response plays an important role in the resistance of C. callossus to T. cruzi.


[The relationship between paracoccidioidomycosis and alcoholism].

The relationship between alcoholism and paracoccidioidomycosis was evaluated by the case-control method. The alcohol consumption of 4 groups of patients was compared: 50 patients with chronic paracoccidioidomycosis, 20 patients with the acute or subacute form of this mycosis and their respective control groups of hospitalized patients, each case matched by sex and age. Between September 1986 and July 1988 the cases and their controls were interviewed by one and the same investigator using a questionnaire on drinking habits: quantity and type of beverage consumed, time of onset and frequency of use and whether they had manifested symptoms of inebriation or of alcohol dependence previously. As compared with control patients, the mean daily ingestion of alcohol in excess of 60 ml was more frequent in the chronic paracoccidioidomycosis group (50.0% x 30.0%). These patients also preferred to drink sugar cane brandy more frequently (89.4% x 68.3%). When the average daily consumption of ethyl alcohol exceeded 100 ml, most patients presented a recurrence of infection during or after antifungal therapy. In the acute-subacute paracoccidioidomycosis group, 64.3% of the patients reported inebriation on one or more occasions, versus 17.6% in the respective control group. The results suggest that alcoholism can be a predisposing factor to paracoccidioidomycosis and, probably, accounts for a worse prognosis for this infection.


Standardization of dot-ELISA for the serological diagnosis of toxocariasis and comparison of the assay with ELISA.

The dot-enzyme-linked immunosorbent assay (dot-ELISA) was standardized using somatic (S) and excretory-secretory (ES) antigens of Toxocara-canis for the detection of specific antibodies in 22 serum samples from children aged 1 to 15 years, with clinical signs of toxocariasis. Fourteen serum samples from apparently normal individuals and 28 sera from patients with other pathologies were used as controls. All samples were used before and after absorption with Ascaris suum extract. When the results were evaluated in comparison with ELISA, the two tests were found to have similar sensitivity, but dot-ELISA was found to be more specific in the presence of two antigens studied. Dot-ELISA proved to be effective for the diagnosis of human toxocariasis, presenting advantages in terms of yield, stability, time and ease of execution and low cost.


[Identification of mycoplasma by the growth inhibition of samples isolated from cell cultures].

Cell cultures must be continuously screened for the presence of mycoplasma because, although these microorganisms sometimes pass unnoticed, they may cause chromosomic alterations and interfere with viral replication, antibody and interferon production etc. The International Organization for Mycoplasmology (IOM) recommends the isolation and identification of mycoplasma with a view to the detection of the origin of the infection and the improvement of the quality of the cultures. In this paper, 37 samples belonging to 27 cell lines contaminated with mycoplasma were assayed by the growth inhibition test. It is known that Mycoplasma orale is the most common human mycoplasma contaminant of cell cultures, the major vehicle of contamination being mouth pippeting, while commercial bovine serum in the main source for Mycoplasma arginini and Acholeplasma laidlawii. M. arginini was found in 18 (48.65%) of the cell samples tested, A. laidlawii in 15 (40.55%), and M. orale in two (5.40%). Two other samples could not be identified by the antisera used (antisera against M. arginini, M. orale, Mycoplasma hyorhinis and A. laidlawii) their characteristics being "fried egg" colonies, digitonine sensitivity, Dienes stained, positive glucose catabolism, negative arginini hydrolysis, and negative tetrazolium reduction. No more than one type of mycoplasma was found in each cell culture.(ABSTRACT TRUNCATED AT 250 WORDS)


[Cognitive changes in workers at a data processing company].

A study of 191 data processing workers undertaken in Porto Alegre, Brazil, in 1989, is presented. The relationship between complaints of loss of memory and their respective scores on cognitive testing in three groups of workers, one with automatized repetitive activities and two others with diversified activities, is analysed. The scores and complaints are compared with the results of a screening test for psychiatric disorders in order to verify the influence of this confounding factor. No significant evidence of cognitive problems was found despite the high prevalence of complaints of memory loss in this population (65.4%). There is a significant statistical association between these complaints and the scores of the psychiatric testing. It is suggested that futures studies should emphasize psychiatric analysis with a view to clarifying the complaints of Data Processing workers.


[Mansonelliasis in the southeast Venezuelan Orinoquia region].

Physical exam and skin biopsy were performed and peripheral blood samples drawn from 10% of the inhabitants of 26 jungle villages of the State of Bolívar, Venezuela. One hundred and fifty three Indians and an inhabitant of mixed blood from 13 different communities were found to be infected with mansonelliasis representing a global index of 36.40% in the endemic area. The parasitosis was found to be concentrated in three areas. The largest, located in the southwest of the country and forming part of an extent infected area embarking neighboring parts of Venezuela and Brazil, contains villages with a parasite index of 80.76% and 94.44%. A second focus is located in the southeast, its carriers, as those of the first, are infected with Mansonella ozzardi. In a third, central eastern focus infections with Mansonella pertans were found. The patients infected with M. ozzardi were apparently asymptomatic and their physical exam was normal, even though individual parasite densities up to 30,000 microfilariae/ml blood and 22,000/gr skin were found.


Trypanosoma cruzi: course of infection in platelets-depleted mice.

The effect of platelet depletion on the course of Trypanosoma cruzi infection in BALB/c mice was investigated. Thrombocytopenia was achieved by inoculation of rabbit anti-platelet IgG during the parasitemic phase of the infection. The number of parasites in the blood of anti-platelet IgG treated was significantly higher than that of non-treated control mice, during the phase of high parasitemia. Cumulative mortality of platelet-depleted mice was consistently but not significantly higher than that of control mice up to the 32nd day of infection; from the 33rd day on they were equivalent, no mortalities occurring from then on, until observations were discontinued on the 60th day. These results suggest that platelets participate of the mechanisms of parasites removal from the bloodstream, but do not have an effective role in the mechanisms of defence against T. cruzi, during the acute phase of infection.


[Evaluation of dietary intake of calcium in adult subjects with idiopathic arterial hypertension].

The calcium-intake relationship with other alimentary and anthropometric variables was investigates in a group of 60 adult (19-75 year-old) subjects, 50 females and 10 males, with essential arterial hypertension (DAP > 90 mmHg). The calcium intake was assessed by three different protocols: 24-hour food intake recall, food-frequency questionnaire and 3 day self-food intake register, repeated along with anthropometric measurements on three different occasions (2-15 month-intervals). The calcium intake assessed by the three methods, as well as the anthropometric data, were statistically similar on all three occasions. The mean data were then compared with those form the control, composed of 75 healthy subjects matched with the hypertensive group by age and sex. The patients ingested less calcium (mean +/- SD) than the controls on the daily (517 +/- 271 x 740 +/- 353 mg/d) and body-weight (8.1 +/- 5.0 x 11.4 +/- 5.9 mg/kg/d) basis. Among the males the calcium intake was the only difference found between groups and could be attributed to the lower intake of calcium-rich foods. The hypertensive females showed also higher lean-body mass (Body-mass index and arm muscle circumference). Thus the calcium intake discriminated both groups being associated with changes in other nutritional parameters only in females.


[Spotted fever: isolation of Rickettsia from a skin biopsy sample].

A 2 years old child living in an area of the State of São Paulo, known in the past as endemic for rickettsiosis developed clinical evidences of spotted fever after a tick bite. Rickettsiae were isolated from guinea pigs inoculated with a skin homogenate. In sera tested by indirect immunofluorescence with Rickettsia rickettsii standard antigen, IgG specific antibody titers raised from 1:512 in the first sample to 1:2048 in the third one; IgM specific antibody titer was 1:128 in the three samples. Also positive were sera obtained from the inoculated guinea pigs. In the last 20 years no other case of rickettsial spotted fever has been confirmed by isolation of the agent in Brasil. To our knowledge, there are no previous reports of isolation of Rickettsiae through inoculation of skin biopsy homogenates.


[The basic network of health services: physicians and their representation regarding the service].

This article aims to analyse the representations of doctors of public sector in Campinas, SP, Brazil, taking as reference the process of decentralization which the health reform being undertaken in Brazil is undergoing. It is assumed that the success of this reform will depend largely on the attitude that these doctors show towards its various aspects. The following subjects were then focused on: the policies and management of the health services, the health-disease process, the doctor-patient relationship and labour process as it affects the health team.


Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case.

This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.


[Changes in physical, chemical, and microbiological characteristics of brines applied in the salting of mozzarella cheese during the period of utilization].

Variation of the physical, chemical and microbiological characteristics of brines during their utilization for salting mozzarella cheese. Forty brine samples used for submersion salting of mozzarella cheese in a dairy industry in the State of S. Paulo, Brazil, were analysed for the purpose of discovering the variation in the physical, chemical and microbiological characteristics observed over their period of utilization. The mean values preparation up to the 21st day of utilization of pH, sodium chloride and protein concentration varied from 7.21 to 5.76, from 27.1 to 24.5 and from zero to 0.126 mg/ml, respectively over the period from their. The mean values of the mesophilic microorganism counts and of the total and fecal coliforms MPN varied from 5.8 x 10 CFU/ml to 6.9 x 10(4) CFU/ml, from zero to 1.6 x 10(5)/100 ml and from zero to 1.1 x 10(5)/100 ml, respectively. Moreover, the mean values of mould and yeast and Staphylococcus positive coagulase counts varied from 0.4 x 10 CFU/ml to 2.0 x 10(3) CFU/ml and from zero to 1.3 x 10 CFU/ml, respectively. The results obtained suggest that the hygienic conditions during the preparation and the utilization of the brine were not satisfactory so that they may represent an important source of contamination for the cheeses. The quality of the product may be harmed, as a result of this fact, in such a way as to represent a potential hazard for the health of the consuming population.


[Evaluation of nutritional status of adult middle class healthy subjects. Energy and protein intake, anthropometry, blood biochemical tests, and immunocompetence tests].

Nutritional status was assessed in 151 middle-class healthy adult individuals (69 medical students, 18-29 y, 34 males, 35 females); 48 university personnel, 30-49 y, 24 males, 24 females; and their older relatives, 34 subjects, 50-79 y, 19 males, 15 females) living in Botucatu, S. Paulo. Methods included anthropometric measurements, energy and protein intakes, blood biochemical analyses and cutaneous delayed hypersensitivity tests. Anthropometric measurements showed higher values in men, with the exception of the triceps skinfold thickness (higher in women) and of the arm fat area (higher in the older age female groups); aging seemed to be associated with increases of weight, arm muscle variables and with arm fat accumulation in women and with increases of arm muscle variables in men. The values for anthropometric measurements were in general higher than those found in other Brazilian studies; on the other hand, they approximate to but do not entirely agree with the data representative of the international referential adult population: differences were mainly concerned with body weight and upper arm muscle parameters, which were lower in our sample. As regards energy intake, values found in subjects under 50 years of age were lower than the recommended dietary allowances; averages found for protein intake were above the level recommended by WHO/FAO/UNU (1985). The mean values for serum proteins and lipids were similar to those of referential data. As regards the hypersensitivity tests, it was found that none of the individuals challenged with four antigens (PPD, Candidin, Vaccinia and phytohemagglutinin) presented less than two positive skin reactions.(ABSTRACT TRUNCATED AT 250 WORDS)


[Risk of infections by the human immunodeficiency virus (HIV) among health professionals].

To investigate the occupational risk of infection by HIV among health professionals, 36 cases of occupational accidents involving exposure to material potentially infected with HIV, reported at a Brazilian General Hospital (HCFMRP), were studied. Of the injured workers 75% were female and 25% male (ranging from 23 to 49 years old) and just one of them had high-risk behavior of HIV infection. Of these health professionals, 52.8% were nursing auxiliaries, 19.4%, nurses, 13.9%, nursing attendants, 5.5%, laboratory technicians, 2.8% surgery instrumentalist, 2.8% accountants and 2.8% nursing technicians. In 47.2% of cases the workers had a parenteral exposure to blood (needlestick injuries). The right hand and fingers were the body areas most effected. The serologic test to detect HIV antibodies by the ELISA method was required of all the workers. The results were negative and no seroconversion was registered during the one year follow-up period. The professionals were retested one month, 2 months, 6 months and one year after the exposure. In conclusion, the risk of infection by HIV among health professionals of HCFMRP seems to be very low. Continuing education should be provided for health care workers with a view to reinforcing the use of universal precaution, especially those to prevent injuries caused by needles or other sharp instruments.


[Accuracy of risk indicators of the Infant Life Defense Program in a region of the São Paulo State, Brazil].

The Infant Life Defense Program of Health Department of Bauru City SP, Brazil, has diagnostic criteria for the inclusion of newborns. The diagnostic criteria combine eleven social and clinical indices of infant mortality risk, defined by in the light of a review of the literature and previous case studies. The indices are easily collected at the hospitals during delivery. The objective of this study is to propose an alternative diagnostic criteria, using the same social and clinical indices, of greater sensitivity and same proportion of children included in the program. The data on the newborns were collected between May 11, 1986 and November 10, 1987. The mortality period was defined as between 7 days and 6 months, which was the follow-up period for the infants enrolled in the program. The method of analysis was the determination for each index of the crude relative risk in a univariate analysis and the adjusted relative risk using the logistic regression procedure. A score system was constructed on the basis of the sum of the excess risk of each index.


[Microhabitats of Aedes albopictus (Skuse) in the region of the Paraiba Valley, São Paulo State, Brazil].

The objective of this study was the determination of extent of the spatial distribution of Aedes albopictus in the Paraíba River Valley, State S. Paulo, Brazil. Thus, collections of larvae and pupae mosquitoes were carried out at six sites distributed along a transection with a 10-km extension. The target was the tree-holes but artificial containers were also used in this investigation. Aedes terrens and Ae. albopictus were the only species of genus Aedes present in the tree-holes mentioned. The segregation of seven species of the tree-hole community was undertaken in the light of macrohabitat and microhabitat features. Thus, the distribution of Ae. albopictus was found to cover the rural, rural-urban and urban zones, but the rural-urban held the preference. Ae. albopictus never present in the residual and primary forest. The favorable factor to infestation with Ae. albopictus in the Paraíba Valley seems to have been the large number of natural niches made vacant by human influence. The rain has been important in the production of larvae and pupae, but the rainfall period does not coincide with the maximum production on them. The tree-holes whose volume exceeded 600 ml were the most productive breeding places. The abundance of these two stages occurs in the summer and autumn. However, the highest peak was observed in the months of March and April. These seasonal variations were found to be common in both the bamboo trap and the artificial container. The temperature data suggest a limit of from 17 to 23 degrees C for the best development of larvae. In the light of this, the strain of Ae. albopictus studied seems to have originated in tropical Asia. Just as happened with Ae. aegypti it may become an important epidemiological vector for the dengue fever and provide links for yellow fever transmission in Brazil.


[Prevalence of serological markers of hepatitis B in a small rural community of São Paulo State, Brazil].

Prevalence of three hepatitis B markers was measured by immunoassay techniques in small rural community of the State of S. Paulo, Brazil. Total prevalence was 7.74%, corresponding to values of 0.10%, 1.69% and 7.74% for HBsAg, anti-HBs and anti-HBc, respectively. The importance of anti-HBc determination in such studies is stressed. Comparisons between the low viral circulation observed in this area and high prevalences described in other rural communities may contribute to the raising of new hypothesis concerning alternative transmission mechanisms of hepatitis B.


[Susceptibility tests of the bedbug, Cimex lectularius L. (Hemiptera, Cimicidae) to DDT in Belo Horizonte, MG (Brazil)].

Susceptibility levels for the adult bed-bug, Cimex lectularius, in Belo Horizonte, Minas Gerais-Brazil, to DDT, were determined during the period 1985 to 1986. The test results showed that a 4% dosage of DDT is not enough to kill 55% of the insects. The data are sufficient to show that there exists bed-bug resistance to DDT in Belo Horizonte.


[The model of state health policy and the system of medical assistance adopted in present-day Brazil].

A contribution to the analysis of the health reform presently occurring in Brazil is presented. The need to consolidate the theoretical background which supports the advances already achieved in order to understand recent events in the area is stressed. In this regard, the health reform is understood as a question transcending the mere administrative and managerial aspect of the health system, since it necessarily involves a redefinition of the concepts of health, disease and the medical practice adopted by the dominant mechanistic paradigm of medicine. The recent events which delineate the health system in Brazil are analysed and criticised in the light of this concern.


[Mortality due to Chagas disease in São Paulo State (Brazil): subsidy for the planning of chagasic patient care].

In order to estimate the size of the population with Chagas' disease, an essential parameter for the establishment of an adequate health care policy for this group of patients, data from 1,646 death certificates from the "Fundação Sistema Estadual de Análises de Dados" in which Chagas' disease was mentioned in the State of S. Paulo in 1987 were examined. The population under study comprised adults between 15 and 70 years of age. Objectives also included the determination of Proportional Mortality, Potentially Lost Years of Life and regional distribution of the events in the counties of the State of S. Paulo. Chagas disease accounted for 0.9% of the totality of the causes of death, Proportional Mortality was 1.2% and the proportional participation of Chagas' disease in the Potentially Lost Years of Life was 1.1%. Corresponding data for Ischemic Heart Disease were, 4.0% and 1.2%. 20.8% of the deaths occurred in counties other than the county of residence, the indexes of evasion varying from 17.8% to 29.1% for different regions. Males (22.8%) more often than females (17.4%) died outside their county of residence. The largest number of deaths occurred in the metropolitan area of S. Paulo, although Ribeirão Preto county presented the highest mortality indexes.


[Evaluation of epidemiologic surveillance practice in the public health service in Brazil].

The results of a process evaluation of the epidemiological surveillance activities in 948 health units, situated in 98 of the most populated cities of each State in the country are presented. The survey was conducted towards the end of 1985. The following aspects were analyzed: information system, data analysis, epidemiological investigation. Institutional insertion, vaccination activities, management aspects and capacitation of the health worker were considered as potential determinants of performance. Data were submitted to correspondence analysis and a process of ascendant hierarchical classification, using the statistical package "Systeme Portable Pour L' Analise de Données-SPAD". The performance pattern was not found to be homogeneous. Six different classes of epidemiological surveillance practice in the health units were observed. In 53.7% of the services visited, even the most elementary norms of activity were not complied with. The presence of vaccination activities in the health units was associated with better performance in epidemiological surveillance. The study points to the need to review the epidemiological surveillance model in use in Brazil. It is no longer acceptable to restrict the practice of epidemiology in health services to communicable diseases, now to manage programs and services without epidemiological information.


Hygiene habits and carriers in families with a child who has had typhoid fever.

The relationship between asymptomatic shedding of bacterial enteropathogens and the hygiene habits of families who have had a child with typhoid fever (TF) are investigated. The sample was made up of 80 families: 40 families in which one child had had TF (Group A) and 40 in which no children or either of the parents had had a history of TF (Group B). In each group 20 families belonged to a low socioeconomic status (SES) and 20 to a high SES. A structured interview was used to evaluate the SES and the hygiene habits of the child; observations were made to measure the hygiene habits of the family (toilet, kitchen and food preparation) and bacteriological studies (fecal samples and hand markers). Results show that carriers were more frequent in Group A than in Group B. The bacterial species found were significantly more numerous in Group A than in Group B (fecal samples: E. coli, the classic serotypes, Shigella ssp, and hand markers: E. coli). Families of Group A had higher carriage rates than those of Group B. Finally there exists a significantly higher association between inadequate hygiene habits and carrier families. These results show the need to teach specific habits of proper hygiene to the entire population, because the fact of belonging to the high SES does not in itself preclude inadequate hygiene habits.


Health and poverty: health management by the woman.

The goal this follow-up study was to relate the mother's marital satisfaction to family health status in a low SES. The random sample was made up of 30 families with children under 7 years old: 15 considered as sick (Group A) and 15 as healthy (Group B). Both group had similar demographic characteristics (age of father and mother, persons per family group and age of children) and SES. Results showed that mothers were those mainly in charge of their family groups. Mothers of Group A were significantly less understanding and more dissatisfied than those of Group B (p < .05 and p < .01). Mothers of Group A had significantly more arguments with their partners than those of Group B (p < .006). Health care was learned less from the child's own mother in group A than in B (p < .05). Health was considered by mothers of Group A as something that "must be taken care of" more than by those of Group B p < .01). The behaviours of mothers in choosing one of the health systems was similar in both groups. Dissatisfied mothers were associated more with sick family members during the 6 month follow-up. It is suggested that the satisfaction of the mother is a factor that needs further investigation because health is managed by mothers is the large majority of families.


[The prevalence of iron deficiency in pregnant women at their first consultation in health centers in a metropolitan area, Brazil. Etiology of anemia].

Three hundred and sixty-three pregnant women enrolled in the Pregnancy Medical Care Program of S. Paulo Health Department in the district of Butantan, S. Paulo city, Brazil, were studied at their first routine consultation between April and October, 1988. Their average age was 25 and 65.9% of them belonged to families with a monthly income below US$50.00 per capita. Only 3.1% presented an income above US$150.00 per capita. Taking the minimum transferrin saturation threshold of 15% as determining iron deficiency, a 4.6% prevalence of iron deficiency was observed in the first trimester, 17.3% in the second trimester and 42.8% in the third trimester, resulting in an overall prevalence of 12.4%. There was no significant difference between prevalences of iron deficiency according to the number of pregnancies. The prevalence of iron deficiency was higher in women presenting incomes below US$50.00 per capita.


[Risk estimates of tuberculosis infection in BCG-vaccinated populations].

The revaccination of schoolchildren can restore the residual allergy induced by vaccination in the first years of life but can not modify the allergy resulting from a natural infection. So revaccination in this population should indicate the group infected by the Koch bacilli. To assess the applicability of these assumptions in estimating the risk of tuberculosis infection in regions with high BCG coverage a study was undertaken on schoolchildren between 6 and 9 years of age who were attending the municipal schools in the east zone of S. Paulo City, in the course of the first semester of 1988. Of 11,455 who were vaccinated only 7,470 were tested with PPD, revaccinated and retested ten weeks later; 3,314 of these were vaccinated in the first trimester of life with a half dose and 4,156 received a full dose at later ages (75% during the first year, 20% during the second and 5% during the third). In comparing the results pre and post vaccination by correlation table, the calculation of infection was made according to the criteria of the original method and to the modifications made by the authors under separate cover for those vaccinated in the first trimester and those vaccinated later. The risk of infection was 0.35% and 0.37%, respectively, for the original model and 0.45% and 0.49% for the modified model. The referential was 0.55%. The difference between model and age or with the referential was not significant (p > 0.005). Data suggest that the method is applicable to estimate the risk of tuberculosis infection in schoolchildren vaccinated with a full dose of BCG during the first year of life.


Data for the properties of Listeria strains (a review).

It seems that taxonomy of listeriae is in a fluid stage. Between beta-haemolytic property and virulence of these bacteria a strong relationship has been demonstrated. These characters are coded by hlyA gene which seems to belong to a monocistronic unit. Virulent Listeria strains possess specific surface antigens and can enter as well as multiply in host cells. Their exact human virulence is not known. Listeriae can grow from around 0 to 42 degrees C and can survive either the effect of frost or of temperature of 48 degrees C. They may form biofilm on different surfaces. Their growth kinetics, persistance and heat resistance can be influenced by many factors (type of growth environment, pH, acidulants, salts, chemicals, antibiotics, plant substances, enzymes, humidity, atmosphere, temperature, prior temperature-effects, microbial competition and the length of influences). Radiation sensitivity of Listeria is usual. Plasmid mediated antibiotic resistant mutant of Listeria monocytogenes is verified.


Colonization of infant mice with flagellar variants of Campylobacter jejuni.

The role of flagella in the colonization of the intestine by Campylobacter jejuni was investigated by challenging infant mice with two flagellated strains and their nonflagellated variants. The intestinal tracts of infant mice were regularly colonized with motile strains, but not by nonmotile variants. Colonization of mice with motile C. jejuni occurred with as few as 1000 bacteria per mouse.


Impact of weather changes on the growth of the unicellular Blepharisma undulans (Stein).

The growth of Blepharisma undulans (Stein) cells durably treated and not treated with insulin was followed up for three months with special regard a possible impact of meteorological factors on the growth rate. The growth rate of the protozoon was not appreciably altered by weather changes but the growth curves for cells treated and not treated with insulin indicated opposing trends of multiplication under the influence of approaching weather fronts. Warm fronts which have a parasympathic effect and cold fronts which have a sympathetic effect uniformly enhanced the growth rate of the untreated cells and retarded that of the insulin treated cells.


The effect of kanamycin treatment of rats on the development of gastro-intestinal syndrome of radiation disease.

Kanamycin pretreatment through stomach tube eliminates the endotoxin producing Gram-negative bacteria of the intestinal flora and can delay the death of rats suffering from gastro-intestinal syndrome of radiation disease. Endotoxins probably play a significant role in the pathological process of the syndrome.


Multiple enlargements in the right inverted terminal repeat of the DNA of canine adenovirus type 2.

The Manhattan strain of canine adenovirus type 2 (CAV 2) was examined. Restriction endonuclease analysis and blot hybridization experiments revealed the heterogeneity of the viral DNA. At least 9 unequally expanded species of the viral genome have been recognized. This diversity is caused by different enlargements in the right inverted terminal repeat (ITR) of the virus. The differences between the individual enlargements were shown to be the different multiples of 150 base pairs. Relatedness of CAV 2 DNA to the DNA of bovine adenovirus type 2 (BAV 2) and human adenovirus type 2 (HAV 2) has also been observed during DNA hybridization experiments.


Modified spot hybridization test using biotinylated DNA probe.

A modification that simplifies the spot hybridization technique is described for using biotinylated DNA probes. Plasmid EWD299 having LT gene insert, labelled with biotin either by nick translation or using photobiotin was used as DNA probe for the specific detection of enterotoxigenic Escherichia coli. A simple protocol has been described for easy lysis of test samples by boiling in distilled water followed by detergent treatment and was found to be as efficient as the lysis using lysozyme and protease. Three different solid supports namely DEAE-cellulose paper, nitrocellulose paper and nylon membrane were also compared for their suitability in this spot hybridization test. Nitrocellulose paper was found to give better colour signal with the photobiotinylated DNA probe.


Distribution of aflatoxin-producing moulds and aflatoxins in dairy cattle feed and raw milk.

Distribution of aflatoxigenic moulds and aflatoxin B1 in Yugoslav dairy cattle feeds as well as the presence of aflatoxin B1 and M1 in raw milk, was tested. The experiments were carried out through three years (in all seasons). Samples were taken from state and private farms in Vojvodina. Feeds were contaminated in 83-100% with moulds. Fungi of farms in Vojvodina. Feeds were contaminated in 83-100% with moulds. Fungi of Aspergillus flavus-oryzae group were present permanently and the highest incidence of them was noticed during the third research year. Aflatoxin B1 was not found in the first year, but malt spent grains used for cows' feeding in summer of the second research year was contaminated with it (50.0 micrograms/kg). The same feed and pelleted sugar beet pulp were contaminated with aflatoxin B1 in winter, spring and summer of the third research year (5.0 to 16.0 micrograms/kg). Aflatoxin B1 and M1 were not found in raw milk through three-years investigations.


Production and regulation of a thermostable protease by Pseudomonas sp. B45.

A Pseudomonas sp. produced an extracellular thermostable protease which required induction by peptone. Growth of the organism and the production of protease was optimum at 30 degrees C. The enzyme was subjected to catabolite repression by glucose. Both chloramphenicol and rifamycin completely abolished protease production indicating de novo synthesis of the enzyme. Leucine, lysine, histidine and glycine enhanced the protease production considerably and they were the most effective when added during the active period of production. Glucose repression could not be relieved by addition of leucine.


A 4-kilobase congo red binding plasmid DNA fragment of Shigella dysenteriae 1 suppresses the growth and cell differentiation in Escherichia coli.

A 4-kilobase congo red binding plasmid DNA fragment of pCAT 120 of Shigella dysenteriae 1 was transferred to an Escherichia coli K12 strain by transformation. Transformants were unable to grow in any liquid broth medium. Electron microscopic studies revealed that the transformants grown on tryptic soy agar were associated in clusters after cell division. Normal cell separation among the transformants in comparison with recipient E. coli K12 was only observed when the growth medium was supplemented with sterile culture filtrate of the recipient strain. An unknown factor(s) required for cell separation located on the chromosome was suppressed by a 4-kb congo red binding plasmid DNA (pCAT 120) fragment of S. dysenteriae 1.


[Carotid body tumors: the clinical, diagnostic and therapeutic aspects].

The authors discuss the epidemiology, histology, symptomatology, diagnosis and therapy of carotid body tumors, basing their discussion on three personal observations and on a case of cervical dermatocyst which showed clinical and radiological data consistent with diagnosis of a glomus tumor. Chemodectomas of the neck are more often seen in the carotid body and are considered histologically benign, although they might induce local or distant metastases. Clinical presentation is often non-specific and may only consist in a slowly growing mass in the higher jugular-carotid region. Among the various imaging techniques (CT, MR), supra-aortic selective angiography, including digital subtraction techniques, is now considered the most reliable tool, while ultrasonography and gammagraphy with 99mTc-gluconate or 131I-MBG are recommended for screening and family testing purposes. Biopsy is to be avoided as it is very likely to cause massive bleeding and because of the high percentage of false negatives. Surgery is the choice treatment, and lateral cervicotomy is the recommended approach for exeresis of the mass, while radiotherapy should be planned in patients with precise contra-indications for surgery and when the tumor mass has already reached the skull base. Pre-operatory selective embolization is still controversial.


[Experimental perilymphatic fistula: the electrocochleographic findings].

The aim of the present study was to evaluate the effect of experimental perilymphatic fistula on cochlear electrophysiological responses. Six albino guinea pigs, in which recording electrodes were implanted in order to record the electrocochleogram, were used. Experimental protocol investigated cochlear responses before the induction of the fistula in the round window membrane perforation and then two month later. Compound action potential thresholds increased immediately after perforation of the round window membrane. The thresholds rapidly recovered. This phenomenon was accompanied by clear-Out reduction in amplitude upon suprathreshold stimulation. This latter observation associated with a decrease in the amplitude of the threshold seems to be a specific audiologic sign of the fistula. The clinical implication are discussed.


[The measurement of cochlear flow by laser Doppler in man: the preliminary results].

Laser-Doppler flowmetry is presently one of the methods of choice in measuring cochlear blood flow. The techniques is non-invasive and is based on the frequency shift of the laser beam induced by the red blood cell movement. Previous studies of cochlear blood flow carried out on animals and humans demonstrated the reliability of laser-Doppler flowmetry and its usefulness in understanding inner ear microcirculation physiology. In this paper we present preliminary data obtained from three patients examined under general anesthesia while undergoing tympanoplasty. Results showed that tracings, whose baseline is proportional with the blood flow, are characterized by waves correlated to pulse beat and automatic ventilation. Moreover, intrinsic contractions of inner ear vessels (waves of vasomotion) as exist in cerebral microcirculation, were observed. Pharmacological hypotension hypocapnia and the application of epinephryne determine a significant reduction of cochlear blood flow. These results suggest that while cochlear blood flow is related to systemic pressure, it has an intrinsic control system. As well since we did not obtain any modification in bone conduction threshold after surgery, we conclude that laser-Doppler flowmetry is a safe technique.


[Orbital and endocranial complications in acute sinusitis in childhood].

Acute infection the paranasal sinus is a rather frequent pathology in children. On the contrary, local orbital complications are rare. The employment of antibiotics reduces the incidence of complications but can sometimes conceal their appearance so that diagnosis is delayed. Orbital as well as intracranial complications of ethmoidal and maxillary sinusitis are most often encountered in childhood. Within a brief time span, 8 patients with complicated frontal and ethmoid-maxillary sinusitis were diagnosed and treated: 4 cases of periorbital cellulitis, 2 of subperiorbital abscess and 2 of orbital abscess (one of which with cavernous sinus thrombosis). Particularly relevant from the diagnostic point of view was the employment of C.T. scan which furnished an accurate definition of the orbit and its surrounding structures which influenced treatment choice. Under antibiotic cover all patients but one (who had been treated very early and had responded immediately to intensive antibiotic therapy) were treated surgically and the clinical course of the disease showed significant improvement very shortly after surgical drainage.


[Mitral valve replacement with porcine bioprosthesis in children. Evaluation of 29 patients during 12 years].

To analyze the clinical result of the mitral valve substitution for the porcine bioprostheses, the incidence of dysfunction caused by calcification and its importance related to the durability of bioprostheses and also the patients' survival. Twenty-nine children of about seven to sixteen years old were operated on from November 1977 to August 1982 and all of them received porcine bioprostheses of low profile. There were three (10.34%) hospital deaths and nine other late mortalities. The follow-up period varied from 4 to 128 months with average of 58.17 months and with the loss of nine patients. An actuarial survival rate of 46.08% has been observed at 11 years after surgery. Calcification of 21 bioprostheses occurred in 14 out of 17 follow-up patients; 47.6% of them happened until the third year of pos-operative and 85.7% until the fifth year. Eleven patients were reoperated on with 9.09% of hospital mortality. There were no cases of thromboembolism. Porcine bioprostheses works well with an evident clinical improvement of patients, with no thromboembolic accidents. However, its durability has been affected by the high incidence of calcification, which is responsible for an increase in late morbidity and mortality. Mitral valve disease treatment in children must be conservative, in an attempt to solve the problem with the different available plastic technics and leave the valve substitution to be a last option. In that case, the preference is given to the homologous bioprostheses.


[Analysis of fever in 58 cases of infective endocarditis].

To evaluate if fever is an objective criterion in the assessment of response to antibiotic therapy and in the prognosis of patients undergoing treatment for infective endocarditis (IE). Fifty-eight cases of IE, occurring from January 1980 to December 1989 have been analysed retrospectively in this study. Emphasis was given to the clinical history and body temperature changes during the first five weeks of treatment. Patients were divided in three groups according to the number of febrile peaks per week. Temperature was assessed weekly from each patient's highest peak weighed average. At the first exam, 52 patients (86.2%) presented fever. All patients had at least one episode of fever during their hospitalization. There seemed to be a relation between the number of febrile peaks during a one week period and the mean body temperature, so that these patients who presented four or more peaks in a week had a higher mean body temperature than those with two or less febrile peaks during the week. After the second week of treatment, patients with two or less febrile peaks had a 93.1% survival and average of 35.5 days of hospitalization, whereas those with three or more febrile peaks had 63.6% survival and an average of 47.5 days of hospitalization. The results of this study show that the intensity of fever is linked to the number of febrile peaks per week, regardless to treatment duration. Should there be three or more febrile peaks weekly after the second week of treatment, therapeutic strategy should be reviewed, considering even surgical treatment. In many cases, the persistence of fever represented the clinical expression of complications which determined a higher mortality rate and a longer hospitalization.


[The treatment of nasal polyposis with the neodymium-YAG laser].

Recurrent nasal polyposis is one of the most common problem in clinical rhinology. The authors describe the anatomic and functional results obtained by Nd:Yag laser procedures performed on 47 patients, with recurrent polyposis. The use of Nd:Yag laser under local anaesthesia, by means of a rigid fiberscope, permitted to obtain a well limited excision of the pathological tissue with respect of nasal physiology. At the end no nasal packing was used because unnecessary. The authors explain the details of the method and the results obtained, pointing out this well tolerated treatment, even when repeated, taking care, in the same time, the different pathogenesis of disease.


[Myocardial infarction as a consequence of infective endocarditis in valvar bioprosthesis].

A sixteen year-old male, followed in the Unicamp Cardiology Clinic with a previous record of rheumatic heart disease and a biological mitral prosthesis, presented with infective endocarditis. In spite of a good initial response to antibiotic therapy, the patient died in two weeks. Autopsy disclosed endocarditis of the prosthetic valve and embolic occlusion of the circumflex branch of left coronary artery.


[Tachycardiomyopathy induced by atrial fibrillation].

A 56 year old woman with a previously normal heart developed severe left ventricular dilation and hypo-contractility after a few weeks of a refractory, high ventricular rate atrial fibrillation. Reduction of heart rate with verapamil resulted in a rapid normalization of myocardial contractility.


[Functional atresia of the pulmonary valve].

Three newborn children with cyanosis due to Ebstein's anomaly of tricuspid valve with an important hemodynamic repercussion presented features of imperforation of pulmonary valve. On the follow-up, clinical and laboratory findings verified that pulmonary atresia was functional resulting from a combination of low right ventricular pressure and high pulmonary vascular resistance.


[Post infarction ventricular septal defect. Echocardiographic analysis of patients treated with positive end-expiratory pressure].

Interventricular septal rupture is a life-threatening complication occurring in 0.5 to 1.0% of patients following acute myocardial infarction and often results in right and left ventricular failure. This study aimed at evaluating the echocardiographic effects of PEEP on right (RV) and left (LV) ventricular dimension in three patients who developed a postinfarction septal defect and in whom acute respiratory failure was a preterminal event. The effects of PEPP on the heart remain controversial. We observed in all three patients a sudden large increase in RV dimensions and hence, probably through ventricular interdependence, a proportional decrease in LV dimensions. The progressive leftward septal displacement with increasing levels of PEEP probably contributed to reduce LV compliance. We concluded that PEEP therapy in this group of patients had no proven beneficial effects and probably contributed to further RV dilatation and failure.


[Invasive nasosinusal aspergillosis in an immunocompetent patient].

The authors describe a case of invasive nasosinusal aspergillosis in an immunocompetent patient. After a careful bibliographic review, they emphasize that in the present case the diagnosis was made by means of fungal culture as the clinical picture, imaging techniques and histopathological findings were aspecific. The pathogenetic agent resulted Aspergillus tamarii which belongs to the Aspergillus flavus group and is one of the most unusual agents in literature. The treatment of choice, in the invasive form, is surgery that should be as radical as possible followed by a medical therapy. In the present case, after two-phase radical surgery on all the paranasal sinuses, medical treatment with traconazole was employed with excellent local results at a follow-up of one year.


[Transdermal nitroglycerin in patients with stable angina].

To evaluate the nitroglycerin patches efficacy and tolerability in patients with stable angina pectoris. One thousand and five hundred and thirty nine patients with stable angina pectoris, mean age 61.0 +/- 10.3, 891 men and 648 women were prospectively evaluated by five hundred and thirty five specialists after 5 mg or, posteriorly, if clinical necessary, 10 mg of nitroglycerin patches during 12 weeks. Clinical evaluation, electrocardiogram (ECG) and treadmill exercise were obtained on study entry and at weeks 2, 4, 8 and 12 for clinical evaluation, and at week 12 for ECG and treadmill exercise. A significative reduction was observed in the number of angina crisis, sublingual nitrates consumption, arterial blood pressure and on the percentage of positive treadmill exercise tests. The heart rate and nitroglycerin patches dose did not show statistical differences. The compliance of transdermal administration was excellent. The nitroglycerin patches administration was effective for stable angina pectoris with excellent patient's compliance.


[Adenotonsillectomy: the evaluation of the long-term results after more than 7 years from the intervention].

A study was carried out on 110 patients with various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids. Sixty-two of these patients underwent adenotonsillectomy, while the others were followed clinically and, where necessary, given medical treatment. At the first observation the patients were between the ages of 2 and 12 (mean age 6.1 years). At the start of the present study the patients ages ranged from 10 to 22 (mean age 17 years). Clinical follow-up was carried out on the patients 2 and 7 years after the first observation and/or adenotonsillectomy. The patients were divided into homogeneous groups according to the severity of symptoms. The A.A. evaluated changes of the following clinical parameters: annual frequency of inflammatory pharyngotonsillar episodes, nasal respiratory obstruction, sore throat, otologic pathology. Evaluations were carried out statistically in each group. After more than 7 years from surgery, the significant reduction of various diseases related to chronic inflammation of the tonsils and to hypertrophic adenoids, in accordance with the findings after 2 years from surgery, underline the effectiveness of adenotonsillectomy in correctly selected candidates.


[Myocardial ischemia with stable angina pectoris: clinico-ergometric evaluation after the use of diltiazem].

To evaluate the efficacy of diltiazem versus placebo in patients with stable angina. Eight-seven angina pectoris patients, mean age of 57 +/- 9, 82 white and 79 male were evaluated in a randomized, double-blind trial of two groups of patients diltiazem and placebo, 3 to 4 tablets a day (diltiazem 180 to 240 mg daily). The patients were evaluated after laboratory tests and clinical-ergometric examinations. A coronary arteriography was performed on study entry. The average of anginal attacks, number of weekly sublingual nitrate, heart rate, systolic and diastolic pressure at rest and at the end of diltiazem period were significantly lower (p < 0.05) regarding same periods on placebo. The percentage of depression for ST-segment was lower for diltiazem when compared with placebo (p < 0.05) and the percentage of patients that reach higher stages in the ergometric test was significantly better for diltiazem. Heart rate and systolic plus diastolic pressures after exercise did not differ in both groups. Diltiazem reduced the clinical and electrocardiographical aspects and raises the effort tolerance during the ergometric test in patients with stable angina.


[Pathogenesis of mitral valve prolapse in patients with chronic Chagas disease: study of papillary muscle myocarditis].

Studying the mitral valve in chronic Chagas' heart disease, searching a possible cause effect relationship between this condition and valve prolapse. Seventeen hearts were surveyed from individuals exhibiting chronic chagasic cardiopathy, 11 males and 6 females, aged between 31-84 (average 54) years. The hearts came from necropsies carried out until a year before. Properly preserved samples were analyzed macro and microscopically. Fragments were excised from the mitral valve papillary muscles, anterior, lateral and posterior regions of the left ventricle, interventricular septum, free wall of right ventricle and atrium walls. Chronic myocarditis was found ill all the samples (mild in 6 of them, moderate in 7 and severe in 4). Also, the papillary muscles exhibited myocarditis in all of the samples, and in 15 of them the degree of severity was equal to or superior than the observed in degree other regions of the heart. The chronic chagasic cardiopathy, the papillary muscle constitute a frequent site of myocarditis. This fact must be held in mind when one discusses the pathogenesis of the prolapse of the valve.


[Acute aortic dissections. Hospital outcome of 186 cases].

To determine in hospital outcome acute aortic dissection patients. We revised 186 consecutive cases (up to 14 days of dissection), in a period of 6 years. The patients were divided according to Daily's classification (types A and B). Type A--127 cases: a) 75 were surgically treated (37 died); b) 2 were medically treated (both died); c) 39 died before the definitive treatment could be initiated; d) 11 died misdiagnosed or undiagnosed. The total mortality was 70.0%. Type B--59 cases: a) 11 complicated cases were surgically treated (6 died); b) 40 were medically treated (8 died); c) 7 died before the definitive treatment could be initiated; d) one died misdiagnosed. The total mortality was 37.25%. In summary, 41.4% of the patients survived. 28.4% died despite the definitive treatment, 24.7% died before the definitive treatment could be initiated and 6.4% died without the correct diagnosis. The acute aortic dissection is a dramatic situation, mainly type A. In this type of dissection many patients (41%) died misdiagnosed, undiagnosed or without enough time to surgical therapy. So, an earlier diagnosis and treatment are imperative.


[Spontaneous intraparenchymatous hematomas. Experience with 134 cases].

One hundred thirty four cases of spontaneous intraparenchymatous hematomas have been studied. They were separated into six groups according to criteria related to topography, level of consciousness, and hematoma volume. Treatment protocols--conservative, conservative with I.C.P. monitoring, and surgical--were different in each group. Results have shown an increased mortality (p < 0.05) among patients whose level of consciousness were more severely compromised, in those older than 50 years old, and in those harbouring quadrilateral, intraventricular or brainstem hematomas. Overall mortality was 26.1%.


[Isolated vasculitis of the central nervous system and involvement of the 8th cranial nerve: rare manifestations of acquired immunodeficiency syndrome].

The authors report the case of an AIDS patient with rare neurologic manifestations: primary vasculitis of the central nervous system and VIII cranial nerve dysfunction. The authors make a review on the subject, and call special attention for the differential diagnosis. In fact, the patient, a 36 year old woman, with promiscuous life, presented with dizziness, gait ataxia, nausea, headache and hypoacusia. Seven days after the admission, she noted blurred vision in both eyes and soon she became blind. The physical examination showed bilateral optic neuritis and vestibulocochlear dysfunction, stiff neck and fever. No abnormalities were detected on CT scan. CSF showed 40 mononuclear cells/mm3, 79 mg/dl of proteins and normal glucose content. Microbiological research was negative. Serum anti-HIV test was positive. The hypothesis of primary CNS vasculitis was made, and pulse methylprednisolone therapy was introduced with good recovery of neurological syndrome except for persistent amaurosis.


[Invasive aspergillosis of the sphenoid sinus and paralysis of the 6th nerve].

A case of aspergillosis of the sphenoid sinus manifested as an isolated sixth nerve palsy occurred in a 74-year old diabetic woman who had no complaints of headache or symptoms suggestive of sinusitis. A CT scan demonstrated a large mass occupying the sphenoid and ethmoid sinuses extending posteriorly to the clivus. There was a calcific density within the opacified sinus and bony erosion of the sphenoid walls and the sella turcica. The patient underwent a sublabial transseptal sphenoidotomy with removal of necrotic material and debridement of the surrounding tissue. Histologic examination revealed granulation tissue with chronic inflammatory cells and abundant dichotomously branching hyphae. Postoperatively the patient was given amphotericin B and 5-fluorocytosine. Three months later the sixth nerve palsy had completely cleared and the patient had no other complaint. Sphenoid sinus aspergillosis is a rare disease and may have variable clinical manifestations according to involvement of different structures located closely to the sinus. Our patient developed an isolated sixth nerve palsy which was at onset considered to be caused by diabetes. Computerized tomography scans disclosed abnormalities strongly indicative of invasive aspergillosis. It illustrates the need of appropriate work-up in cases of an isolated sixth nerve palsy even in patients with diabetes or other risk factors.


[Acute cerebellar infarction simulating posterior fossa tumor].

We report a case of space-occupying infarction of the left cerebellar hemisphere with occlusive hydrocephalus and left to right shift of the fourth ventricle. The patient, a 58 years old man, underwent shunting and decompressive craniectomy of the posterior fossa and survived without neurological deficits.


An association of central post-stroke pain and thalamic hand.

Thalamic hand is one of the clinical expressions of the painful thalamic syndrome. This paper relates on a case of a patient with a syndrome of central post-stroke and supra-thalamic pain who also presents a thalamic hand. The authors emphasize the notion that in the syndrome of central post-stroke pain a direct or indirect (infra or supra)-thalamic lesion seems to be an essential element for the genesis of central pain.


[Iatrogeny. The importance of clinical diagnosis. Myopathies induced by clofibrate].

The authors describe the neurological manifestations of a female patient with hypercholesterolemia who developed myopathy in the course of her treatment with clofibrate. After the drug was tapered off, the neurological signs and symptoms disappeared. Therefore, attention is called for the importance of the differential diagnosis of iatrogenic myopathies with polymyositis.


[Multiple intracranial aneurysms].

Thirty eight patients with multiple intracranial aneurysms were studied. They correspond to 19.4% of all aneurysms treated over a twelve year period in the Servidores do Estado Hospital. 89 aneurysms and 4 infundibuli were detected. In 71.0% of the patients, two aneurysms were found; in 18.4%, three aneurysms; and in 10.4%, 4 or 5 aneurysms were observed. Twenty-seven patients were women and 11 men, ranging in age from 16 to 72 (average 47 years old). Subarachnoid hemorrhage was found in 36 patients (86.8%). The operative mortality in this series was 3.5%. We concluded that patients with multiple intracranial aneurysms should have all aneurysms, that can bleed, clipped through standard micro-neurosurgery technics.


Cognitive functions, epileptic syndromes and antiepileptic drugs.

Cognitive function of patients on monotherapy specific for their epileptic syndrome has been studied infrequently. We evaluated 7 patients with symptomatic localised epilepsies (SEL) on phenytoin aged 30 +/- 12 (mean +/- standard deviation) years, 8 with idiopathic generalised epilepsies on sodium valproate aged 18 +/- 4 years, 16 with SEL on carbamazepine aged 28 +/- 11 years, and 35 healthy controls aged 27 +/- 11 years. All subjects were of normal intelligence, educated appropriately to age, and led productive lives in the community. Two of the patients on carbamazepine and one on valproate had less than five partial, absence or myoclonic seizures monthly, the remaining were controlled. Carbamazepine serum concentrations were 12 +/- 5 micrograms/ml, phenytoin were 23 +/- 7, and valproate were 62 +/- 23 (mean +/- sd). Tests included immediate recall and recognition for pictures, Stroop test, delayed recall and recognition of pictures. Patients on phenytoin and valproate performed significantly worse than controls on immediate recall, and patients on carbamazepine performed significantly worse than controls in Stroop test (p < 0.01). The results indicate relatively minor effects of the epileptic syndromes and of phenytoin, carbamazepine and valproate on cognition of patients with controlled epilepsy leading productive lives in the community. We conclude that the cognitive deficit found in chronic epileptic patients on poly-therapeutic drug regimen must be multifactorial, and that future studies need to control for all possible variables in order to achieve meaningful results.


Neurological manifestations of malaria.

The involvement of the nervous system in malaria is reviewed in this paper. Cerebral malaria, the acute encephalopathy which complicates exclusively the infection by Plasmodium falciparum commonly affects children and adolescents in hyperendemic areas. Plugging of cerebral capillaries and venules by clumped, parasitized red cells causing sludging in the capillary circulation is one hypothesis to explain its pathogenesis. The other is a humoral hypothesis which proposes nonspecific, immune-mediated, inflammatory responses with release of vasoactive substances capable of producing endothelial damage and alterations of permeability. Cerebral malaria has a mortality rate up to 50%, and also a considerable longterm morbidity, particularly in children. Hypoglycemia, largely in patients treated with quinine, may complicate the cerebral symptomatology. Other central nervous manifestations of malaria include intracranial hemorrhage, cerebral arterial occlusion, and transient extrapyramidal and neuropsychiatric manifestations. A self-limiting, isolated cerebellar ataxia, presumably caused by immunological mechanisms, in patients recovering from falciparum malaria has been recognized in Sri Lanka. Malaria is a common cause of febrile seizures in the tropics, and it also contributes to the development of epilepsy in later life. Several reports of spinal cord and peripheral nerve involvement are also available. A transient muscle paralysis resembling periodic paralysis during febrile episodes of malaria has been described in some patients. The pathogenesis of these neurological manifestations remains unexplored, but offers excellent perspectives for research at a clinical as well as experimental level.


Seizure recurrence in infants with neonatal convulsions. A follow-up study.

Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEG, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.


Brain SPECT in the pre-surgical evaluation of epileptic patients. Preliminary results.

Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG) monitoring and anatomical studies (CT and MRI). Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male) using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a) in 4, SPECT findings correlated well with the anatomical findings; (b) in 5 instances, SPECT was able to disclose additional functional deficits; (c) in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n = 10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.


Effects of stimulation intensity, gender and handedness upon auditory evoked potentials.

Left handers and women show less anatomical brain asymmetry, larger corpus callosum and more bilateral representation of specific functions. Sensory and cognitive components of cortical auditory evoked potentials (AEP) have been shown to be asymmetric in right handed males and to be influenced by stimulus intensity. In this study the influence of sex, handedness and stimulus intensity upon AEP components is investigated under basal conditions of passive attention. 14 right handed males, 14 right handed females, 14 left handed males, and 14 left handed females were studied while lying awake and paying passive attention to auditory stimulation (series of 100 binaural clicks, duration 1 msec, rate 1/sec, at four intensities). Cz, C3 and C4 referenced to linked mastoids and right EOG were recorded. Analysis time was 400 msec, average evoked potentials were based on 100 clicks. Stimulus intensity and gender affect early sensory components (P1N1 and N1P2) at central leads, asymmetry is influenced only by handedness, right handers showing larger P1N1 amplitudes over the right hemisphere.


[Normal values of neural conduction velocity in a group of 101 subjects].

Motor and sensory nerve conduction velocities were analysed in a group of 101 normal Brazilians. The normal values were obtained considering the group age, the distal and proximal segments of each nerve, the differences in the right and left side for each nerve. A significant decline in the conduction was found for the elderly aged group.


AIDS. A CSF laboratory experience on 470 cases in a 7 year time period.

In a seven year time period (July 1984 to June 1991) were studied CSF samples of 36,216 new patients, 470 of them infected by HIV. Number of AIDS patients represents 1.30% of total cases examined in the laboratory during this time period. Normal CSF was observed in only 16 cases (3.4%). Associated pathologies occurred in 66% of cases. Opportunistic infections predominated among them (227 cases). Data support indication for CSF examination in HIV infected patients. This exam must be as complete as possible.


[Peripheral facial paralysis in Petropolis].

The author presents 83 cases of "a frigore" peripheral facial palsy, occurred in the mountain city of Petropolis which has characteristics such as a tropical climate without any traces of a dry season and an average temperature of 50 degrees F to 73.5 degrees F. The author relates them with virus infections which appear within a year period. Fifty six patients belong to his clinic and have a follow up, while other 25 patients proceed from another clinics and from them he only has reports on sex, age, side of palsy and the beginning of illness. He shows that the largest number of cases occurred along the months of May, August, September and October. Season distribution for southern hemisphere is analysed. He also considers etiology, incidence, prevalence, treatment and results on patients studied.


[Neurologic changes in congenital heart diseases: a neuropathologic study].

A neuropathologic study in 190 consecutive autopsies of patients with congenital cardiopathy was performed: 116 cases underwent a surgical procedure (S group) and the remaining 74 were non-surgical (NS group). Neuropathologic alterations were observed in 71 cases (41 in the S group and 30 in the NS group). However, most of the 129 cases with a normal examination had died in the first 72 hours either after surgery or the clinical events responsible for the death. Almost all the neuropathologic alterations were hypoxic ischemic. Infarctions, single or multiple, were found in 41 cases (23 in the S and 18 in the NS group). An embolic mechanism could be detected in 12 cases. Diffuse hypoxic changes were present in 17 cases (10 in the S and 7 in the NS group). Hemorrhages were found in 11 (6 in the S and 5 in NS group), 4 of which were related to a disseminated intravascular coagulation. In 17 cases (5 in the NS and 12 in the S group), the picture was of a periventricular leukomalacia. All these cases concerned children under 6 months of age. In 7 cases inflammatory alterations were present (diffuse micro-abscesses in 6 and a frontal lobe abscess in 1). Almost all cases in both groups presented clinical complications, isolated or associated, potentially harmful to the brain, as cardiac arrest, cardiac low output, hypoxemia, and respiratory distress. If was impossible to determine in each case the magnitude of the factor or factors responsible for the correspondent pattern of neuropathologic damage. There was no difference as to the neuropathologic pattern between congenital cardiopathies leading to increased or decreased pulmonary blood flow.


[Motor neuron disease: metabolic evaluation].

The authors studied serum and urinary calcium and phosphorus levels, as well as abnormalities on the spine of 30 patients with motor neuron disease. The authors believe in multifactorial aspects in the pathogenesis of motor neuron disease, calling special attention to toxic and metabolic factors.