[Transvenous hepatic biopsy in patients with blood coagulation disorders]. Severe clotting defects represent the main contraindication to percutaneous liver biopsy. A transvenous liver puncture technique has been developed for patients suffering from blood coagulation disorders. This approach was attempted in 17 of 148 consecutive patients (12%) in whom a needle liver biopsy was indicated. Hepatic tissue samplings were successfully obtained in 16 subjects. The mean size of the specimens was 7 mm. The clinical diagnosis or therapy were modified in 7 patients when the histopathology report was available. No complications related to the procedure occurred. Our early experience suggests that transvenous liver biopsy is indicated in one/ninth of cases in whom hepatic tissue sample is required for diagnosis. This technique is safe, and it has a high success rate to provide liver tissue samples.


[Clinical aspects of depression in general medicine patients]. The prevalence and clinical characteristics of depression were studied in 110 randomly chosen patients attending a general medicine outpatient facility. Two psychiatrists evaluated depression according to DSM-III-R criteria and measured the intensity of depression using the Hamilton scale. 25 cases were diagnosed as Mood disorders and 8 as Adaptative disorders. Depression was minor in all cases. Anxiety and somatic complaints were the main symptoms. The influence of the classification system used, demographic and seasonal factors are discussed.


[Hemolytic disease of the newborn due to ABO incompatibility. A predictive test]. A direct 2 stage enzymatic test and the direct anti gamma globulin test were used to predict hemolytic disease of the newborn. Maternal allo-antibodies were determined in cord blood of all newborns from April to June 1988. 0.25% bromelase was used for the 2 Stage Enzymatic Test and a polyspecific anti-gammaglobulin serum was used for the Anti Gamma Globulin Test. Of 618 newborns 97 had parental ABO heterospecificity. Maternal allo-antibodies were present in 20 cases (3.2%). 20 of 86 fullterm newborns developed jaundice presumably due to ABO incompatibility. Blood exchange was required in 6, while phototherapy was sufficient in the rest. The 2 Stage Enzymatic Test was positive in 20 of these cases and the Anti Gamma Globulin Test was positive in 10. Thus, these tests may be used to predict hemolytic disease of the newborn due to ABO incompatibility.


[Bromocriptine for macroprolactinomas. Discussion of 3 cases treated successfully]. Bromocriptine was used to treat 3 patients with prolactin secreting pituitary adenoma. Diagnosis was based on the presence of a sellar tumor over 1 cm in size at CT scanning and a serum prolactin concentration above 150 ng/ml. All patients were symptomatic from pituitary hypofunction or from tumor compression of neighboring areas. Bromocriptine was given at increasing doses up to 10 mg/day. Prolactin reached normal levels 1 to 7 months later, tumor reduction was confirmed by high resolution scanning. The mechanism of bromocriptine effect on these tumors is discussed.


[Chagas disease with the acquired immunodeficiency syndrome. Clinical cases]. We report 2 patients with AIDS who developed Chagas infection, one with encephalitis, the other with acute myocarditis. The implications of immune depression for the manifestations and course of Chagas disease are discussed. Chagas disease should be considered in patients with AIDS who live in endemic zones and who develop cerebral or cardiac manifestations.


[Liver cirrhosis: pathogenesis of ascites and disturbance of renal function]. The accumulation of ascites in cirrhosis has been classically attributed to the transudation of fluid from the splanchnic vascular bed to the peritoneal cavity due to the presence of portal hypertension. This transudation of fluid would induce hypovolemia responsible for the renal abnormalities frequently observed in these patients. Recent studies, however, indicate that the pathophysiology of ascites in cirrhosis is far more complex. Cirrhotic patients with ascites usually have profound disturbances in systemic hemodynamics and renal function and an activation of the endogenous vasoactive systems that contribute to the formation of ascites. In the present article the pathogenesis of these disturbances and their possible contribution to the formation of ascites are discussed.


[Accreditation of training centers for medical specialists]. A National Committee from the Association of Medical Faculties has conducted a process of accreditation of training centers for specialists. Over a period of 13 years, 483 centers have been reviewed. Rejection of accreditation has been based on inadequate Faculty staff, or insufficient technical support for practice and teaching. Maximal number of trainees for each program are defined according to the available facilities. The Committee makes a strong recommendation to keep training programs under direct tuition from Medical Schools, especially faced with the interest of other medical care institutions in developing in service training. Also, a recommendation is put forward to organize cooperative programs among different Medical Schools and to give special emphasis to training programs for specialists in short supply.


[Classification of septicemias. A clinical and pathogenic approach]. Classic sepsis is characterized by the presence of bacteria in blood originating from a primary infection site with secondary location at other sites. Some infectious diseases like typhoid and paratyphoid fever, brucellosis an others share this pathogenetic mechanism but have a characteristic clinical course and usually a good prognosis. After analyzing the differences between the 2 types the author proposes the terms "non specific" and "specific" for each type of sepsis, respectively. The differences between the 2, the organism involved and different reaction of the host in types, may be related to different pathogenetic effects of each case.


[Validity of test for drug addiction at the forensic medicine service]. The present study was done to test the validity of the clinical examination for drug addiction at the National Forensic Medicine Service of Santiago. The responses to a questionnaire for marihuana consumption and a laboratory test for cannabinole in urine were correlated. The proportion of false negatives was 36.5%. Thus, clinical evaluation for drug addiction has limitations that prevent their use in the legal and penal context.


[Prevalence of chronic diseases in young postpartum women]. Five hundred women 20 to 29 years of age were evaluated 48 hr after delivery to detect the presence of chronic diseases. An overall prevalence of 14.4% was found. Circulatory, osteo muscular, connective tissue and endocrine, metabolic and immune related disorders constituted the main groups of diseases detected. Leading diagnosis were hypertension, scoliosis, gallstones and goiter. No differences were found in type of delivery when comparing healthy and chronic disease affected women. Chronic disease in younger females should be further studied in order to avoid complications, sequelae and to improve reproductive conditions in this population.


[Andres Bello and the Faculty of Medicine of the University of Chile]. Andrés Bello, the first Rector of the University of Chile (1843) was a great supporter of the development of Medicine. In 1842 he said that the Faculty should pay special attention to diseases that were prevalent in Chile, and provide information to the Government concerning public hygiene and related matters. The Faculty of Medicine was one of the first 5 Faculties. It was integrated by academic members including 6 Europeans, T Armstrong, G Blest, N Cox, J Lafargue, L Sazie and 2 Chileans, L Ballester and F J Tocornal. The first Dean was the french surgeon and obstetrician Lorenzo Sazie.


[A study of some pathogenic factors of Salmonella typhi]. 30 strains isolated from clinical cases and a laboratory induced R-mutant or S typhi were studied. The synthesis of Colicin V, Siderophores, hydroxamate and phenolate (Aerobactin and Enterochelin) were investigated using biological assays. All strains were positive for Enterochelin but only strains 6586 and 4448 were positive for Aerobactin. An 80 kD receptor for enterochelin was found in the outer membrane of strains. Only strains 4448, 635 and 4693 produced Colicin V. Plasmid related antibiotic resistance was demonstrated in 7 strains and was considered "cryptic" in 3 others. The LD50 for mice ranged from 2.7 x 10(4) to 1 x 10(9) bacteria per ml. The presence of pathogenic factors was not related to the LD50.


[Normative parameter characterization for the auditory brainstem response of the normal newborn]. The auditory brainstem response generated by clicks was studied in 119 normal newborns. One ear was studied in detail at 20, 40 and 60 dBnHL, the other at 20 and 30 dBnHL, increasing the intensity if no response was found. The latency for waves I, III and V in the detailed studied ear was 2.7 +/- .39, 5.4 +/- .44 and 7.7 +/- .48, respectively. 85% of newborns had thresholds for auditory brainstem response less than 40 dBnHL, 54% less than 20 dBnHL and 15% between 40 and 60 dBnHL. These findings are compatible with conductive loss in the higher threshold group and support data from Stockard, regarding high risk groups. Additionally, our data suggests that an adequate level to screen for hearing loss in newborns is between 30 and 40 dBnHL.


[Transesophageal atrial stimulation in 168 patients]. Transesophageal atrial stimulation was performed in 168 patients, 95 males and 73 males, 20 to 81 years of age. The indication for atrial stimulation was the study of some bradyarrhythmia in 109 and ischemic heart disease in 59. An esophageal catheter was introduced through the nose and placed at a spot where a bimodal P wave was obtained. Stimulation was performed using a baby Medtronic stimulator coupled to a Vygon amplifier delivering an output of 30 volt. Sinus node recovery time was measured after 2 to 3 min of stimulation at different rates. Wenckebach and 2:1 A-V block as well as ST deviation were determined. Sick sinus syndrome was diagnosed in 41 cases through altered sinus node recovery time and/or secondary pauses; 35 patients showed Wenckebach rhythm at a stimulation rate over 120 per min; 2: 1 A-V block appeared in 22. Ischemic ST-T changes were produced in 20 subjects. No complications were observed, confirming this approach as a simple and effective way to achieve atrial stimulation for diagnostic purposes.


[Analysis of data from a database of patients submitted to cardiac catheterization]. 77 variables with data from clinical, non invasive and invasive findings in 591 adult patients submitted to cardiac catheterization and/or coronary arteriography from 1988 to 1991 were analyzed. 51% had coronary arteriography for suspected coronary artery disease: 15% had no or insignificant disease and 8% had main left disease. Among 92 patients with valvular heart disease, coronary angiography ruled out coronary disease in 80%. In this group, 3 vessel disease was found only in patients older than 62 years of age and main left disease was rare. The etiology of valve disease was rheumatic in 72%. Congenital heart disease was the indication for invasive study in 8% of patients, atrial septal defect being the most common entity.


[A cooperative study on early and intermediate gastric cancer: clinical, diagnostic and therapeutic aspects]. A cooperative study involving 13 hospitals in Chile allowed the analysis of 353 patients with gastric cancer in early stages. 82 cancers were located at the mucosal level, 151 at the submucosa and 120 reached the muscular layer. There were no differences in age and sex among these groups. Compared to early stage, patients with intermediate stage had a greater incidence of bleeding, anemia and undernutrition and exhibited lower body weight. Endoscopy had a higher diagnostic yield compared to radiological study. The diagnosis was confirmed by biopsy in 95% of patients. Total or subtotal gastrectomy was performed according to the location of the lesion, with a low operative mortality rate. Early gastric cancer accounts for 8 to 10% of all patients with gastric cancer undergoing surgical treatment.


[Characteristics of gastric cancer in the IX region of Chile]. The results of a prospective protocol for the management of patients with gastric cancer applied from May 1988 to June 1991 are reported. 123 patients were operated on and a resection performed in 55%. Only 14 patients had incipient tumor and 44 had "curative" surgery. There was a preponderance of non differentiated tumors located high in the stomach. Endoscopy and biopsy were performed in cases with positive diagnosis in 91 and 93%, respectively. The overall actuarial survival rate was 37% at 38 months, rising to 50% for patients undergoing resection and to 82% in patients with "curative" resection.


[Detection of respiratory syncytial and adenovirus in nasopharyngeal aspirates: comparison of cellular cultures and immunofluorescence]. Respiratory syncytial and adenovirus are 2 of the most important pathogens for respiratory infection in infancy. We compared the results of cellular cultures and immunofluorescence in the detection of these agents in nasopharyngeal exudates from hospitalized infants. Evidence for respiratory syncytial virus was searched in 776 samples. Immunofluorescence was much more sensitive, detecting 303 positive results, compared to only 142 for cell culture. Compared to immunofluorescence, the sensitivity and specificity of cell culture was 44% and 98%, respectively. Adenoviruses were investigated in 498 samples by both techniques. 88 positive results were identified by cell culture and only 30 by immunofluorescence. The sensitivity of immunofluorescence, compared to cell culture, was 31%, with a specificity of 99%. Thus, immunofluorescence is the technique of choice for detection of respiratory syncytial virus, while cell culture is preferable for adenovirus.


[Evaluation of commercially available reagents for diagnosis of chagas disease in Chilean blood banks. I. Selection of reagents]. Infection with T cruzi through blood transfusion is an important public health problem in Latin America, including Chile. A study on the sensitivity, specificity and applicability of currently applied methods was performed. Ten commercially available products were tested in a panel of 180 blood specimens against the indirect immunofluorescence antibody test (IFAT) and the immunoperoxidase test (IP). Qualitative concordance ranged from 82 to 98%, sensitivity from 64 to 97% and specificity from 93 to 100%. Some commercial products had a low performance and ELISA is recommended for routine use in Chilean blood banks, given its significantly higher sensitivity and specificity when compared to the hemagglutination test. In addition, experience with the use of the ELISA test is widespread in Chile.


[Paracetamol overdose: a new form of suicide in Chile and the value of N-acetylcysteine administration]. Overdose of paracetamol is associated to varying degrees of hepatic necrosis and may lead to severe hepatic failure. In this paper, we report 2 patients with paracetamol overdose for suicidal purposes who were successfully treated using the antidote N-acetyl-cysteine orally. A brief analysis of the literature follows.


[Erythrocytosis associated to idiopathic membranous nephropathy. Case report]. A patient with idiopathic membranous nephropathy and nephrotic syndrome developed inappropriately high red blood cell counts, unrelated to the level of serum creatinine. This unusual event could be explained by an overstimulation of the erythropoietin hormone due to hypoperfusion associated to the nephrotic syndrome.


[Epidemiology and natural history of biliary calculi. Implication for clinical management]. The knowledge of the epidemiology of cholesterol gallstones is mainly descriptive in Chile. Prevalence data has been gathered from several autopsy studies. The prevalence in these studies is similar to the prevalence determined in a cholecystographic study in a sample of the population of Santiago: 51% of women and 17% of men harbor gallstones, or have been cholecystectomized. The risk factors of the disease are well known and include sex, age, obesity, pregnancy, female sex hormones and hypotriglyceridemic drugs, there is scarce data on the natural history of gallstone disease. In this article we review the present knowledge of both the epidemiology and natural history of gallstones. In addition, we present some specific questions related to the potential identification of environmental and genetic risk factors in epidemiological studies. It is stressed that the knowledge of the natural history of gallstone disease is critical for the appropriate rational management of silent gallstones.


[Mechanisms of the antibiotic activity of bacteriocins]. Some bacteria possesses the genetic capacity to synthesize compounds referred to as bacteriocins; such compounds are antagonic for other closely related bacteria by inhibiting bacterial growth. These toxic substances are either simple polypeptides or very complex macromolecules. However the feature of being a "killer" strain is coded by chromosomal or plasmid genes. The mechanism of lethal action is carried out either directly or indirectly against certain functions of the target cell; death of the sensitive strain is produced as a consequence of transport collapse at membrane level resulting in a drastic drop of indispensable metabolites or ions; in other cases the antibacterial effect produces blocking of macromolecule synthesis; or loss of metabolite stabilization within the cell altering the basic metabolism. Repercussions of bacteriocinogeny may be: use as epidemiological tool through bacteriocin-typing techniques; biological control by means of specific bacteriocins; regulation of bacterial growth rate in a population as a competence mechanism for a given ecological habitat; genetic transfer between competent cells; study of superficial receptor sites and its role in natural immunity; use as therapeutic agents through a number of problems like cross-toxicity and specificity of action still remain unsolved.


[The re-enchantment of medicine].

[The re-enchantment of medicine]. This is the speech delivered by Bernardino Piñera MD, a catholic bishop, at the time of his incorporation as an Honorary Member of the Chilean Academy of Medicine. Medicine, health, and life, suffering and death are endowed with marvelous elements of reenchantment; turn pain into well-being, anxiety into serenity, fear into confidence; give sense to life and death, live and make men feel their human dignity. Many a patient miss the times when the doctor was a friend who knew him, not through biochemical or imaging diagnosis but through intimate conversation; when he was familiar with his character, his family and environment; when he could die in peace at home, surrounded by his family and thinking of God according to his religious beliefs. A profound change in medical conscience is needed, a philosophical and cultural change, allowing "high touch" to dominate and use "high tech". Let us transform the words sick or patient into "sick man" or "suffering man". Let us think of death as a culminating moment of life on earth, not as a failure of Medicine, but as the joyful acceptance of human destiny.


[Hospital crisis and the hospital of the XXI century]. The present hospital situation and a projection for the XXIth century, the national and international information, is analyzed. Outstanding characteristics include better health indicators and an explosive growth of costs due to technological advance and health insurance. Inadequate use of resources is noted. The state expense in public health was greatly decreased during the Chilean military government who privileged private investment. At present, the public sector counts 184 hospitals, 373 outpatient clinics and 1053 rural health posts and takes care of the health needs of 80% of the population. There has been no increase in expenses in the public sector compared to a 150% increase in the number of beds in the private sector. Decentralization, a redefinition of the health care model, an investment program and better administration are needed to improve the situation long-term. The health system and levels of health care as well as a model for hospitals in the coming century are described.


[Lorenzo Sazie. His 2nd and 3rd deanships]. This is the continuation of previous articles on Lorenzo Sazie, MD. It deals with advances in Medicine during his second period as a Dean (1855-1865) and the political and cultural atmosphere at the time. Dr Sazie was re-elected as a Dean of the Faculty of Medicine and died from typhoid fever which he acquired while taking care of patients during the 1865 epidemics in Santiago.


[Microbiology in Chile: development through a century of existence]. Microbiology starts in Chile at the end of the XIXth century as part of the effort to develop basic sciences at the University of Chile Medical School. Publications by Vicente Izquierdo on gonorrheae and Alejandro del Río on the organisms of dysenteriae were pioneer works in this area. The field was progressively developed in the Schools of Medicine, Dentistry, Pharmacy, Veterinary Medicine, Institute of Hygiene and Public Health and different hospitals. Many scientists have been trained in the United States, Canada or Europe. Post graduate training in Chile led to the first Masters degree in 1975 and the first doctoral degree in 1987. Although there is a shortage of well trained scientists and specialists, the field remains active as evidenced by publications, meetings and the existence of 3 specialized journals.


[Host metabolic reaction to infection].

[Host metabolic reaction to infection]. At the site of local reaction to infection the interleukin-1 (1L-1) is released signaling to distant tissues the presence of infection and attempting to strengthen the host's defenses and inhibit the bacterial growth. This phenomenon is accompanied by anorexia and fever. The muscle-protein breakdown is sustained and the released amino acids are taken up by the liver and other RE structures where they are used as substrates for energy and for synthesis of defense-related proteins. The metabolic adaptations to sepsis include hyperthermia, increased synthesis of hepatic globulins, development of granulopoiesis and neutrophilia and redistribution of serum iron and trace minerals.


[High dose rate brachytherapy].

[High dose rate brachytherapy]. The high dose rate brachytherapy uses a single source os 192Ir with 10Ci of nominal activity in a remote afterloading machine. This technique allows an outpatient treatment, without the inconveniences of the conventional low dose rate brachytherapy such as use of general anesthesia, rhachianesthesia, prolonged immobilization, and personal exposition to radiation. The radiotherapy department is now studying 5 basic treatment schemes concerning carcinomas of the uterine cervix, endometrium, lung, esophagus and central nervous system tumors. With the Micro Selectron HDR, 257 treatment sessions were done in 90 patients. Mostly were treated with weekly fractions, receiving a total of three to four treatments each. No complications were observed neither during nor after the procedure. Doses, fraction and ideal associations still have to be studied, so that a higher therapeutic ratio can be reached.


[Anesthesia for bronchoscopy].

[Anesthesia for bronchoscopy]. Fiberoptic bronchoscopy is a valuable diagnostic and therapeutic procedure in many clinical situations and is relatively simple to perform with the proper techniques. Local anesthetic techniques are often preferable for bronchoscopy since the examination is mostly undertaken as outpatient procedure. When the topical anesthesia is supplemented with light sedation, the procedure is easier and more acceptable to the patient. We describe a very efficient technique based on the transtracheal injection of a minimal amount of lidocaine directly on the upper airway mucosa, producing adequate anaesthesia. The method is easy to perform and safe.


[Patterns of antimicrobial resistance in gram-negative bacilli isolated from patients in intensive care units]. Minimal inhibitory concentration test with 16 antibiotics was performed for 435 stains of Gram negative bacilli, isolated from patients in intensive care units of five large hospitals. The results were analysed as to provide in vitro sensitivity patterns, as well as cross resistance between the tested drugs. The most frequent species were Pseudomonas aeruginosa, E. coli, Klebsiella spp., Enterobacter ssp., and Acinetobacter calcoaceticu, accounting for more than 80% of all isolates. Best figures were seen with ciprofloxacin and imipenem, with 805 of sensitive strains or more; third generation cephalosporins, aminoglycosides and aztreonam had overall sensitivity rates ranging from 58 to 73%. There was marked cross resistance between ceftazidime and other beta-lactam antibiotics, except for imipenem. These results bear implications regarding the establishment of empirical therapy in critical patients.


Thymectomy for myasthenia gravis: evaluation of results in 282 patients. The results of thymectomy in 282 patients with acquired and generalised myasthenia gravis are presented. The study includes patients submitted to surgical treatment in the period between 1958 and 1990. Remission or marked improvement was obtained in 70% of the patients with follow-up extending from one to 25 years. The total post-operative mortality rate was 8% dying predominantly patients with thymoma. Median sternotomy was made in 278 patients, transcervical thymectomy in two patients and thyroidectomy with concomitant thymectomy in other two. Surgical methods, operatory phases, previous treatment with prednisone and long term evolution with final results are discussed.


[Effect of electromagnetic fields on osteogenesis: an experimental study on rats]. The authors studied experimentally the electromagnetic pulsing field effects in an experimental model in rats, for evaluation of the velocity of consolidation of tibial and fibular fractures. The animals were followed for a period of three weeks under continuous stimulation and there were done radiological evaluation weekly and histological study at the end of the study. There were no histological, clinical or radiological differences between the group of rats submitted to electromagnetic pulsing fields and the control group.


[Functional electrical stimulation in the reciprocal locomotion of paraplegic patients]. The functional electrical stimulations is employed for standing-up posture and reciprocal locomotion in paraplegic patients. Five male paraplegic patients, level D5-D12 mean age 32.4 years, were treated with functional electrical stimulation, during two months. The quadriceps and fibular nerves were stimulated for 30 minutes, twice a day. After the training period, two patients were able to remain in the stand-up position and walk in parallel bars; one of them was able to use a walker. In other patients the technique was without effect for standing and walking. This method is not the solution for locomotion of paraplegics and more research is needed for the improvement of the results of functional electrical stimulation.


[Patients with AIDS admitted to the emergency service of the medical school at the University of São Paulo, in 1990]. In 1990, 12,319 patients, 235 of whom had AIDS (HIV IV), were admitted in the Emergency Division of the Hospital das Clínicas. The number of patients with AIDS represented 1.9% of all admissions and 4.2% of all clinical cases admitted. These 235 patients had 329 admissions; 163 were readmitted only once and 72 more than once. Mean time of permanence, ranging from one to 54 days, was 5.8 days. Approximately 70% of these AIDS patients came to our hospital from outside the area under our responsibility. Most of our patients were drug addicts. Kaposi's sarcoma was unusual.


[Isolation of oocysts of Cryptosporidium sp. in loose stools of patients with AIDS and of immunocompetent children and adults in São Paulo, Brazil]. On the aim of knowing better the prevalence of cryptosporidiosis in Brazil, we performed a survey, in São Paulo, in loose stools of patients with AIDS and immunocompetent children and adults. Using strict methods oocysts of Cryptosporidium sp. were found in 10.4% of the samples; higher rates were observed for patients with AIDS, and children attending day-care centers. The result observed may be considered important and indicate the need to include the search of this organism in routine stool examination.


[Action of 3,5,3'-triiodothyronine (T3) on Walker's 256 carcinosarcoma development]. In order to verify the effects of triiodothyronine (T3) administration in animals bearing Walker tumor, the authors have carried out an experimental study utilizing Wistar rats inoculated with both ascitic and solid Walker tumor, and Balb/c isogenic mice for the study of spreading of macrophages. The animals were treated with T3 20 micrograms/100 g of body weight and the data were analysed by Chi-square and Mann-Whitney tests. The authors conclude that T3 increases significantly the survival of rats bearing Walker tumor, and the spreading of macrophages when inoculated into the peritoneal cavity of mice. The hormone does not alter the weight of tumor mass. These results could be explained by the macrophageal activation and by the synthesis of the tumor necrosis factor.


[Medical pedagogy and special didactics in graduate courses at the medical school of the University of São Paulo, Brazil]. Graduate courses of medical pedagogy and special didactics at S. Paulo University Medical School are analysed. The authors present objectives, subject matters and methodologies of both courses, as well as their evaluation by the graduate students. After an initial rejection, the evaluation became very positive (67% in medical pedagogy and 82% in special didactics). Some future perspectives are discussed.


[Abdominal aortic mycotic aneurysm due to Salmonella: case report and review of literature]. A 59 year old female patient was admitted to the hospital complaining of lower back pain and fever for four months, with worsening of symptoms during the last two weeks. A painful pulsatile abdominal mass was the only positive sign at her physical examination. Her CT-Scan showed a periaortic hematoma and a rupture of the aortic wall while the Aortography disclosed a false aneurysm below the renal arteries. All blood cultures were negative. The patient was operated on and had her aneurysm resected and her aorta reconstructed with an in situ bifurcated aorto-femoral Dacron graft. The bacteriological examination of the aortic wall revealed a Salmonella type B, which confirmed the clinical hypothesis of abdominal aortic mycotic aneurysm. It was not possible to maintain a prolonged antibiotic therapy and the patient had to be submitted to a second operation three months later because of an infected graft; when the aorto-femoral graft was removed and an axillobifemoral bypass prosthesis was done. After a three years follow-up period the patient is doing well and has no signs of recurrences. We conclude, based on the literature review and our personal experience, that: 1) the symptomatologic triad presented by the patient is highly suggestive of those diagnosis; 2) blood cultures may not be positive; 3) the CT-Scan and aortography are the best examinations for the diagnosis of abdominal aortic mycotic aneurysm; 4) either the in situ or the extra-anatomical arterial reconstruction may be employed with good results. Higher infection rates are reported with the in situ grafts; 5) life-long antibiotic therapy is recommended whatever reconstruction procedure is selected.


[A new technique of intrahepatic cholangiodigestive shunt in the right lobe of the liver]. Intra-hepatic cholangiojejunostomy in the left liver lobe is a well standardized procedure. For the right lobe however this procedure may be tedious, difficult and followed by early and late complications. A new technique is described based on two principles: minimal sacrifice of hepatic parenchyma and establishment of latero-lateral cholangio-intestinal anastomoses. Five patients were submitted to this procedure and one of them is alive without jaundice three years after the operation. It's concluded that this technique can be indicated in cases of biliary obstruction in which the anastomoses of the left duct cannot be performed because of local changes and in cases with cholangitis.


[Hematologic changes in female athletes]. Iron deficiency is the most common cause of anemia throughout the world. Physical performance, endurance capacity and resistance to fatigue in human are dependent upon many different factors. One of them is the oxygen carrying capacity of blood, mainly determined by hemoglobin concentration. We used questionnaires, physical examination and laboratory investigation to study the hematologic patterns in 18 volley-ball athletes. Their average intake of iron was 13.99 +/- 6.26 mg/day; the average serum iron concentration was 108.61 +/- 29.13 micrograms/dl; the hemoglobin concentration was 12.94 +/- 1.10 g/dl. Four athletes had less than 12 g of hemoglobin/dl and a serum iron concentration of 99.25 +/- 39.73 micrograms/dl. The maximal aerobic exercise capacity measured by exercise electrocardiography showed no important differences between the athletes with hemoglobin values higher or lower than 12 g/dl. These data support the idea that in São Paulo among young female athletes overt anemia is uncommon.


[Surgical repair of inguinal hernia by the Shouldice technique under local anesthesia]. The author evaluates the results of the surgical correction of inguinal hernia by Shouldice's technique, under local anesthesia, in a group of 62 patients, most of them elder and of high risk. The patients remained in the hospital one day. Bupivacaine 0.5%, associated with vasoconstrictor was used. The operative results were considered good in 94.9% of cases, regular in 3.4% and bad in 1.7%. No major complications occurred; in three patient small hematomas formed inside the surgical wound, the drainage of which was however not necessary. In a 3-year follow-up only one patient had recurrence of the hernia.


[Evaluation of the therapeutic activity of fluconazole in acute experimental infection caused by Trypanosoma cruzi]. On hand of information that fluconazole can inhibit Trypanosoma cruzi, infection, an experimental investigation in acutely infected mice treated with 200 mg/kg daily of this drug during one month was carried out. Parasitemia patency, blood culture, sub-inoculation and histologic examination were the parameters used to evaluate the potential therapeutic activity of the drug. The results did not confirm the hypothesis, but it would be desirable to conduct new trials with this and other imidazole compounds.


[Hemoglobin H: laboratory identification]. Hemoglobin H (Hb H) disease is an alpha thalassemia form characterized by low synthesis of alpha chain and high beta chain concentration; this unbalance induces the beta chain tetramers formation. Hb H is relatively frequent in Thailand and Greece. Isolated cases have been reported in Chinese, Filipinos, Malaysians. In the Near East occasional cases were observed in Greek Cypriots and Jordanian Arabs. Hb H carriers were found in Italy, Spain, Canada, Indonesia and other countries. In Brazil there are descendants of Italians, Chinese and people of negro origin who are carriers of Hb H. We identified the Hb H by electrophoresis, instability and characteristic inclusion bodies.


[Survival analysis of 487 patients with kidney transplantation]. The causes of graft loss were analysed in a group of 487 kidney transplants, of which 252 (51.46%) concerned related donors, 139 (28.5%) cadaver donors and 96 (19.7%) non-related donors. A total of 74 kidneys were lost in the first 3 months after transplantation (15.19%). In 34 cases the loss was due to immunological factors (45.9%) in 21 cases (28.3%) to the death of the patients and in 19 cases (25.7%) to the technical causes. From 34 losses by immunological problems, 32 were rejections with humoral character (acute vascular rejection in 11 cases, late humoral rejection in 11 cases, immediate humoral rejection in 9 cases, ABO incompatibility in one case) and recurrence of original disease in one case. Acute cellular rejection was observed in only one patient. None of the patients died from immunological loss of the graft. The most frequent cause of death were sepsis (13 out of 21 patients) and the most common focus of infection was pulmonary (5 patients). It occurred most frequently with cadaveric donor, (10.07%). Death related to cardiovascular causes occurred in four patients, digestive in two and in consequence of arterial bleeding in two. Among the 23 losses by technical factors renal artery thrombosis was the most frequent (11 cases); renal rupture occurred in three cases, renal vein thrombosis in two rupture of arterial anastomosis in one and inviable kidney in another one. The technical loss was most frequent with cadaver donors (8.63%), followed by non-related donors (4.16%) and related donors (2.77%). Four patients died from causes directly related to technical factors.(ABSTRACT TRUNCATED AT 250 WORDS)


[Physiatric treatment of pain in osteoarthrosis]. The osteoarthrosis is a disease of high incidence in the population affecting chiefly middle-aged women. The chronic pain is the main cause of incapacity and may be responsible for the secondary articular alterations in theses patients. This paper reviews the physiopathology and the treatment of the pain in osteoarthrosis.


[Profile of Brazilian medical schools in 1991]. On hand of an inquiry carried out by Interinstitutional Commission for Evaluation of Medical Education (CINAEM) in 76 medical schools an outline of Brazilian medical education in 1991 was prepared. The positive aspects included active participation in "IDA--Integração Docente-Assistencial" programs, existence of pedagogical support and considerable assistential activity at the school hospitals. There were however also some negative aspects: insufficient research activity of teachers, existence of too many schools, small titular index of teachers and exaggerated clinical practice at the school-hospital. The importance of individual evaluation of each medical school in the future work to be done by CINAEM is emphasized.


[Cholecystectomy in patients with sickle-cell anemia]. The surgical treatment of cholelithiasis in patients with sickle cell anemia is rather frequently followed by the operative complications. In order to study the influence of pre-operative factors and post operative complications, 31 consecutive patients distributed in two groups has been studied. In group I, all the patients have been operated by conventional procedures with 43.75% of complications. In group II, a more appropriated technique and a better metabolic control ensured a lower morbidity (6.67%). There was no pos operative death in this series. Pre operative bilirubin levels was the only condition associated with increased pos operative morbidity.


[The effect of lipid emulsions on the mechanisms of organic defense in infectious injury]. For treatment of metabolic derangements in infective states intravenous lipidic emulsions have been used. Their use is however not harmless existing reports on fat inhibiting the function of blood polymorphonuclear leukocytes and macrophages. The purpose of the research reported herewith was to study in rats the effect of new intravenous lipidic emulsions containing medium chain triglycerides and long chain triglycerides and compare it with the effect of long chain triglycerides emulsion on function of polymorphonuclear leukocytes (chemotaxis, phagocytosis and bactericidal activity). The intraperitoneal implant of an E. coli capsule was used for the study. The transfusions of both lipidic emulsions in septic rats have not altered functions of polymorphonuclear leukocytes when compared with saline infusion. However there was found hepatic steatosis, hypertrophy and presence of fat globules in the Kupffer cells in rats infused with medium chain and long chain triglyceride emulsions. Sequential blood cultures obtained from rats infused with the emulsions showed increased bacterial growth with medium chain triglyceride emulsion. There was no significant difference between the rats that received both lipid infusions and those that received saline infusions as to the mortality. Our experimental study suggests that the use of fat emulsions in infective states be done with care and monitoring of seric triglycerides and steroids.


Juvenile myasthenia gravis and thymectomy: report of ten cases. Ten patients from 7 to 12 years of age presented generalized acquired myasthenia gravis: six had a severe form and four a moderate one. All patients showed progressive worsening and poor response to the medical treatment; all of them were submitted to thymectomy by median sternotomy. Long-term results were beneficial for 60% of the patients who experimented a marked improvement or even complete remission. One patient improved without medication being followed for two years. Another patient has been in remission taking only a minimal dose of anticholinesterase drug for seven years. In most cases prednisone has been used as long-term maintenance in the postoperative phase. Short-term results were not favorable: one death occurred and 30% of the patients worsened.


[Centronuclear (myotubular) myopathy: a case report]. The authors report the case of a female 5-months-old child who presented from the age of two months delayed neuromotor development, marked hypotonia, general muscle weakness and bilateral palpebral ptosis. The muscle biopsy revealed many fibers with central nuclei and the diagnosis was centronuclear (myotubular) myopathy. The difficult histological characterization of this congenital myopathy and the great variability of clinical findings with light, moderate or severe involvement are analysed and discussed.


[Pyogenic arthritis: case reports and a review of the literature]. The authors studied septic arthritis in patients of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. The pathogeny, the etiology and the diagnosis with clinical and laboratory findings are discussed. Our data are in accordance with those found in the literature. The main site was the knee joint and the etiologic agent Staphylococcus aureus. The authors point to the necessity of an early diagnosis and to the fact that the treatment of septic arthritis must be started as soon as possible.


[The use of skinfolds and of the muscle circumference of the upper arm in the diagnosis of protein-energy malnutrition in adults patients: a critical study]. The use of anthropometric measurements of triceps (TSF) and subscapular skinfolds (SSF) and mid-upper arm muscle circumference (MAMC) was examined as far as the diagnosis of energy-protein malnutrition (EPM) is concerned. The study was undertaken in five groups of patients (n = 231): arterial hypertension (AH, n = 63), chronic obstructive pulmonary disease (COPD, n = 17), hemodialyzed chronic renal failure (CRF, n = 19), critically ill patients with an acute event (CA, n = 42) and critically ill patients with chronic diseases (CCD, n = 90). The results were compared to those obtained in a group of healthy individuals (control group, n = 102). The control group and the group of patients were allocated in subgroups according to sex and age (less than 50 and more than 50 years). It was expected that significant differences would be found for the anthropometric values between the control subgroups and the COPD, the CRF and the CCD subgroups of patients. For the skinfold thicknesses (TSF and SSF), significant differences were found between CRF, CCD subgroups and the control subgroups under fifty years of age; however, the differences were not significant when the subgroups over fifty were analyzed. Concerning the MAMC, significant differences were found: 1 degree) between the CRF subgroups (males and females) and the control subgroups under fifty years of age; 2 degrees) between the CCD male subgroups (younger and older subgroups) and the respective control subgroups and 3 degrees) between the COPD and the control subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)


[Minipulses of cyclophosphamide in the treatment of dermatopolymyositis with lung involvement]. A new scheme for the treatment of dermatopolymyositis with pulmonary fibrosis not responding to corticosteroid therapy is presented. Monthly endovenous administration of a small dose of cyclophosphamide is advocated. Two patients with dermatopolymyositis not responding to prednisone were treated for two years with small doses of cyclophosphamide given monthly after which recovered from muscular and pulmonary involvement showing at present normal clinical parameters.


[The evaluation of the effect of formol in the detection of Cryptosporidium sp. oocysts in feces by the methods of Sheater and of the Coprotest]. Frequently it is necessary to search for oocysts of Cryptosporidium sp. in the stools potentially contaminated with human immunodeficiency virus (HIV). For the protection of the laboratory personal handling fecal material formalin has been considered useful. However, this disinfectant has not been evaluated when the stool examinations were performed with the technique of flotation-centrifugation in concentrated solution of sugar and with that of "Coprotest". Our experience indicates that the use of formalin may interfere with the results when the first of these methods is used, but it does not alter the results of the second one. This information is of importance for the future assistential and scientific studies.


[The teaching of resuscitation and intensive care medicine]. The authors analyze the relationship between development of anesthesiology as a specialty and cardiopulmonary resuscitation in the last decades, pointing out to the link between them. In this context, the anesthesiologist is seen as a professional particularly suited to take care of emergency cases. Training programs, both at graduate and postgraduate levels, that are carried on at the Anesthesiology Department of the University of São Paulo are presented. The main goal of these programs is the full training of the anesthesiologist rescuer physician.


[The treatment of residual exophthalmos by resection of the orbital fat]. The possibility of treatment of endocrine exophthalmos by resection of orbital fat has been discussed by Olivari. The orbital fat is located in two spaces: the outer space which surrounds the extraocular muscles the anterior extensions of which form the palpebral bags, and the inner space which surrounds the optic nerve, being crossed by the oculomotor, abducens and trochlear nerves. The surgical anatomy of orbital fat is discussed and the preliminary results of the resection of orbital fat for treatment of the residual exophthalmos are presented.


[The correction of cryptotia with tissue expanders]. Cryptotia is a congenital abnormality represented by the absence of the retroauricular sulcus in its superior portion. As the physiopathology of the problem involves the lack of skin tissue in the superior part of the ear sulcus, Mulliken suggested for the first time in 1988, the use of skin expanders as a method to obtain the extra skin necessary to correct this deformity. We bring forward our experience in the use of skin expanders in the treatment of three patients with cryptotia, bilateral in one of them. The technical aspects of the operations as well as the types of expanders used are described in detail. In all cases the correction of the cartilagenous deformities, freeing of the superior pole of the ear and redefinition of the retroauricular sulcus were performed. There were no significant complications. There was no change of the initial good results after a two years follow-up.


[The classification of skin grafts by the coverage of the receptor area]. Classification of skin grafting in use at the Division of Plastic Surgery and Burns of the São Paulo University for 16 years is presented. It is based on the type and way of the wound coverage from which the esthetic results essentially depend. This classification takes in consideration whether the healing at the receptor site should be or not by second intention or by the limitation of the healing through the reduction of the epithelialization time.


[The use of MPG in preventing the post-reperfusion injury of an epigastric island flap: an experimental study in rats]. The objective of this work was to study the protective effects of the free radical scavenger N2-mercaptopropionylglycine used in a rat model of reperfusion of epigastric island flaps submitted to transient occlusion of their vascular pedicles. In one group the epigastic vein of the flap was occluded for 5 hours. In the second group the epigastric artery was occluded for 21 hours and in the third group both the epigastric vein and artery were occluded for 8 hours. The scavenger or equivalent volume of saline solution was injected 10 minutes before the vascular occlusion and 10 minutes before declamping. The flap viability was assessed on the seventh day after flap reperfusion. In the three types of vascular occlusion a significant, and differential, increase of the areas of flap survival was observed. The protective effect of N2-mercaptopropionylglycine in reperfusion injuries was demonstrated.


[Microsurgical transplants for facial depressions]. From 1877 to 1991, 23 patients, 15 female and eight male, age ranging from eight to 42 years were treated for hemifacial depressions with microvascular transplants. Eight had hemifacial atrophy, four had hemifacial microsomia and one sequelae of hemangioma treatment. Twelve of these patients received paraescapular flaps, five omentum flaps, five great dorsal flaps and one fascial tensor flap. Good result was achieved in 21/23 patients with good symmetry. Two flaps were lost by vascular thrombosis. On of these patients later received a second microvascular flap with good result. Two patients presented late "reabsorption" of the flap after good result in the first year of follow-up. One of them received a second microvascular flap and again the flap lost volume in a long term follow-up. Discussion focuses on this important finding in terms of physiopathology. The results of different kinds of reconstruction are compared and the fact that dermofat flaps achieved best results is emphasized.


[Immediate breast reconstruction with the use of a microsurgical flap of the rectus abdominis muscle]. Breast cancer in advanced stages is a condition still frequently diagnosed in the female patients of this hospital. The surgical treatment proposed tends to be radical and mutilating. The importance of the breast for the female self-image is recognized, as well as the sameness of the prognosis of the disease after breast reconstruction, for which different techniques may be proposed to the patients. Among them is the use of the m. rectus abdominis as musculo-cutaneous free flap. This paper reports our experience in regard to the indication, tactics, results and complications of this technique.


[Esthetic osteotomy of the chin: a critical analysis of its indications]. The authors present thirty-four patients with microgenia operated on by advancement genioplasty. The indications and advantages of this method in improving the facial profile are reviewed and compared with other surgical possibilities described in the literature.


[Toxic shock syndrome after reduction mammaplasty: a case report]. The clinical features of the toxic shock syndrome are well established. It is rapidly developing disease and may be lethal if not recognized and treated in time. Once the syndrome was associated with the use of tampon by menstruating women. Recently this syndrome has been reported as due to Staphylococcus aureus infection. A severe case of toxic shock syndrome in a 18-years-old patient after reduction mammoplasty is reported, and the importance of an early diagnosis is emphasized.


[The early correction of the hand deformities in Apert's syndrome. A preliminary report]. The correction of cranial and limb malformations of the Apert's syndrome requires efforts of a multidisciplinary team. The esthetic and functional repercussions that this syndrome brings to their carriers are severe and so the treatment should aim tom improve the function of the hands in order to integrate these patients in a more normal social live. In our Service, in the period from 1989 to 1992 five patients carrying this syndrome had their hand correction completed before the age of three years. It was observed that surgery was possible in this early stage with no additional complication rate. Quadrangular flaps for the neocomissure and for the coverage of the fingers were successfully used even with skeletal deviations. There was improvement of the esthetics of the hands, but their function could not be evaluated properly. Anyway, because of complex abnormalities the results will never be perfect. The early treatment of these alterations allows the gain of a better hand function and moreover accelerates the physical and intellectual development of the children.


[The personality and motivational aspects of patients for mastoplasty]. Among the conscious or unconscious reasons that lead a woman to ask for an esthetic procedure are the need to improve his self-appreciation and the desire to receive more love and approval from other people. We have found no article in the Brazilian literature regarding the psychological aspects of patients submitted to mastoplasty. Fifty-three patients awaiting mastoplasty were studied in the period between September 1990 and january 1992 as for their motivation, as well as for characteristics of their personality. The method used included an interview and tests of "Human being figure drawn" and "Crown-Crisp Experimental Index (CCEI)". The results of the interview and the "Human being Figure Drawn" showed that the majority of the patients was young, without children or with only one child. They were determined, self-centered, with some difficulties, related to their sexuality and sociality.


[The civil responsibility of the plastic surgeon in esthetic procedures]. The authors discuss the professional liability of plastic surgeon for the results of esthetic procedures. In their opinion, plastic surgery was artificially divided in reconstructive and esthetic one. Legal decisions have also separated them and the success of results in esthetic procedures have been considered to be obligatory by the courts. The authors believe that in all cases of plastic surgery including esthetic operations the surgeon should use the adequate ways to achieve the best possible results that represent the average for the cultural and ethnic group in question.


[The cerebellar cortex in sudden infant death]. The author examined the cerebellar cortex in 190 post-mortem examinations, incl. 79 sudden infant deaths and 56 infants under one year with a clearly defined cause of death, six sudden deaths of toddlers and 8 toddlers with other causes of death and 41 death of subjects aged 17 months to 66 years who died from violent deaths. In 50 sudden infant deaths the authors observed a persistence of the external granular layer, as compared with a control group, in 29 infants no difference was detected. The external granular layer persisted in a 16-month-old toddler who died suddenly and in a 22-month old toddler who was drowned. A persisting external granular layer may be a supporting sign of retarded development of the cerebellar cortex in sudden infant deaths.


[Head injuries after an attack by an unarmed assailant]. From an analysis of injuries ensues clearly that even an attack by an unarmed aggressor aimed at the head of the victim is very dangerous and can cause a wide range of injuries from trivial to very serious ones leading to prolonged work incapacity. It is not possible to conclude from the injuries by how many blows it was caused because even after a single injury severe and complicated injuries may develop. From the injury it is not possible to assess unequivocally whether the injury was proceeded by a fist, open hand or foot or a combination of the two. In two subjects of the group permanent sequelae developed (one injury of the eye, 1 disfiguring scar of the eyelid).


[Drug detection using chlorination in thin-layer chromatography]. In order to assess which drugs give a colour reaction on TLC after chlorination and subsequent heating, more than 110 drugs were investigated. It was revealed that the investigated drugs can be divided into four groups: positive after short-term chlorination positive after prolonged chlorination, positive after prolonged chlorination and heating to 150 degrees C, and negative.


[Angiotensin-converting enzyme activity in dehydrated rats]. The serum activity of angiotensin converting enzyme in 10 rats before and after a five day dehydration was examined. It was measured spectrophotometrically and expressed in units corresponding to 1 mnol of hipuric acid liberated from Hip-Gly-Gly supstrate. The result show that serum activity of angiotensin converting enzyme was significantly increased in rats after the period of dehydration.


[Immunomorphometric study of megakaryocytes in patients with myelodysplastic syndrome]. The purpose of this study was to analyse, by immunomorphometry, megakaryocytopoiesis in patients with myelodysplatsic syndrome. The results revealed that, in spite of marked megakaryocyte hyperplasia, patients with myelodysplastic syndrome suffer from severe peripheral thrombocytopenia. Megakaryocytes in myelodisplastic syndrome have, in average, small cellular and nuclear diameter and 35.3% of them (s. c. micromegakaryocyres) can be identified only by using immunohistochemical technique. In conclusion, there is severe maturation disturbancy, ineffectiveness and disregulation of megakaryocytopoiesis in myelodysplastic syndrome.


[Primary and recurrent cytomegalovirus infection in pregnancy]. Cytomegalovirus is the most common perinatal viral infection. Congenital cytomegalovirus infection is associated with significant congenital anomalies and long-term sequelae. The incidence of primary and recurrent cytomegalovirus infection in pregnancy is studied in this prospective study. Preliminary annual results of serologic and virologic researches of cytomegalovirus in 224 pregnant women showed that the incidence of seropositive pregnant women was 21.42%. It was estimated by detection of viral antibodies of cytomegalovirus class Ig G. The other pregnant women in this study were seronegative and they showed a high risk of primary cytomegalovirus infection in pregnancy and of congenital infection. By indirect immunofluorescence cytomegalovirus was found in vaginal mucous of 8.03% pregnant women. Primary cytomegalovirus infection (viral antibodies of cytomegalovirus class Ig M) was confirmed in 2.23% of them. In the other 5.80% of pregnant women it was a question of recurrent cytomegalovirus infection. This result indicated that pregnancy was not a statistically significant risk factor for the appearance of primary cytomegalovirus in pregnant women (chi 2 = 0.0329; p > 0.05). However, the pregnancy might be a factor of risk for reactivation of latent cytomegalovirus infection (chi 2 = 9.3023; p < 0.001).


[Significance of intratumoral leukocytes in the local immune reaction in squamous cell carcinoma of the lower lip]. 50 cases of squamous cell carcinoma of the lower lip were analyzed histologically. Surgical specimens were examined for presence tumor-infiltrating leukocytes and pattern of stromal invasion. The estimation of the characteristics of local immune reaction was performed at the interface of the tumor and underlying tissues at the site of deepest penetration. As a result, there was a significant inverse correlation between degree of tumor-infiltrating leukocytes and pattern of invasion. Marked of tumor-infiltrating leukocytes is a manifestation of efficiently host immune response to the tumor.


[Cerebellar ataxia and acute cerebellar insult]. Ataxia, loss of muscle coordination during complex movement, is the most important sign of cerebellar lesion. Acute cerebellar attack of ischaemic and/or haemorrhagic nature is a focal disorder of cerebellar function which occurs rarely considering the prominent collateral net of blood vessels conveying blood to the cerebellum and the brain stem. We examined 12 patients with acute cerebellar attack (9 with ischaemic and 3 with haemorrhagic attack) of 300 patients with symptoms and signs of acute cerebrovascular attacks. We used all available diagnostic methods (EEG, neuro-ophthalmological examination, computed tomography as well as brain scintigraphy and angiography) in the management of these patients.


[Etiologic factors in fetal intrauterine growth retardation]. The authors studied the incidence of individual aetiological factors which may cause intrauterine interruption of foetal development. The research concerned 26 pregnant women hospitalized in the Ward for Pregnancy Pathology of the Department of Gynaecology and Obstetrics over the period from 1986-1989. The majority of women with this manifested EPH gestosis: essential hypertension was observed in 3 patients (12%). Particular attention was paid to the final stage of delivery and to the Apgar Score. Discussion includes the results of other authors. In the conclusion the importance and significance of this problem are stressed--within the scope of perinatal medicine--in view of the high morbidity and mortality rates among infants.


[Insulin resistance: pathophysiologic mechanisms, methods of assessment and clinical implications]. In the past years remarkable increase in knowledge of the mechanisms of insulin resistance has been made. Interest for the insulin resistance has been heightened by it's prevalence, and by the fact that it has a key role in pathogenesis of obesity, diabetes mellitus, arterial hypertension, polycystic ovary disease. In this review we discuss current concepts of the mechanisms of insulin resistance, methods for the assessment as well as its implications for a variety of disorders in human beings.


[IgA nephropathy in children with various clinico-histologic features and therapy]. Clinical and hystological features of IgA nephropathy were evaluated in 17 children (age range 6 to 14 years). Hematuria was present in all patients (macroscopic hematuria in 10 patients, microscopic hematuria in 7). Mild to moderate proteinuria was present in 10, nephrotic syndrome in two cases. The majority of renal biopsy showed normal picture of mild mesangial proliferation, with crescents in only one patient. Transient impairment of renal function developed in two patients. One of patients progressed to chronic renal failure. Four patients were treated (two with persistent proteinuria, one with nephrotic syndrome, one with nephritic syndrome). Corticosteroid treatment resulted in aggravation of proteinuria in two patients with persistent proteinuria. Patient with nephrotic syndrome demonstrated only diminution of proteinuria during different treatments: corticosteroids, ciclophosphamid and Ciclosporin A. Ciclophosphamid was beneficial in patient with nephritic syndrome.


[Modern concepts of anti-inflammatory therapy in bacterial meningitis]. Pathophysiologic disorders in bacterial meningitis and their influence on the course and prognosis of the disease are analysed. Deterioration of the CNS is due to inflammatory response of the host combined with other pathophysiological disorders. Inflammatory response in the subarachnoid space is the most intensive, but the most deleterious, as well, in the first several hours of antibiotic therapy when bacterial disintegration ensues. Fragments of the cell wall and endotoxin are very active components, independent of the presence of living bacteria in the subarachnoid space. Each microorganism induces different inflammatory response, and the course of the disease is, therefore, also different. Bacterial disintegration reta and release of the components are determined by the intensity of the inflammatory response in the subarachnoid space. Which, in turn, determine the degree of tissue damage. Bacterial products stimulate release of inflammatory mediators--cytokines from macrophages and other sources. Local production of cytokines from astrocytes and macroglial cells (macrophage equivalents in the CNS) is the first stage in development of the inflammatory response and tissue destruction. Cytokines induce damage of the CNS by attracting the inflammatory cells and by releasing superoxide anions inducing arachidonic acid metabolism and production of vasoactive metabolites of arachidonic acid which result in damage of blood-brain barrier, having, therefore, a direct cytotoxic effect. Consequences of these pathophysiologic disorders are cerebral oedema and elevated intracranial pressure. Current concepts of antiinflammatory therapy are, in the light of pathophysiological events in the CNS, directed to interruption of cytokine activation (steroids), prevention of production of vasoactive arachidonic acid metabolites (non-steroidal agents), and prevention of leukocyte transfer into the subarachnoid space (antileukocyte, anti-integrin antibodies).


Luteal insufficiency as the primary cause of habitual abortion--its successful treatment. In order to assess luteal insufficiency as a causative factor in habitual abortion, serial progesterone determinations were accomplished. Luteal insufficiency was proved on the basis of progesterone values by criteria elaborated by the author in 151 of 160 unselected patients with a history of 2-6 (mean 3.3) unsuccessful pregnancies. Normalization of luteal function before conception resulted in birth in case of 148 (92.5%) and first or second trimester abortion in case of 12 women (7.5%). 148 women with physiological luteal function delivered 205 newborns from 192 pregnancies (in 44 patients two, in 11 patients twin pregnancies and in one case a trigeminal pregnancy). Out of 12 twin pregnancies 10 terminated with mature, one with immature (complicated with uterus bicornis) births and one terminated with spontaneous abortion. One from the two trigeminal pregnancies resulted in immature birth and one in a spontaneous abortion in the second trimester. Fifteen pregnancies conceived in the group of 13 women with uterus bicornis or septus resulted in 13 mature and one premature births and the sole twin pregnancy case ended with immature birth. Based on the results achieved so far, the author regard the treatment of luteal insufficiency--beside the proving the aetiology--as the most successful therapy for habitual abortion.


[Surgical and nonsurgical therapy of malleolar fractures]. Subjective and objective parameters after the treatment of malleolar fractures were studied in 116 patients during a five-year-period. Nonoperative treatment was used in 48 patients and 68 patients were operated. Nonoperative treatment was successful in both supination-eversion and supination-adduction types of fractures, whereas in pronation fractures the operative treatment provided better results. The results were significantly influenced by residual lateral shortening, altered talocrural angle, talar subluxation and the size of posterior fragment. In all types of fractures but in supination-adduction type anatomical reduction and clinical findings correlated. Subjective results are sometimes influenced by factors which cannot be visualized on radiographies.


[Idiopathic normotensive hydrocephalus. Neuropsychologic evaluation after ventriculo-atrial shunt]. Two patients with normal-pressure hydrocephalus were assessed with Luria Nebraska Neuropsychological Battery, before ventriculo-atrial shunting and six months later. The best improvement was recorded in attention, visuospatial and intellectual functions. It is well documented that normal-pressure hydrocephalus dementia can be reversible if proper selection for neurosurgical treatment is made. Cognitive outcome of ventriculo-atrial shunting in normal-pressure hydrocephalus is best assessed with the appropriate neuropsychological testing.


Endocrine abortion in assisted reproduction technologies (ART). Luteal function, endometrial receptivity, endometrial prolactin and glycoprotein secretions, blastocyst-secreted immunomodulant factors and embryo quality are nowadays considered the main determinants involved in embryo implantation control. The endometrial factors are progesterone-dependent. Out of 128 cycles of ART (AIH-IU, GIFT, IVF-ET), performed in 67 women at the Dept. of Obstetrics and Gynaecology of Parma during the period 1986-1991, 31 conceptions were obtained (pregnancy rate: 24.21%), 7 of which miscarried (abortion rate: 22.58%). According to these data, ART high abortion rate is possibly connected with poor luteo-endometrial function and poor embryo quality. Controlled ovarian hyperstimulation is thought to inhibit embryo implantation after IVF-ET by decreasing endometrial receptivity. Such a situation can be treated either by exogenous progesterone administration or by tubal techniques (GIFT, TET) performed in non-tubal infertility. Both strategies showed to better endometrial receptivity. A delayed intrauterine embryo transfer at blastocyst stage, when cocultures allow to, is supposed to raise the implantation rate in tubal infertility by enhancing embryo selection and endometrial receptivity. This paper also reports preliminarily on the predictive value of beta-HGC and estradiol levels, as well as of endometrial thickness, on early pregnancy outcome.


Immunological side effects of some long term taking medicaments. In view of epidemiologic aspects of AIDS we studied the immunological side-effects of oral hormonal contraceptives and the barbiturates--which are used by many people in Hungary. We studied healthy persons using more than six months one of the above described drugs. We found significant decrease in the number of "O" cells and in the serum concentration of IgG in the O.C. test group. In B test group decreased significantly the number of T, B, T-active, T-helper lymphocytes and the serum concentration of IgM. The amount of IgA and IgD increased in both the test groups. We detected HBV-markers only in 0.83% of control-group but in 4.23% of O.C. group and in 2.28% of the B test group. The data suggests that all of studied medicaments cause increase in susceptibility against infections.


[Intracerebral hemorrhage in a female patient with pulmonary sarcoidosis]. Sarcoidosis is a chronic, multisystem disorder of unknown cause which is characterized by the accumulation of lymphocytes and mononuclear phagocytes in non-caseating epitheloid granulomas in affected organs. Sarcoidosis is now thought to be a disease of abnormal immune regulation, probably because of an exaggerated helper T lymphocyte process. The presence of immunoglobulins and complement in sarcoid granulomata suggests that the humoral mechanism may also be important. Signs of neurosarcoidosis are observed in only 5% of patients with equal involvement of the peripheral and central nervous system. A rare case of sarcoidosis with typical pulmonary dysfunction, chronic polyneuropathy of asymmetric type and intracerebral bilateral occipital hemorrhage who recovered dramatically within two months after corticosteroid therapy, is reported. Intracerebral haemorrhage as a complication of sarcoidosis has, to our knowledge, not been previously reported.


[Emergency cardiac defibrillation in a prehospital setting]. It has been show four successful defibrillations performed on a level of the emergency aid under different conditions (ambulance, apartment of a patient, open space) with the definite survival of defibrillated patients who suffered cardiac arrest according to the type of ventricular fibrillation because of various causes. It has been stressed the importance of good equipment and proper education of the Emergency Aid Service for performing complete measures of cardiopulmonary resuscitation including electrotherapy, both in ambulance as well as under difficult out of ambulance conditions. It has been pointed out advantages that Emergency Aid Services have in performing and resulting of cardiopulmonary resuscitation in small urban environments where because of their specific urban characteristic there is a possibility their specific urban characteristics there is a possibility of setting up a connection with clinically dead patients.


Total and specific IgE in sera of HIV positive and HIV negative homosexual male (regulation of IgE synthesis in HIV infection). In the course of HIV infection "atopic" symptoms can often be experienced (atopic dermatitis, asthmatic like symptoms in upper respiratory tract, sensitivity to drugs). Total IgE increase has been detected which is in inverse correlation with CD4 positive lymphocytes. Using semi quantitative and quantitative methods total and specific IgE levels of 30 HIV positive and 30 HIV negative homosexual men without atopic anamnestic data and symptoms have been determined. The age matched control groups were of 30 atopic men with active symptoms and 30 healthy, HIV negative heterosexual men. Determination of CD4, CD8 positive number of lymphocytes as well as B-2 microglobulin have been carried out. Total IgE level of HIV positive and HIV negative homosexuals was higher than that of the healthy controls and lower than that of the "atopic" controls. Specific IgE-s have been found more often in HIV positive and HIV negative homosexuals than in the normal controls. The correlation among CD4 and CD8 positive lymphocytes, and B-2 microglobulin level and total IgE level was not significant.


Demonstration of IgE low affinity Fc receptor (CD23) on normal human epidermal Langerhans cells. In previous studies, IgE molecules were detected along the cell membrane of Langerhans cells (LC) in atopic dermatitis involved skin. However, the exact nature of the receptor still remains obscure. Moreover, large subsets of leukocytes have been recently shown to express the low affinity receptor for the Fc portion of IgE (Fc epsilon RII/CD23). Since LC are epidermal leukocytes the present study was intended in order to verify if LC of normal human subjects express the Fc epsilon RII/CD23. An anti-CD23 monoclonal antibody (MoAb) was used in a double step gold immunoelectron microscopical (IEM) procedure, carried out on Ficoll-Hypaque LC-enriched epidermal cell suspensions, freshly isolated from midly trypsinized normal human skin. Cells with LC features showed gold particles on their surface. Up to now LC from normal human epidermis, investigated using MoAb against human IgE, apparently were IgE-negative. Here we inequivocally demonstrate that the Fc epsilon RII/CD23 is constitutively expressed by normal human LC. It is well known that LC play an important role in antigen presentation. Further, it has been previously described the existence of a steric relationship between CD23 and HLA-DR molecules. Therefore, the present data add further strength to the hypothesis that FC epsilon RII/CD23 could participate to antigen presentation phenomena.


Body sodium, atrial natriuretic peptide and blood pressure in diabetes mellitus. Diabetes mellitus (DM) is frequently associated with hypertension for which an independent pathomechanism has been suggested. We studied 26 patients with insulin-dependent (IDDM) and 18 patients with non-insulin-dependent (NIDDM) uncomplicated DM; all patients were in metabolic balance and none of them had hypertension. Exchangeable body sodium (NaE was estimated by isotope dilution, using appr. 1.1 Mbq 24NA. In a subset of 8 IDDM and 8 NIDDM patients atrial natriuretic peptide (ANP) plasma concentration was determined prior to and after the infusion of 2000 ml physiological saline over 2 hr. NaE was significantly increased both in IDDM and NIDDM patients (104.4 +/- 11.4% and 109.9 +/- 8.0% of the normal value for healthy subjects of identical body surface area; p < 0.05 and < 0.001 resp.). Mean blood pressure (MBP) correlated significantly with NaE in both groups (r = 0.364 and r = 0.520; p < 0.05 and < 0.025, resp.) but not in healthy control subjects (r = 0.112; N.S.). Resting ANP levels were not significantly different in IDDM (34.9 +/- 11.3 pg/ml), NIDDM (42.6 +/- 11.7 pg/ml) or control subjects (40.9 +/- 17.2 pg/ml) however the infusion of saline resulted in a significantly greater increase of plasma ANP in the NIDDM patients (to 82.9 +/- 43.2 pg/ml; P < 0.01) than in the controls (55.6 +/- 23.7 pg/ml; P < 0.01) which was associated with a significantly less increase in sodium excretion (UNAV) in the NIDDM patients (+86% vs. 3170%; P < 0.02) indicating down-regulation of ANP receptors in the kidney of NIDDM patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Glomerular hyperfiltration in essential hypertension: hormonal aspects. Glomerular hyperfiltration is thought to play a pivotal role in causing renal damage in essential hypertension. An increase in glomerular filtration rate can be experimentally induced by an acute oral protein load through still unclarified mechanisms, although hormonal factors have been postulated; in already hyperfiltering nephrons, the capacity to further increase glomerular filtration rate upon stimulation with an acute protein load (i.e. renal functional reserve) would conceivably be reduced, even in the presence of apparently normal renal function. The present study aimed at assessing whether renal functional reserve is preserved and/or is affected by different antihypertensive drugs in essential hypertensive patients without signs of renal function impairment; moreover, we tried to highlight changes in the plasma levels of natriuretic and antinatriuretic hormones potentially involved in the modulation of renal hemodynamics under the chosen experimental conditions. Renal hemodynamic parameters, plasma renin activity, aldosterone and atrial natriuretic factor were measured in fourteen essential hypertensives submitted to an acute oral protein load, alone or with a concomitant administration of either nifedipine or enalapril, as compared with a control carbohydrate meal. Glomerula filtration rate and renal plasma flow rose slightly but not significantly following an acute oral protein load as compared with a carbohydrate meal; no changes were noted in plasma atrial natriuretic factor levels, whereas plasma renin activity decreased. When nifedipine was administered together with the protein meal, both glomerular filtration rate and renal plasma flow increased significantly; there were also, parallel increases in plasma renin activity and atrial natriuretic factor. Administration of enalapril was associated with a decrease in both glomerular filtration rate and renal plasma flow; plasma renin activity showed an expected marked rise, whereas the plasma levels of atrial natriuretic factor were only slightly but not significantly reduced and plasma aldosterone fell. In conclusion, our data suggest that in our patients renal functional reserve was blunted. Clear-cut hyperfiltration was brought about by administration of nifedipine together with a protein meal, whereas enalapril completely abolished even the small increase in glomerular filtration rate seen after protein meal alone. The concomitant alterations in plasma renin activity, aldosterone and atrial natriuretic factor seemed to play no major role in the determinism of the observed renal hemodynamic changes.


Neuronal aspects and plasticity of inferior olivary complex and nucleus dentatus. In primary or physiological ageing, the brain undergoes a 10% weight reduction. This datum was confirmed in vivo by radiological investigation and post mortem by morphological research (Grandi and Coll. 1990, 1990, 1991, 1991), that underscores the same reduction in the medulla oblongata and in the cerebellum. Morphological and cytohistological aspects of primary ageing have been considered for the inferior olivary nucleus and for the dentate nucleus in 41 male subjects, 32 belonging to the decades 7th, 8th, 9th, and 9 to the decades from the 3rd to the 6th. From the two latter structures, separated along standard cut surfaces, serial histological slices were carried out, and histochemical reactions were accomplished, together with immunohistochemistry, for synaptophysin, NF-2F11, NSE, S-100, GFAP, chromogranin. As the weight progressively decreased from the 7th to the 9th decade, it was noted neuronal loss, both in the inferior olivary nucleus, and in the dentate nucleus. Furthermore, the loss appeared to be followed by substitutive astroglial proliferation. Immunocytochemical reaction for synaptophysin revealed peculiar aspects. A consistently regular result of such method concerned the two nuclei studied, in primary ageing, thus allowing the interpretation of the perfect structure of synaptic vesicles as an indirect argument for neuronal plasticity.


The role of sympathetic-adrenergic activity in the regulation of acid-base homeostasis and renal sodium excretion under acute physical stress in type-I diabetic children (IDDM). To evaluate the ability of stress response, plasma and urinary catecholamine concentrations, urinary electrolytes and acid-base status were measured in IDDM children (Group I: newly diagnoses 2-4 weeks, n = 7; Group II: duration 5-7 yr, n = 9; Group III: duration 10-13 yr, n = 12). The data were compared to healthy controls, n = 7, (mean +/- SD). Physical stress was induced by 2 W/kg/10 min bicycle ergometer. IDDM children exhibited metabolic acidosis under stress (pH: Group I = 7.24 +/- 0.08; Group II = 7.25 +/- 0.05; Group III = 7.19 +/- 0.03 vs C = 7.36 +/- 0.02). Stress induced an increase in the concentration of plasma norepinephrine (PNE in each group, the most pronounced elevation was seen in Group I (19.36 +/- 8.8 nmol/I vs C = 8.3 +/- 3.2, p < 0.2). Baseline PNE level showed a significant decrease with the duration of IDDM. Excretion of urinary NE (UNE) also increased under stress, however, the highest levels were measured in Group III (580 +/- 209 pmol/min/l. 73m2 vs 290 +/- 124 in Group I, p < .01). Baseline urinary dopamine (UDA) excretions were similar in each group. Stress caused an elevation in UDA only in C (2.05 +/- 1.8 vs 4.59 +/- 2.9 pmol/min.l. 73m2). The ratio of baseline UNE/UDA was similar in Groups I, II and C, but higher in Group III. Stress induced a shift towards NE excretion only in diabetic children which was most pronounced in children having IDDM more than 10 years. Stress did not affect urine output in Groups I. and II., but a decrease was observed in Group III (1.1 +/- 0.3 vs 0.7 +/- 0.3 ml/min.1.73 m2, p < .007). Urinary sodium excretion also decreased in Group III after physical loading (130 +/- 47 vs 66 +/- 33 umol/min/1.73 m2). The data show, that physical stress induces a severe lactic acidosis in IDDM. In spite of the decreased systemic sympathetic activity, the renal catecholamine response showed a shift towards vasoconstriction, sodium and fluid retention under physical stress in IDDM. These changes correlate with the duration of the underlying disease.


Blood pressure tracking in juvenile insulin dependent diabetes mellitus: preliminary data. One of the most frequent and important complications of IDDM is hypertension. It begins usually in adulthood and is rare in children. In order to study the behaviour and control of BP in IDDM children and adolescents we analyzed the BP levels of 106 patients (48 males, 58 females; age 1.5-16 yrs) in relation to sex, age, duration of the disease, and different parameters of metabolic control; moreover we studied the modifications of BP levels with years (tracking). BP levels, registered every 3-6 mos, were compared to the standard levels for age of the local population (2000 students between 7 and 16 yrs of age) and expressed as standard deviation scores (SDS) of the means. For each subject a line describing the change of the SDS over time was calculated by the method of least squares: the slope of this line is called trend and represents the tendency of the BP to increase or maintain stable or decrease with time, i.e to develop or not hypertension. All patients, except one 16 y. old girl, had normal BP and no microalbuminuria, but 10 of them presented with mean levels in the upper quartile and a constantly upward BP trend. Two of these patients showed after a 2 year follow-up stable hypertension and microalbuminuria. Moreover, an analytical and statistical study pointed out that BP levels of IDDM children seem to be influenced in addition to age, sex, height, weight, ponderal excess, as the general population, by the duration of the disease the insulin dose and some metabolic parameters (HbA1, HbA1c, glycemia, creatininemia).(ABSTRACT TRUNCATED AT 250 WORDS)


Wernicke's encephalopathy: occurrence and pathological aspects in a series of 400 AIDS patients. Wernicke encephalopathy (WE), acute (microhaemorrhages) and chronic (proliferation of capillaries) is actually considered as a not uncommon, and curable, condition in several diseases, and not only in alcoholic patients. Why serotoninergic nuclei, and whether blood brain barrier (BB) are involved were our questions. In a dramatic series of AIDS cases we selected 380 brains, all belonging to drug addicted subjects. In all Thiamine administration had been under 20 mg pro die and by oral way. In the cases considered, opportunistic infections were present in the 40%, and/or HIV specificity in the 35%. "Acute" WE was found in nearly the 10%. All patients presented with CNS lesions, other than those of WE, but HIV specificity was found only in 5. They all showed changes in Choroid Plexus, namely alterations of various type of the cuboid epithelium, such as swelling, disruption, hyperplasia. WE is set in connection with pyruvate accumulation at capillary level, likely bound to the Thiamine deficiency and to the lack of energy thus induced. Apart from obvious haemorrhagic aspects, CFS studies in WE are lacking. Choroid structure is not merely a permeable membrane (CSF is not a filtrate). Our findings would suggest that Thiamine plays a role in the energy supply to BB. Moreover, the existence of free nerve endings through the ependyma for the release and uptake of monoamines, allows to consider the elective involvement of serotoninergic neurons as somehow connected to the choroid plexus changes described.


Gallstone surgery--yesterday, today, tomorrow. After the first cholecystectomy performed by Karl Lagenbuch in 1882 this method has become the choice for treating gallstone disease. Today mortality of this operation is less than 1%. In spite of this fact clinicians tried to find non-operative possibilities to get rid of gallstones. Litholysis performed either by oral way or percutaneous, transhepatic or retrograde, transcystic method can be used only for cholesterol stones which represent only 10% of gallstones. Intracorporeal lithotripsy by percutaneous way is an invasive method. Extracorporeal shock wave lithotripsy can be applied only for cholesterol stones of certain number, but even after careful selection of the patients only 80% become stone free in one year. All the methods which leave the gallbladder intact are not free of complications and they are followed by 50% stone recurrence in 5 years. From 1987 a new surgical procedure: laparoscopic cholecystectomy has spread all over the world. Laparoscopic surgical technique is the way to the future.


Today's treatment of cholelithiasis: laparoscopic surgery. The speed at which laparoscopic biliary tract surgery has been introduced to such a large number of surgeons is without precedent in modern surgical history. At least 4 factors work together to explain such a rapid success: 1) Laparoscopic cholecystectomy removes the diseased gallbladder and ensures permanent cure; 2) Laparoscopic approach allows a telescopic vision and dissections are very precise; 3) Laparoscopic cholecystectomy allows minimal wound pain with complete resolution within a few days, a short hospital stay and the ability of many patients to return to work within a week of operation; 4) There are economic advantages to the patient, his community and the healthcare provider. The procedure proved to be as safe and feasible to use as conventional surgery. Obviously adequate training and credentialing are important processes to faster good patient outcomes. There are some contraindications to laparoscopic surgery, the most part of them are depending upon the experience of the surgeon. The successful application of therapeutic laparoscopy changed the diagnostic approach to lithiasic biliary disease. Whereas the most popular method of documenting gallbladder abnormalities before performing conventional surgery is ultrasonography, most surgeons who have embraced laparoscopic surgery argue for routine cholangiography because of the necessity to document duct anatomy besides minimizing the incidence of retained GBDS.


Limb lengthening with simultaneous correction of the deformity. In congenital malformation of the limbs the shortening of the extremity appears frequently together with its deformity. With Ilizarov's apparatus the limb may be lengthened simultaneously with the correction of the deformity. In spite of the fact that the use of the apparatus is rather complicated and complications are frequent, in 75 cases out of 102 excellent, in 23 good results were achieved. The various indications and results are demonstrated in 4 cases.


Neuronal and synaptic structure of the specific thalamic nuclei. 1. Neuronal organization of the specific thalamic nuclei is rather uniform. The ratio of thalamocortical relay neuron and Golgi II type interneuron is 2:1, as well as 3:1. 2. Interneurons show GABA-immunoreactivity. The presynaptic dendrites (F2-profiles) modify the intrathalamic transmission of the specific afferent impulses. 3. The two principal types of synaptic arrangements were observed in the specific thalamic nuclei: the synaptic glomeruli and the general neuropil. 4. Three different types of axon-terminals could be distinguished in the neuropil of all specific thalamic nuclei: the large RL-boutons are terminals of the specific afferents, the small RS-boutons are mainly the terminals of cortical afferents and the F1-boutons are probably axon-terminals of the Golgi II type interneurons, as well as axon-endings originating from the reticular nucleus of thalamus. 5. Synaptic contacts of the specific afferent fibers have basic importance in the relay nuclei. 6. In associative and anterior thalamic nuclei the RS- and F1-boutons have a significant modification effect on the interneurons (inhibition-disinhibition).


The trans-femoral approach in prosthesis replacements: results after two years. The Authors relate their experience in 14 cases of prosthesis revision using a long stem implant by H. Wagner, performed in 12 cases with transfemoral approach. Notwithstanding the aggressive procedure, that consists of splitting the proximal extremity of the femur for a length of 16 cm to 25 cm, to perform the complete removal of the first implant and of all the cement, after a 2 year check-up, the Authors observed: the complete mechanical stability of the new implant, the rapid process of ossification replacing the surgical fractures and bone loss.


The use of the high power lasers in oral surgery. The treatment of 2989 patients with different type of lasers was described. The argon laser beam was used in 57 cases (portwine stains, telangiectasias, angiofibromas and other vascular lesions) and 84 operations were performed by Nd YAG laser (leukoplakia, hemangioma etc.) furthermore 53 operations by combined laser beams. 2795 operation by carbon dioxide laser were performed in precancerous states and other white lesions, benign tumors and tumor-like states, malignant tumors and other lesions. The laser procedures were performed under local anaesthesia. Operations were rapid and bloodless and excellent cosmetic and functional results were obtained. The experience gained with this group of patients suggests that the ideal case for laser treatment are leukoplakia, hemangiomas and other vascular tumors and lesions of the face and the oral cavity and clotting disturbance.


Apicectomy: localization and isolation of the radicular apex. Apicectomy is a surgical root approach achieved to the preservation of the tooth any time this is possible. To effect a good procedure of primary importance is an anatomic knowledge because all depends on the right localization of the root apex. A radiography must be done before starting any surgical approach in order to have more acquaintance as possible about the exact location, form and correlations with the nearby anatomic parts. The second step after location of apex is its isolation by different procedures. Afterwards the retrograde filling in amalgam is effected. The use of this kind of filling makes the isolation of the surgical field extremely important in order to have a full success, if the isolation is not perfect then all the procedure will not be valid.


[Helicobacter pylori in Barrett esophagus]. The authors evaluated the prevalence of colonize by Helicobacter Pylori in 21 adults patients with Barrett's esophagus; 12 males and 9 females; with ranges of age from 21 to 81 years and a medium of 56.4 years old. It was detected in 23.8% that Helicobacter Pylori was positive in Barrett's esophagus, being quite higher, 26.6% in patients over 50 years old. In the five cases with positive Helicobacter Pylori, the Barrett esophagus presented a fundic gastric mucosa and no one intestinal metaplasia. Helicobacter Pylori was not seen in esophageal biopsies from patients with reflux esophagitis without Barrett's esophagus. The clinical value of the Helicobacter Pylori finding in Barrett's esophagus and its importance of the following at long term must be explained and studied in the future, by the evaluation in numerous patients groups and prolonged follow-up.


[Helicobacter pylori in patients with ulcerative dyspepsia]. A group of consecutive patients with ulcer dyspepsia were studied by endoscopy, antral and duodenal biopsy; by histologic determination of Helicobacter pylori (HP) and by silver staining (Warthin Starry technique). 68.31% were found to be infected. In those patients who showed chronic antritis (69.30% of the patients), HP was present in 92.85% of cases. In gastric and duodenal ulcer patients, similar rates were shown (76.47% and 76.92% respectively. In cases with normal histology findings HP was present in only 12.90% of cases. In the duodenum HP was scarce (7.92%) and there was always concomitant metaplasias. HP is strongly linked with mucosal lesions in our patients with ulcer dyspepsia. We wonder its responsibility in producing these lesions and about the need of performing specific treatment against HP in this patients.


[Liver cirrhosis and pregnancy. An infrequent association. A rare case of liver cirrhosis with 3 pregnancies]. A chronic etylist 46 year old female patient with a chronic active hepatitis of a probable alcoholic origin in presented. Between 1983 an 1987 she became pregnant three times and had normal children. We suggest probable hypotheses for etiology of hepatic cirrhosis, hypogonadism and sterility.


[The evaluation of acute viral hepatitis seen in a regional hospital]. 40 patients have been considered (23 males and 17 females), all affected by acute viral hepatitis, over a period of two years. All where followed up using the facilities of a regional hospital. The following items were evaluated: 23 patients (57.5%) with viral hepatitis A (HVA), 14 (35%) with viral hepatitis No A, No B (HVNANB) and 3 (7.5%) with viral hepatitis B (HVB). we found a significative difference (P > 0.05) between HVA and the other etiologic groups. the most important were jaundice, hyperthermia and asthenia. Several biological parameters where evaluated, including the Ritis Index (GOT/GPT) and prothrombin time and concentration, none correlated with the degree of liver damage. Evolution was followed: 30 patients (75%) showed the usual hepatocellular jaundice; 8 (20%) showed cholestasis and 2 (5%) were anicteric forms. Our results where comparable with those registered by other authors. We remark the high incidence of viral hepatitis A in our patients considering they where all adults.


[Toxic megacolon due to Shigella: a report of a new case]. A new case of Shigella-caused megacolon is described in detailed form. Some considerations are made about frequency, pathology, clinic and prognostic features.


[Increase of cancers of the thyroid gland in children in Byelarus]. Last September, "Nature" reported a great increase in the frequency of thyroid cancer in children in Belarus. Some additional data are now available and strengthen the previous findings. The overall incidence of thyroid cancer in children rose from an average of four cases per year till 1989 to more than 50 in 1991 and 1992. Nearly all of the 146 cancers recorded since 1986 are papillary carcinomas. Moreover these cancers appear relatively aggressive. The occurrence of such an increase within a few years of exposure--and only in children--is quite unexpected. Therefore, it seems very important to monitor trends in future and more information is needed, as different questions remain unanswered: dosimetry, diagnosis methods, other thyroid diseases... In conclusion, the authors stress on the very importance of iodine prophylaxis in case of an accidental contamination by radioisotopes of iodine. It seems possible that cancer excess would have been less important, if Belarus children had been given stable iodine.