[Direct evaluation of thyroid I-127 in an iodine overload situation: in vivo study by X-ray fluorescence and in vitro by analytical ion microscopy]. This review describes the two methods which allow direct estimation of stable iodine (127I) within thyroid gland either in vivo by X-ray fluorescence or in vitro by secondary ion mass spectrometry (SIMS) microscopy on tissue section. Although the measurement of thyroid iodine content (TIC) by X-ray fluorescence has little relevance for routine explorations of thyroid function, this is a valuable method for understanding complex pathophysiological conditions such as the thyroid adaptation to iodine overload. On the other hand, SIMS microscopy which is able to characterize the functional activity of thyroid tissue by measuring 127I concentration within the thyroid follicles, can be used to determine the extent to which exogenous iodine affects the regulation of iodine within the thyroid follicles. Both methods were used to evaluate the quantitative changes in thyroid 127I induced by amiodarone iodine overload. TIC measurements shows that hyperthyroidism occurred only in patients who increased their iodine stores, while the patients who developed hypothyroidism had low iodine stores. The SIMS microscopy data obtained in mice demonstrated that the thyroid response to amiodarone is related to dietary iodine intake leading to an increase in local iodine concentration in iodine deficient mice and to a decrease in iodine supplemented mice. This response is specific and different from that induced by an iodide overload. These results could explain that hyperthyroidism with high thyroid iodine content occurred in areas with low thyroid iodine intake and hypothyroidism with low thyroid iodine content in areas with a supplemented iodine diet.


[Adrenal enzymatic block with late-onset caused by 11-hydroxylase deficiency. Apropos of 29 cases]. Late-onset congenital adrenal hyperplasia is a cause of a spectrum of clinical manifestations of postnatal androgen excess. In these cases, ACTH stimulation test with measurement of 17-Hydroxyprogesterone (17OHP) is usually done to assess 21-hydroxylase (21-OH) deficiency. Determination of the 11-deoxycortisol (S) and the S to cortisol ratio is rarely done, so that 11 beta-hydroxylase (11-OH) deficiency seems unusual. We systematically investigated this biosynthetic defect among women complaining of hyperandrogenism (n = 519) and, comparing the patient's hormonal responses to ACTH with those of 31 normal women, found 29 11-OH deficiency (5.6%): this is the largest group ever reported. S was elevated only 9 times, so that using this single determination, diagnosis of 20 enzymatic defects would not have been made. Only three of the patients (10%) had hypertension, even though the pathway of aldosterone was involved in 33% of cases (criteria: elevation of the ratio desoxycorticosterone to corticosterone). We also described one new patient with both 11-OH and 3-beta-hydroxysteroid dehydrogenase deficiencies. The patho-physiology is particularly interesting in these cases. It is concluded that the single research for 21-OH deficiency is inadequate among women complaining of hyperandrogenism: the screening for 11-OH deficiency should be made, even if blood pressure is normal.


Prolactin-like substance secretion by granulosa cells isolated from bovine ovaries. By the 5-day culture of bovine granulosa cells both in serum-free and in serum-supplemented medium the time-dependent accumulation of PRL immunoreactivity was observed. FSH additions (10-10,000 ng/ml medium) led to a dramatic rise of immunoreactive PRL in a dose-dependent manner. LH stimulated the increase of PRL-like substance only in a great dose (10 IU/ml). Lower LH doses (0.01-1 IU/ml) had no significant influence on this process. Low doses of oxytocin (1 or 10 mIU/ml) blocked, and higher ones (100 or 1,000 mIU/ml) stimulated the granulosa PRL-like substance accumulation. Arginine-8-vasopressin (1-1,000 ng/ml), arginine-8-vasotocin (10-10,000 ng/ml), or LH-RH (10-10,000 ng/ml) failed to influence the PRL immunoreactivity accumulation in the culture medium. Present data may suggest the production of PRL-like substance by bovine ovarian cells, as well as the involvement of gonadotropins and oxytocin in the regulation of this process.


[Influence of dose and modalities of administration of BIM 23014 on growth hormone secretion in patients with acromegaly]. Somatostatin analogs, with prolonged half-lives have been proposed for the treatment of acromegalics. The aim of the study was to evaluate the short term efficacy of different doses and modalities of administration of the new somatostatin analog, BIM 23014 (BIM), on GH secretion in acromegalics. Ten acromegalics, with evolutive disease, who previously had had transsphenoidal surgery (and pituitary radiotherapy in 8) were evaluated in a three step study. The first part included four patients who received in a random order either vehicle or 500, 1000 and 1500 micrograms BIM for a day as a continuous s.c. infusion using programmable pumps at one-week interval for 24 hours to measure plasma GH levels. The second part included six patients who received in a random order either vehicle or 1500 micrograms/24h BIM as 500 micrograms x 3 s.c. injections, 750 micrograms x 2 s.c. injections and a continuous s.c. infusion using programmable pumps at one-week interval. During each period of the study blood was sampled at 4 hour intervals for 24 hours in order to measure plasma GH and BIM levels by radioimmunoassays. The third part of the study included the same 6 patients as the second part, who received 30 mg IM of a long acting formulation of BIM. Blood was sampled before and thereafter on days 1, 3, 6, 9, 12, 15, 18 and 21 following the injection for measurement of plasma GH and BIM levels. In first group 500 micrograms BIM slightly decreased plasma GH levels.(ABSTRACT TRUNCATED AT 250 WORDS)


[Pituitary tumor syndrome and hyperprolactinemia in peripheral hypothyroidism]. We studied 7 women with primary hypothyroidism who were suspected to harbor a prolactinoma on the basis of a pituitary gland enlargement associated with hyperprolactinemia. The diagnosis of prolactinoma was confirmed in 1 case only, which was treated surgically. In the remaining 6 patients the serum prolactin levels fell to normal on thyroxine replacement therapy and reduction in size of the pituitary gland was demonstrated by neuroradiological imaging in the 3 documented cases. This study underlines the fact that hyperprolactinemia associated with pituitary hyperplasia is secondary to hypothyroidism and that thyroid function tests should be obtained in all hyperprolactinemic patients even those with pituitary enlargement.


[Bone risk of hormone-suppressing therapy in differentiated thyroid epithelioma. Study by dual photon absorptiometry]. A decreased bone mineral density is a well known complication of thyrotoxicosis. If bone is also adversely affected by a subclinical hyperthyroidism is still debated. Such a situation is deliberately induced for treatment of thyroid differentiated carcinoma. We compared bone mineral measurements in case of thyroid carcinoma exposed to prolonged suppressive hormonal treatment (288 patient year, LT3 in 87%) and in age and weight matched controls. We did not find any difference in both sexes between the two populations in term of fracture rate and vertebral mineral density measured by dual photon absorptiometry, nor any influence of gonadal status in women.


[Substernal goiters. 218 operated cases]. The authors are presenting a retrospective study on 218 retrosternal goiters operated between 1968 and 1991. 33% of the goiters were incidentally discovered on a plain X-ray of the chest. Symptoms of compression were present in 50.5% of patients and hyperthyroidism in 16.5%. Respiratory manifestations were more frequent and more severe in patients aged 70 and more. Moreover 90% of those old patients were symptomatic. Goiters migrated anteriorly in 57.7% of cases, posteriorly in 33.9%, both anteriorly and posteriorly in 5.5%. Type of migration was unknown in 2.5%. 3.7% were malignant. 27 patients with respiratory symptoms received corticosteroids to reduce the airway compression. Among 52 patients with hyperthyroidism, 36 were given antithyroid drugs. Among them, some received corticosteroid drugs in order to reduce risks of mediastinal compression. A simple cervicotomy was adequate in 92.7% of case and was completed by sternotomy in 7.3%. The operation was iterative for relapsing or forgotten thoracic goiters in 24 cases. Morbidity was slight even for sternotomized patients. Mortality was noted in 2 cases (0.9%) one of them operated on for poorly-differentiated and suffocating carcinoma of the thyroid. We advise a straightforward surgical attitude as a result of the slight morbidity and mortality, even in sternotomized patients in order to avoid severe compressive complications of the airways.


[Pituitary adenoma revealed by Traquair's syndrome]. Junction scotoma is a classic field defect initially described by Traquair in 1917. Sparse cases have been reported until today. The authors report a silent pituitary adenoma in a 58 year-old female revealed by a junction scotoma. The field defects secondary to insult of chiasma from pituitary tumors besides usual bitemporal hemianopsia are reviewed by the authors. The possibility of minor ophthalmologic symptoms despite voluminous tumor has to be emphasized.


[Mitral valvuloplasty with double balloon catheter. Analysis of 200 cases]. To study the immediate clinical, echocardiographic and hemodynamic results of 200 patients who underwent percutaneous mitral balloon valvotomy (PMV) with double balloon technique. Two hundred patients were submitted to PVM for treatment of congestive heart failure secondary to severe mitral stenosis, between August 1987 to July 1991. Their mean age was 35.2 years, and 86.5% were female patients: 81% of them was in functional class, New York Heart Association (NYHA) III or IV; 4% was in atrial fibrilation and 4% had previous surgical commissurotomy. PMV was successfully performed in 89% of the patients. The mitral valve area, by pressure half time method, increased from 0.91 +/- 0.27 to 2.10 +/- 0.47 cm2, p < 0.001; the mean mitral gradient decreased from 20.86 +/- 6.16 to 4.26 +/- 3.13 mmHg, p < 0.001; the left atrium and mean pulmonary artery pressure decreased from 22.3 +/- 7.1 to 11.9 +/- 8.3 and 36.47 +/- 12.93 to 24.56 +/- 9.98 mmHg, p < 0.001, respectively. Complications related to transeptal technique occurred in 12 patients, which resulted in cardiac tamponade in 5 and death in 1. In 19 patients the punction of the atrial septum could not be performed. Mitral regurgitation (MR) immediately after PMV appeared 1+ or more grade in 50 patients, increased in 8 patients and remained unchanged in 11 patients. Ten patients needed mitral valve replacement in the first 48h after PMV, for treatment of severe MR. PMV produces excellent immediate results and can be considered an alternative to surgery for the relief of mitral stenosis.


[Coronary transluminal angioplasty after the use of thrombolytic therapy in acute myocardial infarction]. To present the Cardiology Institute of Rio Grande do Sul experience with percutaneous coronary angioplasty (PTCA), after thrombolytic therapy in acute myocardial infarction (AMI). Fifty-three patients with transmural AMI in whom early successful intravenous streptokinase recanalization was followed by PTCA. The mean age was 50 years, male patients were more frequent, the predominant area of infarct was anterior wall and more frequently the "culprit" coronary was the left anterior descendent. The main indication of PTCA was uniarterial lesion with less than 20 mm of length. The success comes out in 44 patients (81.5%). Ten patients (18.5%) were considered unsuccessful and were referred to emergency bypass graft surgery. The in-hospital AMI rate after PTCA was 5.5%. In the follow-up the reestenoses rate was 11% and reocclusion was 3.7%. New PTCA was necessary in 3 patients (5.5%) and in one, by-pass graft (1.8%). PTCA is an important and secure modality of complementary therapy after thrombolytic therapy with low morbidity and mortality.


[Prevalence of primary dyslipidemia in subjects with and without family history of coronary disease, based on the reference values of the "National Cholesterol Education Program" (NCEP)]. PURPOSE--To compare the prevalence of primary dyslipidemia in 2 groups, based on NCEP guidelines: a) first degree relatives of revascularized patients and b) hospital employees without family history of coronary heart disease (CHD). METHODS--1162 subjects aged over 20 years, were divided in two groups: G Fam consisted of 312 women and 221 men, mean age 30.8 years, siblings, brothers or sisters of revascularized patients (under 55 years old); G Serv consisted of 425 women and 204 men, mean age 30.7 years, all of them being healthy employees of Hospital das Clínicas (Clinics Hospital) with no family history of CHD. There were performed clinical, electrocardiographic and laboratory tests (total blood cholesterol--CT, triglycerides--TG and HDL cholesterol--HDL-C): and VLDL-C and LDL-C values were calculated according to Friedwald, besides CT/HDL-C and LDL-C/HDL-C ratios. Based on NCEP guidelines, the frequencies on values ranges for each parameter were determined. RESULTS--G Fam group showed a higher incidence of women and men with CT and LDL-C levels above 240 mg/dl and 160 mg/dl, respectively; CT/HDL-C and LDL-C/HDL-C values over 5.0 and 3.5, respectively, were seen more often in G Fam group. There were no significant differences on HDL-C and TG. About 35% of men and women in G Serv group showed CT levels higher than 200 mg/dl. CONCLUSION--First-degree relatives, aged over 20 years, from revascularized patients under 55 years old, showed more often lipid levels above those established by NCEP. In accordance to them, 62% of men and 28% of women of this group should undergo to LDL-C analysis, as well as 35% of men and 28% of women in teh G Serv group. It is called the attention for the importance of cholesterolemia evaluation in high risk groups for CHD.


[Arterial blood pressure in the remaining isolated black community of a quilombo north of Goiás-Kalunga]. To evaluate, in an isolated group of black individuals from a quilombo--a previous stronghold of rebel slaves (Kalunga) in the north of Goiás, the arterial blood pressure, as it related to age, sex, salt consumption, physical activities, obesity, tobacco and alcoholic beverage consumption and social organization. We studied 159 people (74 males and 85 females) representing 15% of the adult population. All measurements, were taken by the first author with the patient both sitting and supine, after 3 minutes of relaxation. This procedure was repeated 3 times and only the last measurement was used for research purposes. Of the studied cases only 10 individuals with hypertension (PAd > or = 95 mmHg) representing 6.28% of the population were found. Of the patients with hypertension 2 were between 18 and 29 years of age, 3 between 30 and 45 and 5 over 46 years old. They were 7 females and 3 males. We did not find any significant difference between sexes or any significant elevation in the medium BP value. The salt intake is relatively low among them and 81.7% of the population do not use any salt at all in their food. Alcohol consumption and the habit of smoking are moderate. They have intense physical activity and obesity is rare. The Kalunga have a cooperativist society and money is not frequently used as they favor the barter system. In isolated population that maintain their cultural traits and basic life style, not adding salt to their diet, not being obese and maintaining intense physical activities, the occurrence of arterial hypertension is rare and the increases in BP level with age is not significant.


[Sudden death and tachycardiomyopathy in a young man with incessant tachycardia]. The case of a 19-year-old young man with clinical picture of congestive heart failure and supraventricular tachycardia is reported. Heart failure got better with conventional treatment, but the tachycardia persisted in spite of antiarrhythmic drugs. Echocardiogram showed dilated cardiomyopathy of important degree and the endomyocardial biopsy, mild interstitial infiltration. Scintigraphy with gallium 67 was normal. Twenty days after the patient leaving the hospital, suffered sudden death. It is discussed the hypothesis that patient had developed a tachycardiomyopathy secondary to the incessant tachycardia. The importance of the diagnosis is reinforced by possibility of reversion of the cardiomyopathy by the resection of the anomalous pathway.


[Transcoronary chemical ablation of ventricular tachycardia in a patient with chronic chagas cardiomyopathy]. A case of recurrent ventricular tachycardia in the setting of chronic chagasic heart disease refractory to conventional antiarrhythmic agents as well as high doses of amiodarone (600 mg/day) is reported. Left ventriculography disclosed an apical aneurysm and a filling defect image suggestive of a thrombus. Sustained monomorphic ventricular tachycardia with the same QRS configuration as "clinical" tachycardia could be induced by means of right ventricular programmed electrical stimulation. The risk of systemic embolization precluded endocardial activation mapping of ventricular tachycardia. Intracoronary cold saline injections were done during induced ventricular tachycardia looking for a coronary artery branch related to the arrhythmogenic substrate. Cold saline mapping results pointed to an apical site of origin. Next step was intracoronary injection of ethyl alcohol in the distal part of the left anterior descending artery leading to a small and uncomplicated myocardial infarction. Control programmed stimulation was unable to reinduce ventricular tachycardia. Clinical outcome was uneventful and there was no recurrence of clinical arrhythmia in 6 months of follow-up.


[Clinical course of women with mitral valve stenosis during pregnancy and puerperium]. The clinical evolution of women with mitral stenosis was studied during pregnancy, delivery and puerperium in initial function (FC) class I/II. Ninety-three women were divided in three groups: Group GE--Pregnant women with mitral stenosis (n = 30, mean age 28 years); 26 (86.7%) patients had electrocardiographic signs of left atrial enlargement and nine (30%) had signs of right ventricular hypertrophy. The mitral valvar area was between 0.7 and 1.9 (mean = 1.26) cm2 at echodopplercardiogram; Group GM--Normal pregnant women (n = 32; aged 25.4 years); the electrocardiogram and echodopplercardiogram were normal. Group EM--non pregnant patients, with mitral stenosis (n = 31.33 years); 19 (61.3%) had left atrial enlargement and four (13%) had right ventricular hypertrophy. The mitral valvar area between 0.50 and 1.80 (mean = 1.19) cm2. The variables analyzed were FC and occurrence of the following complications: infective endocarditis, cardiac arrhythmias and thromboembolism. In GE group, 26 (86.7%) patients worsened the FC during gestation, 16 to FC III and 10 to FC IV. In GN group, 18 (56.2%) patients changed from FC I to FC II during the gestation and in EM group 5 (16.2%) patients changed from FC I/II to III during the study. Cardiac arrhythmias and infective endocarditis were not observed; thromboembolic event was registered in one (3.2%) patients from EM group. There were no death in all groups. The large majority of pregnant with mitral stenosis that started pregnancy in FC I/II worsened to FC III/IV during gestation. Medical treatment and eventually balloon valvuloplasty were successful measure to allow a full-term gestation without mortality.


[Early and late results of myocardial revascularization after coronary thrombolysis with intravenous streptokinase in the treatment of acute myocardial infarction]. To study the early and late results of patients treated initially intravenous streptokinase and then with coronary artery bypass surgery. One hundred and twenty one patients with acute myocardial infarction less than 6 hours duration were treated initially with intravenous streptokinase, and 1-38 days after (median 8.80 days) coronary artery bypass was undertaken. Ninety six patients were operated with extracorporeal circulation and 25 without it. Overall operative mortality was 3.30% (4/121). Reoperations due to bleeding was necessary in 3.30% (4/121). Late mortality was 5.40% with survival probability of 94.60% after 36 months and 92.30% after 70 months. Late morbidity events in terms of angina and cardiac insufficiency demonstrated that 7 patients had angina, 4 cardiac insufficiency and two angina and cardiac insufficiency; probability to be free from these events was 88.20% after 46 months and 66.40% after 70 months. Coronary artery bypass surgery after intravenous streptokinase can be undertaken with security and excellent early and late results.


[Angioplasty in native coronary circulation in patients treated with myocardial revascularization]. To evaluate the clinical results after angioplasty in the native coronary vessels in patients who had undergone previous coronary artery surgery. From June 1987 to July 1990, 69 patients with previous coronary artery surgery underwent coronary angioplasty in the native arteries. Age ranged from 31 to 82 (mean = 57.5) years, fifty eight were males. Angina was present in all patients. The patients were classified in three groups according to the following criteria: group I--incomplete revascularization following bypass surgery (28 patients); group II--progression of the disease in ungrafted vessels (24 patients) and group III--progression of the disease in grafted vessels (17 patients). Primary success was achieved in 94% (65/69). Ninety-five percent in group I, 92% in group II and 94% in group III. Complications occurred in 4%; emergency surgery or deaths were not observed in this study. Forty patients (61%) repeated coronary arteriography an average follow-up of 4 months and restenosis was detected in 10 (25%); 8 of them were redilated. Survival rates was 95% and 75% of them were free of coronary events after an average follow-up of 13 months. Coronary angioplasty in these patients is a safe and effective interventional procedure in the treatment of coronary artery disease in native coronary vessels.


[Tricuspid valve endocarditis in children]. Four children, three males, with ages 5, 1, 16 and 6 years, presented with isolated tricuspid valve endocarditis. Two of them were submitted to surgical treatment. Sepsis, cardiac murmur and heart failure were present in all of them. Three presented pulmonary embolism. Echocardiography demonstrated vegetation in the tricuspid valve in all cases. Two patients, one of them submitted to surgery, died. Tricuspid valve endocarditis in children with sepsis, heart failure and pulmonary embolism is a severe condition and early surgical treatment may diminished the high mortality.


[Left coronary vessel anomaly and myocardial infarction]. Anomalous origin of the left main coronary artery from the right anterior aortic sinus is a rare condition (0.02 to 0.07%) and its clinical significance is sometimes controversial. The authors present the case of a 44-year-old female with this anomaly and septal course with clinical, electrocardiographic, scintigraphic and cineangiographic evidences of myocardial infarction without coronary lesions. Literature is reviewed regarding diagnosis, clinical significance, pathophysiology and management. It is probably the first evidence of the potential danger of this anomaly with septal course.


[Infection of polytetrafluorethylene prosthesis in modified Blalock-Taussig anastomosis]. A 16 month-old baby submitted to systemic-pulmonary shunt with a polytetrafluorethylene prosthesis, who presented hyperthermia, radiologic signs of pulmonary opacifications and positive culture for staphylococcus aureus. Reoperation disclosed a prosthesis pseudoaneurysm, with disconnection of the anastomosis and evidences of infection. This complication has a low diagnostic rate and a high mortality and should always be suspected when signs of systemic infection become apparent in the postoperative period of polytetrafluorethylene systemic-pulmonary shunt.


[Captopril in mild and moderate hypertension resistant to diuretics: predictive value of the efficacy by captopril acute test]. To evaluate if acute blood pressure response with captopril can be applied as a predictive test of treatment efficacy in hypertensive patients uncontrolled with large dose of diuretics. Mild and moderate 120 uncontrolled hypertensive patients treated with hydrochlorothiazide 100 mg, were submitted to captopril (25 mg) test. The systolic (SBP) and diastolic (DBP) blood pressure acute and chronic responses were correlated and the linear discriminate function (LDF) and qui-square were applied to test the treatment efficacy. Previously two groups (G) patients were obtained as bad responders (G1) and good responders (G2) respectively, if the mean arterial pressure fall less or equal/more than 15% at the end of the associated treatment with diuretic and captopril. Mean arterial pressure values during placebo were 168 +/- 2/109 +/- 1 mmHg. This values after diuretic and associated captopril treatment were, respectively, 151 +/- 1/101 +/- 1 and 137 +/- 1/90 +/- 1 mmHg, all significant different (p < 0.05). Blood pressure normalization was obtained in 58% of patients. The calculated LDF formula were: LDF = 7.92 - % SBP +/- 1.21 delta % DBP. The G1 LDF mean value was 192 and 361 to G2. The value 276 represents the separation medium point between both groups. As far the distance from the separation medium point for a calculated LDF for a calculated LDF for a problematic patient, as more will be the probability for this patient to belong to this group. LDF and qui-square classified correctly, respectively, 80% and 47% of patients in G1. To G2 good responders patients, LDF and qui-square agreed, respectively, in 72 and 77%. The results obtained suggest that captopril test, could be useful as an auxiliary methodology to select hypertensive patients, uncontrolled with diuretic treatment, which might benefit with the association of converting enzyme inhibitors drugs.


[Slow release diltiazem as monotherapy in primary mild to moderate hypertension. A multicenter study]. To study the anti-hypertensive effect and tolerability of diltiazem SR in mild to moderate uncomplicated hypertensive patients. Out-patients (856) with mild to moderate uncomplicated hypertension (diastolic pressure between 95 and 114 mmHg) received 90 mg of diltiazem SR, per oral, twice a day for 20 days. After this period, the non-responders had the dosage increased to 120 mg twice a day while the responders were maintained with the same dosage for 20 days more. Significative number of patients (77.3%) normalized their blood pressure after 20 days on diltiazem SR therapy. The non-responders had the dosage increased to 120 mg bid for 20 more days. 72% of them achieved normal blood pressure. There were no important side effects with the dosage of 90 and 120 mg bid of diltiazem SR. Diltiazem SR may be a good option as initial monotherapy in the treatment of mild to moderate uncomplicated essential hypertension. It presented a reasonable side effects profile.


[Treatment of mild and moderate cardiac failure with captopril. A multicenter study]. Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.


[Influence of transient and sustained increase of blood pressure on the 1st temporal derivative of the ventricular pressure]. To analyze the influence of transient and sustained elevations of arterial pressure (AP) on the rate of rise of the left ventricular pressure (dp/dt). Thirteen anesthetized, thoracotomized and mechanically ventilated dogs, submitted to pharmacological autonomic block (oxprenolol-3 mg/kg plus atropine-0.5 mg/kg). The AP elevation was obtained by mechanical constriction of the descending thoracic aorta. Two protocols were applied to all animals: Transient Arterial Hypertension (TAH) and Sustained Arterial Hypertension (SAH) and the following variables were evaluated: heart rate (HR), systolic (LVSP) and end diastolic (LVEDP) left ventricular pressure and dp/dt. In TAH the variables were analyzed in the basal condition (To) and at the maximal value of AP attained during the transient pressure elevation (TM). In the protocol SAH the variables were evaluated in the conditions: Control (Ho), hypertension 1 (H1) and hypertension 2 (H2). Considering all conditions, there were no significant differences among the values of HR. In the protocol TAH, the LVSP varied from 133 +/- 22 mmHg to 180 +/- 27 mmHg, whereas in SAH the values of LVSP were as follow: HO = 129 +/- 25 mmHg; H1 = 152 = 23 mmHg; H2 = 182 +/- 24 mmHg. LVEDP changed in both protocols: To = 7 +/- 2 mmHg; TM = 13 +/- 2 mmHg (p < 0.05); Ho = 7 +/- 2 mmHg; H1 = 10 +/- 2 mmHg; H2 = 14 +/- 3 mmHg (p < 0.05). During TAH there was no difference between the values of dp/dt (To = 3.303 +/- 598 mmHg/s; TM = 3.350 +/- 653 mmHg/s; p > 0.05), however, there were increases of the dp/dt during SAH (Ho = 3.233 +/- 576 mmHg/s; H1 = 3.831 +/- 667 mmHg/s; H1 = 4.594 +/- 833 mmHg/2; p < 0.05). The values of dp/dt are not influenced by transient elevation of AP. Sustained increase of AP activates cardiac adjustments, which results in elevation of dp/dt, by stimulation of contractile state. Probably, the inotropic intervention mechanism is the length dependent activation due to the Frank-Starling mechanism.


[Mitral valvuloplasty by balloon catheter. Early results and one-year follow-up]. To evaluate percutaneous mitral balloon valvuloplasty (PMBV) results immediately and one year follow-up. One hundred and four procedures in 103 patients, 89 (87%) were women and mean age was 33. Ninety five (91%) had mitral stenosis, 7 (7%) mitral restenosis and 2 (2%) stenotic bioprosthesis. Twelve (10%) patients were in functional class (FC) II (NYHA), 73 (70%) in FC III and 19 (18%) in FC IV. Ninety three (89%) were in sinusal rhythm, 10 (10%) had atrial fibrillation and 1 (1%) junctional rhythm. In 99% cases the transseptal access was used. The comparative haemodynamic results late x immediately after-PMBV were mitral valve area (cm2) 0.75 +/- 0.27 x 1.68 +/- 0.48 (p < 0.0001), gradient AE-VE average (mmHg) 19.52 +/- 8.03 x 5.44 +/- 4.38 (p < 0.0001); average pressure AE (mmHg) 24.72 +/- 8.76 x 9.63 +/- 6.11 (p < 0.0001), cardiac index (L/min/m2) 2.55 +/- 0.69 x 2.92 x 0.77 (p < 0.0001); average pressure PA (mmHg) 40.17 +/- 16.52 x 25.65 +/- 13.77 (p < 0.0001). The echocardiography results pré-PMBV, post-PMBV, 6 and 12 months after PMBV were respectively: mitral valve area (cm2) 0.89 +/- 0.23 x 1.87 +/- 0.41 x 1.72 +/- 0.43 x 1.64 +/- 0.44 and mitral transvalvar gradient (mmHg) 13.12 +/- 4.66 x 6.44 +/- 2.93 x 7.72 +/- 3.24 x 8.30 +/- 4.17. There was one death immediately after-PMBV in a patient with pulmonary thromboembolism. Four (4%) had severe mitral regurgitation and went to surgery (1 death). There were 2 mitral reestenosis. For selected patients PMBV is a safe method and the good results are maintained in 1 year follow-up.


[Surgical management of the aortic valve in patients older than 70 years of age]. To assess the short and long-term benefits of patients who were submitted to isolated aortic valve replacement or valve replacement (VR) concomitant myocardial revascularization (MR); to evaluate the incidence of postoperative complications, hospital mortality and late mortality. From January 1985, through December 1989, 20 consecutive patients underwent surgical intervention, 15 male (75%) and 5 female (25%), the mean age was 74.8% (ranging from 70 to 86 years old), and the aortic valve gradient ranged between 78 and 180 mmHg (mean = 97 mmHg). They presented preoperative diagnosis to have either isolated aortic stenosis (AS) or As and coronary artery disease (CAD). No patient was in NYHA functional class I; 3 patients (15%) were in class II, 14 (70%) in class III and 3 (15%) in class IV. The most frequent post-operative complications found were: extended intubation in 7 patients (35%), bleeding in 4 (20%), acute renal failure in 3 (15%) and ventricular arrhythmia in 3 (15%). Hospital mortality occurred in 2 patients (10%) who had been submitted to VR and concomitant MR. Late mortality occurred in 1 patient (5%). Through December 1989, 11 patients (64%) were in functional class I (NYHA), 3 (18%) in class II, 3 (18%) in class III and none in class IV. We concluded that the surgical treatment is indicate to elderly patients with isolated AS os with AS and concomitant CAD. There was a significant post-operative improvement of the functional class (NYHA) to the surviving patients.


[Enalapril and myocardial protection from stress by cold]. To evaluate the myocardial protective effect of enalaprilat in rats submitted to stress by cold. Fifteen adults, male rats were studied. They were allocated into four groups: group A received unrestricted diet + intraperitoneal (IP) diluent; group B: unrestricted diet + IP enalaprilat 1.0 mg/kg; group C: high salt diet (HD) for seven days + IP indomethacin 1.0 mg/kg and group D received high salt diet for seven days + IP indomethacin 1.0 mg/kg + IP enalaprilat 1.0 mg/kg. Three animals were the control group. The animals of the groups A, B, C and D were then submitted to stress by cold. Fragments of the left ventricle were obtained for electron microscopy and the occurrence of mitochondrial lysis or preservation of the mitochondrial ultrastructure were considered as parameter for myocardial protective effect evaluation. Crystolysis (partial or total) was observed in 16.2% group A; 19.5% of group C; 3.2% of group B and in 8.8% of group D. Enalaprilat protects the cardiomyocyte from the stress by cold.


[Reinfusion of shed blood after heart surgery]. To asses effectivity of postoperative reinfusion of shed mediastinal blood in reduction of homologous transfusions at cardiac surgery and to study the possibility of side effects. Fifteen patients submitted to cardiac surgery that had their shed mediastinal blood reinfused after surgery were compared to another group of 15 patients. The two groups were compared in relation to: volume of shed blood, number of units of blood used in postoperative period, culture of shed blood, postoperative complications, number of days of hospitalization, hematocrit at the end of hospitalization and mortality. The use of whole blood and packed blood cells decreased from 25 to 10 units with reinfusion of shed mediastinal blood (p < 0.01). Volume of shed blood, postoperative complications, period of hospitalization, hematocrit at the end of hospitalization and mortality were not different in both groups. Culture of shed blood, in 8 patients of control group and all patients of study group were negative. Reinfusion of shed mediastinal blood in postoperative of cardiac surgery proved to be very efficient in decreasing homologous blood transfusions. This procedure is also safe, with no additional risk to patients.


[Shone's syndrome--a case report and bibliographic review]. The case of a 15-month-old patient with Shone's anomaly is reported. This anomaly includes supravalvar mitral ring, parachute mitral valve, subaortic stenosis and coarctation. The patient underwent a corrective surgery with resection of the supravalvar mitral ring, mitral comissurotomy and resection of the subaortic stenosis, anatomically significant lesions, with good postoperative development. A bibliographical review on the anomaly was undertaken.


[Severe tricuspid valve insufficiency due to papillary anterior muscle infarction of the right ventricle secondary to neonatal hypoxia]. A fatal case of a stressed newborn baby who developed tricuspid insufficiency due to an anterior papillary muscle infarction of the right ventricle, related to perinatal anoxia is reported. The baby needed resuscitation management and had a systolic murmur soon after birth. The echocardiographic examination showed a flail anterior leaflet of the tricuspid valve due to an avulsed anterior papillary muscle. There was rupture of chordae tendineae between anterior and posterior leaflet. Necrosis and calcium deposit were found in the area. The conclusion was that the anoxia in perinatal period, in most cases, causes transient lesions, but in few cases might be severe and fatal. It is important a complete cardiac evaluation in every case of prolonged perinatal stress.


[Silent ischemia after an uncomplicated myocardial infarct. A study in asymptomatic patients]. To verify the prognostic value of silent myocardial ischemia (SMI) after an uncomplicated myocardial infarction (MI). Forty asymptomatic patients were studied after a first uncomplicated MI. They were submitted to 48 hour ambulatory electrocardiographic monitoring and exercise-testing, during the 2nd and 8th weeks after the acute event. Thirty-nine patients were submitted to cardiac catheterization and coronary arteriography; one patient was submitted to necropsy. The electrocardiographic study identified 11 (27.5%) individuals with SMI (group A); the other 29 patients were considered group B. Groups A and B were similar in relation to clinical characteristics, infarct site and ventricular function. Group A had significantly more extensive coronary artery disease when compared to group B. After a two-year follow-up, patients from group A had significantly more coronary events (36.3%) when compared to group B (3.4%). Kaplan-Meier analysis demonstrated a significantly higher cumulative probability of not experiencing a new coronary event for the group B patients. SMI may have a prognostic value after uncomplicated MI, as in other clinical manifestations of coronary artery disease.


[Hemorrhagic myocardial infarct. An analysis of the distribution of the hemorrhage and of the permeability of the artery related to the infarct]. To study the extent of hemorrhagic myocardial infarction (HMI) and patency of the infarct related artery. Forty seven cases of HMI diagnosed by necropsy (patient age range 30-81 years, mean 59) were studied retrospectively. Hemorrhagic extent was evaluated by microscopic analysis of myocardial sections of the infarcted areas and coronary patency was studied by angiography and by serial coronary sections at necropsy. In 12 cases hemorrhage extended outside the infarcted area and in the remaining cases it was restricted to the necrotic zone. Coronary patency was spontaneous in 8 of 24 cases, secondary to thrombolytic therapy or angioplasty in 8 and post coronary artery bypass in 15. Recent occlusive thrombus was diagnosed in 26 of 44 cases. Grouping all cases according to angiographic or macro and microscopic evidences of coronary patency, it was found that 35 of 47 studies cases (74.4%) had the infarct related coronary artery free of occlusion. In most cases of HMI myocardial hemorrhage restricted to the infarcted necrotic zone but in almost 25% it could reach areas beyond the infarcted necrotic zone probably resulting in deleterious consequences. Reperfusion is frequent and it plays a role in the hemorrhagic event but it was not seen in 25% of these studied cases. These findings suggest that other mechanisms could participate of the pathogenesis of HMI.


[R-R variability in acute anterior infarct after thrombolytic therapy]. To analyse the effects of thrombolysis on the integrity of the autonomic nervous system, in patient with acute myocardial infarction (AMI) of the anterior wall, using the determination of the heart rate variability. We prospectively evaluated the R-R variability of the 31 consecutive patients with anterior AMI submitted to coronary thrombolysis (25 males; mean age 59 +/- 14 years) from Holter tapes. An algorithm in a 286 computer program was used for heart rate variability (HRV). With this system, R-R variations during sinus rhythm and for a five consecutive minutes periods was determined. The results were expressed as the mean of the total determined periods; the standard deviation of the mean of all determined periods and the mean of the standard deviation. The reperfusion criteria was the early enzymatic rise of the CKMB activity levels (< or = 12 h) combined with a 50% or more reduction in the ST segment elevation within the first hour after thrombolytic therapy and the presence of an accelerated idioventricular rhythm at the same time. The reperfused group (group 1 = 16 patients) and non-reperfused group (group 2 = 15 patients) were compared in terms of R-R variability. Mean R-R: group 1 = 716 +/- 84 ms (540-820 ms); group 2 = 595 +/- 115 ms (390-870 ms)-p < 0.02. ms (34-92 ms); group 2 = 50 +/- 14 ms (23-77 ms)-p < 0.01. HRV 50 ms: group 1 = 2 patients; group 2 = 5 patients. Means SD of the R-R: group 1 = 44 +/- 14 ms (26-65 ms); group 2 = 39 +/- 17 ms (19-69 ms)-p: ns. Patients with anterior AMI and thrombolytic therapy demonstrate greater HRV; this finding suggested better integrity of the autonomic nervous system, with possible effects on prognosis.


[Outpatient heart catheterization. An analysis of experience accumulated over 10 months]. To identify patients suitable for outpatient cardiac catheterization strategy, based on social aspects, risks and complications, for a 24 hour period. In a series of 2.126 cases submitted to cardiac catheterization at the Instituto Dante Pazzanese de Cardiologia, between September 1990 and June 1991, were excluded: a) those over 75 years of age; b) the acute ischemic syndromes; c) those in NYHA functional class IV; d) patients who used 7 or 8 French femoral angiographic catheters; e) patients who had undergone general anesthesia, electrophysiological study or endomyocardial biopsy. After the procedure, the patients were observed for a 3 hour period and in the absence of any complication, they were discharged from the hospital, returning the next day for clinical evaluation. If any complication occurred it was registered. In a cohort of 719 eligible patients, 68% were male, with a mean age of 55.3 years. Sixty one per cent were in NYHA functional class I and most of them (80.8%) were studied by the brachial approach. Eighty-three per cent of the patients were submitted to coronary angiography, with 52% of them having coronary artery disease. Four hundred and fourteen patients were not discharged on the same day: 217 did not have their procedures finish after 6 p.m., 111 for social-economical reasons, 23 because of their physician's refuse, 8 because of left main coronary disease, 55 because of any kind of complication. All the 305 patients who were discharged on the same day, did not have shown any complication in the next day evaluation. Outpatient cardiac catheterization is a safe technique in selected patients, making possible the accomplishment of a greater number of procedures improving bed utilization and decreasing hospital costs.


[The use of a rate-responsive pacemaker after heart transplantation]. The indications and the results of pacemaker implant following orthotopic cardiac transplantation. Four patients implanted a cardiac pacemaker (PM) in the early post-operative period (PO) of orthotopic cardiac transplantation (from 10th to 16th PO day). The patients were 33 to 55 year-old and the indications to PM were supraventricular arrhythmia (atrial fibrillation or flutter) associated with atrioventricular block in three, and complete atrioventricular block in one patient. Previous to PM implant, patients were submitted to endomyocardial biopsy, which was normal in two patients, evidenced mild rejection in one and moderate rejection in the remaining. A ventricular rate responsive pacemaker was implanted in all patients, with sensors responsive to muscular activity in one patient, and to minute ventilation in three. One patient died in the 20th PO due to acute allograft rejection not controlled by immunosuppressive drugs. Three other patients had satisfactory evolution and the pacemakers were programmed during exercise testing, previous to hospital discharge. Recent evaluation revealed that these patients are in good clinical condition at the 6th, 14th and 24th PO months. Adequate pacemaker function was insured by exercise testing and ambulatory electrocardiographic recording. A ventricular rate responsive pacemaker represented a satisfactory mode of pacing, in patients with severe bradycardia, following heart transplantation.


[Meningitis and other neurological complications in infectious endocarditis]. To study the localization, etiological agents and the respective prognosis in patients with infective endocarditis with or without neurological complications, with emphasis on the association of endocarditis and meningitis. 222 patients with clinical, echocardiographic and laboratory diagnosis of infective endocarditis were treated at Instituto Dante Pazzanese de Cardiologia from 1985 to 1990. They were classified in two groups: group A-116 patients without neurological complications, ages 4 months-76 (mean 30) years old and 66.3% males. group B-56 patients with neurological complication, ages 1-71 (mean 31) years old and 46.4% males. A third group, group C, comprised 17 patients, ages 8-51 (mean 23.7) years old and 9 patients (52.9%) male, assisted at Hospital Emilio Ribas, which is specialized at infectious diseases, which presented meningitis as the unique manifestation of neurological complication associated to the diagnosis of infective endocarditis (IE). In all patients the diagnosis of IE was based on the presence of at least two of three essential findings: echocardiogram with vegetations or valvar dysfunctions, positive hemocultures and the compatible clinical picture. For the comparative analysis among the groups was employed through the chi-square test corrected according to Yates. No differences of sex and age of the patients were found among the three groups. Predominated the Staphylococcus aureus as etiological agent. The localization of cardiac lesions was similar in the three groups, except for the tricuspid valve affected in 16.3% of patients of group A and 2.3% of group B. There was a greater association of the structures on the left side of the heart with IE of group B (p < 0.05). Group B and C showed a general mortality rate greater than group A (p < 0.001). Meningitis and other neurological complications showed interrelationship between the presence of "Staphylococcus aureus" as etiological agent of endocarditis and the association with infection of the left heart side.


[Pheochromocytoma. Its diagnostic and therapeutic characteristics]. Pheochromocytoma is a cause of hypertension that frequently can be cured by surgery. The aim of this paper, based on 5 cases of pheochromocytoma, is to relate our experience in diagnosis and treatment in this pathology. In four of 5 patients with pheochromocytoma we observed unusual characteristics of the disease. Association with neurofibromatosis in one case, with rheumatic mitral regurgitation in another; and in a third case the tumor was malignant. One patient had catecholamine-mediated electrocardiographic changes which disappeared with treatment. Since symptoms of adrenergic hyperactivity were present in all cases, the rise in the levels of vanilmandelic acid and urinary metanephrines were useful in confirming the diagnosis. Computed tomography and I-131 meta-benzylguanidine for radioisotopic imaging, displayed not only all tumoral masses but also bone metastases in the malignant case. During the follow-up period, from the sixth month to the fourth year after surgery, four patients were asymptomatic, and have normal urinary catecholamine metabolite levels. The patient with a malignant form of pheochromocytoma continued to show elevated catecholamines release and remained hypertensive in spite of adrenal mass resection.


[Hypocalcemia causing heart failure].

[Hypocalcemia causing heart failure]. A 39-year-old female patient with refractory heart failure has been studied. On February, 1982 she was submitted to right lobar thyroidectomy for remotion of the left thyroid lobe. Following the surgery, she had signs of hypocalcemia and the diagnosis of secondary hypoparathyroidism and heart failure had been made. Seven months after she had acute pulmonary edema, cardiomegaly III (cardiothoracic index = 0.58) with predominant left atrial and left ventricular hypertrophy, which were confirmed by echocardiogram (ECO). The ECO also demonstrated low contractility of the left ventricle. The QT interval was increased on the electrocardiogram (QTc = 0.50 s), the calcium was 5.0 mg/dl with calciuria of 28 mg/day; phosphatemia was 4.8 mg/dl and phosphaturia of 214 mg/day. The level of thyroid hormones (T3 and T4) were in the normal ranges despite the TSH was increased in the beginning of the disease. She was first treated with digitalis, diuretic and vasodilator drugs, thyroid hormone and oral calcium. She had progressive hemodynamic improvement when higher doses of calcium were given with D3 vitamin. The most significant result of this treatment was reduction of the heart size that come back to normal. At the present time patient is treated with thyroid hormone, calcium and D3 vitamin only.


[An open comparative study of captopril + hydrochlorothiazide versus chlorthalidone for the treatment of mild and moderate primary hypertension]. To compare the antihypertensive and metabolic effects of captopril combined with hydrochlorothiazide (C+HCTZ) versus chlorthalidone (CT) in mild and moderate primary hypertensive patients. Fifty five patients, without treatment or treated with 15 days placebo were randomized for treatment with the combination of captopril 50mg and hydrochlorothiazide 25mg (n = 29) against chlorthalidone (n = 26). The clinical evaluation was done during placebo and monthly throughout three months, and the laboratory tests were done before and at the end of the study. The blood pressure were similar between groups during placebo period (C + HCTZ: 161 +/- 25/102 +/- 6-CT: 155 +/- 18/101 +/- 6 mmHg); the diastolic blood pressure decreases significantly at first month already in the group C + HCTZ (89 +/- 8 mmHg) compared to group CT (94 +/- 8 mmHg, p < 0.05). The percentile diastolic and mean blood pressure dropped, in average, 12% in C + HCTZ group and in CT varied between 7 (1st and 2nd month) to 11% (3rd month). Without statistical difference, the blood pressure normalization was obtained in 69% of the patients with the association captopril and diuretic and in 50% of the patients in the chlorthalidone group. It was observed a significant reduction of potassium in patients treated with chlorthalidone (4.2 +/- 0.7 to 3.7 +/- 0.4 mEq/L, p < 0.01) that was not observed with the captopril and the thiazide associated. The last treatment also significantly reduced the cholesterol levels (219 +/- 39 mg/dl to 202 +/- 39 mg/dl, p < 0.04). Our results indicate that captopril combined with low diuretic dose normalize the blood pressure in 69% mild to moderate primary hypertensive patients, and acts faster than chlorthalidone in this control. In addition has metabolic benefits reducing cholesterol levels with no alteration in potassium levels.


[Metabolic response of cirrhotic patients (Child A) to the increase of protein and/or caloric intake. Nitrogen balance study]. The dietary protein assimilation by cirrhotic undernourished patients (lower lean body mass and plasma TBPA and RBP levels) was investigated in five-adult male subjects suffering from histologically diagnosed liver cirrhosis, in its clinically mild stage (Child-Turcotte-Pugh grade A). During the 9 day-dietary study the patients received orally a sequence of complete-regional diets containing different protein-energy compositions identified as (g prot/Cal/kg/day): D0 = 0.42/20.9; D1 = 0.91/37.5; D2 = 0.99/47.9 and D3 = 1.60/40.5. The respective N-balance values (g/day) found were (mean +/- SD): low protein calorie (D0) = -4.24 +/- 2.46; normal protein calorie (D1) = 0.66 +/- 1.99; normal protein-high calorie (D2) = 1.14 +/- 2.54; high protein normal calorie (D3) = 5.12 +/- 2.48. The correspondent urea-N output (g/kg/day) were D0 = 0.22 +/- 0.100; D1 = 0.238 +/- 0.099; D = 0.20 +/- 0.063 and D3 = 0.310 +/- 0.121. The present data thus suggest that protein rather than energy intake would be the limited factor for increasing the N-retention in (mild) cirrhotic patients whom tolerate well dietary protein at either normal or elevated levels.


[Hepatitis B virus markers in peripheral blood mononuclear cells]. Recent studies have shown tropism of the hepatitis B virus (HBV) by peripheral blood mononuclear cells (PBMC). The consequences of this phenomenon and their clinical use are not yet clear, however. Seventy-nine patients were studied between March 1989 and October 1990. Sixty-nine patients had chronic liver disease with histological evaluations, and 10 were vaccinated for HBV. The following markers were determined: serum: HBsAg, HBeAg, anti-HBe, antitotal-HBc, anti-HBs, anti-HCV, HBV-DNA; lysated PMBC cells: HBsAg, HBeAg. Hepatic tissue: HBsAg, HBcAg. Four groups were formed according to serology. Group I--positive HBsAg patients (n = 25) HBsAg was observed in the lysated of PBMC in 19 (76%) of the patients. HBeAg in PBMC was detected in 8 (32%), all of them showed evidence of viral replication (presence of HBcAg and/or HBV-DNA in the serum HBcAg in the tissue). Group II--antitotal HBc/anti-HBs positive (n = 14), HBsAg in PBMC was found in 5 (36%) and HBeAg in 1 (7.0%). In this patient replication markers in the serum and in the tissue (HBV-DNA, HBcAg) was also present. Three patients out of 9 anti-HBs positive had HBsAg in PBMC. Group III--seronegative patients for HBV. HBsAg was present in PBMC in 2 (6.6%) of the patients, but was absent in all of them. There was concomitant presence of HBsAg in MN and the hepatic tissue in 1 patient. Replication markers were not observed in the group. Group IV--10 asymptomatic individuals vaccinated for HBV. Except anti-HBs in serum, no other HBV marker could be identified in serum or in PBMC.(ABSTRACT TRUNCATED AT 250 WORDS)


Influence of hormonal secretion and fertility in merino mutton sheep by exogenous pheromone application during the breeding season. The effect of a ram-pheromome extracted from the wool of insemination rams with excellent libido sexualis of the merino mutton sheep breed was examined with respect to the hormonal secretion and fertility of adult ewes during the breeding season. A control group (untreated animals) was at disposal for every experiment. There were significant differences between the ewes treated with pheromone and the controls in the course of the preovulatory LH wave and the oestradiol concentration of the oestrus sheep at the beginning of the breeding season. The ovulation in ewes after prostaglandin application was stimulated by pheromone applications. The regime practised in the experiment on pherome application had a positive influence on the conception rate of the inseminated ewes and resulted in a significant increase of the lambing results (lambs/birth).


[Differentiation of fattening and slaughtering performance and carcass quality of broiler genotypes with and without the dwarf factor and fast or slow feathering under heat stress]. In a comparative study the influences were tested of the origins NWR (normal-growth White Rocks) and ZWR (dwarf-growth White Rocks) with a speed for slow (K) and fast (k) feathering as well as the effect of a high environmental temperature (UT, 32 +/- 2.5 degrees C) on the fattening and slaughtering performance of male broilers and their meat quality. Also investigated were effects of these factors on the fatty acid pattern of the two valuable parts--breast and leg. Dwarf broilers kept under high UT had a lower liveweight (LM8) in their 8th week as compared with NWR and animals kept under the usual UT. No influence was found of the feathering on the fattening and slaughtering performance. The effect of heat stress (high UT) and of the dwarfing gene on the breast and leg parts was statistically highly significant (P < 0.001). Dwarfed broilers and animals under normal UT exhibited a smaller slaughtering proportion as compared with normal animals and animals under a higher UT. The abdominal fat content was significantly higher under heat stress. Meat quality showed no dependence on the origin or the climatic conditions. In the fatty acid analysis no dependence could be detected of the FS pattern on the origins (genotypes), whereas an effect was found of the UT on some unsaturated and saturated fatty acids. Palmitic acid and stearic acid formed the largest part of all saturated FS investigated. Among the unsaturated FS the oil, linoleic, and palmitic acids reached the highest share. The effect of higher UT was not uniform in the FS pattern. The sum of saturated FT was increased under heat stress, thus suggesting a more favourable fat quality of the meat.


[Dietary fiber intake in women with constipation]. The objective of this study was to investigate the food pattern of women with constipation. It was carried out a 24 h recall and a food frequency survey in 31 constipated women and compared the results with a control of 31 women without constipation. Their mean daily crude fiber intake were no statistical different (2.33 +/- 1.4 vs 2.17 +/- 0.9 g/day), but the usual intake of fruits and vegetables of the constipated ones were irregular. These results call the attention for the influence of the kind and schedule of the food rich fiber intake on the intestinal habit.


[Gastric paracoccidioidomycosis. A case report and considerations on the pathogenesis of this disease]. The authors report an unusual case of fungal gastric lesion in a patient with the chronic form of paracoccidioidomycosis. For a period of 8 months the major symptoms of the patient were abdominal pain and body weight loss. The endoscopic evaluation of the upper gastrointestinal tract showed a partial gastrectomy made previously, a great and irregular ulcer in the stomach and a granulated aspect of the duodenal mucosa. A granulomatous process and Paracoccidioides brasiliensis were observed in the histopathological examination of the gastric and duodenal biopsy tissue. New endoscopic evaluation 4 months after treatment with sulfadiazine revealed healing of the gastric ulcer. It was suggested that abdominal lymph nodes involvement, duodenal infection and anatomical and atrophic alterations of the stomach were predisposing factors for the gastric paracoccidioidomycosis.


High and low litter size trait and its relationship with serum and urine progesterone, serum zinc, and serum phosphorus in New Zealand white rabbits and improvement for the low litter size trait. A number of does was classified according to their initial litter size to high (> 6 bunnies, group 1) and low (< 5 bunnies, group 2) in New Zealand White rabbits. Incidence of low litter size in the herd in the present study was 23%. The number of matings/conception, total mortality, corpora lutea/foetus, number and percentage of resorbed foeti were markedly higher in group 2 than in group 1. The litter weight, number of foetuses, implantation sites, and corpora lutea in group 2 showed a marked decrease over group 1. Serum and urine progesterone levels in pregnant rabbits of group 2 were significantly (P < 0.01) lower than in group 1, however, non-efficacious progesterone levels were significantly (P < 0.01) lower in group 2. The zinc content in serum, foetal dry weight and uterine horn dry weight, and serum inorganic phosphate in group 2 were significantly (P > 0.01) lower than in group 1. The litter size was significantly (P < 0.01) correlated with zinc and inorganic phosphate in group 2, while it was correlated with serum and urine progesterone in the two groups. The correlation coefficients were significant (P < 0.01) between urine progesterone and serum zinc and between serum progesterone and inorganic phosphate more frequently in group 2 during the gestation period than in group 1. The treatment of group 2 does with calcium carbonate, sodium phosphate dibasic, and zinc acetate in drinking water improved the serum progesterone, urine progesterone, and non-efficacious progesterone in addition to serum zinc and inorganic phosphate, which led to improvement of the number of matings/conception, litter size and litter weight, and lowered total mortality.


[Anorectal pain].

[Anorectal pain]. The aim of the present study is bring to the colo-proctologists and clinicians the importance of the correct interpretation of ano-rectal pain. Sometimes this pain is so characteristic that it becomes pathognomonic of some diseases. The authors detail the rectal and anal canal innervation and distinguish 2 opposite types of pain in this region: a cutaneous or superficial and a visceral or deep pain. The pain sensation depends of 2 components: perception through physiologic mechanism and reaction through basically psychogenic mechanism. The authors discuss the characteristics of the pain in many anorectal diseases, like inflammatory ones, piles, tumors and very complex neuralgias found in some psychotic patients.


[Use of different superovulation regimes and laparoscopic studies of ovarian function in African dwarf goats]. 17 African dwarf goats were treated with 4 different superovulation regimes. The results of the treatments were assessed spectroscopically and checked laparoscopically. The quantitative basis of the investigation is too small to allow statistically well-founded statements, but is indicative of distinctive trends. A proportion of 73% CL and CLA in the overall ovarian changes after treatment with 750 IE PMSG (2 days before removal of the sponge) and 125 micrograms PGF2 alpha (at the time of the sponge removal) proved an acceptable method of treating African dwarf goats as regards the requirement of labour and material as well as the superovulation effect.


[Comparative study of the gastric emptying of disaccharides and their respective monosaccharides in rats with ontogenic lactase deficiency]. In order to evaluate the gastric emptying of disaccharides and their monosaccharides, 64 male, Wistar rats weighing approximately 180 g, were divided into the following eight groups containing eight animals each: maltose, sucrose, lactose, and lactulose, and their correspondent group of monosaccharides: glucose, fructose plus glucose, galactose plus glucose and galactose plus fructose. Each animal received, after a 20 hours fast, 2 ml/100 g weight of a test meal containing a 10% solution of the correspondent sugar and phenol red (6 mg/dl) as a marker. Gastric retention was determined at 10 minutes after orogastric infusion and expressed as a percentage of the infused volume. The observed values (mean +/- SE) of gastric retention (%) of sucrose (35.0 +/- 1.8), lactose (30.4 +/- 1.5), and lactulose (29.5 +/- 1.6) were significantly lower (t test alpha = 0.05), than those observed with their respective monosaccharides, i.e. glucose plus fructose (46.9 +/- 2.6), glucose plus galactose (48.3 +/- 2.4), galactose plus fructose (43.5 +/- 1.5). No difference was noted between gastric retention of maltose (49.9 +/- 4.7) and that of glucose (53.0 +/- 3.0). As far the disaccharides are concerned, statistical analysis (ANOVA followed by Tukey test alpha = 0.05) revealed no differences among the values of gastric retention of sucrose, lactose and lactulose. Gastric retention of maltose was significantly greater than that of the other disaccharides. No differences were found among the gastric retention of monosaccharides.(ABSTRACT TRUNCATED AT 250 WORDS)


[Bronchial asthma and duodenal ulcer and erosive bulbo-duodenitis in children: report of 6 cases]. The coexistence of moderate and severe asthma and duodenal ulcer is not very well established as yet. We started a protocol trying to establish the presence of reflux esophagitis in children with moderate or severe asthma. Thirty two patients underwent upper digestive endoscopy and, surprisingly, we found six children (18.7%) with the following digestive aspects: four children had duodenal ulcer, and two had erosive duodenitis. We report these cases and discuss some etiopathogenic aspects about these possible association, and beware the clinician to pay attention to abdominal pain in children with bronchial asthma.


Prevalence of complement-fixing antibody to the African horse sickness virus in domestic animals in Nigeria. The occurrence of antibodies against the African horse sickness virus was investigated in 246 domestic animals (horses, donkeys, camels, dogs) in various regions of Nigeria by means of the complement-fixing rate. 34% of the sera tested were positive: 75% in donkeys, 68% in horses, 19% in camels, and 9% in dogs. Among the horses, those of 6 to 15 years of age had higher than average prevalence rates than the other age groups. Stallions from the northern regions had higher prevalence rates than mares generally and stallions from other regions. These findings are important for the epidemiology of the African horse sickness in Nigeria just as the complement-fixing rates are in camels and dogs for the epidemiology of this sickness in the whole of Africa.


Calcium homeostasis and hypercalciuria in hyperprostaglandin E syndrome. Children with hyperprostaglandin E syndrome, a neonatal variant of Bartter syndrome with enhanced renal and systemic formation of prostaglandin E2, have hypercalciuria, nephrocalcinosis, and osteopenia. Because prostaglandin E2 affects tubular calcium handling, stimulates the formation of calcitriol in vitro, and has osteolytic activity, we studied calcium homeostasis and the influence of prostaglandin E2 formation on hypercalciuria in nine patients with hyperprostaglandin E syndrome during long-term indomethacin treatment and after its withdrawal. Suppression of prostaglandin E2 formation by indomethacin resulted in improvement of biochemical and clinical features of hyperprostaglandin E syndrome. However, hypercalciuria, osteopenia, and nephrocalcinosis did not completely resolve. Despite a low calcium diet, daily urinary calcium excretion was enhanced during and after withdrawal of indomethacin treatment (median 6.3, range 5.3 to 14, and median 9.4, range 4.4 to 38 mg/kg per day, respectively). Daily urinary calcium excretion was greater after withdrawal than during indomethacin treatment. Urinary calcium excretion was not correlated with urinary prostaglandin E2 excretion. Plasma levels of intact parathyroid hormone (median 11, range 6.8 to 12 pmol/L) and calcitriol (median 157, range 108 to 236 pg/ml) were elevated during indomethacin treatment and decreased after withdrawal of indomethacin. These data suggest that hypercalciuria in hyperprostaglandin E syndrome is mainly due to a renal leak of calcium, which is caused by enhanced renal formation of prostaglandin E2 and a tubular defect not related to prostaglandin E2 formation. There is no evidence for prostaglandin-stimulated calcitriol formation. Decreasing plasma levels of parathyroid hormone in the presence of renal calcium losses after withdrawal of indomethacin treatment may be due to a bone resorption process caused by systemic prostaglandin formation; the process may contribute to hypercalciuria in the patient not receiving indomethacin.


Relapsing polychondritis: a paraneoplastic syndrome associated with myelodysplastic syndromes. We report an unusual case of a patient with a myelodysplastic syndrome associated with life threatening relapsing polychondritis. The improvement in symptoms attributable to the relapsing polychondritis during treatment of the hematologic disorder suggests that relapsing polychondritis is a paraneoplastic syndrome associated with myelodysplastic syndromes.


Neurolymphomatosis: a clinicopathologic syndrome re-emerges. We describe a patient with sensorimotor peripheral neuropathy and cranial neuropathy due to autopsy-proven neurolymphomatosis defined by infiltration of peripheral nerves by tumor cells and review the findings in 39 previously reported patients. The cause of the neuropathy is not known. The association with immune-deficient states suggests virally mediated pathogenesis, possibly a retrovirus.


Regulation of human NAD(P)H:quinone oxidoreductase gene. Role of AP1 binding site contained within human antioxidant response element. Deletion mutagenesis and transfection studies into hepatic (mouse hepatoma (Hepa-1) and human hepatoblastoma (Hep-G2)) and nonhepatic (HeLa) cells indicated that high levels of expression of the human NAD(P)H:quinone oxidoreductase gene in tumor cells and its induction by beta-naphthoflavone and 3-(2)-tert-butyl-4-hydroxyanisole are mediated by human antioxidant response element (hARE) located in the region between -470 and -445. The hARE, when attached to the thymidine kinase promoter and transfected into several mammalian cells, expressed high levels of the chloramphenicol acetyltransferase gene that was inducible by beta-naphthoflavone and 3-(2)-tert-butyl-4-hydroxyanisole. Nucleotide sequence analysis of the hARE revealed the presence of a recognition site for binding to the AP1 protein. Mutation of the AP1 binding site located within the hARE resulted in the loss of expression and induction upon transfection into various cell types. Band shift and competition assays with hARE and nuclear extracts from control and beta-naphthoflavone-treated Hepa-1, Hep-G2 and HeLa cells indicated specific interaction of regulatory protein(s) to the hARE. The supershift assays using antibodies against specific proteins of the AP1 family identified Jun-D and c-Fos as two members in the hARE-protein complex observed in band shift assays.


Massive spontaneous subcutaneous emphysema. Acute management with infraclavicular "blow holes". Four patients who recently developed massive spontaneous subcutaneous emphysema in our intensive care unit are reported. No obviously remediable intrathoracic process was found in any of these patients. The acute physiologic impairment and grotesque cosmetic deformity were immediately alleviated by making bilateral 3-cm infraclavicular incisions down to the pectoralis fascia. These acutely decompressed the progressive subcutaneous dissection and each patient's subcutaneous emphysema resolved without any additional invasive therapy.


Syncope or seizure? A matter of opinion. We studied the diagnostic interpretation by physicians of written histories of 118 patients with a transient loss of consciousness. Considerable disagreement about a diagnosis of either syncope or seizure was found. Overall agreement was only 31%; an erroneous diagnosis was made in 16% of cases. We concluded that the diagnosis of a seizure after a single event is often too unreliable to justify early treatment.


Desferrithiocin is an effective iron chelator in vivo and in vitro but ferrithiocin is toxic. The efficacy and toxicity of the siderophore desferrithiocin (DFT), which has shown potential application in iron chelation therapy, were assessed in vivo and in vitro. DFT was evaluated in vivo in two ways: firstly, by measuring the effect of a single dose of DFT (10-100 mg/kg) on 59Fe excretion in iron-loaded rats labelled with 59Fe; and secondly, by examining the effect of the daily oral administration for 2 weeks of DFT (10-25 mg/kg/d) on the growing rat. DFT and its ferric complex, ferrithiocin (FT), were assessed in vitro from their effects on transferrin and iron uptake and mobilization from rat hepatocytes in culture using transferrin doubly labelled with 125I and 59Fe. Both oral and subcutaneous DFT were highly effective in promoting iron excretion in vivo, but showed evidence of toxicity after oral administration for 2 weeks at 25 mg/kg/d. In addition, DFT was much more effective than desferrioxamine or pyridoxal isonicotinyl hydrazone in reducing hepatocyte iron in vitro. However, FT was cytotoxic, causing membrane disruption and release of intracellular aspartate aminotransferase. It was concluded that DFT should not be considered for chronic iron chelation therapy without extensive further evaluation.


I kappa B interacts with the nuclear localization sequences of the subunits of NF-kappa B: a mechanism for cytoplasmic retention. NF-kappa B is an inducible transcription factor comprised of a 50-kD (p50) and a 65-kD (p65) subunit. Induction of NF-kappa B activity, which is a critical event in many signal transduction pathways, involves release from a cytoplasmic inhibitory protein, I kappa B, followed by translocation of the active transcription factor complex into the nucleus. Earlier studies suggested that I kappa B targets the p65 subunit of NF-kappa B. However, we demonstrate by in vitro and in vivo methods that the recently cloned I kappa B/MAD-3 interacts with both the p50 and p65 subunits of NF-kappa B, as well as c-Rel. Furthermore, an alternatively spliced, dimerization-deficient transforming variant of p65 (p65 delta) interacts extremely weakly with I kappa B/MAD-3, suggesting that dimerization is important for interaction. We demonstrate that the conserved nuclear localization sequences (NLSs) of NF-kappa B and c-Rel are the targets for I kappa B/MAD-3 interaction. Indirect immunofluorescence experiments demonstrate that I kappa B/MAD-3 expression retains both p65 and p50 in the cytoplasm. Furthermore, and most important, a p65 that contains an SV40 large T antigen NLS in addition to its own NLS is no longer retained in the cytoplasm in the presence of I kappa B/MAD-3. We propose that I kappa B/MAD-3 masks the NLSs of NF-kappa B and c-Rel and that this constitutes the mechanism for cytoplasmic retention of these proteins.


Centrum ovale infarcts: subcortical infarction in the superficial territory of the middle cerebral artery. The centrum ovale, which contains the core of the hemispheric white matter, receives its blood supply from the superficial (pial) middle cerebral artery (MCA) system through perforating medullary branches (MBs), which course toward the lateral ventricles. Though vascular changes in the centrum ovale have been emphasized in dementia, stroke from acute infarction in the centrum ovale is less well documented. We studied 36 patients with infarct limited to MB territory, without involvement of the lenticulostriate territory. Ten patients had a large infarct, associated with severe disease of the ipsilateral carotid artery and with neurologic-neuropsychological impairment not different from that of large MCA infarcts. In 26 patients, the infarct was small and round or ovoid, and was associated with hypertension or diabetes and with "lacunar syndromes," usually of progressive onset. These findings show that two forms of centrum ovale infarcts can be delineated according to infarct size and shape, clinical picture, risk factors, and associated vascular disease. We propose to classify subcortical infarcts in the carotid system into four main territory groups: (1) deep perforator territory (from the MCA trunk, carotid siphon, anterior choroidal artery, anterior cerebral artery trunk, Heubner's artery, and posterior communicating artery); (2) perforating MB territory (from the superficial MCA branches); (3) junctional (territory between 1 and 2); and (4) combined territories.


Lenticular burns following argon panretinal photocoagulation. Photocoagulation burns of the crystalline lens are a rare complication of posterior segment laser surgery. These burns occur more commonly in eyes with cataracts and with small, high-power, long-duration argon blue-green burns. We describe the first occurrence of lenticular burns caused by a fractured laser fibre optic cord.


Stress-riser fractures of the hip after sliding screw plate fixation. Fractures occurring after fixation of intertrochanteric femur fractures have been described previously in the literature. Terms such as "stress-riser fracture" and "Young's modulus fracture" have been applied. The prevalence of these fracture types has increased, and so has use of the sliding screw plate device for fixation of intertrochanteric hip fractures. The object of this paper is to describe, by case examples, types of stress-related fractures of the proximal femur in association with the sliding screw plate and to define each biomechanical type in review.


A new therapeutic method for chronic subdural hematoma in adults: replacement of the hematoma with oxygen via percutaneous subdural tapping. Seeking radical removal of chronic subdural hematoma using a simple and less invasive procedure, the author has devised a new method--replacement of the hematoma with oxygen via percutaneous subdural tapping. In this study, 40 patients were treated with this procedure. All patients made a full recovery after the treatment, without complications related to replacement of the hematoma with oxygen. Follow-up investigation showed recurrence of the lesion in two patients (5%). Because of its simplicity, reduced invasiveness, and short hospitalization, the procedure presented here is acceptable as an optimal therapeutic modality for chronic subdural hematoma in adults. Theoretical considerations supporting the safety of this procedure are discussed.


Release of vasoactive substances during cardiopulmonary bypass. Cardiopulmonary bypass is associated with bleeding and thrombotic complications, massive fluid shifts, and cellular and hormonal defense reactions that are collectively termed "the whole body inflammatory response." A host of vasoactive substances are produced, released or altered during cardiopulmonary bypass. These hormones, autacoids, and cytokines react with specific receptor proteins distributed throughout the body, and mediate the vascular smooth muscle and endothelial cell contractions that are responsible for much of the morbidity associated with open heart operations. This essay briefly reviews the actions, sources, and perturbations of the approximately 25 vasoactive substances known or believed to be altered by cardiopulmonary bypass, and provides an introductory reference list.


What was wrong with Tiny Tim?

What was wrong with Tiny Tim? One of the most endearing characters in English literature is Tiny Tim, the crippled son of Ebenezer Scrooge's clerk, Bob Cratchit. Yet the nature of Tiny Tim's multifaceted and implicitly reversible illness is a mystery and open to debate and speculation. From details of the original manuscript and the eight film versions, it is possible to construct a differential diagnosis for Tim's short stature, asymmetric crippling disorder, and curious intermittent weakness that would lead to his death, if untreated, within a period of 1 year. Following the ghostly visitations, Scrooge vows to assist the struggling Cratchit family financially, thereby making available the best medical care money could buy. From review of pediatrics texts from 1830 to 1850, a recommended treatment plan would have included (1) general measures such as country air and exercise, and fish oils such as cod and halibut (vitamin D), and (2) specific treatments of tonics (containing combinations of belladonna, opium, sodium bicarbonate, sodium citrate, and potassium chloride) emphasizing alkalis, and splinting and bracing the limbs. Such treatments with vitamin D and alkalinization with sodium bicarbonate and sodium citrate suggest the plausible speculation that Tiny Tim had renal tubular acidosis (type I), a disorder that is characterized by growth failure and, if left untreated, complicated by osteomalacia with pathologic fractures, hypokalemic muscle weakness and periodic paralysis, nephrocalcinosis leading to renal failure, and death. I propose that Tiny Tim had distal renal tubular acidosis (type I).


Prophylactic intramuscular ephedrine prior to caesarean section. Thirty healthy parturients, having given informed consent, were randomly allocated in a double-blind study to receive an intramuscular injection of either 0.9% sodium chloride (control), ephedrine 25 mg, or ephedrine 50 mg, 30 minutes prior to general anaesthesia for caesarean section. Nine patients (90%) in the 50 mg group and five patients (50%) in the 25 mg group demonstrated reactive hypertension of 20% or greater from control. The mean maximum increase in the 50 mg group was 28.2% (range 4.4-38.3%). Maternal pH was significantly lower (P = 0.03) in the ephedrine 50 mg group. Neonatal acid base status was significantly impaired in the ephedrine 50 mg group with umbilical venous pH (P = 0.0001) and umbilical arterial pH (P = 0.001) being significantly lower than the control group. The associated increase in umbilical arterial base deficit suggests a metabolic component due to fetal asphyxia related to decreased uterine blood flow. We conclude that the prophylactic administration of intramuscular ephedrine prior to spinal anaesthesia is associated with an unacceptably high incidence of maternal hypertension, and should the spinal fail and general anaesthesia be required, also results in adverse neonatal biochemical changes. The technique is therefore not to be recommended.


Combination therapy with cisplatin: modulation of activity and tumour sensitivity. Although cisplatin is applied with success in clinical oncology, this success is limited because some cancers are initially unresponsive to cisplatin or become so during treatment. In this review, some strategies to overcome this problem are discussed. Among these are combination with the differentiation inducing agent, retinoic acid, combination with radiotherapy, and the use of hyperthermia.


Acute filarial myositis.

Acute filarial myositis. An uncommon case of filariasis presenting as acute myositis is described. The patient was treated initially with steroids and antihistamines with no response. Later on with the confirmation of filariasis he was treated with diethyl carbamazine with complete recovery.


Screening, diagnosis and education of women with gestational diabetes. A study was conducted of the screening, diagnosis and education of women with gestational diabetes in South Australia. This paper provides a review of the relevant literature and a brief summary of the study, together with an overview of a patient education initiative introduced as a consequence of the study findings.


A skin irritant phorbol ester from Euphorbia cooperi N E Br. From the fresh latex of Euphorbia cooperi N E Br was isolated by partition and chromatographic methods, a diterpene ester 12-deoxyphorbol-16-isobutyrate-13-tigliate. The phorbol ester exhibited highly irritant activity on the mouse ear. Since skin irritancy is an indication of possible tumour promotion, the use of this plant as a medicine should be discouraged.


Plasma fibrinogen levels, leucocyte and platelet counts in male Zimbabwean hypertensives. Plasma fibrinogen levels, leucocytes and platelets are among the many factors known to influence haemostasis. Impaired haemostatic processes in hypertension are thought to contribute to the other cardiovascular diseases seen in this condition. This study compares the level of plasma fibrinogen, and leucocyte and platelet counts between 17 male hypertensives and 24 male normotensives. The results for the hypertensives were: leucocyte count mean 5.45 x 10(9)/L, platelet count mean 234.7 x 10(9)/L, and plasma fibrinogen 4.13 g/L. The results for the normotensives were: leucocyte count mean 4.83 x 10(9)/L, platelet count mean 222.9 x 10(9)/L, and plasma fibrinogen 3.27 g/L. The hypertensives had higher plasma fibrinogen levels, and leucocyte and platelet counts compared to the normotensives, but this only reached statistical significance for the plasma fibrinogen levels (p < 0.025).


RNs' utilisation of research findings.

RNs' utilisation of research findings. This study examined the relationship between methods of disseminating research findings and their subsequent utilisation. Results indicated that registered nurses with access to a summary of research findings were more likely to consider putting them into practice than their colleagues with no access to the research.


Computer analyses of qualitative data: a literature review of current issues. Nurse researchers have a choice of computer software packages that have been developed for use in analyses of qualitative data. This paper considers the impact computational methods have on qualitative research by reviewing the issues discussed by a number of authors.


Bilharzia in a small irrigation community: an assessment of water and toilet usage. A questionnaire study was conducted in the Mushandike small scale irrigation schemes in Zimbabwe to investigate the following: 1) to establish whether field latrines are used or not; 2) to find out why people visit natural water bodies for bathing and laundry instead of using water from boreholes for these purposes; 3) to assess people's knowledge on the transmission and control of schistosomiasis. Results of the study indicated that the field latrines are utilised and that the borehole water is not preferred for bathing and laundry because of its hardness and oily nature. The results further indicated that the community was aware of schistosomiasis but their knowledge on transmission and control of the disease was limited. Possible reasons for the observations made are discussed in the paper and recommendations emanating from the study are stated.


Development and implementation of an instrument measuring CNCs' activities. This report describes the development and introduction of a 'Clinical Nurse Consultant Activity Report' for use within the nursing division at a major metropolitan teaching hospital. The project involved the designing of an appropriate reporting format and definitions that could encompass all clinical nurse consultants' professional activities. Following the Report's development, an intensive education program was conducted, the Report was successfully trialled and evaluated and some minor modifications were made.


Cataract patients' post-op eye-care: development and evaluation of a teaching program. A project was undertaken to develop and trial an eye care education program for use in routine nursing care. It was initiated in response to research findings that suggested patients may have been discharged from a particular hospital inadequately prepared to perform their own eye care following cataract surgery. The trial assessed the program's effectiveness in relation to predetermined standards of eye care behaviour; its practicability and its performance relative to a conventional teaching approach. Outcomes of the trial indicated that neither the program nor the conventional teaching approach provided adequate preparation for the self delivery of eye care. This is believed to relate to the limited time nurses had for face-to-face teaching and, hence, for facilitating the consolidation and application of learning. The study concludes that the provision of effective eye care education in an inpatient context lies in approaches which reduce the amount to be taught in the limited teaching time that is available. It is suggested that the relevance may not be confined to eye care education.


Intrapartum foetal heart rate monitoring--continuous electronic versus intermittent Doppler--a randomised controlled trial. To compare different methods of intrapartum foetal heart rate monitoring in high risk pregnancies in detecting foetal heart rate abnormalities, need for operative delivery for foetal distress, and neonatal mortality and short term neonatal morbidity. A prospective randomised controlled trial. Women in labour at a referral maternity hospital. Women who were 37 weeks or more pregnant with singleton cephalic presentation and normal foetal heart rate prior to entry into the study. Women were randomly allocated using sealed opaque envelopes to either continuous electronic foetal heart rate monitoring or intermittent monitoring using hand held doppler foetal heart rate detector. These include abnormal foetal heart rate patterns, need for operative delivery for foetal distress, neonatal mortality, Apgar scores, admission to NNU, neonatal seizures, and hypoxic encephalopathy. Randomisation achieved good comparability between the two groups. Abnormal FHR patterns were more frequent in the electronic group (54 pc versus 32 pc). Caesarean section rate was not significantly different in the two groups (28 pc versus 24 pc) although slightly higher compared to overall for the unit (18pc). Foetal outcome was also comparable between the two groups. Asphyxia can be detected with a hand held doppler just as reliably as by the use of electronic monitors and their use should be further evaluated and promoted in obstetric units caring for high risk pregnancies in developing countries with scarce resources.


Colon atresia and stenosis in Zimbabwe: case reports and a review of the literature. Two neonates with colon atresia and one with colon stenosis presented in Harare over a six month period. The first patient was treated with a local resection and primary anastomosis for a type II colon atresia. The second had an excision of obstructing septum, widening coloplasty and cecostomy for a type I colon atresia. The third patient had a sigmoido-rectoplasty and cecostomy for a sigmoid colon stenosis. The third patient also had a cystic duplication of the small bowel. No other anomalies were noted. All three patients survived and were developing normally at six months post-operatively. A review of medical records at Harare and Parirenyatwa Hospitals revealed no other case of colon atresia in the last 10 years. The incidence by site of gastro-intestinal atresias in Zimbabwe is consistent with other reports.


Herpes zoster treated by acupuncture.

Herpes zoster treated by acupuncture. The treatment of Herpes zoster by acupuncture is described. These were four patients with acute zoster and four with post-herpetic neuralgia. In a majority of the cases electro-acupuncture was found to be effective, and this treatment should be instigated as early as possible. Since the treatment of Herpes zoster by drugs is not routinely successful and can prove expensive, acupuncture, whose side effects are minimal, merits a trial.


[Epidemiologic survey of psychiatric disorders in specialized consultation]. This epidemiological survey was performed with 317 clinicians of each structure of care (hospital, private practice...), randomly selected among french psychiatrists. During one day of a week, in January or June, all outpatients completed a self-questionnaire regarding sociodemographic data, previous and actual symptoms and for some of them randomly selected, the clinicians filled in a semi-standardized evaluation form and had to give the complete diagnosis according to the DSM III-R criteria. 2686 outpatients have completed the self-questionnaire and for 1568 (51%), the diagnosis DSM III-R was given. The mean age was 41.3; most of patients were females (59.2%), married (50.5%), urban (77.2%), employees (25.2%). The most frequent main diagnoses were: mood disorders (26%), schizophrenia (19.5%) and generalized anxiety (15%); in 47% of the cases, a second diagnosis was given. There was no significant difference between the 2 periods of evaluation. among psychiatric outpatients, the proportion of depression and anxiety disorders is nearly the same as in the total psychiatric population; in contrast, schizophrenia is more frequent, and alcohol or drug abuse less frequent.


[Study of the uni-dimensionality of the Yesavage-Brinck geriatric depression scale. Comparison between classical methods and Rasch's model]. The authors present a contribution to the french validation of the self-rating questionnaire of the depression in the elderly proposed by Yesavage and Brink (1982), the Geriatric Depression Scale (30 items). This study focusses on the assessment of the homogeneity and of the unidimensionality of this scale. 99 aged women living in old-people homes or attending a geriatric somatic day-hospital, not known to be psychiatrically ill, filled the GDS and were interviewed by either a psychiatrist or by a clinical psychologist. This interview yielded 44 cases of Major Depressive Disorder or of Dysthymia (DSM III). Firstly, we have applied the classical correlational methods of assessment of scale Reliability and Construct Validity: Cronbach's coefficient alpha and item-total correlations (homogeneity) and Principal Component Analysis (PCA) without rotation. Then, we have performed a Rasch Model Analysis: this method which belongs to the general frame of Latent Trait Theory relies on a probabilistic model of subject's response to individual questions. In the Rasch model, the response probability of a given subject to a given item is a logistic function of the difference between the item location parameter and the subject location parameter along a single continuous latent dimension. Our results have shown that the Cronbach's alpha was very high (.902) and that the item-total correlations were quite satisfactory (mean .470), thus giving a strong impression of homogeneity (similar to unidimensionality for many authors).(ABSTRACT TRUNCATED AT 250 WORDS)


[Use of ROC analysis in psychiatry].

[Use of ROC analysis in psychiatry]. The fundamental principles of ROC analysis are described. This method provides a means to assess the overall discriminant power of psychiatric rating scales for the full range of their scores. For each cut-off, an instrument has a sensitivity (true positive rate) and a specificity (true negative rate). High values of these coefficients are desirable although they are inversely related. ROC curves can be obtained by plotting the false positive rate and the true positive rate for different thresholds of the rating scale. The curves which would be obtained with a perfect, a worthless and a typical instrument are drawn to illustrate various situations found in ROC analysis. Among the several indices proposed, the area under the curve (AUC) is the most commonly used index to assess the overall discriminant power of an instrument. To calculate this area, the non parametric trapezoidal method is advocated. The area under the curve varies between 0.50 which corresponds to the chance line up to 1.0, a value associated with perfect accuracy. This parameter can be interpreted as the probability of classifying correctly the subjects of a pair where one is normal and one is diseased. Then, the appropriate statistic to compare several ROC indices is provided for the general case of independent observations. When the observations are paired, the standard error of the difference between two areas needs to be corrected.(ABSTRACT TRUNCATED AT 250 WORDS)


[Screening of depressive disorders during the postpartum period with the Zerssen self-evaluation scale]. The frequency of post-partum depressive states is well know. Post-partum blues is considered in the literature, to be a frequent transitory and benign syndrome, as it affects between 20 and 80% of women after childbirth. This blues only lasts a few days, and generally occurs around the 4th days post-partum. Research dealing with the relations between the mother and her newborn needs to include an evaluation of mothers' mood which could modify these interactions. The study of transitory post-partum blues requires a standardized mood measuring instrument which can be adapted to an experimental situation (as for instance, the study of the first relations between the mother and the newborn). The scale must be easy and fast to use so as not to over-burden the mothers with tests. The test must also be able to be used day after day to show the rapid variations in mood. The Zerssen self-rating scale, which requires ten minutes to complete was used. 61 women filled out the rating scale each morning from the 2nd to 7th day after the birth of her child. The score obtained with this scale became a quantitative evaluation of the mothers' depressive mood. Each score can be put into one of the following five categories: [table: see text] The results show that 23% of the mothers suffered from transitory post-partum depression, 23% of the mothers are anxious and 54% are relaxed. The days when the mothers were depressed were day 3 and to a lesser extend, day 4 post-partum.(ABSTRACT TRUNCATED AT 250 WORDS)