Multimodal and motor influences on orientation: implications for adapting to weightless and virtual environments. Human sensory-motor control and orientation involve the correlation of sensory information from many modalities with motor information about ongoing patterns of voluntary and reflexive activation of the body musculature. The vestibular system represents only one of the acceleration-sensitive receptor systems of the body conveying spatial information. Touch- and pressure-dependent receptors, somatosensory and interoceptive, as well as proprioceptive receptors contribute, along with visual and auditory signals specifying relative motion between self and surround. Control of body movement and orientation is dynamically adapted to the 1G force background of Earth. Exposure to non-1G environments such as in space travel produces a variety of sensory-motor disturbances, and often motion sickness, until adaptation is achieved. Exposure to virtual environments in which body movements are not accompanied by normal patterns of inertial and sensory feedback can also lead to control errors and elicit motion sickness.


A postural model of balance-correcting movement strategies. The patterns of joint torques and movement strategies underlying human balance corrections were examined using a postural model. Two types of support-surface perturbation, dorsiflexion rotation (ROT) and rearward translation (TRANS), were employed. These two perturbations were adjusted to produce similar profiles of ankle dorsiflexion in order to obtain information on the role of lower leg proprioceptive inputs on triggering balance corrections. In addition, the dependence of balance control on head angular and linear accelerations was investigated by comparing the responses of normal and vestibularly deficient subjects under eyes-closed and eyes-open conditions. Differences in ROT and TRANS movement strategies were examined in three ways First, the amplitude and polarity of active joint torques were analysed. These were obtained by altering joint torques applied to a postural model until movements of the model accurately duplicated those of measured responses. Second, the pattern of body-segment angular movements depicted by stick figures moving in response to the computed joint torques was investigated. Third, the peak amplitude and patterns of crosscorrelations between joint torques were measured. Active ankle, knee, and hip joint torques computed for normal subjects rotated the body forward for ROT. In the case of TRANS, computed active torques in normals were of opposite polarity to those of ROT and reversed the forward motion of the body. Subjects with vestibular deficits had lower amplitude torques for ROT and failed to counter the platform rotation. Hip torques for TRANS in vestibular deficient subjects were of opposite polarity to those of normal subjects and resulted in excessive forward trunk rotation. Normally, neck torques acted to stabilize the head in space when trunk angular velocity peaked. Vestibular deficient subjects displayed head movements in response to ROT similar to those generated when neck torques were absent. For TRANS, these same subjects exhibited overcompensatory neck torques. Stick figures of normal responses indicated a stiffening of the body into a leg and a trunk-head link for ROT and a flexible multilink motion for TRANS. Likewise, normal response strategies, defined by using crosscorrelations of joint torques, differed for ROT and TRANS. All joint torque crosscorrelations were significant for TRANS. Neck torques led those of all other joint torques by 40 ms or more, and hip joint led ankle torques by 30 ms. Joint torque correlations for ROT were organised around hip and ankle torques without a major correlation to neck torques. Fundamental changes in all torque crosscorrelations occurred for vestibularly deficient subjects under both eyes-open and eyes-closed conditions.(ABSTRACT TRUNCATED AT 400 WORDS)


Effect of positioning of the feet in posturography. Static posturography has been developed from a basic research test to a widely used clinical tool for evaluating dizzy patients. Before any actual standardization can be achieved, however, several aspects of the test situations have to be evaluated, including the position of the feet. The quantitative significance of the standing position in posturographic measurements was evaluated with healthy volunteers studied under visual and nonvisual conditions, using 4 foot positions: heels together with the toes 30 degrees apart or at an angle of the volunteer's own choice, and the feet parallel and either 0 or 10 cm apart were studied separately. Each measurement was characterized in terms of 5 parameters (body sway velocity, vibration-induced shift of centre of force in anteroposterior and lateral directions, and maximum displacement of centre of force in the same directions). Body sway velocities were smallest when the feet were parallel and 10 cm apart. Although the position chosen by the subject was usually more stable than that with the toes 30 degrees apart, the difference was nonsignificant. According to our results, the standing position is not crucial in posturographic measurements provided that the distance between the heels is determined, and the subject can just as well choose the angle between the feet if the heels are kept together.


Ultrastructural studies on the medulla of rabbit pineal gland in the diurnal rhythm. Presence of numerous capillary vessels was detected, featuring thin unfenestrated endothelium with low number of plasmalemmal and pinocytic vesicles. Visual appraisal demonstrated no differences in number of cellular transport exponents between stages at which maximum and minimum melatonin levels were noted in the serum. Pineal parenchyma consisted of two types of pinealocytes: clear and dark ones. In hour of the peak gland activity the number of dark pinealocytes was doubled. No evident differences were observed between the two time points in the number of clear pinealocytes and of glial cells.


Ultrastructural changes in the parotid serous cells of white male rats after experimental encortone. Mature male rats received encortone in a dose of 1 mg/kg of body mass for 7 days and 30 days. The following changes were observed in the cells of parotid gland of the experimental animals in comparison with the control: a) after 7 days of encortone treatment increase of secretory cells activity appeared in the intensive production and secretion, b) after 30 days of encortone treatment a decrease in secretion production. Moreover, hyperplasia of serous cells, hyperthropy of cell nuclei, pycnosis of nuclei in some serous cells and hyperplasia of epithelium in some intercalated ducts were observed.


The anatomical variations of the inferior mesenteric artery and its branches in human fetus. Authors present the anatomical variations of the course of the inferior mesenteric artery and its branches in 62 human fetus. They mark out three types of supply of descending colon, sigmoid and rectum.


The morphological evaluation of frontal sinuses in the human skulls. Using cranial radiographs of 214 skulls representing white population, morphological features (size and shape) of the frontal sinuses were evaluated and compared with data on Eskimo and Indian series representing yellow population. In both populations, white and yellow, the sinuses are better developed and are usually larger in men than in women. The sinuses of smooth contour are usually smaller than those with serrated contour, and in case of the first ones, the left one is missing. Distinct racial, qualitative and quantitative differences occur in the presence and size of the frontal sinuses area.


Subpleural vascular anastomoses in lungs of human fetuses. Studies were performed on 35 left lungs, originating from human fetuses, who died at the age of 20 to 29 weeks of fetal life, using corrosion casts, microangiographic technique or methyl salicylate induced translucency. A typical network of subpleural vessels was observed, which joined pulmonary arteries and veins and formed direct anastomoses between pulmonary arteries and veins within pulmonary acini of the subpleural layer.


Accessory subapical segment (Sx) within the lower lobe of the left lung in the man. The studies were performed on 100 lungs originating from human bodies of either sex, using corrosion casts and, in a proportion of cases, the traditional preparative technique. The accessory subapical segment (Sx) was identified in 31% cases of 100 left lower lobes.


[Periodic disease of the child].

[Periodic disease of the child]. Familial mediterranean fever is a childhood disease which usually starts around the age of 4 years. Its onset is insidious with common and misleading symptoms such as fever and abdominal pain. Accordingly, this disease is often recognized belatedly from evocative data from previous history such as the recurrence of attacks, familial descent from certain ethnic groups and the lack of other obvious etiology. The clinical picture within this age group is similar to that observed in adults and does not present any clinical or biological originality. Colchicine remains the only efficient treatment to prevent both acute manifestations and amyloidosis. The former is geared toward its current use among children (growth retardation and gonadic disturbances) and is not really relevant, at least in this particular disease.


[Drash syndrome].

[Drash syndrome]. The authors report one case of Drash syndrome: association of Wilms' tumor, nephropathy and genital abnormalities. The definition, prognosis and origin of this triad are discussed.


[Neonatal resuscitation and preventive continuous positive pressure ventilation]. One of the aspects of prematurity in neonates is the respiratory distress syndrome. Although treatment with mechanical ventilation reduced the mortality rate, bronchopulmonary dysplasia still develops in many neonates. We have attempted to reduce intubation and mechanical ventilation by using, in the delivery room, humidified and warmed gas with fractional inspired oxygen as low as possible to obtain SaO2 between 85 and 95%. The gas was administered with a face mask using continuous positive air pressure 3-5 cm H2O. Seventeen out of 66 premature neonates born before the 35th week of gestation were ventilated immediately (n = 11) or subsequently (n = 6). Seven out of 26 infants (27%) born between 30 and 32 weeks required mechanical ventilation. In contrast, ventilation was necessary for eight out of 16 premature neonates born before the 29th week of gestation. Mortality rate was 6% (4/66) in the latter group (< 29 weeks), and only one neonate developed bronchopulmonary dysplasia.


[Hydatid cyst of the kidney in the child]. Three pediatric cases of hydatic cyst of the kidney are reported. This is a very rare condition in children. Usually, the presentation is a cystic space-occupying lesion of the kidney. Several diagnostic methods are available but it is stressed that ultrasonography may be sufficient. Surgical treatment is still necessary.


[Neonatal hyperchloremia related to bromide poisoning]. Hyperchloremia may reveal bromism during the neonatal period. The authors report on two cases of neonatal bromism. The first case concerns triplets without clinical signs although the children and their mother displayed hyperchloremia. In the other case a 6 week old infant displayed neurological abnormalities associated with hyperchloremia and elevated plasma bromide levels.


[Fetal echocardiography. I. The technic and fundamentals]. This study describes the method and principles of fetal echocardiography, analyzing the technics and the utility of bidimensional mode, M mode and Doppler ultrasound on congenital fetal cardiopathies. The importance of early diagnosis in the structural alterations and fetal cardiac arrhythmias is emphasized.


[Fetal echocardiography. II. Biometry of the normal fetal heart]. Normal fetal hearth biometry is analyzed by echocardiography in 80 pregnant women with 20 and 40 gestational weeks. Intraventricular septum, aorta, left and right ventricular dimensions were obtained. All dimensions showing progression with gestational age.


[Fetal echocardiography. III. The antenatal diagnosis of structural and rhythm changes]. We present 119 echocardiographies in 90 high-risk pregnancies, 20 to 40 weeks gestational age. There were found 18 fetuses with abnormal examinations (20%), six of them with structural alteration (6.6%), and 14 arrhythmias (15.5%). The diagnostic correlation in structural alterations with a sensibility of 83% and 100% specificity, and 100% of sensibility and specificity in arrhythmias. The importance of antenatal diagnosis in cardiac malformations and arrhythmias is described.


[The significance of meconium in the intrahepatic cholestasis of pregnancy]. 1. We studied 202 pregnant women who were porter of pregnancy intrahepatic cholestasis (CIE). They were attended at the High Risk Fetus Unity (FAR) at the Hospital Salvador Maternity. They were compared with a control group that was composed by 404 patients with normal pregnancy. 2. The patients with CIE presented three times more risk of having a newborn infant of preterm than the other group (p < 0.01) omitting the cesarean factor. 3. The patients with CIE but without an associated pathology, also didn't present a greater risk of having a newborn infant of below weight (< 2,500 g) neither a newborn infant with Apgar 1' > 7, at any gestational age and any way of delivery, than the control group. 4. The risk of having meconium is three times greater in the patients with CIE. This risk increases (Odds ratio = 4.87 with p < 0.01) when they present an associated pathology. 5. Analyzing separately the group of patients with CIE and meconium and comparing with the control group, we didn't find any difference between both groups in relation with the risk of below weight (< 2,500 g), Apgar 1' < 7 and strangely preterm delivery. 6. The presence of meconium in patients with CIE and without an associated pathology, disposing adequate monitoring of pregnancy and delivery, is postulate that it isn't in relation with bad new born infant prognostic.


[The evaluation of transabdominal pelvic fluid collections. Clinical cases]. Two cases of pelvic collections of different etiology, admitted in the isolation unit of the Gynecology and Obstetrics Department of Hospital del Salvador are presented. Both were resolved by means of ultrasound transabdominal puncture, the first a tubo-ovarian abscess, in which there was placed a percutaneous drainage, and the second, a Residual Lutein Cyst, (Subsequent' to an Ectopic Pregnancy resolved by surgery) by means only of punction. In the first case (tubo-ovarian abscess) the patient became pregnant 2 months after de punction having actually a physiologic evolution. In the second case the patient is asymptomatic and has normal medical controls.


[The tap test in the rapid evaluation of fetal lung maturity]. A new test for the evaluation of fetal lung maturity, called tap test, been recently developed. This rapid, inexpensive, and reliable test is easy to perform and can be used whenever testing for phospholipids are not available. We performed this test in 260 clear samples of amniotic fluid obtained by transabdominal amniocentesis and the results were compared with those of the "shake test". When the "shake test" was positive (n = 156), the tap test was consistent with fetal lung maturity in all cases. When the "shake test" was intermediate or negative (n = 61 and n = 43, respectively), the tap test was consistent with immaturity in only 19.2% of the cases. Fifty-four fetuses were born within 72 hours after the amniocentesis. The "shake test" was positive in 50, intermediate in 3, and negative in 1. In all but one of there cases the tap test was consistent with maturity. The only case of RDS in this series occurred in an infant with immature result. These findings indicate that the tap test is a reliable indicator of fetal pulmonary maturity and probably with a higher specificity than the "shake test".


[The pH of the fetal scalp: 30 years later]. The experience of 16 cases of fetal scalp sampling to determine the PH was evaluated in relation to fetal electronic monitoring. It was concluded that currently its purposefulness is limited and expensive.


[Ovulation induction by the chronic administration of naltrexone in a patient with secondary hypothalamic amenorrhea]. An ovulatory cycle was induced by oral administration of a specific opiate antagonist: naltrexone, at a dose of 50 mg/day for 26 days in a woman suffering from secondary hypothalamic amenorrhea. The follicular growth was monitored by ultrasound and serial blood measurement of LH, FSH, E2 and progesterone. The hormonal and ultrasound profiles showed an ovulatory cycle with a single dominant follicle. After discontinuation of the treatment, the patient became amenorrheic again. The gonadotropin as well as estradiol plasma levels declined, to that observed before treatment. Naltrexone may be a useful agent for induction of ovulation in women suffering from hypothalamic amenorrhea.


[Transvaginal echography in the diagnosis of placenta previa]. To illustrate the usefulness of transvaginal sonography in diagnosing placenta previa, a case managed in our unit is presented. The literature available shows that this method has more sensibility and specificity than the transabdominal technique.


[Endoscopic surgery of the ovary: the resection of a mature cystic teratoma. Translaparoscopic oophorectomy]. Mature teratoma cyst translaparoscopy resection (oophorectomy) is reported. Details of surgical technics are shown in a video.


[Maternal-fetal Doppler study in a pregnant woman with prior ligation of the hypogastric arteries]. We present the results of color Doppler ultrasound in a pregnant with previous hypogastric arteries ligation. It was in a normal range.


[Eclampsia at the Rancagua Regional Hospital]. Forty-four cases of eclampsia with an incidence of 2.3 in 1,000 deliveries were analyzed. The major frequency was in primiparas (81.8%) and were less than 19 years old (54.5%). Convulsions occurred during pregnancy in 65.9% of patients, during labor 6.8% and 11.4% postpartum. In 91% of patients a cesarean section was performed. The most frequent indication was low pelvic score. The 61.4% of the labor occurred at 37 weeks or less. Perinatal mortality was 2.3% (one new born of 1,340 g death in the neonatal period). We don't have maternal mortality.


[Menometrorrhagia in adolescence].

[Menometrorrhagia in adolescence]. Forty-six patients with the diagnosis of menometrorrhagia, currently under control in the infantile and adolescent unit of Obstetrics and Gynecology Hospital del Salvador. We emphasize that uterine hemorrhage is a frequent emergency during adolescence requiring fully studies. Medical treatment using different hormonal schemes solve the majority of menometrorrhagias. Only a small group require a D & C using the virginal approach. Patients should be controlled during various cycles once bleeding is stopped to avoid relapse and future problems related with anovulation, endometrial hyperplasia or fertility problems.


[Puerperal uterine involution: an echographic follow-up]. We have studied 87 puerperal women during the first month postpartum. They were liable to ultrasound on the first, second and third day of this period. Eighteen of them were examined on the 15th and 30th day. The measure of the uterine area (pi x 1/2 length x 1/2 width) is seen as the most sensible method for this evaluation. The uterus involutionated symmetrically and in thirty days complete this process. They were no significative differences appreciated in the uterine involution that depends on the lactation, parity and the use of uterine retractors.


[Ultrasonography-guided transvaginal puncture of ovarian cysts]. Presenting the experience in 18 cases of ovarian cystic transvaginal puncture guided by ultrasonography. The cystic selected for puncture were unilateral, regular contours, uniloculated without internal papillae, without ascites. This procedure was made in women on reproductive age with failure to medical treatment.


[Primary carcinoma of the fallopian tube. A report of 3 clinical cases]. Three cases of primary adenocarcinoma of the Fallopian tube have been treated at the Gynecology Department of Hospital A. C. Camargo, Fundación A. Prudente, São Paulo, between 1972-1987. The diagnosis was only possible at surgery. The poor prognosis was due to the advanced stage of the disease. In view of its rarity further studies are necessary for a better diagnostic and therapeutic approach.


[A molar pregnancy coexistent with a viable fetus in a twin pregnancy]. A case of molar gestation associated with an only fetus, both product of an twin gestation is presenting. We analyzed the clinical picture, the diagnostic method, the after birth resolution and evolution of this gestation. The result of a live newborn of 1,300 g and verify coexisting of complete hydatidiform mole.


[The results of a program of in vitro fertilization and tubal embryo transfer (ZIFT)]. Twenty-one sterile couples, between September 1989, and August 1991, were treated for ovulation stimulation of their cycles, in order to practice in them, a in vitro fertilization and tube embryo transfer (ZIFT). Two protocols of ovulation induction were used, both with leuprolide acetate (Lupron), one in the luteal phase and the other in follicular phase and since the second or the fourth day of the cycle, respectively, gonadotropins were added (Metrodine and Pergonal). Out of all the twenty-nine initiated cycles, twenty-seven were aspirated (93.1%) and twenty-four reached an embryo transfer (82.8%). Seven clinic pregnancies were obtained (29.17% per transfer) and four deliveries (16.67% per transfer). The sterility period average was 69.64 +/- 36.6 months and the patients age average was 34.1 +/- 4.38 years. The global rate of fertilization was 63.53%. With luteal phase Lupron best results were got (pregnancy rate of 38.46% per transfer) and there were not considerable difference in the number of gonadotropins ampulla employed. When embryos were transfer to the tubes and the uteri the pregnant rate was 50% per transfer, in comparison to 18.75% when transfer was made only in the tubes.


[The ultrasonographic characteristics of the endometrium during the spontaneous ovulatory menstrual cycle]. Six hundred and four serial transvaginal sonograms were performed in 70 normal and healthy women throughout an ovulatory cycle. The endometrium was classified in 4 types (0, 1, 2 and 3) according to: the aspect of the myometria-endometrium and endometrium-endometrium interfaces, and the texture and thickness of the functional layer. Type 0 appears as a smooth, pencil line endometrium. Type 1 has a trilaminar structure with an iso or hypoechoic functional layer. Type 2 is also trilaminar, but myometria-endometrium interfaces are thicker than type 1. Type 3 appears as a thick and homogeneously echogenic image. The relative frequency of each type of endometrium was determined for every day of the menstrual cycle. Day 0 was defined sonographically as the day of follicle rupture. Type 0 was found during and immediately after menstruation. Type 1 was seen during mid-follicular phase and until day +2. Types 2 and 3 were observed post ovulatory in 100% of the cases. The endometrium increases in thickness more during preovulatory phase (mean: 5.5 mm), than in the luteal phase (mean: 2.6 mm). We conclude that this working classification of the endometrium is useful in clinical practice when associated to the ultrasonographic aspect of the ovaries and the moment of the menstrual cycle.


[Sexually transmitted microorganisms and immunoglobulins in the amniotic fluid in mothers who carry sexually transmitted diseases]. Fetal behaviour as an intrauterine patient is unknown. In the diagnosis of sexually transmitted diseases (STD) and in the criteria for treatment only the mother is considered leaving the fetus out. The presence of immunoglobulin M in the amniotic fluid is an indicator of fetal infection and could allow an accurate diagnosis of fetal disease or treatment, if the measurement is related to the presence or absence of organism in the amniotic fluid. In this way, the study of fetal behaviour under these conditions could be done. The objective of this research was to determine the presence of STD organism in the amniotic fluid of the STD infected pregnant women and to evaluate the prevalence and evolution of these pathologies in the fetus. No STD organism, nor immunoglobulin M were found in the 13 samples of amniotic fluid (8 pre and 5 post-treatment) of infected pregnant women. The presence of microorganisms and its relation to immunoglobulin M was not observed. More cases are needed to arrive to a conclusion regarding fetal immunology and to a better understanding of antibacterial properties of the amniotic fluid. We concluded that no contamination in the amniotic fluid or fetal infection was found in pregnant women with STD.


[Cervical and abdominal microbiology in infertile patients]. The microbiology of twenty-nine asymptomatic infertile women was evaluated prospectively. Samples were taken from the cervix and the endosalpinx during laparoscopy. Cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Mycoplasma, Ureaplasma urealyticum and Chlamydia trachomatis were performed. No association was found between the presence of germs in the abdomen or cervix and tubal abnormalities. History of previous IUD use was associated with tubal disease.


[Plasma estrogen levels in postmenopausal women treated with estrogens alone or combined with medroxyprogesterone acetate in the same tablet]. A study was carried out with 30 postmenopausal women, treated with conjugated estrogens, alone, or associated with medroxyprogesterone acetate in the same tablet, assaying their plasmatic estrogen levels before and during the treatment, besides its clinical efficacy. There were no significative differences of a given doses in neither of both aspects. The conclusion was that the associated hormonal replacement therapy is a good choice that improves patients compliance with the therapy.


[The medical management of tubal pregnancy. Preliminary experience]. We present 3 cases of tubal pregnancy treated with methotrexate. According to the success that we have been obtaining, and the reports of the literature, we propose a local protocol of management of the unruptured tubal pregnancy using a single injection of intratubal methotrexate.


[The successful prolongation of a twin preterm pregnancy complicated by a dead fetus and disseminated intravascular coagulation]. A clinical case of twin pregnancy with one in utero death fetus, at 24 weeks of gestation is presented, accompanied by disseminated intravascular coagulation. The successful treatment with heparin its described.


[A laparoscopic approach to a paratyphoid ovarian abscess]. A case report of a 29-year-old nulligravid patient with a ovarian typhoid abscess managed endoscopically is presented. Puncture and drainage of the pelvic mass was performed laparoscopically. The infrequency of Salmonella paratyphi as an etiologic agent of pelvic inflammatory disease is discussed and a review of the literature regarding endoscopic management of purulent pelvic collections is presented.


[Hydronephrosis and urinary retention secondary to extrinsic compression by an ovarian cyst in a girl]. The indications for laparoscopy have increased markedly in the last few years. It is becoming necessary to define it's role and it's limits. Currently laparoscopy should only be used to treat ovarian tumors that are benign by clinical and ultrasonographic criteria. This case report describes a 12-year-old girl who presented with urinary retention and was found to have bilateral hydronephrosis and a ovarian cyst. She had no evidence of renal compromise and the cyst appeared benign by ultrasonographic criteria. The ovarian cyst appeared to be causing external bilateral ureteral compression. A laparoscopic cystectomy was performed with resolution of hydronephrosis. This case report helps illustrate the benefits and disadvantages of the laparoscopic approach to ovarian surgery.


[Recurrent loss of pregnancy in patients with anticardiolipin antibodies (ACAb)]. The high level of antibody anticardiolipins in pregnancy was related with fetal mortality abortion and low birth weight. The authors used prednisone and aspirin, with success in this patients.


[The gestrinone (R-2323) treatment of endometriosis]. Results of medical treatment with gestrinone are evaluated in 29 women with minimal (10), mild (9) and moderate (7) endometriosis. After a diagnostic laparoscopy, patients started gestrinone 2.5 mg/day 2 times a week per 6 months. Clinical evaluations and blood samples were performed at the end of the ist, 3rd and 6th month of treatment. A second look laparoscopy, in 26 out of the 29 patients, was performed within a month after discontinuation of the drug. Nineteen patients (73.1%) showed a diminishing in endometriosis score. Moreover, 2 of them presented with a normal pelvis at the time of the 2nd laparoscopy. Overall post treatment scores were significantly lower than pre treatment scores (6.1 +/- 6.9 versus 11.3 +/- 10.2 respectively, p < 0.025). Nineteen out of the 26 patients had amenorrhea, most of them (18) since the second month of treatment. Nineteen patients presented with dysmenorrhea at the beginning of the treatment and in 13 of them it disappeared during the first 3 months of the drug. Reversible elevation in serum transaminases was observed in 4 patients. Red blood cells count and platelet concentration increased at the end of the treatment. A clear pituitary suppression to basal levels was seen. No significant changes on androgen levels were appreciated. Seven patients achieved a spontaneous pregnancy, out of 22 that desired fertility (31.8%), all of them were clinical pregnancies.


[The cytogenetics of premature ovarian failure]. Premature ovarian failure is defined as the occurrence of menopause before the age of 40 years. Etiology has been related to genetic, autoimmune or infectious factors, resistance to gonadotropins and others. Forty-seven patients with this diagnosis were referred for cytogenetic analysis. Sixty-eight percent of the cases had a normal karyotype. In 10.7% there was one 45,X cell and they were catalogued as normal. In 15% of the patients there was a mosaicism with normal cell lines and additional 45,X, 47,XXXX and 48,XXXX ones. Two women had a chromosomal constitution 47,XXX. In one 22-year old patient there was a reciprocal balanced translocation 46,X t(X; 18) (q21.2;q22). The presence of different cell lines, including 45,X cells, could explain an accelerated loss of gametes in the ovary. In women with 47,XXX karyotype, fertility problems and premature menopause have been described. The study of the balanced X-autosome translocation with DNA technics could allow to find the molecular basis of the ovarian failure, permitting the direct search of the gene involved at the site of disruption.


[Podalic version in multiparae. Vaginal or cesarean?]. A review of maternal and perinatal results of multiparous patients with breech presentation was done during two period; two years before and two years after establishing the rule of cesarean section for all multi-parous with breech presentation. Seventy cases were considered at the first period in which 47.1% were vaginal delivery, proportion that significantly decreased (15%) at the second period. No significant differences on maternal results by delivery form were found and the same was found in perinatal results at comparing vaginal delivery and cesarean section. A different situation was reported studying only elective cesarean section, in which a significant decrease of severe neonatal depression was found comparing to vaginal delivery (24.2% and 0%). Because of rapid recovery there were no differences at fifth minute. As a conclusion, it appears as an exaggeration the option of cesarean section for all multiparous with breech presentation. Secondly, the adequate selection of cases to resolve by vaginal delivery may not produce adverse maternal and perinatal results.


[2 rare cases of a presentation of endometrial cancer]. Two cases of endometrial carcinoma with an atypical presentation are analyzed. The first case was formerly submitted to pelvic irradiation because a cervical carcinoma, and the second case to a long-term tamoxifen co-adjuvant therapy on account of a breast carcinoma. The risk for seconds primaries carcinomas and the eventual association of pelvic radiation and tamoxifen therapy with a subsequent endometrial carcinoma are discussed.


[Invasive mole with uterine rupture].

[Invasive mole with uterine rupture]. A case of chorioadenoma destruens with uterine rupture is reported. The patient was admitted because a persistent uterine bleeding after abortion about two months before. The titulation of gonadotrophic hormone resulted in 25,000 unities. After curettage she was complicated with hemoperitoneum and went to surgery. During hysterectomy were identified trophoblastic tissue in the broad ligament and partial blocking of the right ureter. After repeated chemotherapy she presented severe immuno depression and sepsis complicated with hemopericardium and died five months after the first admission. The pathology study demonstrated a perforation because a trophoblastic invasion in the right side of the cervix and in the autopsy was demonstrated right ureteral obstruction due to a fibro necrotic an inactive trophoblastic tissue determining significant right hydro-uretero nephrosis.


[A giant hepatic hemangioma and pregnancy]. We present a clinical case of a pregnancy with giant hepatic hemangioma. At term it presented like a consumption coagulopathy with thrombocytopenia. Maternal and fetal color Doppler was normal. The perinatal outcome was successful.


[What results can be expected from in vitro fertilization and other technics of assisted fertilization?]. Results of assisted reproductive techniques (IV, GIFT and ZIFT) have improved progressively during the last years but they are still not satisfactory specially when they are analyzed in terms of cost efficacy. During 1990, in the world literature, the following successful results were reported: pregnancy rates of 20% and delivery rates of 15% for IVF-ET, 29% and 22% for GIFT and 21% and 16% for ZIFT. In spite of the small number of cases reported in Chile, results are similar to those of USA and Europe. Results of assisted fertilization techniques have improved with the use of Gn-RH agonists and are worse in patients older than 35 years of age than in younger ones. Pregnancies rates are higher when the number of transferred ovocytes increases although transfer of more than 3 or 4 ovocytes or embryos is contraindicated because of the risks of multiple pregnancies. When more than 3 or 4 embryos are obtained those not transferred are usually cryopreserved. IVF-ET is the first choice of treatment in cases of infertility due to severe tubal damage and/or extensive and dense pelvic adhesions. In cases of infertility with normal tubes, intrauterine inseminations in 3 to 4 controlled hyperstimulated cycles are recommended before indicating an assisted fertilization procedure. The most risky complication of assisted reproduction, besides multiple pregnancy, is severe ovarian hyperstimulation syndrome (SOHS). This syndrome is prevented by not injecting HCG or by not transferring ovocytes or embryos in cases of high estradiol levels after HMG and/or FSH administration.


[Genetic evidence corroborates Negme's hypothesis about the greater mildness of American trypanosomiasis in Chile]. Chagas disease is present in northern and central Chile. Not more than 25% of infected individuals have had a pathologic condition presumably due to Trypanosoma cruzi. The majority of individuals with chronic infectious Chagas disease in Chile are asymptomatic in contrast to what has been observed in other South American countries. Historic and paleopathologic evidences suggest that this particular behavior could be explained by a genetic adaptation of Chilean aborigines to T cruzi. Associations between ethnic admixture, presence of Chagas disease, associated cardiac pathology and 4 blood groups (ABO, MNSs, Rh and Duffy) were investigated among inhabitants of San Pedro de Atacama in northern Chile. Cardiac pathology was determined by positive serologic reactions in individuals with abnormal electrocardiographic findings. Individuals with negative serologic results had a significantly greater aboriginal admixture (88%) compared to those with positive serology (66%). This findings supports the hypothesis of genetic adaptation explaining mildness of Chagas disease in Chile.


[Anticardiolipin antibodies in connective tissue diseases]. The incidence of anticardiolipin (ACL) antibodies in connective tissue disorders other than systemic lupus was investigated in 113 subjects: 68 had rheumatoid arthritis, 23 primary Sjogren syndrome and 22 had systemic sclerosis. VDRL, thromboplastin time and determination of IgG and IgM ACL antibodies (ELISA) were performed in all subjects. Overall, 45% of patients were positive for ACL antibodies, mostly of the IgG variety (90%). No differences were observed among the investigated diseases. Positive ACL antibodies were not related to evidence of antiphospholipid syndrome nor to clinical characteristics of the different diseases. These results confirm that ACL antibodies may be present in connective tissue disorders other than systemic lupus, but they do not predict the development of antiphospholipid syndrome nor help to characterize the severity of the disease.


[Epidemiologic study of factors associated with hypospadias]. From August 60 to December 90, 103 male newborns with hypospadias were diagnosed among 124 588 consecutive newborns examined (8.3 per 10,000). Mortality among them was 1.94%. The annual incidence rate increased significantly over the study period (p < 0.001. Hypospadias was an isolated finding in 92% of cases, and its was associated to other non genital malformation in 8.7%. Location of hypospadias was distal in 73% and proximal in 15.5%. There was no seasonal variation in the incidence rate. Weight of affected individuals did not differ from that of controls. Older age of parents among affected individuals was not statistically significant.


[Radiofrequency fulguration in patients with reciprocating tachycardias]. The use of radiofrequency for catheter ablation of accessory pathways and dual AV nodal pathways has been recently introduced. In this paper the results obtained in 5 patients are reported. Three patients had accessory pathways and 2 a dual AV nodal pathway. After a complete electrophysiologic study, a 7F Door Knob catheter coupled to a Radionics radiofrequency generator delivering a maximum of 16 watt at 480 KH was used to ablate the abnormal pathway. Success was obtained in every patient at times varying from 30 sec to 3 min, using 3 to 17 energy deliveries. These results include the first successful ablation of a left lateral bundle with radiofrequency using an energy of only 16 Watt.


[The hepatic porphyrias: experience with 105 cases]. Hepatic porphyria is a rare metabolic syndrome caused by abnormal enzyme activity in heme biosynthesis. Between 1974 and 1991; 105 patients have met criteria for diagnosis of hepatic porphyria based on typical clinical findings and/or laboratory abnormalities. According to type, 42% had porphyria cutanea tarda, 21% porphyria variegate, 15% protoporphyria, 6.7% acute intermittent porphyria, 6.7% coproporphyria and 1.9% porphyria due to porphobilinogen deficit. A proper classification was not established in 6.7% of patients. Porphyria cutanea tarda was more common in males (70%) and porphyria variegata, in females (90%). A family history of the disease was present in 33% of patients; 20% of patients were of European descent and 4% of Mapuche descent. Diagnosis was usually established in the third decade, somewhat later in porphyria cutanea tarda (45 years of age) and very early in protoporphyria. 10% of patients were asymptomatic and 29 patients developed at least one porphyric crisis. These were related to pregnancy in 6 patients, to hormone administration in 7, to antibiotics in 5. No cause was established in 21 cases. Severe crisis were successfully treated with Hematin. Venipuncture was used to treat 50% of patients with porphyria cutanea tarda with 95% success. Thus, hepatic porphyria is recognized with increasing frequency and can be treated successfully in most cases.


[Radiotherapy in the treatment of non-small-cell lung cancer]. The results of curative radiotherapy in 59 patients with non-small-cell carcinoma of the lung treated from 1977 to 1988 are reported. Squamous cell carcinoma without evidence of metastatic disease was present in 28 patients. Radiotherapy alone was used in 43 patients; 13 patients received either pre or post operative radiotherapy. Complications developed in 6 patients, only 1 had esophageal stenosis deemed important. The first site of failure was extrathoracic in 76% of patients, the brain being the most frequently involved site (41%). Brain failure rate was greater for squamous cell carcinoma than for other tumors. The 5 year survival rate was 20% with a minimum follow up period of 24 months (median 57). Better results were obtained in patients receiving high dose continuous radiotherapy and in those with associated surgery. Thus, radiotherapy is an alternative therapy for patients with lung carcinoma, with a reasonable survival rate and few complications.


[Osteopenia in anorexia nervosa evaluated by dual photon-densitometry. Role of malnutrition and hypogonadism]. 30 female patients with anorexia nervosa (AN) were studied and compared with 45 age-matched normal controls. All the patients had severe weight loss and nutritional involvement. Mean and SE body mass index, BMI (kg/m2) were 15.8 +/- 1.8 in anorectics compared to 21.7 +/- 4.7 in normals (p < 0.0001). All the patients presented amenorrhea lasting between 3 and 120 months (mean 24.8 +/- 25.3). A nutritional survey and a dual photon bone densitometry, including spine, hip, total body and total mineral content were performed. The mean values +/- SE in patients and controls were: spine densities (L2-L4) in g/cm2: AN 0.84 +/- 0.1, controls 1.03 +/- 0.1 (p < 0.002). Total mineral content (g): AN mean 1733 +/- 261, controls 2045 +/- 276 (p < 0.0001). In anorectic patients the correlations between bone density and BMI for spine were r: 0.52 (p = 0.002), for hip r: 0.37 (p = 0.04), and total mineral content vs BMI gave r: 0.64 (p = 0.0001). Mean calcium intake in 23 studied patients was lesser than the classic recommended dietary allowance in the whole group, it was less in the pure restricters as compared to vomiters. The relation between duration of amenorrhea and bone density showed than a decrease in the later was evident when the absence of menses was longer than 24 months. In conclusion, in patients with AN there is a real decrease in bone density which is strongly related to low weight and in lesser proportion to the duration of amenorrhea, particularly when it was longer than 24 month.


[Asymptomatic primary hyperparathyroidism: evaluation of bone mass using dual-photon bone densitometry]. Dual-photon bone densitometry of the lumbar spine and hips was performed in 11 patients (9 females) with asymptomatic primary hyperparathyroidism and in 11 control subjects. The age was 54.7 +/- 14.8 years. The asymptomatic state of the disease was established by the absence of clinical or radiologic evidence of renal, digestive or bone involvement. 10 of 11 patients had histologic confirmation of the disorder, in addition to the biochemical and RIA findings which were present in all. Serum calcium ranged from 10.6 to 11.8 mg/dl, and P levels were decreased in 7 subjects. Alkaline phosphatase levels were elevated in 7 patients. Urinary calcium output was 341 +/- 216 mg/24 h. Bone density was 16% lower at the lumbar spine and 20% lower at the hip in patients compared to controls. In 5 patients bone density was lower than the level associated to increased risk for fractures (compared to 2 controls). No correlation existed between bone density and biochemical indices of hyperparathyroidism. Thus, decreased bone density and increased risk of fracture may exist in patients with hyperparathyroidism even at the asymptomatic stage.


[Duchenne and Becker muscular dystrophy in Chile]. Duchenne muscular dystrophy is one of the best known forms of muscular dystrophy. The incidence in different countries varies from 130 to 390 per million male live births. Becker variety may be considered a mild form of Duchenne dystrophy, with an incidence 10 times lower. A sex linked recessive inheritance is involved in both forms, the affected gene is placed at locus X21. The incidence of both forms in Chile is similar to that reported worldwide, and has been increasing since 1950. Increased CK and LDH levels are confirmed in patients, and overall, they are also higher in female carriers. However only 26% of carriers have increased CK levels and 21% increased LDH levels, compared to normal subjects. Electromyograms show myopathic characteristics in all carrier women. The scope of a prospective clinical, genetic and epidemiologic study currently underway is discussed.


[Pregnancy in a class-T diabetic patient]. We report the pregnancy of a 35 year old diabetic woman with a positive Australia antigen, 3 years after a successful cadaver kidney transplant. Immunosuppressive therapy with prednisone, azathioprine and cyclosporine was maintained. Pregnancy was complicated by an acute rejection episode on week 13, mild hypertension and intrahepatic cholestasis on week 22. Cesarean section and tubal ligation were performed at 32 and a half weeks. A 2020 g female infant was delivered, with Apgar scores of 8 and 9 at 1 and 5 min, respectively. Mild respiratory distress, jaundice and hypocalcemia were noted. The Australia antigen was negative. No fetal anomalies were detected. The high risk of pregnancy in a class T diabetic patient is confirmed in this case.


[Reappearance of pica symptoms during erythropoietin treatment]. Absolute or functional iron deficiency decreases the effectiveness of erythropoietin in patients undergoing hemodialysis. We describe a patient who developed pica associated to a ferritin level of 800 ng/ml during recombinant human erythropoietin treatment. The symptom subsided after supplementation with iron dextran. Therefore we recommend iron supplementation during the initial phase of treatment with erythropoietin until serum ferritin levels raise above 1000 ng/ml.


[Neurotoxicity caused by cyclosporin A in renal transplantation in children]. Cyclosporine is a specially useful immunosuppressor agent in children subjected to renal transplantation, minimizing the deleterious effect of steroids on growth and the development of Cushing syndrome. However, side effects which require close supervision are well known, including liver, kidney and central nervous system toxicity. Seizures, cerebellar ataxia, aphasia, paresthesia and behavioral disorders are characteristic of the latter. Hypertension and hypomagnesemia have been identified as risk factors. In contrast to nephrotoxicity, CNS toxicity is not related to plasma levels of cyclosporine. In this paper 2 patients, 10 and 11 year old, manifesting cyclosporine neurotoxicity after renal transplant, are reported.


[Fournier's disease].

[Fournier's disease]. Fournier's disease or perineal gangrene is a severe necrotizing process affecting the ano-rectal, perineal and scrotal region which is usually secondary to ano-rectal pathology and periurethral or cutaneous processes. Ample surgical debridement, wide spectrum systemic antibiotics and general supportive measures are essential for survival in this very serious disease.


[Hydatidosis in the IXth Region of Chile. A regional problem and challenge]. Infection by Echinococcus granulosus is the main zoonosis affecting the human population of the IXth Region in southern Chile. Prevalence rates vary from 18.2 to 48 per 100,000. Animals are affected with prevalence rates of 40% for bovines, 39.5% for sheep and 14.8% for pork as estimated at the central meat processing plant in the city of Temuco. A cost of approximately $300,000 is estimated to treat affected individuals. Much greater losses may be estimated from unnotified meat processing in rural areas and from reduced yield of animal products such as wool an milk. Accordingly, a regional program for control of this zoonosis is urgently required.


[The Chilean National Health Service: an intellectual and humanitarian adventure]. This is the speech delivered by Dr Abraham Horwitz, Emeritus Director of the Panamerican Health Organization, when he was granted a decoration from the Chilean Government. I believe--he said--that protection and promotion of health are not only an ethical imperative but also a basic political need of nations and peoples, a foundation for peace and development of human beings and society. Analyzing the origin and development of the Chilean National Health Service in 1952, he concludes that this was an intellectual and humanitarian endeavour of a group of idealists who devoted their best to improve the condition of the Chilean people.


[The embryo, the human and the humanized]. Since the moment of fecundation the human embryo is endowed with the properties of unity and uniqueness and its existence is therefore inviolable. Disputing arguments against this thesis are analyzed. Recent views of some biologists negate the human character to the embryo since the essence of a human being would be its cultural nature and ability to communicate. However, the embryo contains all the genetic information that will allow him to develop the ability to communicate. Any attempt to separate the 3 moments of time, past present and future is a definitive violation of ethics. A basic foundation of ethics is that present and future are implicit in the past and vice-versa. Finally, the idea that the unwanted child is not a cultural being should be discarded.


[Chilean hospitals: availability and productivity of the public and private sectors]. Hospital bed availability, trends in number of beds, productivity and administrative aspects in the public and private hospital sectors are analyzed. At present, there are 3.3 beds per 1000 population in Chile. This represents a decrease from previous figures, in spite of increasing demands derived from population aging and greater birth assistance needs. Overall productivity of the hospital system is reflected in 31 annual admissions per bed, an average hospital stay of 8 days and a 75% occupancy rate. The National Health Service System is responsible for 76% of admissions. However, it takes care of more than 90% of bed needs for tuberculosis patients and more than 80% for hospital birth assistance, complications of pregnancy, perinatal disease, communicable diseases, respiratory illnesses, miscarriages and skin diseases. The private sector takes care of more than 40% of rheumatic and musculo skeletal diseases and more than one third of mental health problems. The National Health Service, compared to the private sector, exhibits a greater occupancy rate with an average stay only one day longer. Complexities of hospital administration, new world trends and the relation to external economic resources are discussed.


[Application of a model for predicting morbidity in children from a low socioeconomic level]. An instrument to be used at a primary health care level was built on the basis of a predictive model for diarrhea obtained during a previous study. The instrument was applied to 720 mothers or caregivers of infants living in the Southeastern area of Santiago. 83 infants who fulfilled the requisites of the instrument were surveyed during July-August 1989 and compared to age, nutritional and socioeconomic status matched children not fulfilling the same requisites. Infants selected by the predictive instrument suffered 4 times more morbid episodes and respiratory infections and 5 times more diarrheal episodes than controls. Symptoms were present in them during 50% of the survey period as opposed to 14% in controls. Mothers of children at risk had inadequate behaviors in respect to health care of their children and did not follow many of the National Health programs available for their families. The predictive instrument tested may be useful to identify children at high risk of morbidity, creating the possibility for special interventions in them.


[Lorenzo Sazié].

[Lorenzo Sazié]. The first Dean of the University of Chile School of Medicine was Dr Lorenzo Sazié a young and bright French academician, endowed with superb skills in Surgery and Obstetrics. His nomination as Dean (1843) extended until December 1st, 1865 when he died, just a few days after the passing away of Andrés Bello, the Rector of the University of Chile. Sazié's fulfillment as physician, Professor, Dean, Member of the University Council and President of Protomedicatus Court, was outstanding. He organized medical curricula according to French medical scopes, to local resources and to Chilean prevalent diseases. He enabled scientific development by means of a close connection between the School of Medicine and the School of Physical and Mathematical Sciences. Works of both Schools were supposed to be related with matters of public interest and were published in "Revista de Santiago". He also provided subscriptions to the principal European scientific journals. As President of Protomedicatus he applied severe measures to regulate medical and paramedical performances. In addition, as President of the "Junta de Beneficencia de Santiago" he supervised and updated hospital care management and founded several health institutions such as the Madhouse, the Orphan House and the School of Midwifery. As a physician Sazié was a frugal, generous and dedicated man who, regardless of social or economic positions, served everyone with the same devotion. He died from typhoid fever while taking care of his patients during an epidemic outbreak which took place in Santiago in those days.


[Extracurricular activities and drug abuse prevention: a controversial issue]. Data obtained from 16,117 high school students in fifteen Brazilian cities, relating to participation in a number of extracurricular activities and consumption of drugs and alcohol, are described. In the great majority of cases, no association was found between participation in artistic, community or sports-related activities and the use of these substances. On the other hand, a weak but constant negative correlation was found between alcohol/drug consumption and involvement in religious activities. The authors discuss these findings in the light of some of the current preconceptions prevailing in Brazilian society: namely, that such activities constitute effective strategies for drug use prevention; and that "idle" young persons tend to be potential drug users. They also discuss the implications of the fact among students involved in religious activities drug and alcohol consumption has been shown to be slightly lower.


[Correlation between maternal age, social class and smoking, and birth weight]. An epidemiological survey was carried out in Ribeirão Preto, Brazil, from June 1978 to May 1979. Interviews were held with mother of singleton live borne children, delivered in hospitals, which accounted for 98% of all births in the area. The higher percentages of low birthweight children related to the offspring of smokers, young mother and women belonging to the working class. The majority of young women were found in the working class and the prevalence of smoking was higher in the group of women below 20 years of age. There was no statistical difference in the smoking habit as between different social classes. A larger number of low birthweight children were observed in nonsmoking women of the working class than among women smokers of the middle class. A log model was adjusted to the data in order to study the possible multiple association of smoking, maternal age and social class with birthweight. The results indicated that maternal smoking, maternal age and social class had independent effects on birthweight. The was no interaction between them. These findings suggest that the higher prevalence of low birthweight in nonsmoking mothers of the working class in relation to smoking mothers of the middle class probably reflects clustering of other risk factors-such as poor education inadequate prenatal care, high parity and differences in reproductive behavior in women of the working class.


[Oral health status in people 60 years old or older in the municipality of São Paulo (Brazil)]. The oral health status of people aged 60 years or over in S. Paulo in 1989 is discussed. According to data relating to dental caries, periodontal diseases, need and use of prosthesis and prevalence of hard and soft oral tissue pathologies, this study concludes that elder people present a very bad oral health status. The definition of a policy and dental care programs addressed to the aged are recommended.


[Anemia in a population from an endemic area of malaria, Rondônia (Brazil)]. With the purpose of describing the prevalence rate of anaemia among inhabitants of a malaria endemic area--Candeias district, a periurban locality near Porto Velho, in Rondônia State, Brazilian Amazon Basin--a random population sample comprehending 1,068 individuals of all age groups (14.1% of the total population) was screened for anaemia (measurement of blood haemoglobin concentration) and malaria (Giemsa-stained thick-smear microscopy). Two-hundred and ninety-nine individuals (28.0% of the sample) were found to be anaemic, using the cut-off haemoglobin values proposed by the World Health Organization for each age group. Highest prevalence rates were found among children with ages varying from 6 months to 1 year (70.0%) and from 1 to 6 years (38.4%), as well as in pregnant women (41.2%, 7/17) and malaria patients (44.4%, 8/18). Parasitological stoll examinations were made on a voluntary sample of 476 individuals (44.6% of the sample population); of these, 118 (26.8%) were positive. Eggs of Ascaris lumbricoides, the most frequent intestinal parasite in this population sample, was detected in 67 stool samples (14.1%); only 27 patients (5.7%) eliminated Ancylostomidae eggs. In this voluntary sample, no significant difference in anaemia prevalence rates between parasite carriers and non-parasited individuals was detected. On the other hand, the more recent the last malarial episode referred to by the patients, the lighter prevalence rate of anaemia in individuals above the age of 14 years. The role played by malaria as an underlying cause of anaemia in Candeias district inhabitants, particularly in the economically active age group, is further discussed.


[Prevalence of bovine cysticercosis in the state of São Paulo (Brazil)]. A retrospective study of Cysticercus bovis in cattle raised and slaughtered in the State of S. Paulo, Brazil, during the year of 1986, was undertaken on the basis of official records of the Brazilian Meat Inspection Service. The analysis of its special distribution was carried out in accordance with the political-administrative division adopted by the State Government, composed of 11 Administrative Regions (ARs) and one Metropolitan Region (MR), subdivided into 42 Governmental Regions (GRs), totaling 572 municipalities. The prevalence rates of each political-administrative unit were statistically compared using the "Z" test of two proportions. From records relating to 896,654 head, 48,957 cases of cysticercosis were detected, equivalent to a prevalence of 5.5% in the State. The prevalence results were obtained for 385 municipalities, in 42 GRs, 11 ARs and in the MR. Statistically significant prevalence values were observed in 97 municipalities, in 14 GRs and 4 ARs.


[Characterization and antigenic relationship of 3 new Bunyaviruses in the group Anopheles A (Bunyaviridae) of arboviruses]. The isolation and characterization of three new viruses obtained from the Tucuruí hydroelectric dam region is reported. These three agents belong to the Anopheles A serogroup, genus Bunyavirus, Bunyaviridae. The Tucuruí (TUC), caraipé (CPE) and Arumateua (ART) viruses have close relationships with each other and with Trombetas (TBT) virus, an Anopheles A virus previously isolated in the Amazon Region of Brazil. These viruses form the "Trombetas complex". TUC, CPE and ART viruses were obtained from pools of Anopheles (Nyssorhynchus) sp captured in Tucuruí, Pará State, in February, August and October of 1984, respectively. Until 1990 TUC, CPE and ART were isolated 12, 32 and 28 times respectively, in the Tucuruí hydroelectric dam region. At the moment, these viruses have only been obtained from mosquitoes of the Anopheles (Nyssorhynchus) complex, especially from An. (Nys.) nuneztovari and An. (Nys.) triannulatus, that are considered to be secondary vectors of Plasmodium in Amazonia. Serological tests performed with human and wild animal sera were negative, except for one specimen Nasua nasua that had neutralization antibodies to TUC.


[Phonoaudiology in public health].

[Phonoaudiology in public health]. An undestanding of the activities and functions of a speech therapist within the specific context of the Basic Health Units (Unidades Básicas de Saúde) is sought. Difficulties relating to the introduction of a new service on the basis of one of the health professions that has not hitherto belonged to the group of categories which are traditionally incorporated in these same Basic Units. When the statistical data on the demand for speech therapy services by the population who attend health centres were considered, it was discovered that 32% were of schooling age and had been referred by schools, allegedly due to "learning problems". Closer contact with these children, through speech therapy, has brought a different aspect to light i.e. that one cannot consider as disturbance/deviation/problem/pathology written signs which constitute indications of the shock between the process of literacy and that of learning how to read and write. To understand the problem from the point of view of public health, a programme of teacher counselling is proposed, with the purpose of helping the school to clarify its role as co-constructor of the child's literacy process and of returning to the teacher the responsibility for the success and/or failure of teaching how to read and write. A similar programme is proposed for creches where coincidently, a greater proportion (44%) of the younger children (2 to 5 years of age) are seen to have difficulties in oral language development.(ABSTRACT TRUNCATED AT 250 WORDS)


[Management of the health sector in the 80's, in the state of São Paulo, Brazil]. The shared management put into effect by the "Ações Integradas de Saúde" (Integrated Health Actions) in the State of S. Paulo (Brazil), in the early 80s is analysed. The relevant data were collected from the minutes of the meetings of the "Comissão Interinstitutional de Saúde" (Interinstitutional Health Committee). The data collected show the most frequent subjects discussed by the members at the meetings, the number of members related to each of the different government levels, in addition to the kind of resolutions taken at the meetings. The data analysis has demonstrated that important changes took place in public health management in the State of S. Paulo in the decade in question. The shared management process was replaced by one in which government powers were clearly divided a towards the end of the 80s. Those changes have led the public health members from each level of governmental administration to give up the common goals and the shared negotiations among them.


[Gender and health in Brazil: considerations based on the National Household Sampling Survey]. As in the principal industrial countries, Brazilian women have lived longer than men. However, paradoxically, women present higher morbidity indicators than men. Knowledge of the Brazilian pattern regarding this matter could be a useful contribution to an understanding of their determinants in our specific reality, as well as enabling us to foresee future trends that would make it possible to plan adjustment in the health system. A morbidity study based on data from the National Household Sample Survey (PNAD/IBGE), was undertaken in ten Brazilian states in 1986 with this in view. Coefficients of the prevalence of perceived morbidity, demand for and utilization of health services according to sex, standardized by age and using the direct method, were built up. As a measurement of the differentials, sex ratios were calculated. The excess of perceived morbidity in women was constant in all the regions. The sex differential in the utilization of health services showed regional variations, suggesting a relationship with the health services supply. Sex differentials were not observed in childhood; the highest values were found during the woman's reproductive period, decreasing sharply after 60 years of age. The pattern is very similar in all regions. In the present study, the findings could be partially explained by the methodology adopted, but they are similar to the findings reported in other countries. The intense transformations in the reproductive pattern and in the social status of Brazilian women probably have a considerable impact on the health status and on the recourse to health services, not as yet evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)


[Transfusional Chagas infection detected in the program for the control of Chagas disease in the state of São Paulo (Brazil)]. A system of surveillance for Chagas' disease aiming at a systematic investigation of the occurrence of triatominae in human dwellings in S. Paulo, Brazil was proposed. It included a serological survey of residents in house considered to be potential breeding places for blood-sucking triatomines. Serologically positive cases were observed to be distributed in age groups from 19 years of age upwards. Case-investigation revealed that the infection had been acquired either in S. Paulo in the past or recently in other States. A serologically positive (titre = 128 - IgG) case of an 8-year-old male child, was detected by the In direct Fluorescent Antibody Technique (IFAT). In S. Paulo State natural transmission is now of low probability. An epidemiological investigation disclosed the fact that this was a case of blood transfusion infection. The donor was found to be serologically positive (IFAT, titre = 1024 - IgG). His case-history was typical of vector transmitted infection. It is worthy of note that blood had been donated by this patient in four instances, without his condition having been diagnosed. The necessity of organizing an integrated Public Health Service to take more efficient care of such cases is stressed.


[The problem of true knowledge in epidemiology]. The philosophical basis of the validation of scientific knowledge, with a view to establishing a critical point of view as to the adoption of Popper's propositions in epidemiology is examined. The conservative character that results from the technical limitations implied in this adoption is a noteworthy aspect of the discussion, despite the evident increase in heuristic rationality and creativity that result.


[Nutritional assessment of children 0 to 5 years old cared for by the municipal network of urban health of the southern region of Brazil, 1988]. An epidemiological survey was undertaken to fulfil one of the conditions required for the establishment of the Nutritional Surveillance System, on the basis of data from 1988. In this survey an anthropometric examination was employed for the purpose of discovering the prevalence and the kinds of protein energy malnutrition among children under five years of age who had been assisted at Health Centers of the Municipal Health Department of Curitiba, Paraná (Brazil). Of a sample population of 4,213 children it was found (by the Gòmez criterion) that 28.1% had malnutrition 3.6% of this percentage being of second or third degree. By the use of the Seoane-Latham criterion as modified by Batista Filho, 19.7% of the children presented some kind of malnutrition. The distribution of the sample in centiles showed that it contained an excess of children in the first centiles after 6 th months of age as compared with the reference population. This excess was more evident in the 12 to 24-months age group.


[Follow-up of children with moderate or severe malnutrition in the peripheral population (Brazil)]. What happens to children who develop moderate or severe malnutrition? What is done for them? Keeping in mind these questions, the present research was undertaken with the following objectives: to assess the nutritional status of children who develop moderate or severe malnutrition before the age of 5 years, after a period from 2 to 4 years after diagnosis; to assess the nutritional status of the under 5-year old siblings of these children; to study the influence of nutritional programs available in the community for the improvement of the nutritional status of the malnourished children; and to identify factors interfering with nutrition of these children during the study period. After a period of 2 to 4 years from the time of diagnosis of moderate or severe malnutrition the authors tried to locate the families of 61 malnourished children of Porto Alegre, RS (Brazil). The mothers their substitutes were interviewed and the children and siblings under 5 years of age were weighed and measured. Thirty-nine children were located. Of these, 4 (10%) died and 22 (56%) presented an increase of at least 10% in weight for age. Of the 35 children who survived, 29 (82%) still presented some degree of malnutrition (weight/age < or = 90% of the standard), 25 (71%) were stunted (height/age < or = 95%), and 5 (14%) were wasted (weight/height < or = 90%). The nutritional status of the 5-year old siblings was similar to that of the malnourished children.(ABSTRACT TRUNCATED AT 250 WORDS)


[Risk factors for death caused by pneumonia in children younger than 1 year old in a metropolitan region of southeastern Brazil. A case- control study]. In a case-control study, a sample of post-neonatal deaths from pneumonia occurring in the Metropolitan Area of Rio de Janeiro, Brazil (1986-1987) were compared with healthy controls who lived in the same neighborhood. Risk factors investigated were variables related to the mother's pregnancy history and the child's birth, to the family's social condition and to the use of health services. Using the univariate logistic regression model, the coefficients of each independent variable, the relative risk and its confidence limits were first estimated. Birth weight and age of weaning were strongly associated with the dependent variable. After adjustment by means of the multiple logistic regression model, only 4 variables remained statistically associated with mortality: age of weaning, birth weight, over crowding, and BCG vaccination. Based on the available data, it was concluded that mortality from pneumonia in children under 1 year of age is significantly related to the social condition of the family, particularly to that of the mother.


[Mortality among women of reproductive age in a urban area of the southeastern region of Brazil. Evolution in the past 20 years]. Information about women's mortality during the childbearing years has become of increasing interest in the health area in view of women's health programs. On this basis, the mortality of women aged between 15 and 49 years of the municipality of Ribeirão Preto, S. Paulo, Brazil, was studied for the period from 1985 to 1989 and compared to that of the period from 1970 to 1974. Mortality data were obtained from the civil Registry Offices of the municipality and population data were estimated on the basis of the last 2 censuses. Mortality was analyzed according to origin, marital status, seven 5-year age groups, and causes according to CID, 9th Revision, 1975. A total of 1,471 deaths occurred during the period under study, 705 of them being of town residents. The 4 major causes of residents' deaths in decreasing order of importance after calculation of proportional mortality rates, were: Chapters VII, II, XVII and I. Chapters III and V, which were very infrequent during the period from 1970 to 1974, had tended to increase owing to AIDS and chronic alcoholism, respectively. The 4 major causes continued to be the same as those of 1970, thought in a different order. The mean quinquennial death coefficients according to causes and age groups showed a gradual increase with age, more marked from 35 years on for Chapters VII, I and II. Chapter XVII showed a lower amplitude of variation from younger to older women in the periods studied. When the data were compared for a 15-year period, the general trend was a decrease in coefficient values, especially in Chapter I.(ABSTRACT TRUNCATED AT 250 WORDS)


[Mortality differentials in men and women in the southeastern region, Brazil--1960, 1970 and 1980]. Male and female mortality rates in the city of Rio de Janeiro in 1960, 1970 and 1980 are studied with a view to analysing the different risks to which men and women are subject by age group. Mortality differentials by sex and cause were studied by means of male/female mortality ratios, relative and absolute differences among rates, and standardized rates. An analysis of differentials by selected groups of cause for 1980 was undertaken. Male mortality rates were higher than the female rates in all age groups in the three years studied, with an increase of the male/female mortality ratio for the 15-34 age group over this period. The excess of male death was mainly due to the increase of deaths from violent causes among young men, a dramatic circumstance that can hardly be changed by "technical" procedures. As regards deaths from other causes, biological determinants and the different risks for men and women should be considered in order better to understand this situation.


[Sociodemographic profile of the population seeking medical and hospital care in the region of the State of São Paulo, Brazil, 1988]. A descriptive, retrospective study of the socio-economic profile of the population seeking health services in a Northeastern region of the State of S. Paulo was carried out and the results compared with those of previous studies. A total of 126,297 patients discharged from 25 general hospitals of the region in 1988 were studied according to sex, age group, residence, source of financing and hospital indicators. The results of this study show that the distribution of the demand according to sex and age is similar to that known from the relevant literature. These results suggest that the regionalization of assistance, in spite of planning and of pertinent legislation, is unsatisfactory, strongly influenced by the presence of large urban centers and socio-economic development. Various sources of financing are used together with a considerable increase of private health insurance and a diminishing participation of governmental institutions over the years. The region studied presents a high rate hospitalization as well as rate of hospital bed utilization.


[Predictive value of the standardized tuberculin test in children vaccinated with BCG]. The applicability of tuberculin test in children under five years of age, BCG-vaccinated during their first year of life, is a controversial matter. With a view to clarifying the subject the predictive positive value of the test in a region of high BCG coverage and low prevalence of tuberculous infection was analysed. From the proportion of strong reactors among infants and school-age children, vaccinated and not unvaccinated, the declining rate of BCG induced allergy and the increment rate of naturally acquired tuberculin sensitivity between the first and the seventh years of life were calculated. Those calculations allowed for the estimation of the respective values for the intermediate ages. The numbers of false positives to be expected were calculated by difference. Knowing the sensibility and the specificity (1 - FP) of the test, the BCG coverage and the prevalence of infection, the predictive values for tuberculous infection were: 1.52%, 4.22%, 8.26%, 14.86% and 23.00%, respectively from the first to the fifth years of life. Under these conditions, the probability of a strong reaction being provoked by BCG is very high, decreasing the applicability of the test both in clinics and epidemiology.


[Effect of larval, pupal, and egg extracts on the oviposition behavior of female Aedes(s) albopictus (Skuse)]. Larval, pupae and egg water extracts were tested for their influence on the oviposition behavior of Aedes (s) albopictus females. Significant (alpha = 0.05) attraction was exercised by larval and pupal extracts containing 1 larva/3 ml and 1 pupa/3 ml. Eggs water extract containing 1 egg/3 ml did not influence the oviposition.


[Aquatic macrophytes from a marginal lake of the Embu-mirim river, São Paulo, Brazil]. In the years 1984/1985, limnological surveys were carried out at a marginal pond of the Embu-mirim river belonging to the hydrographic basin of Guarapiranga Reservoir (S. Paulo, Brazil), in order to obtain data for the determination of physical, chemical and biological parameters. Results obtained from the study of the aquatic macrophytes and their relationships with other environmental parameters are analyzed. Eichhornia crassipes (Mart.) Solms, the dominant macrophyte, was observed in several water bodies of that basin, including the river it self, thus favoring an evaluation of its behavior in similar water bodies of the basin.


[Presence of intestinal parasites in vegetables sold in the metropolitan region of São Paulo, SP, Brazil. I--Search of helminths]. Vegetables in natura, commercially traded in the metropolitan area of S. Paulo, were analysed by the appropriate methodology with a view to discovering an identifying the paths of transmission of enteroparasites of medical interest. The vegetables under study consisted of 50 samples of each variety listed below: lettuce (Lactuca sativa)-oily leaves and crisphead varieties, endive (Chicorium sp) and water-cress (Nasturtium Officinale). Results showed high rates of contamination in all the vegetable varieties analysed. However, the water-cress was that which presented the highest frequencies of enteroparasites. The endive presented middle values ranking, in general, between the lettuces and the water-cress. Though high, the average number of helminth eggs and larvae obtained per 100 gr. of sample did not present statistically significant differences as between the four vegetable varieties studied. A great variety of helminths and protozoans such as occur frequently in the resident population of the metropolitan area of S. Paulo, were observed in the samples. However, the most frequent were: hookworms and Ascaris sp. Eggs of Toxocara sp, Fasciola sp and Trichostrongylidae were also recovered from the samples thus corroborating the occurrence of vegetables contamination with faeces of domestic animals. In view of the results obtained, the importance of these kinds of food in the transmission of enteroparasites is stressed, as well as the need for actions which improve the sanitary conditions of these products.


[Increasing risk of skin melanoma in Brazil]. The occurrence of cutaneous malignant melanoma in Brazil is analysed on the basis of available mortality data from the National Ministry of Health and from the incidence data of six Population-based Cancer Registries (Recife, Fortaleza, S. Paulo, Porto Alegre, Goiânia e Belém). The incidence in these State capitals has an intermediate pattern if compared to the world pictures. For Porto Alegre, the capital that had the highest rates, a comparison between the periods 1979-1982 and 1987 showed a proportional increases of 38% among males and 11% among females. The conclusion is reached that it is necessary to undertake studies in Brazil among fairskinned people from particular communities which may show a potentialized risk for the development of cutaneous melanoma in order to be able to define what kind of specific control actions should be developed.


A case-control study on the association of hepatitis B virus infection and hepatocellular carcinoma in northeast Brazil. Hepatitis B virus (HBV) serological markers were investigated in 40 incident cases of hepatocellular carcinoma (HCC) and in two age and sex matched control groups, comprising 40 patients with other cancers and 80 healthy individuals, resident in Bahia, Brazil. Serologic tests were done by radioimmunoassay. The study observed high proportion of seropositivity to HBsAg (42.5%) and of those presenting HBsAg or antiHBc (65.0%) among HCC cases, higher in men than women and in those aged 17 to 30 years old. HBsAg seropositivity among HCC patients was greater than in the control group with other cancers (7.5%) and in healthy controls (2.5%), corresponding to odds ratio estimates of 15.0 (95% CI 3.29, 68.30) and 33.0 (95% CI 9.13, 119.28), both statistically significant. HBeAg was not observed and antiHBe was present in 41.2% of cases, suggesting the absence of viral replication, possibly with viral DNA integration into the hepatocyte genome. The presence of cirrhosis was associated with HBsAg seropositivity among HCC cases. A history of chronic alcoholism is shown to be more frequently related to those cases with cirrhosis. This study highlights the relevant association between HCC and HBV in Northeast Brazil, particularly for young individuals, and the high risk of development of HCC for HBsAg carriers.


[Injury patterns in motorcycle accident victims]. An analysis of the injury patterns presented by inpatients of a government teaching hospital, known as one of the emergency centers of S. Paulo city, Brazil, is given the majority of victims are young, male adults and most of them were later discharged from the hospital. In relation to the injuries the majority of the patients were classified as being of minor injury grade (ISS between 1 and 9) and the most frequent injuries were extremity and pelvic fractures, surface trauma, traumatic brain injury and extremity and pelvic dislocations. Besides extremity and pelvic fractures, the victims who died showed abdominal organ injury and traumatic brain injury and the ISS was over 20. Head injury patients who had a high Glasgow Coma Scale score had a low ISS and vice-versa.


Blood lipid associations in 18 year-old men. The association of cigarette smoking, physical activity at work, and social class with total cholesterol and with high and low density lipoprotein cholesterol were examined in a random sample of 238 males, of 18 years of age, of Rosario, Argentina. The mean (mg/dl) total serum cholesterol of the whole sample was 174.7, the high density lipoprotein cholesterol 52.8, and the low density lipoprotein cholesterol 121.5. Black tobacco consumers, evenly distributed by social class, had higher levels of total and low density lipoprotein cholesterol. Total cholesterol was higher in the high social class, differently from what smokers' distribution by social class, would lead one to expect. While a highly negative association was found between social class and physical activity at work, there were no significant differences in lipoprotein levels between manual and non-manual workers. It is possible that the nutritional differences by social class still prevail over the smoking habit in their influence on the lipoprotein levels in these subjects.


[Salmonellas and fecal coliforms in drinking water for animals]. Sixty small farms of Botucatu County, S. Paulo, Brazil, given over to cattle breeding were studied. These farms account for 15% of the total of 402 farms that exist in the county. The sample was drawn by simple probabilistic technique. There were found to be one hundred and thirteen drinking places located on the farms. Samples of water were taken from these drinking places and examined for bacteria of the genus Salmonella, for the determination of Most Probable Number (MNP) of fecal coliform bacteria as well as determination of the water's pH. Water temperature was measured before collection. Samples from 15 drinking places (13.3%) were positive for Salmonella. The drinking places belonged to 12 of the sixty farms studied (20%). The following serotypes were identified: S. dublin, S. newport, S. madelia, S. IV 43:g,z57:-, S. saphra, S. glostrup, S. IV ochsenzool; S. I9,12:i:- and two new serotypes S. IV 41:z52:- and S. IV 50:d:-. Of the 113 samples studied 14 (12.4%) presented MPN/100ml of fecal coliforms above 4,000. There was no relationship between MPN/100ml of fecal coliforms above 4,000 and positivity for Salmonella. Highest positivity both for Salmonella and MPN/100mL of fecal coliforms over 4,000 occurred at temperatures above 18 degrees C. As regards pH, in both situations the highest positivity occurred between 6.0 and 7.0.


[Evaluation of household chemical disinfectants for Vibrio cholerae EL TOR (non toxigenic strain)]. The methodology of microbiological evaluation of disinfectants in permanently being questioned because the laboratorial protocols do not correspond to the real conditions under which these products are used. In 1985 the Use-Dilution method of AOAC was adopted in Brazil for microbiological qualification of chemical disinfectants for commercial purposes. Domestic disinfectants are tested in this way against Salmonella choleraesuis and Staphylococcus aureus ATCC strains, was chosen for this evaluation Vibrio cholerae in view of its current importance in Brazil, in terms of Public Health associated with the study of the disinfectant's antimicrobial activities. Nineteen disinfectant products for domestic use for available to the public were evaluated microbiologically by means of simplified Use-Dilution test with 10 carriers. The active compounds of the products included formaldehyde, phenols, cresols, quaternary ammonium compounds, chlorine and ethanol. Seven were mixtures of these. According to the recommendations for their use, sixteen products should be used undiluted. Under these conditions, 9 disinfectants were vibriocides and 7 did not demonstrate this antibacterial activity. Four products in dilutions not clearly specified were also ineffective. The vibriocide products which must used without dilution were tested again, diluted at 1:2. These solutions did not inactivate V. cholerae showing that, microbiologically, their active compounds are used in limited concentrations. Commercial alcohol (95.5 degrees GL) at 1:3, chlorine 2.8% Agua sanitária at 1:200 and Lysoform at 1:20 came up to the standards required by the test.


[Presence of intestinal parasites in vegetables sold in the metropolitan area of São Paulo-SP, Brazil. II--Research on intestinal protozoans]. Vegetables in nature, commercially traded in the metropolitan area of S. Paulo, Brazil, were analyzed by means of the appropriate methodology with a view to discovering and identifying protozoan cysts of medical interest. The vegetables under study consisted of 50 samples of each of the varieties listed below: lettuce (Lactuca sativa)-oily leaves and crisp-head varieties, endive (Chicorium sp) and watercress (Nasturtium officinale). Results showed high rates of contamination in all the varieties of vegetable analysed. However, the watercress was the one which presented the highest frequencies of enteroparasites. Both the oily leaves and crisp-head varieties of lettuce presented the lowest rates of contamination, whereas endive presented values ranking, in general, between those of the lettuce and those of the watercress. A great variety of those protozoans which occur frequently in the population resident in the metropolitan area of S. Paulo were observed in the samples, the most frequent being Entamoeba sp (with 4 and 8 nuclei) and Giardia sp. Cysts of Iodamoeba sp, Endolimax sp and Chilomastix sp were also recovered from the samples, thus corroborating the occurrence of high rates of fecal contamination. The significance of these kinds of food in the transmission of protozoans is discussed in the light of the results obtained.


Populations of larvae of anopheles spp. in natural breeding sites in western Venezuela, an area of refractory malaria. Studies have been undertaken into on the diversity and relative abundance of larvae of Anopheles (Nyssorhynchus) spp. in 22 permanent or temporary pools in an area of 70 km2 in the eastern piedmont of the Venezuela Andes, between the mountains and the plains, an area in which malaria is refractory and A. nuñeztovari is present. Twelve species were identified, the most frequent, abundant and sympatric being A. triannulatus, A. albitarsis, A. nuñeztovari, A. oswaldoi and A. strodei. The samples from the permanent pools showed greater diversity of species and greater numbers of larvae than the samples from the temporary pools. The existence of the same larval associations in pools of other localities in the eastern piedmont of the Venezuelan Andes suggests the possibility of the making an ecological map of the breeding sites of A. nuñeztovari and for these anophelines in a region extending for 430 km.


[Biology of Biomphalaria occidentalis Paraense, 1981 and Biomphalaria tenagophila (d'Orbigny, 1835), in laboratory conditions]. Specimens of Biomphalaria occidentialis and Biomphalaria tenagophila were reared in S. Paulo, Brazil under laboratory conditions, with a view to know their biological characteristics. Oviposition and eggs/oviposition ratio were recorded over twelve months so as to obtain information on the number of egg-masses per animal and the number of eggs per egg-mass, as also the number of hatched eggs per egg-mass for each period of 30 days, i.e., the hatching-rate per period. The incubation period was about the same for both species, but the oviposition and egg oviposition ratio were greater in B. tenagophila.


[Longitudinal study of weight gain in premature infants from birth to the 6th post-term month]. The dynamics of weight gain were studied in 95 preterm adequate for gestational age infants between birth and their 6th post-term month. The infants were divided into 4 groups according to the number of weeks of gestation at birth, i.e., 33, 34, 35 and 36 weeks, respectively. To compare the results, weight gains were studied for each group of the same corrected ages up to the 64th week of post-menstrual age, corresponding to the 6th post-term month. Weight gain was small during the first 2 weeks of post-natal life but increased considerably over the subsequent weeks with an almost constant periodical increment (GRI) being maintained in all 4 groups during the first months of life. However, unit growth rate (UGR) reached its highest value during the first post-natal month and decreased a similarly in all 4 groups during the subsequent months, with values approximating to those reported for infants in developed countries.


[Clinico-neuro-psychological evaluation of workers exposed to metallic mercury in the electric lamp industry]. This research project was undertaken for the purpose of studying poisoning by metallic mercury among workers of an electric lamp factory located in S. Paulo (Brazil). 71 workers were investigated, of whom 61 (85.92%) were chronically poisoned. Exposure period ranged from 4 months to 30 years. The 57 (80.30%) of chronically poisoned workers showed poor psychomotor co-ordination, 56 (78.88%) showed neurological impairments, 51 (71.83%) decreases in memory capacity, 47 (66.20%) pathological findings in the clinical exam, 45 (63.38%) psychiatric disturbances and 37 (52.10%) poor performance in the concentration test.


[Prognostic factors of hospital mortality from diarrhea or pneumonia in infants younger than 1 year old. A case-control study]. Diarrhea and pneumonia are common diseases in children aged under one year, for which there are simple therapeutic measures. However, infant mortality due to these diseases is still very high, varying markedly according to socio-economic status. The characteristics of children who died (cases) and of those who were hospitalized with diarrhea or pneumonia, but survived (controls), were studied. The following groups of variables were studied: socio-economic, environmental and biological conditions, nutritional status and breast-feeding. Information on cases and controls was collected from hospital records and through home interviews. Important losses occurred in the latter: 40% of cases and 50% of controls were not interviewed. There were no significant differences between cases who were included and those who were not, in terms of age, sex or place of residence. To estimate relative risks of prognostic factors unconditional Logistic Regression was used to calculate the odds ratios and their 95% confidence intervals. Prematurity, low birth weight, weight/age deficit, presence of edema and poor general status at hospital admission were prognostic factors for hospital case-fatality. In relation to the anthropometric variables, it was not possible to conclude for certain whether the increased case-fatality was linearly or non-linearly (threshold) associated with nutritional deficit. The duration of breast-feeding was only associated with case-fatality for pneumonia. Socio-economic factors were not important for the prognosis of children admitted to hospital with diarrhea or pneumonia. Some of the expected risk factor associations were not detected, maybe due to the small sample size (resulting from the high losses) which was insufficient to show small differences. In this study the biological conditions of children with diarrhea or pneumonia appeared to be the important prognostic factors for hospital case-fatality.


[Ethylene oxide sterilization. I. Influence of the sporulation medium on the resistance of spores of Bacillus subtilis var. niger]. Some elements influencing the resistance of spores used in ethylene oxide sterilization process control are standardized. Spores of Bacillus subtilis var. niger were produced in chemically defined liquid and solid sporulation media to a total of 12 lots; after standardization of the number of spores, they were challenged by sub-lethal cycles, followed by a lethality study. According to the statistical model applied, there were no differences between the resistance of spores produced in chemically defined liquid and those produced in solid sporulation media. The advantage of the solid sporulation media consists in the larger production of spores.


[Ethylene oxide sterilization. II. Influence of test devices on the performance of biological monitors and its evaluation]. In view of the importance of the assurance of the sterility of medical devices, with a large incidence of tubular forms, a study of biological monitors was undertaken, using paper as a carrier, the dimension of the test specimens being the variable considered. After the sterilization process in an industrial cycle, followed by the recovery of the surviving spores through inoculation of the carriers into thioglycolate broth, soybean-casein broth and this last with the addition of bromothymol blue. No differences were found between the growth promoting capacity of these 3 media. The effectiveness of sterilization was dependent on the dimension of the test specimens. The periodic determination of residual gas content on the test specimens, as well as the monitoring of the industrial environment demonstrate the need and importance of the legislation in force.


[RC-IAL: rabbit kidney continuous cell line--characteristics and substrate for viral replication]. A rabbit kidney cell line RC-IAL, isolated in 1976 and at present at 150a passage, has had its characteristics analysed. The cells presented morphology similar to fibroblasts throughout their culture. The cellular growth proportion remained unaltered from its isolation, with a cloning efficiency of around 9%. The line showed growth dependent on anchorage and chromosomic analysis presented the modal number of the species with small variations to about one chromosome, to a total of about 50%. The line's species of origin was confirmed through indirect immunofluorescence reaction and susceptibility to some viruses with cytopathic effect was verified with vaccinia, cowpox, herpes simplex types 1 and 2 and rubella viruses. This cellular substract is free from contaminating agents, thus satisfying the conditions for its use in scientific work, especially that relating to public health.


[Sick building syndrome in bank employees]. This study seeks, for the first time, to identify the sick building syndrome in Brazil. The study population consisted of 312 bank-clerks distributed in two closed buildings situated in S. Paulo city, Brazil. Data were collected by questionnaire, the design was cross-sectional and analysis made by logistic regression. Female, job satisfaction and inappropriate temperature were related to general symptoms. Female and inappropriate temperature were related to mucus membrane symptoms. Job satisfaction was related to absenteeism.


[Prevalence of dental caries in elementary school children from a metropolitan area of the province of Córdoba, Argentina]. The results of a dental health epidemiologic study in primary school-children (aged 6-12) attending both public (municipal and provincial) and private schools in the city of Cordoba are described. The incidence of deciduous teeth caries was from moderate to high among the 6-year-old school-children from municipal schools but it was low in the provincial and private schools (dmf-t = 4.44, 2.31 and 1.27 respectively). Among both provincial and municipal school-children the most significant component corresponded to teeth with caries and diagnosed extraction, whereas in private school-children it corresponded to filled teeth. The absence of active caries in children was 13.6% in municipal schools, 52.2% in provincial schools and 76.9% in private schools. In 12-year-old school-children, the prevalence of caries in permanent teeth was at the same low level in all schools with a DMF-T ranging from 1.85 (municipal) to 2.59 (private). In general, the need for dental treatment was considerable in all schools. It is concluded that the dental health levels achieved by municipal and provincial schools at the age of 12 must be attributed mainly to preventive measures; should children be assisted earlier, the results would be enhanced.