[Growth and development of children with low birth weight at their first birthday]

The aim of this prospective study was to evaluate the effect of low birthweight on growth and development at one year of age, in a cohort of infants born between March 1992 and March 1993 at Hospital de Famalicão. Information was obtained from 199 children, 89 low birthweight cases and 110 born with a normal (> or = 2500 g) weight. The infant mortality rate (56 vs 9 per 1000), the frequency of growth (32% vs 4%, p = 0.0000003) or developmental delay (30% vs 11%, p = 0.002) were significantly higher in low birthweight babies. However, all cases of developmental delay corresponded to minor impairments. At age one, children born with a normal weight presented mean higher values for weight (10.0 +/- 1.1 kg vs 9.2 +/- 1.2 kg; p = 0.000005), length (74.2 +/- 7.1 cm vs 72.9 +/- 3.1 cm, p = 0.0006) and head circumference (46.4 +/- 1.9 cm vs 45.8 +/- 1.6 cm; p = 0.004). Prenatal characteristics such as the planning of the pregnancy, gestational birth weight, diseases during the pregnancy, gestational age or twining, significantly affected development at one year of age, showing that delays can be prevented before a child is born. In addition, post-natal exposures, such as home conditions, energy and nutrient intake, or coping with vaccination schedules and the occurrence of diseases during the neonatal and post-neonatal periods were significantly associated to developmental delay.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of acute promyelocytic leukemia with trans-retinoic acid. Experience of the Santa Maria Hospital, Medical School of Lisbon]

Acute promyelocytic leukemia (APL) is a rare subtype of acute myelogenous leukemia that is usually associated with a fatal hemorrhagic diathesis. All trans-retinoic acid (ATRA) is an active metabolite of vitamin A that differentiates the malignant cell clone, corrects the coagulopathy, and induces complete remission in the vast majority of patients with APL. Between June 1992 and September 1993, 8 patients with APL (4 previously untreated, 3 in first relapse and 1 in second relapse) received ATRA. Complete remission was achieved in 7 patients; in 5 with ATRA alone and in 2 with ATRA followed by cytotoxic chemotherapy due to the development of asymptomatic hyperleukocytosis. The earliest signs of response were the correction of the coagulopathy and an increase in the white blood cell count. Sequential morphological and immunophenotypical analyses of the bone marrow revealed differentiation of the malignant cell clone, in the absence of bone marrow hypoplasia. 4 of 5 patients treated only with ATRA until complete remission had late leukopenia. The most frequent adverse effects were dryness of skin and mucosae, hypertrigliceridemia and hypercholesterolemia, and a moderate increase in liver transaminases. An increase in the white blood cell count was common, and in two cases exceeded 35.0 x 10(9)/l. One of these patients developed multiple thrombosis of the extremities after cytotoxic chemotherapy. We frequently observed an increase in lactic dehydrogenase levels that was concomitant with the peak in the white blood cell count. The only patient on whom complete remission was not achieved was 60 years old, had chronic obstructive pulmonary disease, and died in the third week of therapy with a pulmonary distress syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

An integrated YAC-overlap and 'cosmid-pocket' map of the human chromosome 21

We describe here the construction of an ordered clone map of human chromosome 21, based on the identification of ordered sets of YAC clones covering > 90% of the chromosome, and their use to identify groups of cosmid clones (cosmid pockets) localised to subregions defined by the YAC clone map. This is to our knowledge the highest resolution map of one human chromosome to date, localising 530 YAC clones covering both arms of the chromosome, spanning > 36 Mbp, and localising more than 6300 cosmids to 145 intervals on both arms of the chromosome. The YAC contigs have been formed by hybridising a 6.1 equivalents chromosome 21 enriched YAC collection displayed on arrayed nylon membranes to a series of 115 DNA markers and Alu-PCR products from YACs. Forty eight mega-YACs from the previously published CEPH-Genethon map of sequence tagged sites (STS) have also been included in the contig building experiments. A YAC tiling path was then size-measured and confirmed by gel-fingerprinting. A minimal tiling path of 70 YACs were then used as probes against the 7.5 genome equivalents flow sorted chromosome 21 cosmid library in order to identify the lists of cosmids mapping to alternating shared--non-shared intervals between overlapping YACs ('cosmid pockets'). For approximately 1/5 of the minimal tiling path of YACs, locations and non-chimaerism have been confirmed by fluorescence in situ hybridisation (FISH), and approximately 1/5 of all cosmid pocket assignments have independent, confirmatory marker hybridizations in the ICRF cosmid reference library system. We also demonstrate that 'pockets' contain overlapping sets of cosmids (cosmid contigs). In addition to being an important logical intermediate step between the YAC maps published so far and a future map of completely ordered cosmids, this map provides immediately available low-complexity cosmid material for high resolution FISH mapping of chromosomal aberrations on interphase nuclei, and for rapid positional isolation of transcripts in the highly resolved regions of genetic interest.

[Free thrombi in the left atrium. Report of a clinical case]

The authors describe a case of a floating thrombus in the left atrium, detected by a 2D echocardiography in a female patient suffering from dilated cardiomyopathy. At the follow-up, it was found that the mass was no longer detected inside the left atrium. This occurrence was not associated to any major embolic phenomena. A transesophageal echocardiographic study revealed the presence of a thrombus in the left atrial appendage.

[Spinal brucellosis. 4 years of experience]

The Authors retrospectively studied 17 patients who have been admitted to the Infectious Diseases Clinic of Coimbra University Hospital during a four year period and whose final diagnosis was brucellar spondylitis. Clinical, epidemiological, laboratory and imaging features are analyzed, as well as those related to the therapeutic schedules and outcome. Females were more often affected (70.58%) and the mean age was 53.35 +/- 13.82 years. Lumbar spine was most frequently involved and an unusual elevated incidence of paravertebral soft tissue swelling was noticed (23.52%). Two patients were also suffering from neurobrucellosis (11.76%). The preferred therapeutic schedule was rifampin and doxycycline and surgery was performed in one patient. Finally, several comments are made regarding basically the incidence, laboratory and imaging diagnosis, therapeutic aspects and evolution of the disease. The imaging similarities and differences between tuberculous, pyogenic and brucellar spondylitis are briefly approached.

Immunohistochemical analysis of ras oncogene p21 product in human gastric carcinomas and their adjacent mucosas

In an attempt to clarify the relationship between ras oncogene expression and the clinico-pathological features of malignant and pre-malignant lesions of the stomach we undertook the immunohistochemical study of the expression of ras gene p21 product in a series of eighty gastric carcinomas and their respective adjacent mucosas. In two cases the mRNA of Ha-ras was also studied by in situ hybridization. The majority of gastric carcinomas as well as their adjacent non-neoplastic mucosas expressed ras gene product. There was a significant relationship between the expression of ras gene p21 product and the morphologic pattern of the tumours. An enhanced ras expression was found in several conditions regarded as precursor lesions of intestinal and/or diffuse types of gastric carcinoma (dysplasia, foveolar hyperplasia and even the neck zone of normal-appearing gastric glands, namely in the mucosa adjacent to diffuse carcinomas). Ras expression was actually more prominent in most of these conditions than in their respective adjacent carcinomas. No significant relationship was found between ras expression and invasiveness of the wall, nodal metastases and venous invasion.

Amplification and overexpression of the EGF receptor and c-erbB-2 proto-oncogenes in human stomach cancer

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Familial gastric polyposis revisited. Autosomal dominant inheritance confirmed

We update and review a large pedigree originally described by Santos and Magalhães with familial gastric polyposis and a high incidence of gastric cancer. The present observation of male-to-male transmission of the disease clearly demonstrates the autosomal dominant pattern of inheritance. The histologic review of the polyps present in several members of the family allowed the diagnosis of hyperplastic polyposis. Eight members of the family (two with concomitant gastric pathology) have severe cutaneous psoriasis. This finding may represent the existence of two different disorders segregating in the family or, alternatively, pleiotropic manifestations of the same gene.

[Phlebectasis of the external jugular vein]

Phlebactasia of the external jugular vein is a rare nosological entity. Few reports appeared in the world literature. Clinically it presents as a cervical mass enlarging with a Valsalva maneuver. The Authors present one clinical case, emphasizing the possibilities of Computed Tomography (CT) in a precise diagnosis, etiological and topographical, without using other invasive modalities.

Cytology and development of a mycorrhiza-like infection in the gametophyte of Conocephalum conicum (L.) Dum. (Marchantiales, Hepatophyta)

An aseptate fungus associated with the gametophyte of the hepatic Conocephalum conicum (L.) Dum. was studied by light and electron microscopy. The fungus forms a highly branched mycelium external to the plant. Fungal hyphae colonize the smooth-walled rhizoids, through which they pass into the gametophyte parenchyma of the midrib. The fungus in the parenchyma is entirely intracellular. Vesicles are found in rhizoids and a few ventral layers of parenchyma cells. Prominent arbuscules develop in more internal cells from lateral branches of infecting hyphae that spread from cell to cell. Infected host cells show cytoplasmic proliferation, especially of ribosomes, Plastids and mitochondria, The arbuscules eventually degenerate leaving clumps of collapsed hyphae. Reinfection of cells with degenerate arbuscules was not observed. The ultrastructural and developmental characteristics of the fungus and its high cytological compatibility with the host are indicative of a well integrated symbiotic association similar to the vesicular-arbuscular mycorrhizas of higher plants.

[Collapse of the aortic valve in dilated myocardiopathies: echocardiographic study]

In order to clarify the early systolic partial closure (notching) of aortic valve in patients (pts) with dilated cardiomyopathy (DC), authors (AA) evaluated the M-mode echocardiograms corresponding to 41 pts with DC. Pts were separated in two groups, according to the presence of systolic notching: group A (18 pts) presenting systolic notching; group B (23 pts) in which no systolic notching was observed. For each group, the same echocardiographic parameters were evaluated related to aortic root, left atrium, left ventricule (LV), aortic valve and mitral valve. Both groups were compared statistically. Results--Group A presented a reduced motion of aortic root and greater initial maximal aortic cuspids separation. AA therefore conclude that in pts with DC the systolic notching has no eventual relation with mitral regurgitation. In this setting no conclusions about LV function can be inferred, and it is suggested that systolic notching may bear some relation with differences in the distribution of transvalvular aortic flow.

Prenatal screening and pregnant women's attitudes toward the abortion of defective fetuses

We studied the attitudes of 490 pregnant women toward the abortion of defective fetuses. Three hundred of these women were participating in a prenatal screening program for neural tube defects. Although theoretical accounts of the effects of behavior on attitude would suggest that participation in a screening program would affect abortion attitudes, evidence in support of such an association was weak. The overwhelming majority of women, regardless of whether they had participated in the screening program, believed that women are justified in having an abortion in the face of fetal abnormality. There was a sharp increase in the number of screening program participants who said they would have an abortion when the probability of the fetus being affected with a neural tube defect rose from 95 per cent to 100 per cent.

Pancreatic ascites. Calcification as a clue to diagnosis

Pancreatic ascitis in a 31-year old black male is described. The diagnosis was suspected by the presence of pancreatic calcifications and confirmed by an elevated ascitic fluid amylase and protein content. Ascites was successfully treated by caudal pancreatectomy followed by a Roux-en-y pancreatojejunostomy.

Polyposis coli associated with fibrosis of mesentery, mesocolon and retroperitoneal tissues: a rare variant of Gardner's syndrome

The association of polyposis coli, osseous and dental abnormalities with fibrosis of mesentery, mesocolon and retroperitoneal tissues is described in a black male. The prognostic significance of this association, rendering colectomy impossible, is stressed.