Direct analysis of human blood (mothers and newborns) by energy dispersive X-ray fluorescence

This work is an application of energy dispersive X-ray fluorescence (EDXRF) as analytical technique for trace element determination in human tissues. Potassium (K), calcium (Ca), iron (Fe), copper (Cu), zinc (Zn), bromine (Br), rubidium (Rb) and lead (Pb) were determined directly in blood samples from 66 mothers at delivery after full-term pregnancies. The corresponding 66 cord-blood samples of the newborns were also analysed, in order to find element correlations between maternal and newborn blood at birth. The studied samples were obtained from mothers aged between 15 and 39 years old, the gestational age being between 35 and 41 weeks and the newborns' weight between 2.310 and 4.310 kg. Samples were lyophilised and analysed without any chemical treatment. Very low levels of Pb were found both in maternal and fetal cord blood samples. Cu values ranged from 3 to 13 microg g-1, both for mothers and children. A correlation between Cu and Fe concentrations in maternal and fetal cord blood was found. Zn is considered as one of the key elements in newborn health. Concentrations between 10 and 40 microg g-1 were measured. A positive correlation between Br levels in mothers and children was observed. Positive correlations for mothers were observed between Zn and Rb as well as K and Fe. The corresponding correlations in fetal cord blood samples were not observed, however positive correlations were found between Ca and K; Cu and Fe. The mean concentrations for each element were similar in maternal and in fetal cord blood, except for Cu and Zn, being higher in maternal samples. No correlations between element concentrations and pathologies of the mothers were observed.

Dermatomycoses caused by Nattrassia mangiferae in São Paulo, Brazil

Nattrassia mangiferae formerly known as Hendersonula toruloidea, is a phaeoid coelomycete described by Nattrass in 1933. We report five cases of N. mangiferae infections in São Paulo, Brazil. This fungus was isolated from interdigital lesions on the feet in one patient, toenails in three cases and fingernails in the other one. The infections were initially considered to be caused by a dermatophyte. Although there are only a few cases described in the medical literature, the five cases reported suggest that N. mangiferae should be taken into consideration in the differential diagnosis of tinea pedis infections.

Domino liver transplant: influence on the number of donors and transplant coordination

The shortage of organs forces coordinators to seek new forms of generating organs for transplantation of the increasing numbers of patients on waiting lists. A recent technique called sequential transplant or domino liver transplant (DLT) allows the transplantation of a patient with chronic liver disease by implantation of a full-size liver derived from a patient with familial amyloidosis polyneuropathy (FAP) who receives a cadaveric graft. Therefore, it is possible to transplant two patients with only one cadaveric liver. The present report illustrates the use of this technique for the first time in our country, thereby increasing the number of hepatic transplants by 25%.

Neurofibromatosis 2 in the pediatric population

Neurofibromatosis 2 is a severe autosomal dominant disorder characterized by the occurrence of bilateral vestibular schwannomas and other benign tumors of the nervous system. Excellent natural history studies exist for adults with neurofibromatosis 2, but limited outcome data are available for children with neurofibromatosis 2. In this study, we present clinical data on 12 patients with neurofibromatosis 2 and age at diagnosis before 18 years. Full record review included surgical reports, pathology reports, and imaging studies; all patients were personally examined by a single author. One third of the patients presented with hearing impairment and another third presented with other cranial nerve dysfunction. Tumor load was extensive, including cranial meningiomas in 75%, cranial schwannomas other than vestibular schwannomas in 83%, and spinal cord tumors in 75%. Family history was present in two thirds of the patients. Surgical removal of vestibular schwannomas was performed in 58%; none had full preservation of hearing postsurgery. Functionally, 75% of children had hearing loss, 83% had visual impairment, 25% had abnormal ambulation, and 25% were performing below grade level. In conclusion, increased clinical awareness, better imaging techniques, and molecular diagnostics have made pediatric diagnosis of neurofibromatosis 2 feasible, but outcomes appear to be worse than in adult patients. Further work is needed to determine optimal management of pediatric neurofibromatosis 2.

Trace elements determination by energy dispersive X-ray fluorescence (EDXRF) in human placenta and membrane: a comparative study

This work is an application of energy dispersive X-ray fluorescence (EDXRF) as an analytical technique for trace elemental determination in human membrane and placenta and elemental concentrations correlations in both tissues. Whole samples were collected during the delivery from healthy mothers and full-term pregnancies. The age of the mother was between 25 and 40 years old, and the weight of the infants ranged from 2.56 to 4.05 kg. Samples were lyophilised and analysed without any chemical treatment. No significant differences in elemental content of placenta and membrane samples were observed except for Ca. Very low levels of Se, As and Pb were observed in all the analysed samples. Zn, considered as one of the key elements in newborn health, was not significantly different in the analysed samples, all of which originated from healthy mothers and healthy babies. The obtained values agree with the literature except for Ca, which is much higher in the studied samples.

[Evaluation of analgesia after cesarean section]

OBJECTIVE

The aim of this study was to evaluate the efficacy of post-caesarean analgesia comparing three techniques most frequently used.

PATIENTS AND METHODS

For three months all pregnant women submitted to elective or urgent caesarean section, under general or regional anaesthesia, were evaluate with a total of 129 parturient. These parturient were divided into three groups with different techniques of postoperative analgesia: Group 1 (n = 26) received intravenous pethidine and paracetamol per os, group 2 (n = 58) received epidural morphine and group 3 (n = 45) epidural morphine and intravenous propacetamol. Pain was assessed at rest and during mobilisation using a scale of 0-without pain, 1-mild pain, 2-moderate pain and 3-severe pain. Overall satisfaction was assessed with a verbal qualitative scale of very good, good, sufficient and bad. Side effects were analysed.

RESULTS

The records of pain at rest and during mobilisation were significantly lower with epidural analgesia compared with intravenous pethidine. There were no significant differences between groups 2 and 3. Similar results were observed in the degree of satisfaction. For 50% of parturient of epidural analgesia (groups 2 and 3) and only 4% of intravenous pethidine (group 1) the analgesic technique was very good. Propacetamol and epidural morphine (group 3) had better pain scores (very good and good) when compared with morphine alone (group 2) but there were no significant differences. Epidural morphine was associated with more pruritus.

CONCLUSION

From this study we are able to conclude that epidural morphine offers a good quality of analgesia with better satisfaction and minimal side effects.

Sensory organ generation in the chicken inner ear: contributions of bone morphogenetic protein 4, serrate1, and lunatic fringe

The chicken inner ear is a remarkably complex structure consisting of eight morphologically distinct sensory organs. Unraveling how these sensory organs are specified during development is key to understanding how such a complex structure is generated. Previously, we have shown that each sensory organ in the chicken inner ear arises independently in the rudimentary otocyst based on Bone morphogenetic protein 4 (Bmp4) expression. Here, we compare the expression of Bmp4 with two other putative sensory organ markers, Lunatic Fringe (L-fng) and chicken Serrate1 (Ser1), both of which are components of the Notch signaling pathway. L-fng and Ser1 expression domains were asymmetrically distributed in the otic cup. At this early stage, expression of L-fng is similar to Delta1 (Dl1), in an anteroventral domain apparently corresponding to the neurogenic region, while Ser1 is expressed at both the anterior and posterior poles. By the otocyst stage, the expression of both L-fng and Ser1 largely coincided in the medial region. All presumptive sensory organs, as identified by Bmp4 expression, arose within the broad L-fng- and Ser1-positive domain, indicating the existence of a sensory-competent region in the rudimentary otocyst. In addition, there is a qualitative difference in the levels of expression between L-fng and Ser1 such that L-fng expression was stronger in the ventral anterior, whereas Ser1 was stronger in the dorsal posterior region of this broad domain. This early difference in expression may presage the differences among sensory organs as they arise from this sensory competent zone.

An audit of European training in obstetrics and gynaecology

During 1997, The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) circulated a questionnaire to audit training in Europe. Results describe number and gender in each country, access to training, duration of training, tutor/tutee scheme, logbooks, minimum curriculum, assessment, criteria for accreditation, training abroad, final examination, hospital inspection, subspecialty, academic training, and career progression. Quality of life is tried to address with questions relating to salary, working hours, maternity leave, annual leave and study leave. EBCOG has drawn up recommendations to try and achieve a standardisation of quality of training whilst fully understanding that complete standardisation of training is not a realistic possibility due to social, cultural and ethical differences. A repeat audit is planned after 3 years to close the feedback loop.

Randomized comparison between intravaginal misoprostol and dinoprostone for cervical ripening and induction of labor

OBJECTIVE

We sought to evaluate the efficacy and safety of intravaginal misoprostol and dinoprostone for labor induction.

STUDY DESIGN

One hundred eighty-nine women with singleton term pregnancies and unfavorable cervices were randomly assigned to receive intravaginal misoprostol or dinoprostone. The outcome variables were change in Bishop score, time from application to active phase of labor and delivery, fetal and maternal morbidity, and the incidence of cesarean deliveries.

RESULTS

The interval from application of the initial dose to the beginning of the active phase of labor was 9.8 +/- 5.8 and 14.2 +/- 10.2 hours (P <.01), and the interval from initial dose to delivery was 15.3 +/- 9.8 and 19.1 +/- 13.2 hours (P =.027) for the misoprostol and dinoprostone groups, respectively. There were no significant differences in Bishop score change, cesarean delivery rate, and the incidence of tachysystole, hypersystole, and hyperstimulation. No maternal and neonatal adverse effects were noted.

CONCLUSION

Intravaginal misoprostol is more effective than intravaginal dinoprostone for labor induction in low-risk patients at term with unfavorable cervices.

Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases

The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4%) out of 322 patients reported fever at admission to hospital and 55 (17.1%) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8%). Tuberculosis (32.7%), Pneumocystis carinii pneumonia (10.9%), and Mycobacterium avium complex (9.1%) were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5%), sinusitis (3.6%), Salmonella-S. mansoni association (3.6%), disseminated histoplasmosis (3.6%), neurosyphilis (1.8%), and isosporiasis (1.8%). Four patients had non-Hodgkin's lymphoma (7.3%). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.

Induction of labor with intravaginal administration of misoprostol

OBJECTIVE

The purpose of this study was to evaluate the efficacy and safety of intravaginal misoprostol for labor induction.

METHODS

110 singleton term pregnancies with or without rupture of membranes were enrolled. Fractionated doses of misoprostol were applied (50-100 microg), every 6 h until a maximum of three doses or beginning of labor.

RESULTS

The average interval (+/- S.D.) from vaginal application to the beginning of active labor and to delivery were, respectively, 9.5 +/- 5.7 h and 14.8 +/- 9.5 h. Failed labor induction was observed in two cases (2%). Cesarean section rate was 14%. The incidence of tachysystole was 18% and hypersystole 4%, but these situations were associated with abnormal fetal heart rate pattern (hyperstimulation) in only 3%. No maternal side effects and neonatal adverse effects were noted.

CONCLUSIONS

Intravaginal misoprostol administration with low doses is an effective and safe method for labor induction in term pregnancies, with or without rupture of membranes.

Second primitive malignant tumour in patients with gynaecological cancer

OBJECTIVE

The purpose of this study was to characterise the occurrence of multiple primitive gynaecological malignant neoplasias, restricted to the genital tract and breast or associated with other organs, and to detect which types of association are most frequent concerning location, histology and staging.

POPULATION AND METHODS

The records of patients with gynaecological cancer at the Portuguese Institute of Oncology--Lisbon Centre, between 1986 and 1993 were used in this study.

RESULTS

Of the 10,746 women with gynaecological cancer, 91 (0.8%) were found to have a second primitive malignant neoplasia. Of these neoplasias, 64% (58 cases) were also located at a gynaecological site. The most frequent associations were endometrium/breast (13 cases), bilateral breast (12 cases) and ovary/endometrium (11 cases). The majority of primitive multiple gynaecological tumours were synchronous. Regarding gynaecological cancer and non-gynaecological cancer, in 28 cases (31%), the most common non-gynaecological location was the colon/rectum. Five patients had triple tumours.

CONCLUSION

Although these situations are relatively rare the possibility of multiple primitive cancers should be considered with the presence of malignant tumours in two or more organs. This distinction between multiple primitive or metastatic cancers could be important for treatment as well as prognosis.

Aeroallergens and work-related respiratory symptoms among office workers

OBJECTIVE

We sought to determine the association between office workers' respiratory tract symptoms and immediate skin test reactions with exposure to fungal and house dust mite aeroallergens at their work sites.

METHODS

An initial prevalence survey was conducted among 1102 full-time workers in six mechanically ventilated, air-conditioned, nonindustrial buildings in downtown Montreal. Detailed environmental measures of 214 subjects' work sites were determined. Half of the workers reported frequent work-related respiratory tract symptoms on the initial survey. Participants simultaneously underwent allergy skin prick testing and completed a second self-administered questionnaire.

RESULTS

Contaminant levels were low and not associated with symptoms in the great majority of workers. For approximately 17% of workers, symptoms were associated with exposure to total concentrations of house dust mite allergen greater than 1 microg/gm floor dust (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.3, 19.5]) or to detectable airborne Alternaria allergens in their offices (OR, 3.3; 95% CI, 1.2, 9.4 and in the ventilation system supplying their offices (OR, 3.9; 95% CI, 1.6, 9.6). Workers with positive skin test reactions to Alternaria extract were exposed at their work site to airborne Alternaria allergen (OR, 4.4; 95% CI, 1.4, 14.5) and cited significantly more respiratory symptoms on both questionnaires. Detection of airborne Alternaria allergen at work sites was significantly associated with detection in the ventilation system (OR, 4.0; 95% CI, 1.4,10.9); this was in turn associated with lower efficiency filters.

CONCLUSIONS

Potentially avoidable exposure to aeroallergens accounted for symptoms in a small subgroup of office workers with frequent work-related respiratory tract symptoms.

The expression domain of two related homeobox genes defines a compartment in the chicken inner ear that may be involved in semicircular canal formation

Homeobox-containing genes encode a class of proteins that control patterning in developing systems, in some cases by acting as selector genes that define compartment identity. In an effort to demonstrate a similar role for such genes during ear development in the chicken, we present a detailed expression study of two related homeobox-containing genes, SOHo-1 and GH6, using in situ hybridization. At otocyst stages the two genes define a broad lateral domain of expression, which may represent a developmental compartment. Three-dimensional computer reconstructions of SOHo-1 expression at these and later stages revealed that the lateral domain becomes progressively restricted to the three semicircular canals. Thus, SOHo-1 and GH6 are among a small group of markers for a specific structural component of the inner ear. The gene expression domain initially includes the sensory regions of the semicircular canals, known as the cristae ampullaris, but none of the other four sensory organs which were recognizable by BMP4 expression during early morphogenesis (stages 19-24). Significantly, two of the sensory organs (the superior and posterior cristae) were found at the limits, or boundaries, of the SOHo-1/GH6 expression domain, suggesting that compartment boundaries may be involved in specifying sensory organ location as well as identity. Maintained expression at the boundaries may aid in specifying the location of canal outgrowth. These concepts are presented as a formal model which emphasizes that patterning information could be provided at the boundaries of gene expression domains in the inner ear.

Effect of a new ventilation system on health and well-being of office workers

Sick building syndrome is the term given to a heterogeneous constellation of symptoms that affects workers in modern mechanically ventilated office buildings. Although the cause is unknown, there is evidence that the local environment of the work station is an important determinant of symptoms. In this study, investigators examined the effect of a new, individually controlled ventilation system on workers' symptoms. Investigators studied two groups of workers in one mechanically ventilated office building: (1) a control group at whose worksite no intervention was made and (2) an intervention group. The intervention consisted of installation of a device that allowed each worker control over the ventilation supplied to his or her worksite. Just before, and 4 and 16 mo after installation of this device, workers completed self-administered questionnaires regarding occurrence of symptoms. The new ventilation system resulted in higher air velocities, more variable temperatures, and higher concentrations of airborne dust and fungal spores. Four months after installation, workers with the new ventilation system reported fewer symptoms that were (a) work-related (p < .05) and that were work-related and frequent (p < .05); in addition, they reported fewer symptoms that reduced their capacity to work (p < .01). Sixteen months after installation, workers with the new device reported fewer symptoms than at baseline (although not as significantly), and they indicated that the indoor air quality improved their productivity by 11%, compared with a 4% reduction of productivity among the control group of workers (p < .001). Investigators concluded that the new ventilation system, which provided the workers with individual control over ventilation, was associated with important and sustained reduction in symptoms.

Exposure to varying levels of contaminants and symptoms among workers in two office buildings

OBJECTIVES

We hypothesized that exposure to contaminants would be associated with symptoms reported by office workers.

METHODS

In two mechanically ventilated office buildings in. Montreal, the outdoor air supply was manipulated for 6 weeks, while symptoms were reported and environmental parameters were measured at multiple sites.

RESULTS

Contaminant concentrations varied considerably, in part related to experimental changes in outdoor air supply. Eye symptoms were reported with higher dust and with higher concentrations of nitrogen dioxide. Mucosal symptoms were increased with higher TVOCs, higher nitrogen dioxide, and higher total contaminant load. Systemic symptoms were associated with higher dust levels.

CONCLUSIONS

Symptoms reported by the workers were associated with increased concentrations of several contaminants and a summary measure of all contaminants.

[Postgraduate training in gynecology and obstetrics. Results of an individual national survey of interns]

The national survey on the trainees in this specialty was conducted to find out the trainees' opinions and expectations regarding postgraduated in Gynecology and Obstetrics and professional opportunities. A total of 320 questionnaires were send to all the trainees registered with the Portuguese Medical Association. Some of the topics of this survey were: structure and quality; curriculum requirements; assessment and professional opportunities. We received a total of 109 replies, which are presented in this article.

Increased oxyradical production during reoxygenation of perfused rat liver. Signal versus injury

Despite general agreement on the importance of oxyradicals in mediating "reperfusion" injury, the precise event(s) mediated by increased free radical production remain unclear. In this study we describe for the first time a model of unenhanced chemiluminescence of isolated perfused rat liver demonstrating a marked increase in oxyradical production after reoxygenation. Using aspartate aminotransferase and purine nucleoside phosphorylase release as measures of liver injury, there was no direct link between oxyradical production and hepatic injury. However, there was an abrupt increase in neutrophil chemotaxis activity in the perfusate at the time of reoxygenation with a subsequent decrement, following the pattern of oxyradical production. These data suggest that free radical formation during hepatic reperfusion may mediate signal transduction, as opposed to direct cell injury, as a primary mechanism of action.

The effect of varying levels of outdoor-air supply on the symptoms of sick building syndrome

BACKGROUND

The sick building syndrome is the term given to a constellation of symptoms reported by workers in modern office buildings, hypothesized to occur when the supply of outdoor air is reduced, because of the accumulation of contaminants arising from within the building. We undertook this study to determine the effect of changing the supply of outdoor air in four office buildings on the symptoms reported by workers and their perception of the indoor environment.

METHODS

Within each of three consecutive two-week blocks, the ventilation systems in each building were manipulated, in random order, to deliver to the indoor environment an intended 20 or 50 ft3 (0.57 or 1.4 m3) of outdoor air per minute per person for one week at a time. Each week, the participants, unaware of the experimental intervention, reported symptoms and the indoor environment was thoroughly evaluated.

RESULTS

Of 1838 eligible workers in the four buildings, 1546 (84 percent) participated in the study. The supply of outdoor air averaged 7 percent and 32 percent in the ventilation systems and 30 and 64 ft3 (0.85 and 1.8 m3) per minute per person in the work sites at the lower and higher ventilation levels, respectively. These changes in the supply of outdoor air were not associated with changes in the participants' ratings of the office environment or in symptom frequency (crude odds ratio, 1.0; 95 percent confidence interval, 0.9 to 1.1). After work-site measures of ventilation, temperature, humidity, and air velocity were included in the regression analysis, the adjusted odds ratio was also 1.0 (95 percent confidence interval, 0.8 to 1.2).

CONCLUSIONS

Increases in the supply of outdoor air did not appear to affect workers' perceptions of their office environment or their reporting of symptoms considered typical of the sick building syndrome.