[Mushroom poisoning in Portugal]

The renewed interest in mycology has been reflected in growing use of wild mushrooms in culinary, driven by its nutritional, organoleptic and commercial value. However, the international scientific literature describes several syndromes of poisoning by mushrooms. We live, therefore, a paradigm conducive to an increase of mycetism, whose diagnosis requires a high level of suspicion and knowledge of clinical profiles. In Portugal, the real dimension of this problem is unknown. Although some mycetisms, such as the hepatotoxic syndrome, have high morbidity and mortality, their relative incidences are unknown. Add up to the shortage of international scientific literature, often outdated and inappropriate to clinical practice. In this context, this article provides an updated epidemiological and clinical perspective emphasizing a narrative and descriptive information on the forms of presentation, differential diagnosis and therapeutic approach, with the ultimate goal of the elaboration of a national diagram-oriented approach to decision-making diagnosis. We analyzed all the clinical records of patients admitted into ten hospitals between 1990 and 2008, notified with the code 988.1 of GDH (acute poisoning by mushrooms). There were registered demographic data, way of presentation, time between ingestion and onset of symptoms, the annual distribution, clinical profile, clinical and analytical treatment performed and complications. We identified 93 cases of acute poisoning by mushrooms, with equal gender distribution and inclusion of individuals of all age groups (from 1 to 85 years), but with greater representation from 21 to 50 years. There was a bimodal seasonal pattern, with a higher peak between September and December and a second in the spring. The hepatotoxic profile presentation corresponded to 63.4% and 31.7% of the cases to gastroenteritis syndrome. The mortality in cases of hepatotoxicity was 11.8%. The developmental profile of the rate of prothrombin time (PT), aspartate aminotransferase (AST) and bilirubin, was an important setting for diagnosis and prognosis. TGO increases early, always within 48 hours, having an essential role in the diagnosis of hepatotoxicity. Despite the late elevation of bilirubin, the cases of death revealed that there was an earlier increase, reaching higher values, which seems to have a prognostic value, to be evaluated with further studies. Finally, we propose a diagram of diagnostic performance, considerating the generalized lack of mycological diagnosis in Portugal, which emphasizes the need for a careful history, focused on quantifying the latency period.

Lipids analysis in hemolymph of African giant Achatina fulica (Bowdich, 1822) exposed to different photoperiods

The influence of different photophases (0, 6, 12, 18 and 24 hours) on the triglycerides and total cholesterol contents in the hemolymph of A. fulica was evaluated, since there is no information in the literature about the influence of this factor on lipids metabolism in mollusks. After 2 and 4 weeks of exposure the snails were dissected. The cholesterol content at the 2nd and 4th weeks post exposure only varied significantly in the groups exposed at 24 hours and 0 hour of photophase, respectively. Probably, such increase may be a result of a rise in cholesterol biosynthesis and/or remodelling of cell membranes. There were no significant differences among the content of triglycerides in the snails exposed to 6, 12, 18 and 24 hours of photophase during two weeks. The snails exposed to intermediate photophase (6 and 12 hours) had the triglycerides content increased, ranging over values near to those observed in the group exposed to 0 hour. Results showed that triglycerides metabolism in A. fulica are more influenced by photoperiod than cholesterol metabolism. A negative relation is maintained between the triglycerides content in the hemolymph and the different photophases, with lower mobilisation of triglycerides under shorter photophases.

Nematode cysts and larvae found in Achatina fulica Bowdich, 1822

This study describes the morphology of the nematode cysts and larvae found in Achatina fulica (giant African snail) in Brazil. Sixty snails were collected in Mesquita, Rio de Janeiro State. Fourteen of the snails were naturally infected. The cysts were spherical, pink colored and measured 0.97 to 1.57 mm in diameter. In the majority of cases they had a single larvae involved in amorphous material. A total of 222 encysted larvae were recovered. Of these, 30 were utilized in the morphological study. The length of the larvae varied from 2.57 to 5.8 mm and they were classified as small--up to 3.5 mm; medium--from 3.53 to 4.5 mm; and large--greater than 4.52 mm. The average length of the larvae in the three groups was 2.85, 3.87 and 5.23 mm, respectively. The larval cuticle was white, shiny and transversally striated until the posterior end of the body. At the anterior end there is a mouth with three lips, with amphids and papillae, followed by a muscular esophagus with average length of 0.61 mm, terminating in an esophageal bulb and having a nerve ring in the middle third of the esophagus, and an intestine with an opening near the posterior end. The tail begins from this opening and has two types of ends: short and abrupt or long and gradually tapering. The difference in the tail end can suggest sexual dimorphism, although no primordial reproductive structures were observed. These characteristics were not sufficient to identify the larvae, so there is a need for further study.

The population density effects on the reproductive biology of the snail Bradybaena similaris (Férussac, 1821) (Mollusca, Gastropoda)

The influence of population density on some aspects of the reproductive biology of the snail Bradybaena similaris was studied. Molluscs were maintained under 0.2 (isolated), 0.3, 0.6, 1.0, 1.3 and 1.7 snail/m(2) densities. The animals maintained under 0.3 and 0.6 snail/m(2) showed the lowest numbers of eggs laid/snail, being the highest value observed to the 1.7 snail/m(2). The hatching of the snails maintained under 0.3 snail/m(2) density, begun at the 21st day after laying, and the maximum time required to the hatching was 36 days was observed to the eggs came from snails maintained under the densities 0.6, 1.0, 1.3 snail/m(2), respectively. The highest percentage hatchability (55.56%) was observed to isolated snails. The galactogen content in the albumen gland did not seem to accompany the alterations occurred in the reproduction of B. similaris in response to the different population densities.

Soluble markers for the assessment of biological activity with PTK787/ZK 222584 (PTK/ZK), a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor in patients with advanced colorectal cancer from two phase I trials

BACKGROUND

Plasma and serum biomarkers of angiogenesis and activated endothelial cells were evaluated to assess biological activity of PTK787/ZK 222584 (PTK/ZK), a novel oral angiogenesis inhibitor targeting all known vascular endothelial growth factor (VEGF) receptor tyrosine kinases.

PATIENTS AND METHODS

Patients with colorectal cancer (CRC) (n=63) were enrolled into two phase I/II dose escalation trials of PTK/ZK in 28-day cycles until discontinuation. Patients with stable disease for > or =2 months were categorized as 'non-progressors'. Plasma markers of angiogenesis, VEGF-A and basic fibroblast growth factor (bFGF), and the serum markers of activated endothelial cells, sTIE-2 and sE-Selectin, were assessed at baseline, and pre-dose on days 1, 8, 15, 22 and 28 of every cycle, with additional assessments 10 h post-dose on days 1 and 15. The percentage change from baseline was subsequently correlated with AUC and C(max) of PTK/ZK on day 1, cycle 1 and clinical outcome.

RESULTS

A dose-dependent increase in plasma VEGF-A and bFGF was observed in the first cycle of PTK/ZK treatment. The correlation of change in plasma VEGF-A with AUC and C(max) was characterized by an E(max) model, suggesting that a change of > or =150% from baseline VEGF-A correlated with non-progressive disease. Change from baseline plasma VEGF-A within the first cycle of treatment was significantly correlated with clinical outcome by logistic regression analysis (P=0.027).

CONCLUSIONS

In patients with CRC treated with PTK/ZK, changes in plasma VEGF-A and bFGF demonstrate biological activity of PTK/ZK, may help to establish optimal dose and correlate with outcome.

Morphology of the rediae of Echinostoma paraensei (Trematoda: Echinostomatidae) from its intermediate host Lymnaea columella (Mollusca, Gastropoda)

The morphology of the rediae of Echinostoma paraensei obtained from Lymnaea columella was studied using light, scanning and transmission electron microscopy. The measurements of the mature rediae differ from those described originally, and the taxonomic importance of the ambulatory buds and papilliform process is discussed. Uniciliated papillae were observed in the mouth region. The birth papilla is a bulb-like structure, well defined at the anterior end of the body of the rediae, which opens through a split. There are no microvilli in the tegument surface of the larvae, but numerous tegumental folds, varying according to the contraction of the body of the rediae. The outer syncytial layer is located on a thick basal lamina below which the circular and the longitudinal muscle fiber layers are located.

Laparoscopic adrenalectomy for pheochromocytoma

BACKGROUND

Laparoscopic adrenalectomy is a safe and effective treatment for most surgical diseases of the adrenal gland. However it has been suggested that catecholamine effects associated with pheochromocytoma render the laparoscopic approach a more challenging and a more morbid procedure. The purpose of this study was to compare the operative characteristics and outcomes of laparoscopic adrenalectomy for pheochromocytoma to those of aldosteronoma and incidentaloma.

METHOD

Patient records and operative reports were retrospectively reviewed for demographics, diagnoses, operative management, and outcomes for patients undergoing laparoscopic adrenalectomy between June 1994 and July 2002 at two academic medical centers. A total of 74 patients were included and analyzed by diagnosis. Differences were considered statistically significant at p < 0.05.

RESULTS

Twenty-eight patients with pheochromocytoma, 27 with aldosteronoma, and 19 with incidentally discovered nonfunctioning adrenal masses underwent laparascopic adrenalectomy. Patients undergoing resection for pheochromocytoma trended toward more operative blood loss (150 ml) compared to aldosteronoma (88 ml) and incidentaloma (75 ml). Eight patients were converted to an open procedure for a 10.8% conversion rate. The mean operative time was 171 min and there was a 10.8% perioperative complication rate. The mean hospital stay was 3.4 days. These results were not statistically significant between diagnostic groups.

CONCLUSION

Despite concern about increased operative times and morbidity associated with pheochromocytoma, our experience supports that laparoscopic adrenalectomy may be performed as safely as, and achieve outcomes similar to, those for other diseases.

Early postnatal behavior deficits after maternal carbon dioxide pneumoperitoneum during pregnancy

BACKGROUND

In this study, we tested the hypothesis that maternal pneumoperitoneum produces early postnatal behavior deficits in the offspring.

METHODS

Time-dated pregnant guinea pigs were exposed to 45 min of carbon dioxide (CO2) pneumoperitoneum at a pressure of 7 mmHg. There was no manipulation of the control animals. On postnatal days (PND) 10 and 20, the behavior of their offspring was assessed by monitoring the locomotor activity of each of the pups in a 1 x 1 m chamber demarcated into 100 squares. Locomotor data was log-transformed and expressed as mean values (SD).

RESULTS

At PND 10, pneumoperitoneum offspring exhibited significantly higher levels of locomotor activity than the offspring of controls (1.81 +/- 0.48 vs 1.33 +/- 0.78). The pneumoperitoneum pups continued to exhibit hyperactive behavior at PND 20 (1.83 +/- 0.72 vs 1.20 +/- 0.72).

CONCLUSIONS

Maternal pneumoperitoneum produces postnatal hyperactivity in guinea pig offspring, suggesting that there may be long-term consequences associated with the physiologic changes produced in the fetus during CO2 insufflation.

Aminotransferases activity in the hemolymph of Bradybaena similaris (Gastropoda, Xanthonychidae) under starvation

Aminotransferases (GOT and GPT) activities in the hemolymph of Bradybaena similaris under experimental condition of starvation were studied. At the 10th day of starvation, GOT activity was 416.6% higher than that observed in the fed snails, being reduced and ranging values near to that shown by the control group onwards. GPT activity only varied significantly at the day-30 of starvation. The results were discussed.

Serum dehydroepiandrosterone sulfate concentrations across the life span of laboratory-housed rhesus monkeys

Cross-sectional studies of humans have shown that dehydroepiandrosterone sulfate (DHEAS) peaks shortly after sexual maturation and declines thereafter, suggesting that the progressive reduction in DHEAS may play a role in the aging process and in the development of age-related morbidity. The present study examines changes in DHEAS concentrations across the life span of rhesus monkeys as part of the development of this primate model for studies of aging. Serum concentrations of DHEAS were measured in 792 laboratory-housed rhesus monkeys (Macaca mulatta) aged 0.5-36 years (527 females, 265 males). DHEAS concentrations in all monkeys were used to formulate an equation that describes two levels of decline of DHEAS with age. The most rapid decline occurs from infancy until approximately 5 years of age. The decline then occurs gradually with increasing age. There were no signs of an andrenarche just prior to sexual maturation, as is seen in humans or the great apes. This equation can be used to predict the expected mean serum DHEAS concentration and normal ranges of male or female rhesus monkeys at any age greater than 5 months.

The New York State universal newborn hearing screening demonstration project: outpatient outcome measures

OBJECTIVE

To investigate outpatient outcome measures of a multi-center, state-wide, universal newborn hearing screening project.

DESIGN

Eight hospitals participated in a 3-yr, funded project. Each hospital designed its own protocol using common criteria for judging whether an infant passed a hearing screening. Infants were tested in the hospital, and those either failing the in-hospital screening or who were not tested in the hospital (missed) were asked to return 4 to 6 wk after hospital discharge for outpatient rescreening. Those infants failing the outpatient rescreening were referred for diagnostic auditory brain stem response testing. Each hospital used its own audiological equipment and criteria to determine whether a particular infant had a hearing loss. All data were collected and analyzed for individual hospitals, as well as totaled across all hospitals. Data were analyzed in terms of year of program operation, nursery type, and geographic region.

RESULTS

Seventy-two percent of infants who failed the in-hospital screening returned for outpatient testing. The percentage of in-hospital fails returning for retesting was significantly higher than the percentage of in-hospital misses returning for retesting. The percentage of infants returning for retesting increased with successive years of program operation. Some differences were noted in the percentage of infants returning for retesting among hospitals and geographic regions of the state. Some differences in outpatient outcome measures also were noted between infants originally born into the neonatal intensive care unit (NICU) and the well-baby nursery (WBN). The percentage of infants from the NICU who returned for retesting was slightly higher than that for infants from the WBN. The percentage of infants from the WBN passing the outpatient rescreening was higher than that for the NICU infants. The overall prevalence of hearing loss was 1.96/1000, with that in the NICU being 8/1000 and that in the WBN being 0.9/1000. Positive predictive value for permanent hearing loss based on inpatient screening was approximately 4% and based on outpatient rescreening was approximately 22%.

CONCLUSIONS

Several outpatient outcome measures changed with successive years of program operation, suggesting that programs improve over time. Also, some outpatient outcome measures differ between NICU and WBN populations. The differences noted across regions of the state in the percentage of infants returning for outpatient retesting require further research to determine whether differences are due to demographic and/or procedural differences.