[Bronchial stenosis secondary to severe thoracic contusion. Comment on 2 cases]

Two cases with complete bronchial stenosis of the mainstem bronchus secondary to thoracic blunt trauma are presented. One patient had hemoneumothorax on the left side, the other one had bilateral hemothorax. Both were initially treated with drainage by thoracostomy tube with partial resolution of the thoracic bloody pleural collection. Later, the two patients developed complete atelectasis of the lung, one on the left side and the other one in the right; this later case was subject to lung decortication. The fiberopticbronchoscopy showed a complete occlusion of the mainstem bronchus in both patients. A bronchoplasty with sleeve resection of the stenotic segment was performed; the lumen of the bronchus was preserved by an end-to-end suture with separate stitchs of Vycryl 0000. Both cases remain without bronchopulmonary pathology after 4 years of follow-up of bronchoplasty. In cases of blunt thoracic trauma, it is important to consider the possibility of bronchial rupture. The importance of bronchoscopic diagnosis and surgical treatment is stressed.

Prevalence of skin reactivity to coccidioidin and associated risks factors in subjects living in a northern city of Mexico

BACKGROUND

Coccidioidomycosis is a reemerging fungal disease seen mainly in the states located at the Mexican-U.S. border. The finding of advanced cases of the disease are now more frequent.

METHODS

A cross-sectional study was conducted to determine the prevalence of skin reactivity to coccidioidin in the city of Torreón, Coahuila, Mexico, located in the northern region of the country. A multifactorial association of environmental, social, and health conditions was analyzed. A total of 1,653 coccidioidin skin tests was applied in male and female subjects older than 8 years of age.

RESULTS

The overall rate of positive reactivity in this city was 40.2%, with a 95% confidence interval of 37.8-42.5. This was related to time/life exposure risk and to the habitat of unpaved streets. No statistically significant difference regarding gender, socioeconomic level, and working activities was found. The highest reactivity was observed in subjects between 30 and 65 years of age.

CONCLUSIONS

Positive results were related to exposure risk and habitat, principally in the southeast region of the city. These results were applied both to residents and outsiders with no differences between the groups. Of the total, 87.5% were considered high-risk subjects. It is recommended that future surveys be carried out in other northern cities of Mexico to obtain more useful data concerning the extent of the infection and mainly to establish preventive measures, such as appropriate reforestation and urbanization procedures.

Ultrastructural and functional study of the liver pigment cells from Rana esculenta L

A study of the liver pigment cells of Rana esculenta L. has been performed on both liver in toto and cells in culture. Ultrastructural and cytochemical analyses showed a close relationship between this visceral pigment cell system and the cells of hepatic macrophage lineage. Like the latter, the liver pigment cells present phagocytic activity, in the sinusoids and in vitro, and give a positive response to tests for peroxidase and lipase. The liver pigment cells are isolated, together with the Kupffer cells, from the sinusoidal cell fraction of the liver. In culture, they maintain their melanogenetic ability, demonstrated by the presence of dopaoxidase activity in the soluble, membranous, and melanosome fractions. Analysis of the cultures showed that as culture time increased, so did melanosome dopaoxidase activity, the number of pigmented fields, and the level of pigmentation of the cells. The values of dopaoxidase activity of the pigment cells in culture show the same seasonal oscillations as the system in toto, indicating that the cells maintain an internal clock, at least in the first 72 h of culture. There is evidence that the pigment cells are macrophages which can express a melanogenetic function. Our results and other experimental data provide a basis for hypothesizing that the pigment cells in Rana esculenta L. liver may derive from, or have a common origin with, the Kupffer cells.

Enzyme-linked immunosorbent assay (ELISA) with mycobacterial crude antigens for the sero-epidemiological diagnosis of active tuberculosis

In search for reliable, nonexpensive procedures for tuberculosis diagnosis suitable for seroepidemiological studies in leprosy-endemic areas, enzyme-linked immunosorbent assays (ELISAs) with whole intact bacilli, whole lipid-free bacilli and protein-enriched soluble extracts from the H37Rv Mycobacterium tuberculosis strain were evaluated. Sera tested came from 47 active, pulmonary tuberculosis adult cases, 60 household contacts of active tuberculosis cases, 20 lepromatous leprosy adult patients, and 67 healthy adult controls obtained from low and high leprosy and tuberculosis endemicity areas. There was no influence of such endemicity levels in the number of positive results in control sera. Antibody levels obtained with each of the antigens in ELISAs were significantly different in tuberculosis patients and the control groups. Ten percent of tuberculosis contacts were positive with some of the antigens and three of them showed suggestive chest radiographs. The best combination for a high number of positive results with tuberculosis sera and low positive results with leprosy sera was the BCG soluble extract (91% and 15%, respectively). This preparation also yielded excellent sensitivity and specificity values for tuberculosis (91.5% and 92.5%, respectively). These data suggest that BCG soluble extract ELISAs could provide helpful information to estimate tuberculosis prevalence only in leprosy-free areas, under a situation of unavailability of purified antigens. In pulmonary cases, sputum microscopic examination and culture have higher sensibility than serodiagnosis; therefore, the utilization of BCG soluble extract ELISAs as a diagnostic aid in individual patients with suspected active tuberculosis only can be useful in extrapulmonary cases.

Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multicenter trial

To test the efficacy of intrapleural fibrinolytic therapy in patients with loculated pleural effusions, we conducted an open, prospective, and multicenter trial among five hospitals in Mexico. We enrolled patients with hemothorax or empyema, clotted and/or loculated, that was not resolved through conventional pleural drainage with chest tube and antibiotics in patients with empyema. All patients received repeated doses of 250,000 IU of streptokinase through chest tube. Effectiveness criteria were before and after intrapleural streptokinase (IPSK) drainage, and poststreptokinase radiographic and respiratory function test improvement. Forty-eight patients were studied; there were 30 patients with empyemas, 14 with hemothorax, and 4 patients with malignant pleural effusions without lung trapping. Successful fibrinolysis was obtained in 44 patients, with complete resolution of the pleural collection and adequate radiologic and spirometric improvement. In three of four patients with multiloculated malignant hemothorax with high-yielding pleural drainage, IPSK allowed successful lysis of loci and an adequate pleurodesis was achieved. Only four patients required surgical treatment. The overall success rate in our series was 92%, similar to previous reports. The results in this first prospective and multicentric trial suggest that intrapleural fibrinolysis is an effective and safe adjunctive treatment in patients with heterogeneous pleural coagulated and loculated collections to restore the pulmonary function assessed by respiratory function tests and can obviate surgery in most cases.

[Bronchogenic cancer at the Hospital General de México. A study of 2 decades]

Among 1,855 thoracic neoplasms seen from 1971 to 1990, there were 923 with bronchogenic carcinoma (CaBr), 50%. The relation male:female was 1.95:1. Sixty three period thirty one percent were male. The histologic type were epidermoid 32.2%, adenocarcinoma 28.4% and small cells 13.2% in men; in women adenocarcinoma 38.9%, epidermoid 28.9% and mixed 7.7% with a significative difference for both sexes for these neoplasms. Other types were less frequent. There is significative difference between smokers and non smokers of both sexes p < 0.001. Epidermoid, adenocarcinoma, small cells, large cells and mixed were the most frequent in male smokers, in women these varieties were more frequent in nonsmokers. Comparison with the reference group with no CaBr suggests that epidermoid, adenocarcinoma and small cells carcinomas have a great possibility to be found in male smokers. Ninety two period two percent of cases were stage III (Tumor Node MetastasIs) with no chance for radical treatment. Only 94 were subject to surgery with 36 total resections. CaBr is an important problem in the General Hospital of Mexico. Antismoking programmes must be stressed in relation to the frequency of CaBr in smokers.

[Pulmonary alveolar microlithiasis in two siblings]

The study of two brothers with pulmonary alveolar microlithiasis (MLA) a rare lung alteration with autosomic recessive character is presented. In one case the lung biopsy made the diagnosis by the identification of multiple calcospherites. The importance of the familiar study is stressed, as a sister with the same radiographic image was discovered this way. The literature is revised and the main data of MLA are presented; the radiologic images and histopathologic findings are commented.

[The tobacco habit among the workers in a general hospital. A survey report]

Survey among the workers of a general hospital to investigate how may of them smoke by means of a closed questionnaire given to 1092 Subjects. Smoking habit was positive in 678 (62.1%) and negative in 414 (37.9%); statistical difference was significant p 0.01. The rate for nocturnal workers was 80.0 in comparison with those of the morning and evening with 55.81 and 62.38 respectively. Men smokers had 66.79 of rate and women 57.55 with no statistical difference. Cigarette was the most common form of tobacco consumption, pipe and cigars were very rate. The most important number of smokers were 31-40 (65.4% and 21-30 (62.7%) years old, very few under 21 but among these 63% were smokers. Smoking habit was more common in the groups of high schooling [correction of scolarity]. Physicians were an important group of smokers, 61.6 per cent of 284 use to smoke while working in the hospital. Other characteristics of smokers are discussed and it is concluded that is necessary to take action to get a tobacco free hospital.

Behavior of the pulmonary circulation at rest and during exercise in miliary tuberculosis

We studied the hemodynamic behavior of the pulmonary circulation at rest and during exercise in six patients with MTB. As a group, in contrast to advanced fibrocaseous tuberculosis, these patients exhibited normal pulmonary hemodynamics at rest and during exercise. Only minor abnormalities in pulmonary vascular resistance at exercise (increased PAd-PWP gradient) were noted in two of the patients. The increase in Rp during exercise does not appear to be related to acute hypoxic vasoconstruction but rather to functional changes (compliance or recruitment or both) of the pulmonary microvasculature. In the genesis of these functional changes, chronic alveolar hypoxia and the inflammatory-fibrotic process might be interacting.

Morpho-functional characterization of cultured pigment cells from Rana esculenta L. liver

A simple method to isolate and culture liver pigment cells from Rana esculenta L. is described which utilizes a pronase digestion of perfused liver, followed by sedimentation on a Ficoll gradient. A first characterization of isolated and cultured cells is also reported. They show both positivity for nonspecific esterases, and phagocytosis ability, like the cells of phagocytic lineage. Furthermore, after stimulation with a phorbol ester, these cells generate superoxide anions. At phase contrast microscope, liver pigment cells present variability in size, morphology, and in their content of dark-brown granules. Inasmuch as a cell extract obtained from cultured cells exhibits a specific protein band with dopa-oxidase activity, when run on nondenaturing polyacrylamide gel electrophoresis, liver pigment cells from Rana esculenta L. should not be considered as melanophages, but as cells that can actively synthesize melanin. The method presented here seems to be useful to more directly investigate this extra-cutaneous melanin-containing cell system and to clarify its physiologic relevance.

Effects of copper on the tyrosinase of liver pigment cells from Rana esculenta L

1. The liver pigment cells of R. esculenta L. constitute a peculiar pigment cell system of histiocytic nature and contain a tyrosinase-like activity localized in the protein component of melanosomes. 2. The effects of addition and/or removal of Cu on the DOPA-oxidase activity of the system were studied. 3. It was concluded that: (a) this tyrosinase behaves as a Cu-enzyme; (b) Cu could be involved in the regulation of the enzyme activity; and (c) mixtures of apoenzyme and active enzyme coexist in the melanosomes.

[Determination of secretory immunoglobulin A, IgG and IgM in bronchial lavage from patients with primary and metastatic lung neoplasms ]

It has been informed in cases with epithelial neoplasias an increased level of secretory immunoglobulin A (IgAS) in bronchial secretions: IgAS, IgG and IgM were measured in bronchial secretions and sera in four groups: bronchogenic carcinoma (Brc), lung metastasis, chronic bronchitis (CB) and voluntary subjects without respiratory disease. It was employed radial immunodiffusion method (RID) with a control from human colostrum for IgAS and commercial controls with the same method for IgG and IgM. To avoid dilutional factor it was established the relation between IgAS, IgA and IgM with total proteins in the samples of bronchial lavage (Ig/tp). Using ANOVA it was found a significative difference (p less than .002) in IgAS/tp among the four groups in the bronchial samples. With Mann-Whitney there was a p less than .05 comparing the healthy control group with any of the others. There was no statistical differences among the BrC and the metastasis or CB groups; IgG and IgM did not showed differences. The seric values of the immunoglobulins has normal levels. It was detected low levels of IgAS in the groups with pulmonary pathology in comparison with the healty controls. The present results are different with the previously reported in the revised literature.

Melanogenesis in the pigment cells of Rana esculenta L. liver: evidence for tyrosinase-like activity in the melanosome protein fraction

This work demonstrates the presence of a tyrosinase-like activity in the pigment cells of frog Rana esculenta L. liver. The activity was evidenced in the protein melanosome fraction extracted with differential centrifugation methods. The study of this activity, carried out with spectrophotometric methods, indicates 1) the system presents the characteristics of an allosteric enzyme; 2) the grade of cooperativity shows oscillations going from negative cooperativity toward the substrate, evident in the warmest months of the year, to an absence of cooperativity in the coldest months of the year; and 3) the levels of activity of the system also vary according to season, with the highest levels appearing in the coldest months of the year. Given that this extracutaneous system of pigment cells, different from melanocytes, is able to carry out melanogenesis, we suggest its inclusion in the classification of pigment cells.

Transthoracic needle biopsy in neoplastic and nonneoplastic pathology: experience in a general hospital

Transthoracic needle biopsy (TNB) was performed in 344 cases of intrathoracic pathology. In 60 of them, the material obtained was inadequate. In the remaining 284, the possibilities of TNB to identify malignant cells were evaluated. Of them, 202 had neoplastic lesions and 82 had nonneoplastic processes. Among the neoplastic cases, malignant cells were found in 188, (true positive), and in 14 the results were false negative. In the group of nonneoplastic processes, there were 80 without malignant cells (true negative), and two were diagnosed as malignant, (false positive). In these 284 cases with cytologic diagnosis, the global sensitivity was 0.93, and the specificity was 0.97; however, including all cases and the inadequate samples as false negatives, the sensitivity is lower--0.71. TNB required some skill, the use of fine needles, and the collaboration of an expert cytopathologist. TNB is an important method with which to explore intrathoracic pathology.

Open window thoracostomy and plastic surgery with muscle flaps in the treatment of chronic empyema

Open window thoracostomy (OWT) and plastic surgery using myocutaneous flaps of extrathoracic muscles, was done in nine patients with chronic empyema, after conventional therapy had failed. In all these patients, the pleural cavity and bronchopleural fistulas, when present, closed within eight to 61 days (mean 30), after the second stage of surgery comprising the myoplasty; this in turn was performed between three to seven (mean 3.0) months after the OWT. All patients were considered cured with a minimal deformity of the chest wall. The final scar had an acceptable cosmetic appearance.

Effects of vitamin A in the presence of vitamins D3, E, K1 on red cell membrane structure

The incubation of erythrocyte ghosts with mixtures of vitamins A+D3, A+E, A+K1 produces decrease or increase of fluorescence anisotropy r of the DPH probe, depending on the vitamin/vitamin ratio. We found a correlation between the order parameter S and cell fusion phenomena observed by phase contrast microscopy.