[Asplenia syndrome with duodenal stenosis]

We report a patient with asplenia syndrome. To our knowledge this is the first case described of asplenia syndrome with duodenal stenosis and no heart anomalies. An other important finding has been the absence of vomiting in her symptomatology.

Detection of cytomegalovirus in urine of HIV-infected patients by DNA-DNA hybridization comparison with virus isolation, immunofluorescence and immunoperoxidase

Immunofluorescence and immunoperoxidase test directed against early viral antigens, and DNA-DNA hybridization were compared with viral isolation for their abilities to detect Cytomegalovirus (CMV) in the urine of 89 HIV infected patients. From the 100 urine samples collected, 70 were found positive by at least one method. Considering viral isolation as the "gold standard" technique, immunofluorescence and immunoperoxidase had a sensitivity of 92.3% and 88% respectively, with a specificity in both cases of 95%. DNA-DNA hybridization showed a sensitivity of 90% but with lower (60%) specificity. All of the three assays were effective in detecting CMV from urine and the technical advantage of each is discussed.

[Toloxatone and depression]

One hundred and one depressed inpatients were treated by the authors with a second-generation antidepressive original molecule: Toloxatone, a specific and reversible MAO A inhibitor. Upon admission, all 101 patients with depressive illness did not score higher than 20 on Hamilton's Scale, and did not score lower than 4 on Fischer, Fernández Labriola and Rodríguez Casanova's Endogeneity Test. Biological profiles (Phenyl-ethylamine, NA, and MHPG) were available on 57 subjects. At the beginning of the experiment: (a) No subject was taking antidepressives, (b) Patients' age averaged 46; (c) The 6-week experiment was a double-blind vs. placebo type. Daily toloxatone dose was standardized in a 400 mg intake. Significant modifications were detected in 51 subjects. Among the 59 subjects that were administered active substance, 37 achieved either "excellent" or "good" outcomes. Biological markers pointed out a profile of patients with a better response to Toloxatone: Namely, patients with a lower noradrenergic activity. Anxiety-free depression as well as inhibited depressions are a psychiatrist's choice for administering Toloxatone.

Diagnostic potential of IgA coated Candida cells in mucous membrane candidiasis

The significance of in vivo IgA coated yeast cells for the diagnosis of candidiasis of the oral and vaginal mucosal membranes was evaluated by direct immunofluorescence in 70 patients with or without clinical symptoms, shown to be positive for yeast growth in the cultural test. Most of the patients with clinically suspected candidiasis of the mucosal membranes gave positive results by serologic assays in contrast to the majority of symptomless patients. The diagnostic approach proved to be essentially consistent with the clinical signs, persistence of infection, response to antifungal therapy and quantitative cultural data.

Characterization of two aminoglycoside-(3)-N-acetyltransferase genes and assay as epidemiological probes

Two genes encoding for aminoglycoside-(3)-N-acetyltransferases (AAC(3)s) of different substrate patterns, present in multiresistance plasmids of hospital strains of Serratia marcescens and Escherichia coli isolated from urine, have been cloned and characterized. The first, aacC1 with AAC(3)I activity, contained a 531 base pair open reading frame which encodes a polypeptide of 177 aminoacids and 19,392 daltons, confirmed by minicell analysis. Its sequence differed from previously published work in four positions. Three of the changes did not alter the aminoacid sequence while the fourth was a substitution of an alanine by a proline. The second gene, an AAC(3)II encoded by aacC2, resulted from the translation of an 858 base pair open reading frame, which encoded a 286 aminoacid polypeptide of 31,574 daltons and was identical to those from plasmids isolated in Germany and the United States. However, the homology was broken in a position between the -10 and -35 promoter sequences, which resulted in different -35 hexanucleotides and levels of resistance conferred. The assay of both genes as molecular probes has revealed their specificity with respect to other aac genes, although their usefulness was limited in the case of aacC1 derived sequences to isolated plasmid DNA, since it hybridized under stringent conditions with chromosomal DNA of some strains of E. coli.

[Detection of cytomegalovirus by the immunoperoxidase technique and viral isolation]

An Immunoperoxidase assay was applied to detect early antigens of cytomegalovirus (CMV) in 150 urine samples from immunocompromised patients, using the commercial available monoclonal antibody against CMV E13. The detection of early antigen by IP (IPCMV) is compared to the conventional cell culture isolation regarding specificity and sensitivity in order to evaluate is usefulness in the diagnostic of CMV infections. The IPCMV showed a sensitivity of 89.8% and a specificity of 91.3% when compared to the isolation method. The great advantage of the IPCMV is based on the shorter time results are achieved, since 48-72 Hs can be enough to provide evidence of CMV infection, while in the isolation technique cytopathogenic effect was present around 14 days after sample inoculation.

[The use of computed tomography in assessing parotid masses]

Thirty-one patients with suspected parotid masses have been studied by computed tomography (CT) without and with contrast to demonstrate the existence of this and to value possible relation between degrees of malignancy and the morphological characteristics of the masses.

The Higher Fullerenes: Isolation and Characterization of C76, C84, C90, C94, and C70O, an Oxide of D5h-C70

The toluene extract of the fluffy carbon material produced by resistive heating of graphite contains a variety of molecules larger than C(60) and C(70) in a total amount of 3 to 4% by weight. Repeated chromatography of this material on neutral alumina has led to the isolation of stable solid samples of C(76), C(84), C(90), and C(94). The characterization, which includes mass spectrometry, (13)C nuclear magnetic resonance, electronic absorption (ultraviolet/visible) and vibrational (infrared) spectroscopy identifies these all-carbon molecules as higher fullerenes. In addition, C(70)O, a stable oxide, has been isolated that is structurally and electronically closely related to D5h-C(70). This compound forms during the resistive heating process and probably has an oxygen atom inserted between two carbon atoms on the convex external surface of the C(70) skeleton.

[ELISA for detecting antibodies against herpes simplex virus]

The results are presented of the normalization of an indirect ELISA test for detecting herpes simplex antivirus antibodies, and the conditions and criteria for positive tests are established. It was applied to 89 serum samples from patients with immunodepression and to 76 samples from blood bank donors. The results of the survey were compared by the indirect immunofluorescence technique.

[Microbiological quality of spices consumed in Cuba]

The microbiological quality of some widely consumed spices in Cuba was evaluated by means of aerobic mesophilic microorganisms count, filamentous fungi, yeasts, coliforms, thermophilic and thermoresistant microorganisms. Salmonella spp was looked for too. Black pepper and cumin resulted the most contaminated spices with values of total count and thermoresistant microorganisms at levels of 10(6) per gram, and coliform values up to 10(5) per gram. Oregano and cinnamon showed satisfactory microbiological quality; the contamination detected in these spices was lower than 10(4) per gram. Salmonella spp and yeasts were not detected.

[Sublingual captopril versus nifedipine in the treatment of hypertensive crisis]

The currently accepted drug of choice for treatment of hypertensive crisis is sublingual nifedipine. We compared the effects of sublingual captopril (25 mg) to those of nifedipine (10 mg) in 54 patients with this complication who came to the emergency room. Five min after administration of captopril, blood pressure decreased from 197.5 +/- 32.7/118.3 +/- 8.2 to 156 +/- 27.2/95.8 +/- 12.9 mmHg and heart rate decreased from 87.9 +/- 15.1 to 74.7 +/- 10.9 (p < 0.05). Blood pressure in the nifedipine group decreased from 198 +/- 27.3/120 +/- 9.8 to 147.7 +/- 17.8/86 +/- 17.9 (p < 0.05), while no change was observed in heart rate. Delayed measurements showed lower diastolic pressures at 60 and 75 min and lower systolic pressure at 120 min in the nifedipine group (p < 0.054). Few and not significantly different side effects were observed with both drugs. Thus, sublingual captopril is useful for treatment of hypertensive crisis.

Acyclovir resistant genital herpes virus infection in a patient with AIDS

Three acyclovir resistant strains of HSV-2 were isolated from mucoulcerative lesions in a patient suffering from AIDS in whom the oral and intravenous acyclovir treatment was unsuccessful. All the isolates were classified by monoclonal antibodies and showed no differences in DNA restriction patterns.

Dot ELISA for direct detection of BK virus in urine samples

The dot ELISA technique was applied for direct detection of BK virus in clinical urine samples. The assay was performed on nitrocellulose paper dotted with the polyethylene glycol precipitated urine samples free of cellular debris. BK virus was detected with an anti-BK virus monoclonal antibody, and the complex was visualized by immunoperoxidase staining. Positive reaction appeared as well-defined dark blue spots. Of the 110 urine samples examined, 31 were positive in the dot ELISA and 79 proved negative. Comparing with the IIF results, the dot ELISA had a 88.46% of sensibility and 90.4% of specificity, and the results agreed completely in 99 samples. The simple dot ELISA technique can be recommended for detection of BK virus excretion in routinary diagnostic.

Contemporary management of a potentially lethal fetal anomaly: a successful perinatal approach to epignathus

Prenatal diagnosis of epignathus (a teratoma originating in the oropharynx) has been reported previously. However, in many of these cases the neonates succumbed to acute respiratory distress secondary to airway obstruction at the time of birth. We describe a case of antepartum diagnosis of epignathus using ultrasonography and magnetic resonance imaging as complementary techniques. The ability to accurately define the fetal anomaly permitted us to plan a unique strategy for peripartum management. After cesarean delivery of the infant from the uterus, the umbilical cord was not clamped and the fetoplacental circulation was left undisturbed. A tracheostomy was then performed, after which the umbilical cord was clamped and the infant was stabilized. Several hours later, a debulking procedure was performed in the operating room to remove the tumor from its attachment to the bony palate. Both mother and infant did well postoperatively. The ability to plan and perform a controlled tracheostomy while the infant remained oxygenated and ventilated proved to be lifesaving in this case.

High-dose intravenous gamma globulin: does it have a role in the treatment of severe erythroblastosis fetalis?

The role of high-dose intravenous (IV) gamma globulin in the treatment of erythroblastosis fetalis was assessed in five pregnancies with severe Rh (four) or Kell (one) isoimmunization. These women were treated with IV gamma globulin (1.0 g/kg body weight) once a week. In addition, fetal blood transfusions were performed when indicated. In four patients with Rh sensitization, high-dose IV gamma globulin treatment had no apparent effect on the total number of intrauterine transfusions required, the interval between transfusions, or the volume of blood required at each transfusion. The treatment did not prevent fetal hydrops and had no effect on maternal antibody titers. In one patient with Kell sensitization, however, the course of the disease was less severe than anticipated, suggesting that IV gamma globulin treatment may have modified the severity of the disease. We conclude that high-dose IV gamma globulin does not appear to be useful in the treatment of severe Rh disease. Its role in Kell and other types of red-cell isoimmunization deserves further evaluation.

[Munchausen's syndrome: a study of 6 cases]

We report 6 patients with Munchausen syndrome, a fictitious disorder with physical symptoms. There were 4 females and 2 males, the age ranged from 21 to 29 years. Abdominal pain (2), hemoptysis, shock and hypoglycemia were the presenting symptoms. The diagnosis was made after a prolonged and costly hospital course, including invasive and non invasive diagnostic procedures. Two patients were ill enough to be at risk of death. An early diagnosis may help prevent unnecessary or risky procedures in these patients.