The humoral immune response to the kinetoplastid membrane protein-11 in patients with American leishmaniasis and Chagas disease: prevalence of IgG subclasses and mapping of epitopes

The kinetoplastid membrane protein-11 (KMP-11) is a major target of the humoral immune response during Leishmania-infections. The majority of sera from visceral leishmaniasis, mucocutaneous leishmaniasis and even some cutaneous leishmaniasis patients contain detectable IgG antibodies against KMP-11. We also provide evidence that this protein may act as a potent antigen in T. cruzi infections, since most Chagas sera show immunological cross-reactivity. Therefore, KMP-11 cannot be used as a specific diagnostical tool for the serodiagnosis of leishmaniasis in those regions where both, Leishmania and T. cruzi infections overlap geographically. When analyzing the subclass specificity of the antibody response to KMP-11 we observed the following order of reactivity: IgG1 > > IgG3 > IgG2 > IgG4, which is similiar to that seen in crude parasite extract. The mapping of antigenic determinants by using synthetic 20-mer peptides revealed the existence of predominantly conformational epitopes in leishmaniasis, while 50% of sera from Chagas patients reacted with a particular KMP-11 peptide. These results therefore suggest the presence of disease-specific B-cell epitopes.

Reelin expression during embryonic brain development in lacertilian lizards

The expression of reelin mRNA and protein was studied during embryonic brain development in the lacertilian lizards L. viridis and L. galloti, by using radioactive in situ hybridization and immunohistochemistry. At all stages studied, high reelin expression was consistently found in the olfactory bulb, in the lateral cortex, and in neurons of the marginal zone and subplate of medial and dorsal cortical sectors. In the dorsal ventricular ridge (DVR), reelin expression was confined to deeply located, large cells which were more abundant in the caudal than the rostral part of the DVR. In the diencephalon, the ventral lateral geniculate complex and the perirotundal were strongly positive, whereas other nuclei were mostly negative. High reelin signal was associated with some layers in the tectum, with the torus semicircularis, cerebellar granule cell layers, and the ventral horn of the spinal cord. A more moderate signal was detected in the septal nuclei, striatum, retina, habenular nuclei, preoptic and periventricular hypothalamic components, and in reticular nuclei of the mid- and hindbrain. The medial and dorsal cortical plate and Purkinje cells were reelin-negative but expressed disabled-1 (Dab1) mRNA. When they are compared with reelin expression during mammalian brain development, our data reveal an evolutionarily conserved canvas of reelin expression, as well as significant differences, particularly in developing cortical fields. The developing lizard cortex differs from that of turtles, birds, crocodiles, and mammals in that it displays heavy reelin expression not only in neurons of the marginal zone that might be homologous to mammalian Cajal-Retzius cells, but also in subplate neurons. This difference in the pattern of reelin expression suggests that the elaborate radial organization of the lacertilian cortical plate, somewhat reminiscent of its mammalian counterpart, results from evolutionary convergence. Our data lend support to the hypothesis that the reelin signaling pathway played a significant role during cortical evolution.

[Factors to consider in the evaluation of intellectual achievement of an epileptic child]

In this paper, factors related to the intellectual achievement of epileptic children are reviewed. These should be taken into account by medical and paramedical staff when making the intellectual prognosis of each patient. The factors related to epilepsy include: The type of crisis and epileptic syndrome, the aetiology of the epilepsy, genetic factors, age of onset, duration of the disorder and frequency of crises, electroencephalographic alterations, a history of status epilepticus, the antiepileptic drugs and their metabolic effects. The most important psychosocial factors are: The school, the family and the patient's personality. The significance of the multifactorial effects is emphasized.

[Influence of epilepsy-related factors on scholastic achievement in an epileptic child]

We studied 30 children aged between 5 and 12 years (mean = 8.7 years: standard deviation = (+)-1 9678) who suffered from partial epileptic crises, with or without secondary generalization, cryptogenic, who had had this disorder for more than one year, and who attended ordinary schools. The objective was to ascertain the educational results obtained, and to evaluate the effect of some of the factors related to epilepsy, in these results. The scholar's family was interviewed in all cases to record: the age of onset and duration of the illness, the frequency of crises, attendance at school and results obtained in the previous school year. The school results were: 5 children had results E (16.67%). 10 (33.33%) were classed as MB, 6 (20%) as B, 5 had R (16.67%) and 4 (13.33%) were evaluated as M. It is concluded that the factors most closely related to poor school results in the group studied were: a frequency of more than three crises in the previous year, partial crises with secondary generalization and failure to attend school because of crises.

[Intellectual achievements of the epileptic child in primary school]

Thirty children aged between 5 and 12 (M = 8.7 years, DS = +/- 1.9678) who suffered from cryptogenic partial crises, with or without secondary generalization, for more than one year and attended primary schools for normal children were studied to determine their intellectual achievements. Evaluation of intellectual output (WISC) was done for all these children. These findings were then compared with a control group of 30 children matched for age, sex and school grade using the mean comparison tests. In the group studied there was an average IQ of 90.03 and in the control group of 97.00 with a significant difference between both groups (p < 0.05). The implementing and subtest keys (p < 0.05) also showed significant differences. It is concluded that there is a significant difference in the quantitative expression of intellectual output between the two groups in spite of there being a normal mean and that the frequency of borderline cases is significantly greater in the group of epileptic children.

Metformin's effects on glucose and lipid metabolism in patients with secondary failure to sulfonylureas

OBJECTIVE

To compare results obtained with metformin versus those obtained with DNA-recombinant insulin in obese patients with NIDDM suffering from secondary failure to sulfonylureas.

RESEARCH DESIGN AND METHODS

We conducted an open, prospective, randomized, and comparative study comprising a total of 60 patients selected and placed in two parallel groups. We had previously confirmed that the subjects had secondary failure to high doses of sulfonylureas. The initial metformin dosage was a single 850 mg tablet, and the dosage was increased to two or three tablets depending on the patient's metabolic changes. The initial dosage of DNA-recombinant insulin was 24 U, subcutaneously administered and divided into two portions: two-thirds at around 8:00 A.M., before breakfast, and the remaining third at 8:00 P.M., before dinner. The dosage was adjusted based on the patient's clinical and metabolic response.

RESULTS

The initial average glucose value for the metformin group was 269.1 +/- 32.2 mg/dl, decreasing by the end of the study to 159.7 +/- 30.5 mg/dl. For the insulin group, these figures went from 270.7 +/- 24.0 mg/dl at the beginning of the study to 134.8 +/- 26.7 mg/dl. This decrease correlates with the reduction in glycosylated hemoglobin from 12.8 to 8.9% for the first group and from 12.3 to 8.2% for the second, as well as with the reduction in triglyceride values from 230.3 to 183.1 mg/dl and from 218.4 to 186.3 mg/dl, respectively. The BMI (27.5-26.4), blood pressure (systolic from 145.7-132.1 mmHg, diastolic from 90.3-84.8 mmHg), and total cholesterol levels (235-202 mg/dl) decreased in only the metformin group.

CONCLUSIONS

Metformin is an effective, safe, and well-tolerated treatment that improves metabolic control and favorably modifies secondary clinical alterations due to insulin resistance, such as arterial hypertension, overweight, and hyperlipidemia, in obese patients with NIDDM suffering from secondary failure to sulfonylureas.

[Coloanal anastomosis (Parks operation) in the treatment of acute radiation rectitis]

AIM

To assess immediate and late results of Parks operation in the treatment of severe radiation rectitis.

PATIENTS AND METHOD

Retrospective review of clinical histories of 35 patients with uterine cervical cancer, 5 with endometrial cancer and one with vaginal cancer that received radiotherapy. Two years as a mean after radiotherapy, 14 women had rectal bleeding, 19 fistulae, 7 stenosis and 1 a rectal ulceration. All were initially treated with a discharge colostomy and after a mean interval of 1.6 years, a Parks operation was performed.

RESULTS

One patient died after surgery (2.4%) due to peritonitis and sepsis. Early surgical complications were necrosis of descended colon in 2, intra-abdominal abscess in 1, splenic rupture in 1 and postoperative bleeding in 1. Colostomy was closed in 37 patients three months after surgery. During late follow up (ranging from 3 to 64 months) rectal continence has been assessed as good in 30 patients, fair in 5 and bad in 2. Three women required a new colostomy.

CONCLUSION

Parks operation is a viable therapeutic alternative for severe radiation rectitis.

[Leiomyosarcoma of the inferior vena cava. Presentation of 1 case of autopsy and review of the literature]

This is a clinico-pathological report of a 30 years old male patient that presented with acute epigastric pain. Ultrasound examination showed a retroperitoneal tumor, thrombosis of the inferior vena cava and ascites. CAT scan disclosed thrombosis of hepatic vein and inferior vena cava with right atrium involvement. Necropsy showed a leiomyosarcoma of the inferior vena cava. There are seldom reports of this tumor in the last 5 years and an early diagnosis allows therapeutic interventions associating surgery, radiotherapy and chemotherapy.

[Soft tissue sarcoma. Combined treatment of drug therapy, radiotherapy and conservative surgery]

The preliminary results of a prospective and cooperative protocol for the treatment of soft tissue sarcomas of trunk and extremities, stages IB-IIIB are presented. Thirty one patients (17 males, 22 with a tumor larger than 5 cm) aged 16 to 68 years, were treated with one dose of epirubicin 70 mg/m2 i.v. and radiotherapy (3000 rads in 10 fractions) Two or three weeks later an ample surgical complications occurred in 6 patients and were all of infectious origin. The median follow up period has been of 26 months. During this period 5 patients presented late surgical complications (edema in 4 and a pathological fracture in 1), 2 patients had a local tumor recurrence and distant metastases appeared in 7. Actuarial survival was 60% at 48 months. Ninety six percent of surviving patients conserved their extremity. It is concluded that with this treatment modality local recurrence is acceptable, morbidity is low and that the majority of patients do not require amputations or crippling resection.

Prospective study of amniocentesis performed between weeks 9 and 16 of gestation: its feasibility, risks, complications and use in early genetic prenatal diagnosis

This paper demonstrates that the outcome of amniocenteses performed between the 9th and the 14th weeks is similar to that of amniocenteses performed between the 15th and 20th weeks. We have performed and prospectively followed 615 amniocenteses between the 9th and 16th weeks of gestation. The outcome, risks, and complications are similar to those of amniocenteses at the usual time (after 15 weeks) and to the other groups of early amniocentesis (before 15 weeks). Early amniocentesis differs from amniocentesis at the usual time in that it carries higher rates of fetal losses and of amniotic fluid leakage, more confined cytogenetic abnormalities, and an increased number of patients who have the procedure postponed. Two cultures (0.32%) failed to produce results, 595 (96.7%) samples were obtained at the first tapping, 20 (3.3%) at the second attempt. alpha-Fetoprotein levels reach their maximum at 13 weeks. Amniocenteses between 15 and 16 weeks (293, or 47%) constitute the control group, those between 9 and 14 weeks (322) the experimental group. Early amniocentesis appears to be a safe early genetic prenatal diagnosis technique, an alternative to chorionic villi sampling.

[Acute cardiac rupture in myocardial infarction. A case report]

A 60 year old woman with a large anterior wall myocardial infarction developed severe hypotension 12 hr after admission to the coronary care unit. X rays showed an enlarged cardiac shadow and echocardiography signs of pericardial effusion. Swan Ganz catheterization revealed severe venous hypertension and no suggestion of ventricular septal rupture. Emergency surgery, initiated with partial cardiopulmonary bypass, showed a 1 cm tear of the anterior wall of the left ventricle, close to the left anterior descending artery. A successful repair was obtained by suture on teflon pledgets. After a difficult postoperative course, the patient was doing well 8 months after surgery.

El género Panphalea (Compositae: Nassauvieae) en Uruguay

Se realiza la revisión taxonómica de Panphalea Lag. (Compositae: Nassauvieae) para Uruguay. Panphalea en Uruguay consiste de cinco especies: Panphalea bupleurifolia Less., Panphaleacardaminifolia Less., Panphalea commersonii Cass., Panphalea heterophylla Less. y Panphalea maxima Less. Todas las especies uruguayas fueron evaluadas y circunscriptas en base al análisis de los protólogos, análisis de laboratorio, estudio cuidadoso del material tipo, observación de especímenes de herbario y observaciones a campo. Se presenta una clave dicotómica para la identificación de las especies reconocidas para el Uruguay. Para cada especie se provee sinonimia, descripciones ampliadas, distribución geográfica y dibujos. Se designan dos neotipos