[The most common conditions in a neurology specialty clinic]

OBJECTIVE

To present the most frequent diagnosis among patients referred for neurological evaluation to estimate their labour capacities at the unit of National Institute of Social Security (INSS), Florianópolis-SC, southern Brazil.

METHOD

Review of all medical records of 108 patients evaluated between October 97 and May 98. The sample was submitted to judicious medico-legal assessment to define their final diagnosis.

RESULTS

Neurological evaluation disclosed as the commonest disorders, in decreasing order of frequency: epilepsy, rheumatic diseases, psychiatric illnesses, neurological disorders related to chronic alcoholism, head trauma syndrome and cerebrovascular diseases.

CONCLUSION

Neurological disorders may be responsible for important disability among workers in our society. However, the potential for social rehabilitation, often underestimated, must be considered. Moreover, diverse non-neurological conditions used to be sent for neurological evaluation.

Prognostic value of simple measurement of chronic damage in renal biopsy specimens

BACKGROUND

A simple method of measurement of chronic damage in renal biopsy specimens would be useful in clinical management, prognosis, comparisons between different centres and trials.

METHODS

An interactive image analysis system was used to outline and measure areas of chronic damage in 247 renal biopsy specimens to give an index of chronic damage, expressed as a percentage of cortical cross-sectional area. Prognostic value was analysed by the Kaplan-Meier method to study time between biopsy and onset of permanent dialysis.

RESULTS

There was no significant bias between measurements by the same observer or different observers. The index of chronic damage ranged from 0 to 90%. Increasing severity of chronic damage was associated with shortened renal survival. Each increase of 10% in the index increased the hazard ratio of risk of permanent dialysis by 1.5 times (95% confidence interval 1.4-1.7, P<0.001).

CONCLUSIONS

A simple measure of chronic damage was a powerful indicator of prognosis. This is likely to be clinically useful in routine practice and trials.

Effects of storage time and temperature on atresia of goat ovarian preantral follicles held in M199 with or without indole-3-acetic acid supplementation

Maintenance of follicular quality after removal and during transport of ovaries is necessary for studies on development of preantral follicles in vitro. The present work investigated the effectiveness of M199 and M199IAA for preservation of goat preantral follicles in ovarian tissue. At the slaughterhouse, the ovarian pair of each animal was divided into 19 fragments. One ovarian fragment was immediately fixed (control--Time 0). The other 18 fragments were randomly distributed in M199 or M1991AA at 4, 20 or 39 degrees C and stored for 4, 12 or 24 h. Histological analysis showed that storage of ovarian fragments in either solution at 20 or 39 degrees C significantly reduced the percentage of normal preantral follicles when compared with the control, in all cases except after preservation in M199IAA at 20 degrees C for 4 h. In contrast, preservation at 4 degrees C, in either solution, kept the percentage of normal preantral follicles at control values. Reduced cellular metabolism may explain why the best preservation of preantral follicles was at 4 degrees C. The addition of IAA to the TCM 199 was effective for goat preantral follicle preservation at 20 degrees C for 4 h.

Analysis of phenolic compounds in Spanish Albrariño and Portuguese Alvarinho and Loureiro wines by capillary zone electrophoresis and high-performance liquid chromatography

The concentration of different phenolic compounds was measured in Spanish Albariño and Portuguese Alvarinho and Loureiro white wines by capillary zone electrophoresis (CZE), in order to characterize them. Although all samples presented the same qualitative pattern (characterized by tyrosol; (-)-epicatechin; syringic acid; ferulic acid; p-coumaric acid; caffeic acid, gallic acid; 3,4-dihydroxybenzoic acid; cis-coumaroyl tartaric acid (COUTA); trans-COUTA; trans-caffeoyl tartaric acid (CAFTA), and hydroxycinnamic esters), some quantitative differences were observed. When samples were analyzed by high-performance liquid chromatography (HPLC), in order to compare the results obtained by both techniques, no significant qualitative or quantitative differences were obtained. Nevertheless, CZE proved to be a more convenient technique for the routinary analyses of these wines, due to better separation of the different compounds, better peak shapes, and higher speed than HPLC.

Morphological and ultrastructural changes occurring during degeneration of goat preantral follicles preserved in vitro

The present work has investigated the morphological and ultrastructural changes occurring during degeneration of goat preantral follicles preserved in vitro and showed quantitative data about the distribution of follicular degeneration types in the control and after preservation in coconut water solution or Braun-Collins solution at different temperatures (4, 20 or 39 degrees C) and incubation times (4, 12 or 24h). At the slaughterhouse, the pair of ovaries of each animal was divided into 19 fragments. One ovarian fragment was immediately fixed (control: Time 0). The other 18 fragments were randomly distributed in tubes containing 2ml of coconut water or Braun-Collins solution at 4, 20 or 39 degrees C and stored for 4, 12 or 24h. Normal preantral follicles exhibited a healthy oocyte surrounded by one or more well-organized layers of granulosa cells. The ooplasm contained numerous rounded or elongated mitochondria with continuous mitochondrial membranes. Golgi complexes were rare. Both smooth and rough endoplasmic reticulum were observed, either as isolated aggregations or complex associations with mitochondria and vesicles. Degenerated preantral follicles in the control tissue exhibited pycnotic nuclei of the oocyte, vacuolated ooplasm and normal granulosa cells. This kind of degeneration also predominated significantly (P<0.05) after preservation at 4 degrees C. In contrast, after preservation at 20 or 39 degrees C a significant predominance (P<0.05) of preantral follicles showing a retracted oocyte and swollen granulosa cells was observed. These follicles showed large irregularity of the oocyte and nuclear outlines. The ooplasm exhibited moderate proliferation of the endoplasmic reticulum and mitochondria showed disappearance of most of the cristae and damage to the mitochondrial membrane. Some follicles had numerous vacuoles in the ooplasm. Granulosa cells were spread and a low density of organelles was observed. The alterations in follicular structure progressed with an increase of temperature from 20 to 39 degrees C as well as with an increase of the incubation time from 4 to 12, or 24h. In conclusion, the present study shows for the first time that initial proliferation of the endoplasmic reticulum and damage to mitochondria are the first signs of degeneration in goat preantral follicles during storage in vitro.

[Brazilian Nurses Association-Rio de Janeiro Chapter: a short history]

The objective of the present article is to reveal the work done by the Brazilian Association of Nursing (ABEn) in the federal state of Rio de Janeiro along its fifty-five years of history. It describes the foundation of the main office and regional branches, the acquisition of the building for the headquarters, the promotion of events, awards offered, achievements and other interesting facts that constitute the history of this association. The study also brings the names of the presidents and vice-presidents from 1963 until the present days. It finalizes with the event of the assassination of the president of the association and his wife, in 1999.

Differential effects of thalidomide on angiogenesis and tumor growth in mice

Thalidomide, clinically used as an antiinflammatory and antitumoral drug, inhibited sponge-induced angiogenesis when administered systemically (100 mg/kg(-1)) in mice. However, it failed to inhibit solid Ehrlich tumor in the same mouse strain. We have used functional, biochemical and histological parameters to assess neovascularization and fibrovascular tissue infiltration of the mice sponge granuloma. The neovascularization growth as detected by development of blood flow and hemoglobin content extracted from the implants showed that thalidomide inhibited fibrovascular tissue formation by 40%. The functional and biochemical parameters correlated well with the histological study. Thalidomide had no inhibitory effect in the development of Ehrlich tumor. The detection of this selective action using the same animal strain bearing two different processes, supports the hypothesis that rather than species specificity, thalidomide is tissue specific. This approach may be used to identify the specificity of other therapeutic agents against distinct angiogenesis-dependent diseases.

HPLC/UV analysis of proteins in dairy products using a hydrophobic interaction chromatographic column

High-performance liquid chromatography using a Chrompack P-300-RP column containing a polystyrene-divinylbenzene copolymer-based packing was examined to analyze bovine milk protein components. The separation of major raw-milk proteins could be performed rapidly and reliably with this HPLC/UV method. The determinations were performed in the linear ranges of 0.01-2.0 mg/ml for alpha-lactalbumin, 0.04-2.5 mg/ml for caseins and 0.02-2.0 mg/ml for beta-lactoglobulin. The validity of the method was verified. Since the chromatographic column enabled the quantification of only "native" milk proteins, the extent of denaturation and loss of milk proteins could be examined. Thus, evaluation of heat-induced proteins denaturation was carried out in raw milk heated for 5 min at pre-determined temperatures.

Evidence of type II pneumocyte apoptosis in the pathogenesis of idiopathic pulmonary fibrosis (IFP)/usual interstitial pneumonia (UIP)

BACKGROUND/AIMS

The pathogenesis of idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), a chronic and incurable human respiratory disease, is not well established. This study was designed to investigate whether the apoptosis of type II pneumocytes could be the precipitating factor in the pathogenesis of IPF.

METHODS

Nineteen specimens obtained by retrospective review of the medical and pathological records of 55 patients with IPF, four normal subjects, and 10 disease control lungs were analysed. The selected specimens had normal alveoli with intervening patchy scarring of the lung parenchyma, fulfilling the pathological criteria for UIP. To identify individual cells undergoing apoptosis in the normal alveoli, electron microscopy and in situ end labelling of fragmented DNA were performed on paraffin was embedded sections using digoxigenin-11-dUTP and the enzyme terminal deoxynucleotidyl transferase.

RESULTS

Apoptosis was detected in the normal alveoli of 17 of the 19 patients with IPF/UIP and was absent in the controls. Electron microscopy demonstrated apoptotic changes in type II pneumocytes. These results indicate that apoptotic type II pneumocyte death occurs in normal alveoli of IPF/UIP and could be the principal cause of several events that account for the histological, clinical, and functional alterations seen in IPF/UIP.

CONCLUSIONS

In conclusion, numerous type II pneumocytes from the normal alveoli of most patients with IPF/UIP actively undergo programmed cell death. This finding may shed new light on the pathogenesis of this disease, with implications mainly for the treatment of affected patients.

Structural characterisation of flavonoids and flavonoid-O-glycosides extracted from Genista tenera by fast-atom bombardment tandem mass spectrometry

Genista tenera is a plant native to the Madeira Island (Portugal). From the ethanol extract of its powdered aerial parts, two flavones, three isoflavones and one 7-O-glucosyl isoflavone were isolated. A mass spectrometric study of these compounds was performed using liquid secondary ion mass spectrometry (LSIMS) in combination with high-energy collision-induced dissociation (CID) and tandem mass spectrometry (MS/MS). Characteristic fragmentation patterns were observed in all the investigated compounds; the loss of small neutral species from the protonated molecules was useful for identifying the presence of specific functional groups in the A- and B-rings. In order to help to establish the proposed structures, NMR and UV studies were also performed.

Renal pathological findings in infective endocarditis

BACKGROUND

Accounts of renal pathological findings in infective endocarditis are mostly based on studies from many years ago. We reviewed a group of patients with infective endocarditis in the light of modern concepts of renal pathology, including the largest reported series of renal biopsies in this condition.

METHODS

Renal tissue was available for retrospective study from 62 patients with confirmed infective endocarditis out of 354 diagnosed with the disease between 1981 and 1998 inclusive. Twenty patients had a renal biopsy and 42 a necropsy.

RESULTS

Common renal lesions noted were localized infarcts in 31%, noted only in necropsy material, and acute glomerulonephritis in 26%, noted in biopsy and necropsy material. The commonest type of glomerulonephritis was vasculitic, without deposition of immunoproteins in glomeruli. Of the renal infarcts over half were due to septic emboli, mostly in patients infected with Staphylococcus aureus. Acute interstitial nephritis was found in 10% but was more common in biopsy material and seemed attributable to antibiotics. Renal cortical necrosis found in 10% was apparent only at necropsy. There were various other findings in the kidney.

CONCLUSIONS

The kidneys are commonly affected in infective endocarditis by a variety of complications of clinical significance. The commonest type of glomerulonephritis does not appear to be attributable to deposition of immune complexes. A renal biopsy may be helpful in the investigation of renal impairment in a patient with infective endocarditis.

Treatment of vasculitic IgA nephropathy

BACKGROUND

Patients with IgA nephropathy and histological vasculitic/crescentic lesions have a poor prognosis. We performed a retrospective study to assess whether treatment with steroids and immunosuppressants would preserve renal function by healing these lesions and thereby prevent progression to glomerular sclerosis and renal failure.

METHODS

Sixteen patients with IgA nephropathy and a vasculitic/crescentic glomerulonephritis diagnosed by renal histology were treated with a reducing course of prednisolone (initial dose 60 mg/day). Six patients also received cyclophosphamide (2 mg/kg/day) for three months followed by azathioprine (100 mg/day) in five patients. Ten patients received azathioprine (100 mg/day) in addition to prednisolone. The median duration of treatment was 12 months (range 5-30 months). At the end of treatment each patient had a second renal biopsy.

RESULTS

Following treatment there was a significant reduction in the proportion of glomeruli with acute vasculitic lesions from a median of 17.4% (range 4.8-57.5%) to 0 (range 0-15.8%) (p=0.001). There was an increase in the proportion of globally sclerosed glomeruli from a median of 13.4% (range 0-44.4%) to 21.5% (range 0-90%) after treatment but this did not significantly differ from baseline (p=0.24). The proportion of renal cortex with chronic tubular atrophy increased from 2.55% (0.4-57.7%) to 11.3% (0.3-61%) (p=0.09). The median duration of follow-up was 30 months (inter-quartile range 6-30 months). At both 12 and 24 months there was no significant increase in serum creatinine. Four patients, however, developed end-stage renal failure between 24 and 81 months.

CONCLUSION

In this retrospective study we show that treatment with steroids and immunosuppressants leads to healing of vasculitic lesions and may thus arrest progression of glomerular scarring.

Persistent trigeminal artery: a unique anatomic specimen--analysis and therapeutic implications

OBJECTIVE

Persistent primitive carotid-basilar artery anastomoses are uncommon, and are usually seen on an angiogram or discovered at autopsy. The most frequent type of anastomosis is the persistent trigeminal artery.

METHODS

A single case of a medial variation of the persistent trigeminal artery, as seen in a well-preserved human adult anatomic specimen injected with red latex, is presented, and the anatomy of this uncommon anastomosis is discussed.

RESULTS

This specimen is unique in its clear preservation of the artery, which arises from the medial portion of the right intracavernous carotid artery and gives rise to two branches, the inferior hypophyseal artery and the dorsal meningeal artery to the clivus.

CONCLUSION

A new variation of the persistent trigeminal artery is described, which is important to support the possibility that more than one variety of carotid-basilar anastomosis exists in this region.

Discriminate analysis of roasted coffee varieties for trigonelline, nicotinic acid, and caffeine content

Arabica and robusta roasted coffees from several geographical origins, in a total of 29 samples, were characterized for their contents in caffeine, trigonelline, and nicotinic acid by a recently developed HPLC/diode-array detector method. All samples were subjected to the same roasting procedure in order to eliminate the variations due to this process. Characterization was achieved by applying multivariate and nonparametric analysis to the chromatographic results. The two coffee varieties were clearly separated by their trigonelline and caffeine contents. Nicotinic acid could not be used as a variety discriminate factor. There was no association with the geographical origin of the samples.

Combined ion-pair extraction and gas chromatography-mass spectrometry for the simultaneous determination of diamines, polyamines and aromatic amines in Port wine and grape juice

An accurate and very sensitive method which allows for the simultaneous determination of the diamines (1,3-diaminopropane, putrescine and cadaverine), of the polyamines (spermidine and spermine), and of the aromatic amines (beta-phenylethylamine and tyramine) found in Port wines and corresponding grape juices is presented. Sample clean-up consisted of the extraction of the amines with the ion-pairing reagent bis-2-ethylhexylphosphate dissolved in chloroform followed by a back-extraction with 0.1 M HCl. The hydrochloric extract obtained was dried and the amines were further derivatized with heptafluorobutyric anhydride and analyzed by GC-MS in the selected ion-monitoring mode, with a total run time of 18 min. Under the adopted conditions, the extraction of all the studied compounds was almost complete and the obtained extracts were free of potential interferents present in the samples, namely sugars, and most of the amino acids and polyphenols. Via the use of a set of five selected internal standards (amphetamine, [2H8]putrescine, 1,7-diaminoheptane, norspermidine and norspermine), the data obtained from the linearity, repeatability and recovery experiments were very good for all the compounds assayed. The corresponding limits of detection were invariably below 10 microg l(-1). The method was successfully applied to measure the content of biogenic amines in twelve young and five aged Port wine samples, eleven grape juice samples as well as in ten Portuguese red and white table wines. Results are presented and briefly discussed.

Analysis of phenolic compounds in the evaluation of commercial quince jam authenticity

The phenolic compounds present in 17 samples of Portuguese commercial and three homemade quince jams were analyzed by reversed-phase HPLC/DAD, to determine their authenticity. Two different extraction methods were needed for the complete definition of quince jams profiles, one of them including an Amberlite XAD-2 cleaning step. These analyses showed that all the samples presented a similar profile composed of at least eight identified phenolic compounds, several unidentified characteristic procyanidin polymers, and sodium benzoate as preservative of quince jams. Several samples also contained arbutin, suggesting that these quince jam samples were fraudulently adulterated with pear puree.

Vitis vinifera must varietal authentication using microsatellite DNA analysis (SSR)

A microsatellite DNA-based method for Vitis vinifera grape must authentication is presented. Five of the most important port wine producing grape cultivars (Tinta Roriz, Tinto Cão, Touriga Francesa, Touriga Nacional, and Tinta Barroca) were typed at four microsatellite loci described by Bowers et al. (Genome 1996, 39, 628-633) and Thomas and Scott (Theor. Appl. Genet. 1993, 86, 985-990). The corresponding 5 varietal musts and 26 must mixtures that result from the combination of the five varieties were also typed at the four loci. There were no differences between the corresponding leaf and varietal must profiles. All must combinations showed the expected band profiles corresponding to the sum of the varietal band profile components. Among the 26 must mixtures, 8 could be discriminated using the four loci.

Glomerular prolapse as precursor of one type of segmental sclerosing lesions

A distinctive segmental glomerular abnormality is confined to the region of the tubular opening. The hypothesis was that this followed prolapse of the tuft into the tubule. Analysis was made of 39 renal biopsy specimens with acute postinfective glomerulonephritis, later material from ten cases, four specimens from three women with pre-eclampsia, and 21 control specimens, with morphometry of glomeruli and immunohistological examination for immunoproteins and monocytes/macrophages. Prolapse was found in 14 specimens with acute postinfective glomerulonephritis, associated in eight with adhesion to Bowman's capsule and local alterations in the tuft, which together constitute early tip changes. Another three had early tip changes only and eight others had thin adhesions between the tuft and capsule next to the tubular opening. Later material confirmed this order of development and showed another late change, with sclerosed and hyaline material in the tuft and adhesion at the tubular origin. Findings in pre-eclampsia were comparable. Glomeruli were significantly larger in acute postinfective glomerulonephritis than in controls and were shown by others to be larger in pre-eclampsia than in normal pregnancy. Immunohistology showed IgM and a few foamy monocytes/macrophages in early tip changes but not in prolapsed loops. Glomerular prolapse appears to be a temporary consequence of acute enlargement of the tuft, probably causes mechanical damage to epithelial cells, and is a precursor of permanent structural changes near the tubular origin. This gives a unifying hypothesis to explain how these changes can be seen in acute postinfective glomerulonephritis, pre-eclampsia, and many other human and experimental renal disorders.

Gas chromatographic quantification of amino acid enantiomers in food matrices by their N(O,S)-ethoxycarbonyl heptafluorobutyl ester derivatives

Several amino acid enantiomer derivatives were prepared with different chloroformates and analysed by gas chromatography (GC) on a Chirasil-L-Val GC column, at a temperature below 200 degrees C. Among them the N(O,S)-ethoxycarbonyl heptafluorobutyl esters presented the best compromise between short retention times, high yield responses and good resolution for almost all the tested amino acids. These derivatives proved to be suited for quantification of amino acids in aqueous media, with L-p-chlorophenylalanine as internal standard. The developed procedure was applied to several food samples for determination of their free amino acid profiles.