Nutritional assessment and surgical risk markers in children submitted to cardiac surgery

In order to assess the nutritional status of children with heart diseases and to evaluate nutritional parameters for predicting postoperative complications, 50 children undergoing to cardiac surgery and classified in high and low surgical risk prospectively evaluated. Assessment parameters included anthropometry and plasma proteins albumin, transferrin and prealbumin. The nutritional classification according to Waterlow's modified criteria showed a high prevalence of malnutrition in the population studied (78%). The measures of arm circumference when located below the 5th percentile showed a significant association with general postoperative complications in the high risk group (arm circumference, p = 0.0019; arm muscle circumference, p = 0.0419). The percentage of weight per height, serum albumin and transferrin has not played a prognostic role concerning postoperative morbidity. The mean value of prealbumin was significantly lower in high risk group patients developing postoperative infections (p < 0.01) compared to those who did not. The sensitivity-specificity analysis of prealbumin as risk indicator for postoperative infection was 87.5% and 59% respectively. The nutritional risk classification seems to be a good way to identify the subgroups of children with additional postoperative surgical risk. However, more specific and sensitive tests are desirable to provide an individual identification of these children.

[Comparative study of transthoracic Doppler echocardiogram, computed tomography and aortography in the diagnosis of thoracic aortic dissection]

PURPOSE

Comparative and prospective evaluation of three methods (transthoracic echo-Doppler (TTE), computerized tomography (CT) and aortography (AORT) utilized for aortic dissection diagnosis.

METHODS

The 39 patients with confirmed aortic dissection (surgery or autopsy) underwent, within a few hours of each other, all three methods scrutinized. There were 19 cases of type A and 20 of type B dissection.

RESULTS

In type A dissection the methods were equivalent (TTE = 73.7%, CT = 84.2%, AORT = 73.7% p = NS) but for type B, TTE was significantly inferior to the other two methods (TTE = 60%, TC 90%, AORT = 80%, p < 0.05 for TTE, for TC and AORT p = NS). In three occasions, even though all three methods were performed, the diagnosis was not obtained.

CONCLUSION

The methods which were evaluated make the diagnosis in the majority of cases. In type A all methods are similar, however, in type B, TC and AORT are superior to TTE. Even performing all three methods in each patient, in three instances the diagnosis was not made.

Radioaerosol 99mTc-DTPA characterization produced by some nebulizers

1. The radioaerosol 99mTc-DTPA produced by jet and ultrasonic nebulizers was characterized by measuring the median mass diameter (MMD) and geometric standard deviation (sigma g) and these characteristics were interpreted in terms of the aerodynamic principles of inertial impactation. 2. Jet nebulizers of the same model, with different outflows (NSA = 0.14 ml/min; NSB = 0.24 ml/min and NSC = 0.40 ml/min) showed different radioaerosol mass distribution, with MMD (NSC) > MMD (NSA). The ultrasonic nebulizer US-1000 from Narcosul, which is operated with an air flow of 2 l/min and frequency of 1.6 MHz, generated radioaerosol with MMD = 2.40 microns, higher than that obtained with most of the jet nebulizers evaluated (NSA = 1.50 microns; NSB1V = 1.40 microns; NSB2V = 1.20 microns and PITT#1 - 0.80 microns), and the ultrasonic nebulizer presented the highest outflow of the nebulized solution (1.15 ml/min). 3. Connecting one or two impactation reservoirs to the NSB jet nebulizer modified the mass distribution, which became significantly narrower for NSB2V when compared to the other two nebulizers. NSB2V presented a mass percentage with a diameter of 3 microns or less and a sufficient outflow for use in ventilation and pulmonary permeability studies. 4. Comparison of the mass collected in the cascade impactor and the total mass generated by the NSB, NSB1V and NSB2V nebulizers showed, on average, 4.5% efficiency in radioaerosol generation with a diameter of less than 16 microns and 3.2% efficiency for a diameter of 3 microns or less.

[Evoked potentials by median nerve stimulation: comparison of central conduction time defined by different measure points]

After stimulation of the right median nerve in 20 normal adult volunteers interpeak latency N13-N20 and the difference in onset latency of the components N11-N20 are compared. A fractionation of the last measure was made at the onset of the P13-14 complex. The results concur with the ones in the literature, and it has been observed that all points measured could be obtained without significant difference on the C6-FZ and P3-FZ montages.

[Related observations for the use of mounting between neck posterior and scalp in evoked potentials by median nerve stimulation]

Somatosensory evoked potentials after stimulation of the median nerve were obtained in a group of normal individuals. The components obtained between 12 and 22 ms were analysed with cephalic and non-cephalic references. It is shown that the P13-14 complex is the major contributor for the amplitude of the N13 component recorded with electrodes between the posterior neck and the scalp. It has not been possible to detect differences in amplitude or latencies for the components N18 and P22 recorded between FZ-non cephalic and C6-FZ. Implications of these findings to clinical interpretations of the responses are discussed.

Effects of subinhibitory concentrations of chemical agents on hydrophobicity and in vitro adherence of Streptococcus mutans and Streptococcus sanguis

The aim of this investigation was to determine whether sublethal concentrations of chlorhexidine (Cx), hexetidine (Hx), cetylpyridinium chloride (Cc), sodium dodecyl sulfate (SDS), sanguinarine (Sg), sodium fluoride (NaF), and ammonium fluoride (NH4F) could affect hydrophobicity and adhesion of Streptococcus sanguis and Streptococcus mutans to saliva-coated hydroxyapatite (S-HA). Determination of the minimum inhibitory concentrations (MICs) showed that both species were susceptible to all agents tested. Growth in the presence of sub-MIC concentrations of Cx, SDS, Cc, NaF, or NH4F did not change significantly the hydrophobicity of S. sanguis cells when compared to the control which lacked any agent. However, growth in the presence of Hx or Sg resulted in a significant reduction in their hydrophobicity. Sub-MIC levels of SDS or Sg in the growth medium resulted in S. mutans cells with increased affinity for hexadecane compared with the control. The adherence of S. sanguis was changed significantly only by Hx or Sg, resulting in less cells adhering to S-HA. However, S. mutans cells previously incubated with NaF, NH4F, or Sg showed a higher adherence to S-HA than the control. The mechanisms of interference with adherence are at present not completely understood. Thus, antimicrobial agents at sub-MIC concentrations can interfere selectively with hydrophobicity and/or adhesion of oral streptococci.

Blood glucose and insulin response to intravenous glucose by patients with chronic Chagas' disease and alcoholism

Blood glucose and insulin responses to intravenous glucose 500 mg/kg in a group of alcoholic chagasic patients (Group I, N = 15) were assessed and compared to those of a group of patients with Chagas' disease without alcoholism (Group II, N = 16), a group of alcoholics without Chagas' disease (Group III, N = 22), and a group of non-alcoholics without Chagas' disease (Group IV, N = 15). Determinations of serum glucose and insulin were done under fasting conditions, 5 and 10 min after the injection of 50% glucose. There was no difference in mean serum glucose levels between groups. Mean serum insulin levels at times 5 and 10 min and for the total integrated response were lower (P < 0.05) in Groups I and II as compared to Group IV; at time 10 min the mean was lower (P < 0.05) in Group III as compared to Group IV. There was a nonsignificant trend for a lower insulinemic response in Group I as compared to Group II. These data suggest denervation of or injury to pancreatic B cell by Chagas' disease.

Proximal humeral ossification center of the fetus: time of appearance and the sensitivity and specificity of this finding

Ultrasonographic examinations were performed on 1,000 pregnant women between the 28th and 40th weeks of gestation who had been seen at a private clinic. For all women the date of last menstruation was known, and none had obstetrical or clinical-surgical complications. All were singleton pregnancies, and cases of fetal malformation were excluded from the study. The proximal humeral epiphyseal ossification center was visualized significantly frequently after the 38th week (P < 0.001). With respect to a gestational age of more than 38 weeks, its specificity was elevated (99%), as also were its positive (91%) and negative (93%) predictive values. Its sensitivity, however, was low (58%). Routine determination of the proximal humeral ossification center is a valuable aid for the estimation of gestational age in the third trimester.

Glucose absorption by the interposed colon segment after intestinal resection

One of the proposed surgical treatments of Short Bowel Syndrome is the interposition of a distal colon segment between two portions of the remnant small intestine. This method proved to reverse the nutritional disorders caused by this morbid entity. Surgical technique consisted in an 80% small bowel resection and the interposition of a 3 cm segment of distal colon between the remaining jejunum and ileum. After 70 days, the animals were reoperated and the interposed and the distal colon were isolated and tied. By using the method of rapid and successive absorptions of a glucose solution through the intestinal lumen, the relations between the absorption curves of the interposed and the normal colon could be drawn. Results show that the interposed colon segment absorbs more glucose (mean = 1.43 +/- 1.16 mg/dl) than the distal colon (mean = 0.37 +/- 0.29 mg/dl) and that its absorption pattern is similar to the small bowel rather than the colon. These results allow the use of this method for further studies in which the interposed colon adaptation is studied with other nutrients and/or under specific conditions.

Histological study of the endometrium in menopausal women with breast carcinoma

The first reference concerning the multiple primary malignant neoplasms was made by Bilroth, 1880 and since then a large number of studies have been published. Furthermore, an increasing incidence of simultaneous cancers are currently observed (16,18). At the same time, several retrospective populational studies evidenced the association between breast and endometrium carcinoma. It is well known that both uterus and breast are hormone-dependent organs and are likely to be influenced by the same oncogenic stimulus, either of endocrine nature or dietary origin (2, 3, 14). The risk of developing endometrial carcinoma is higher in patients already affected by breast neoplasm and is much more evident in older women within the first five years following the diagnosis of breast tumor. Conversely, patients with endometrial carcinoma may present a second mammary neoplasm and the relative risk is around 2.0 (1, 17). Although the existence of a correlation between these two primary malignant neoplasms is clearly observed, the absence of systematic studies directed to the screening of endometrial cancer in women with breast carcinoma is surprising. This study deals with histological analysis of the endometrium of postmenopausal patients with breast cancer and aims to determine the possible changes that might have occurred in the onset of the disease.

Frequency of X-chromatin in pregnant women during the second trimester of gestation

The frequency of X-chromatin was determined in pregnant women during the second trimester of gestation in order to establish possible correlations with the changes in steroid hormone levels occurring during this period and compare the curve with that for normal nonpregnant women. The mean frequency of X-chromatin in oral mucosa cells from a salivary suspension was 19.97% for the 24 patients studied, a statistically higher value than that obtained for nonpregnant women.

Iron, copper and alpha 1-antitrypsin deficiency in the liver of cirrhotic and schistosomotic patients

While a number of studies investigated iron and copper storage or alpha 1-antitrypsin (A1AT) deficiency in the liver of patients with cirrhosis, we did not find any similar study in schistosomotic patients reported in literature. We investigated the storage of both metals and the A1AT deficiency in the liver of 72 cirrhotic and 27 schistosomotic patients (5 with the hepatointestinal and 22 with the hepatoesplenic form of the disease). Forty-four patients with cirrhosis were also alcoholic, and 28 were not. Iron storage was detected in 23 patients with cirrhosis (31.9%); among these 16 (36.3%) were alcoholic and 7 (25.0%) non-alcoholic (the difference was not statistically significant). Thirteen (56.5%), 5 (21.7%) and 5 (21.7%) patients presented I-grade, II-grade, and III-grade iron storage, respectively. Copperstorage was detected in 24 cirrhotic patients (33.3%), 15 being alcoholic (34.0%) in contrast with 9 non-alcoholic patients (32.1%), a statistically non-significant difference. A1AT deficiency was observed in 2 patients with cirrhosis (2.8%), one with history of alcoholism. HBsAg and HBcAg in hepatic tissue were detected in 5 cirrhotic patients (6.9%), three of them with a history of alcoholism. Iron and copper storage and A1AT deficiency were observed in 3 patients with cirrhosis (12.5%), while iron storage and A1AT deficiency were found in 2 additional patients with cirrhosis (2.8%). The authors underline that neither iron nor copper storage nor A1AT deficiency was found in any schistosomotic patient. The authors discuss the possible importance of these data.

[Electroneurography of the facial nerve: methods of stimulation and records]

In this study it is, intended to establish the more appropriate points to register the compound action potential from m. frontalis m. orbicularis oculi and nasolabial fold muscles. The optimum site for stimulating electrodes and differences between the first and the last compound action potentials after 20 consecutive stimuli delivered at 1 Hz were analysed.

Quantitation of red cell-bound IgG by an enzyme-linked antiglobulin test in human immunodeficiency virus-infected persons

Anemia, thrombocytopenia, and neutropenia have been observed in patients with acquired immune deficiency syndrome (AIDS) and AIDS-related complex. To investigate whether red cells (RBCs) of patients with human immunodeficiency virus infection were coated with IgG and/or complement (C3), blood samples of 239 patients were tested. The prevalence of a positive direct antiglobulin test on RBCs was 16.7 percent. By use of an enzyme-linked antiglobulin test (ELAT) to measure more accurately the number of IgG molecules per RBC in a group of 67 patients, 30 of the 67 individuals were observed to have increased numbers (mean, 155) compared to normal controls and to patients with hypergammaglobulinemia due to multiple myeloma or chronic liver disease. Hemoglobin level was correlated with the number of IgG molecules per RBC (p = 0.008), but no correlation could be demonstrated between those numbers and serum immunoglobulin (p = 0.10) or circulating immune complexes (p = 0.38). Our results with ELAT suggest that some AIDS patients may have specific binding of IgG on the surface of their RBCs, rather than nonspecific uptake; further clinical correlations are necessary to confirm these findings.

Early immunization of neonates with trivalent oral poliovirus vaccine

Described is the evaluation in Brazil of the immune response of early immunization with trivalent oral poliovirus vaccine (TOPV). A total of 85 normal neonates from São Paulo were assigned one of the following immunization schedules: group A--one dose of TOPV at birth and subsequent doses at 2, 4, and 9 months of age; or group B--one dose of TOPV at 2, 4 and 6 months of age. Blood samples were collected sequentially from the mother at delivery, from the umbilical cord, and from the child at 2, 4, 6, 9 and 12 months of age for assay of poliovirus neutralizing antibodies. Administration of TOPV at birth, in addition to establishing immunity against poliomyelitis at an earlier stage, produced a superior immune response to poliovirus type 3. At the end of the first year, the proportion of susceptible individuals was 3.7% in group A and 25.9% in group B. When immunization against poliomyelitis is started at birth, excellent seroconversion rates are obtained from the third dose onward.

Bacteriology of the anal wound after open hemorrhoidectomy. Qualitative and quantitative analysis

The purpose of this study is to analyze the size of the bacterial colonies in anal wounds after open hemorrhoidectomy. Twenty patients were studied during predetermined postoperative time periods. Material was collected from the surface and from within the tissue of each patient's three open wounds, intraoperatively, on the 6th, 13th and 20th postoperative days for bacteriologic examination in aerobic, microaerophilic, and anaerobic media. The bacterium most commonly identified was Escherichia coli, followed by Staphylococcus aureus and Staphylococcus epidermidis. Pseudomonas aeruginosa, Enterococcus faecalis, Klebsiella pneumoniae, Proteus vulgaris, and Proteus mirabilis were also identified. Critical indexes of colonization were present since the intraoperative stage (greater than 10(5) bacteria/g of tissue and greater than 10(6) bacteria/ml); obligate anaerobic bacteria were not identified; neither the species nor the number of bacteria, even when critical indexes were present, prevented proper healing. The same bacteria were not necessarily present on the surface and in the tissue; the bacterial load observed among the three wounds (left lateral, right posterior, and right anterior), was the same.

[Behavior of cystic tumor of the ovary after wait-and-see management and hormonal treatment]

The authors have analyzed the results of the treatment of benign ovarian cysts with 30-49mm (group I) or more than 50mm in diameter (group II). 40 patients were treated with progestogen, 41 with contraceptive pill, and another 48 patients were only observed without any treatment (control group). Ovarian cyst regression was observed in 84.6% of patients in group I, and in 83.3% of patients in group II; 85.4% of patients in group I and 88.9% of patients in group II were treated with contraceptive pill; 92.5% of patients in group I and 93.1% of patients in group II were treated with progestogen. The authors have concluded that hormone treatment is not necessary to induce functional regression of ovarian cysts.

[Treatment of human papillomavirus infection of the uterine cervix with gel interferon]

Treatment of uterine cervix infection caused by human papillomavirus still is an enigma. Some drugs have been tested with cure rates between 60 to 70%. Most of such agents are substances which produce a strong epithelial desquamation and have shown strictly toxic side effects. The use of interferon in this infection has been studied, but different authors disagree in their therapeutic findings. A randomized, double blind trial was conducted to compare interferon to placebo. Preliminary results are presented in this article. 47 patients were followed so far. 18 of them were evaluated and the results are shown in this article.

[Diagnosis of cervicovaginal infection by human papillomavirus. Value of colposcopy, cytology and histopathology as methods of diagnosis]

The authors evaluated 476 patients to determine the accuracy of colposcopy, cytology, and histopathology as diagnostic methods for cervical and vaginal HPV infections. Results were treated by statistical analysis which showed significant disagreement among the methods tested. Colposcopy was positive in 87.8% of the cases. Abnormal transformation zone was the most frequent finding in the cervix, acetowhite epithelium being its main representative. Condylomatous vaginitis was the most frequent feature in the vaginal surface. Cytology was positive in 76.9% of the cases. To increase sensitivity of this method, the authors suggest that not only koilocytosis is important, but other major aspects are also important, such as minimal koilocytosis, dyskeratosis, karyopyknosis, binucleation, and multinucleation. Histopathology was positive in 81.9% of the cases. In conclusion, the three diagnostic methods studied presented statistical disagreement, however, they are supplementary and efficient.

[Influence of exposure time to silica and smoking on pulmonary function of workers in the ceramic and stone quarry industry]

The aim of this study was to analyze the influence of the numbers of years a worker is exposed to silica dust and the smoking habit upon his lung function. In order to be included in this study the worker should have been exposed to silica dust for a minimum of ten years and give his oral consent to have his lung function studied and a chest X-ray done. The study was done with individuals who claimed for compensation for silicosis to the Brazilian National Institute of Social Security during the period from 1973 to 1981, in Jundiaí city, São Paulo state. The study groups were made up of 137 workers: Group I, exposure between 10 and 20 years (44 workers) and Group II, exposure over 20 years (93 workers); 59 (42.4%) workers were cigarette smokers, 53 (38.1%) non-smokers and 27 (19.4%) former smokers. Lung function was accomplished through spirometry (FVC, FEV1, FEV1/FVC and FEF 25-75%) flow volume curves breathing air and helium-oxygen mixture (Vmax 50%, Vmax 25% and VisoV). No difference was found between the two groups concerning radiological chest nodules, spirometry, flow volume curves and smoked packyears; smokers had a worse lung function when compared to the non smokers of the same group. These alterations in Group I smokers were predominantly in the peripheral airways (Vmax 25%--p less than 0.05) whereas in those smokers of Group II large airways were also involved (VisoV, FEV1, FEV1/FVC--p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pathology associated with uterine leiomyoma: review of 600 cases]

The authors analyzed 600 patients with uterine leiomyoma examined at the Escola Paulista de Medicina and submitted to surgical treatment between 1976 and 1987. The uteri were carefully studied and leiomyomas were confirmed. Other diseases were also found in 71.17% of the cases. Uteri from hysterectomies performed for conditions other than leiomyoma were also studied for control purposes. Major conditions found were chronic cervicitis; adenomyosis; follicular cysts; tubal changes (congestion, edema, and salpingitis); uterine polyps; endometrial hyperplasia; endometriosis; ovarian and endometrial neoplasias.

[Ultrastructural and morphometric study of the myeloid parenchyma cells of mice prior and after X-ray exposure]

An electron microscopic study of initial X-ray changes in ultrastructures of bone marrow cells was performed. Such changes reached nucleous and cytoplasm organellas early (1 hour) after radiation, but were more proeminent later on. Subsequent readings (2, 6 hours) showed them more proeminent in cytoplasm structures, and the morphologic appearance was close to normal within 12, 14 days. Quantitative analyses were performed using the marrow recovery coefficient (MRC).

Serum type III procollagen peptides in patients with hepatointestinal and compensated hepatoesplenic schistosomiasis forms

The Serum Type III Procollagen Peptides (SIIIPP) were determined in 35 individuals: 25 untreated schistosomotics: 16 with hepatointestinal (HI) and 9 with the compensated hepatosplenic (CHE) forms and a control group (C) consisted of 10 healthy volunteers. Kits of radioimmunoassay were performed for SIIIPP dosage. It was searched whether there was relationship between the SIIIPP and the serum levels of alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), alkaline phosphatase (AP) and gamma glutamyltranspeptidase (GGTP). The mean values of SIIIPP in the forms of HI (13.0 ng/ml) and CHE (17.0 ng/ml) were significantly higher than controls (9.0 ng/ml) (p less than 0.05). No significant difference was observed in SIIIP values between the HI and CHE patient groups, and between SIIIPP and ALAT, ASAT, AP and GGTP serum levels.

[Evaluation of the effects of ionizing radiation and cyclophosphamide on the bone marrow of mice, by counting non-nucleated and nucleated cells]

Bone marrow injury after exposure to ionizing radiation and cyclophosphamide was evaluated by morphologic analysis and by the ratio erythrocytes/nucleated cells (NN/N). The authors show the efficiency of the method proposed, which can be determined in bone marrow samples of variable and unpredictable size.

Swaroop and Uemura's proportional mortality ratio. The need for periodic revision of the definition

Utilizando dados referentes a 34 países, em quatro épocas, 1950,1960, 1970 e 1980, foi verificado que a percentagem de óbitos com 50 anos e mais, que constitui a Razão de Mortalidade Proporcional, indicador de nível de saúde de populações proposta por Swarrop e Uemura, não proporcionou o maior poder de discriminação entre países mais e menos desenvolvidos, em qualquer das épocas; nas duas últimas, foi a percentagem de óbitos com 75 anos e mais que correspondeu esse maior poder. Verificou-se ainda que os deslocamentos de óbitos para faixas etárias mais elevadas, durante um determinado período, foram também mais bem traduzidas pelas variações no mesmo período, dessa percentagem, sendo útil a complementação dessas informações pelas variações da percentagem de óbitos com 65 anos e mais. E sugerida a conveniência de reformulação das classes propostas por Swaroop e Uemura, definindo-se outras baseadas na RMP dada por 75 anos e mais, com os seguintes limites: 0 |—20, 20 |—40, 40 |—50, 50 |—55 e 55 ou mais, com previsão de desdobramento futuro da última.