[Dyslipidemia and hyperinsulinemia in normoglycemic-obese relatives of patients with non-insulin dependent diabetes mellitus]

To determine the most frequent dyslipidemias among first-degree relatives of NIDDM patients, and its association with their glucose-tolerance status and hyperinsulinemia, we have started to examine members of NIDDM pedigrees, according to American Diabetes Association guidelines for nuclear family studies. In a large family with 2 NIDDM siblings in the 2nd generation, and 4 siblings with NIDDM in the 3rd generation, we have evaluated 14 first degree relatives and also 15 sex and aged matched healthy control subjects without family history of diabetes. The NIDDM relative group presented BMI = 31.8 +/- 3.9 kg/m2, SBP = 128 +/- 18.2 mmHg, DBP = 84 +/- 12.7 mmHg. Both relatives and controls were subjected to a 2h 75g OGTT for glucose and insulin determinations. Although none of NIDDM relatives has IGT, both Glycemic Area (GA) and Insulin Area (IA) were greater (p < 0.01) in the NIDDM relative group. The Insulin/Glucose ratio was also higher (p < 0.01) at 0 and 120 min of OGTT, this might be indirect evidence of Insulin- Resistance. Fasting serum lipids in the NIDDM relatives were TG = 148 +/- 24mg/dl, T-Chol = 244 +/- 10.7mg/dl, HDL-C = 34.2 +/- 2.5mg/dl; lipids in the control group were TG = 84.8 +/- 10.1mg/dl, T-Chol = 167 +/- 10.2mg/dl, HDL-C = 44.4 +/- 2.6mg/dl. Electrophoretic pattern showed type IIa (30.7%) and IIb (61.5%) hyperlipidemias in the NIDDM relatives. In this group, there was a positive and significant association between basal insulin and DBP (r = 0.67; p < 0.01), and between DBP and both TG (r = 0.74; p < 0.01)) and VLDL-C (r = 0.58; p < 0.05). It was also obtained a negative association between basal insulin and HDL-C (r = -0.89; p < 0.001). These data suggest that hyperinsulinemia in association with lipid abnormalities could appear early (before the development of Impaired Glucose Tolerance and Diabetes) in first degree relatives of NIDDM patients.

Correlates of college student binge drinking

OBJECTIVES

This study examines the individual correlates of college student binge drinking.

METHODS

Questionnaires were completed by a representative national sample (n = 17,592) of students on 140 campuses in 1993. Binge drinking was defined as five or more drinks per episode for men and as four or more drinks per episode for women.

RESULTS

Overall, 44% of the students (50% of the men and 39% of the women) binged. While demographic factors such as sex and race were significantly related to binge drinking, prior binging in high school was crucial, suggesting that for many students, binge drinking begins before college. The strongest predictors of college binge drinking were residence in a fraternity or sorority, adoption of a party-centered life-style, and engagement in other risky behaviors.

CONCLUSIONS

Interventions must be targeted at high school binge drinking as well as at several characteristics of college life--most notably fraternity residence. Legal drinking age fails to predict binge drinking, raising questions about the effectiveness of the legal minimum drinking age of 21 in college alcohol policies.

[Paternity study applying DNA polymorphism: evaluation of methods traditionally used in Chile]

Simultaneous detection of several VNTR loci using a single DNA probe is the basis of the technique called "DNA fingerprint" (DNAfp) of increasing application in parenthood identification. According to the data gathered by different laboratories worldwide, father exclusion can be made in a larger number of cases when compared with the customary tests based on erythrocyte antigens. The question could then be whether DNAfp will completely replace erythrocyte antigens tests. We report here our experience in applying DNAfp to 92 samples corresponding to 34 paternity cases and comparing these with the results obtained with the antigens of the systems ABO, Rh, MNSs, Duffy and Kidd. Most of the HaeIII/digested DNA samples produced 13 to 16 bands larger than 4.3 Kb (average 14,0761 +/- 2,205). Average band sharing between pairs of unrelated individual was 1,9107 +/- 1,083. Two cases presenting an a posteriori probability of being the father of 80.7% and 76.5% by erythrocyte antigens were clearly excluded by DNAfp. All exclusions made by antigens were confirmed by DNAfp. In the cases reported as father "rather probable" (28 cases) by DNAfp, these shared with the child 6,7407 +/- 1.7 bands on average. Because of time, cost and simplicity we favor a procedure starting with the antigens test and continuing with DNAfp only when an exclusion is not possible. Economy will increase as the number of exclusions increases.

Health and behavioral consequences of binge drinking in college. A national survey of students at 140 campuses

OBJECTIVE

To examine the extent of binge drinking by college students and the ensuing health and behavioral problems that binge drinkers create for themselves and others on their campus.

DESIGN

Self-administered survey mailed to a national representative sample of US 4-year college students.

SETTING

One hundred forty US 4-year colleges in 1993.

PARTICIPANTS

A total of 17,592 college students.

MAIN OUTCOME MEASURES

Self-reports of drinking behavior, alcohol-related health problems, and other problems.

RESULTS

Almost half (44%) of college students responding to the survey were binge drinkers, including almost one fifth (19%) of the students who were frequent binge drinkers. Frequent binge drinkers are more likely to experience serious health and other consequences of their drinking behavior than other students. Almost half (47%) of the frequent binge drinkers experienced five or more different drinking-related problems, including injuries and engaging in unplanned sex, since the beginning of the school year. Most binge drinkers do not consider themselves to be problem drinkers and have not sought treatment for an alcohol problem. Binge drinkers create problems for classmates who are not binge drinkers. Students who are not binge drinkers at schools with higher binge rates were more likely than students at schools with lower binge rates to experience problems such as being pushed, hit, or assaulted or experiencing an unwanted sexual advance.

CONCLUSIONS

Binge drinking is widespread on college campuses. Programs aimed at reducing this problem should focus on frequent binge drinkers, refer them to treatment or educational programs, and emphasize the harm they cause for students who are not binge drinkers.

Nuclear presence of two lysosomal enzymes in rat implantation sites

OBJECTIVE

To test the Szego hypothesis of increased beta-glucuronidase and acid phosphatase activities in hormone target tissues.

METHODS

The presence of beta-glucuronidase and acid phosphatase activities in nuclear subcellular fractions obtained from decidual (implantation site) and stromal (nonimplantation zone) tissues was demonstrated by both biochemical measurements and ultramicrographic analysis utilizing a histochemical reaction.

RESULTS

Acid phosphatase was almost twice as abundant in nuclei and lysosomes of epithelial cells (implantation sites), and beta-glucuronidase also was significantly more active in nuclei from epithelial and decidual tissues than in nonimplantation tissue.

CONCLUSION

Our results, utilizing the implantation process as experimental model, support the Szego hypothesis of the lysosomal role in hormonal mechanisms of action.

Sympathetic nervous system activity in major depression. Basal and desipramine-induced alterations in plasma norepinephrine kinetics

BACKGROUND

To determine whether elevations of plasma norepinephrine (NE) in major depression represent increased sympathetic nervous system (SNS) activity and to assess the effects of desipramine hydrochloride on sympathetic function.

METHODS

SNS activity was assessed in depressed patients and controls by an isotope-dilution, plasma NE kinetic technique using mathematical modeling and compartmental analysis. This approach provided estimates of the rate of NE appearance into an extravascular compartment, which is the site of endogenous NE release from SNS nerves, the corresponding rate of NE appearance into plasma, and the rate of NE clearance from plasma.

RESULTS

Norepinephrine appearance into the extravascular and vascular compartments was significantly elevated in 17 depressed patients compared with that in 36 controls. The rate of NE clearance from plasma was similar in both groups. This is compatible with increased SNS activity in major depression. Desipramine, given for 2 days, significantly reduced the concentration of NE in plasma of patients and controls by markedly suppressing the rates of extravascular and vascular NE appearance, compatible with a short-term reduction in SNS activity. Desipramine prolonged the rate of NE clearance from plasma, consistent with a blockade of NE re-uptake into SNS nerve terminals. The initial suppression of SNS activity by desipramine was reversed by long-term (28 days) treatment of patients, with extravascular and vascular NE appearance rates returning to approximately basal levels. An associated rise in plasma NE concentrations compared with the baseline was attributable to a progressive reduction in plasma NE clearance.

CONCLUSION

Sympathetic nervous system activity is elevated in major depression and is suppressed by short-term desipramine administration. The demonstration of SNS reactivation occurring with prolonged desipramine treatment is compatible with the theory that long-term treatment desensitizes CNS alpha 2-adrenergic receptors and emphasizes the value of examining the temporal course of responses to pharmacological challenges of neuroendocrine systems. Previously reported elevations of plasma NE during prolonged administration of tricyclic antidepressants are probably the result of a reduction in plasma NE clearance, not an increase in SNS activity.

Effect of desipramine on cerebrospinal fluid concentrations of corticotropin-releasing factor in human subjects

To assess the effect of desipramine (DMI) on corticotropin-releasing-factor (CRF) activity in the central nervous system, we measured cerebrospinal fluid (CSF) concentrations of CRF in healthy volunteers following short-term administration of DMI or placebo. DMI administration for 2 days was associated with a significant dose-related reduction in CRF concentrations. There was a nonsignificant 6% reduction in CRF concentrations among the 10 subjects who received 50 mg DMI (delta CRF: -3 +/- 2 pg/ml) and a significant 14% fall in the CRF concentrations of the eight subjects who received 100 mg DMI (delta CRF: -8 +/- 3 pg/ml). The mean CSF concentration of CRF was unchanged in the six subjects randomized to placebo (delta CRF: 1 +/- 5 pg/ml). DMI administration had no effect on CSF norepinephrine concentrations (n = 24) or on plasma cortisol (n = 25). We conclude that short-term administration of DMI in healthy volunteers is associated with a dose-related reduction in CSF concentrations of CRF.

[Potter syndrome caused by bilateral renal agenesis and duodenal atresia]

A case of Potter syndrome secondary to renal agenesia and duodenal atresia with anular pancreas is presented. The karyotype was 47 XY-21. We discuss the antenatal diagnosis and the perinatal management.

[Clinical and legal aspects of brain death criteria: evaluation of the degree of knowledge of neurologists and neurosurgeons]

The level of knowledge of clinical and legal aspects of brain death criteria was tested in 25 neurologists and 15 neurosurgeons. The answers were wrong or the questionnaire had not been responded in 36.9% of the cases. The highest percentage of mistakes concerned the apnea test and what Chilean law said regarding brain death. No differences were found between neurologists and neurosurgeons. Physicians with less than 10 years were better informed than those with more than 10 years of medical practice (p < 0.005). Although brain death as a criterion of death is accepted by Chilean law in order to donate organs for transplantation, a considerable percentage of physicians (30%) rejected this concept. The significant lack of knowledge found in this study may suggest that brain death diagnosis is being inadequately performed in many cases. This fact raises important medical, ethical and legal considerations.

[Clinical and cytogenetic analysis of 257 cases of Down's syndrome]

Among 257 patients with clinical diagnosis of Down's syndrome, 56.4% of male gender, in whom cytogenetic studies were performed, 14 (5.4%) had normal karyotypes and 243 (94.6%) had 21 trisomy. Of these last, 225 (92.6%) had free 21 trisomy, 10 (4.1%) showed mosaics, 8 (3.3%) had translocations. Average maternal age of this sample was significantly higher than that of patients attending the same maternity wards (32.14 vs. 24.85 years) and 41% of Down syndrome's patients came from mothers aged 36 years or more, even though only 9.7% of this country's deliveries proceed from women of that age group. As to seasonal occurrence, the proportions of births which happened in summer almost doubled that of winter (33.1% vs. 16.9%). The frequency of characteristic clinical signs of Down's syndrome was somewhat different than that described for patients from some other countries, for instance: epicanthus, short neck and widening of the space between 1st. and 2nd. toe were more frequent, while Brushfield's spots, depressed occiput, dental anomalies, heart malformations and fissured tongue seemed less frequent. The importance of cytogenetic studies for diagnosis and genetic counseling is stressed.

[Lesions of the fallopian tube following tube occlusion]

This is a study using light microscopy and electronic microscopy of Fallopian tube subjected to sterilization; and compare it with a control group. A total of 60 samples from patients with different surgical procedures, whose age was from 20 to 40 years; they were amenorrheic, without antecedents of pelvic inflammatory disease nor endometriosis. Among the control group, there were lesions as isthsmical nodular salpingitis in 30.7%. There was chronic salpingitis in 15.3%; follicular salpingitis in 23%, and polyps in 15%. In the group with OTB antecedents, endosalpingiosis was found in 20%; follicular salpingitis in 30% and chronic salpingitis in the remaining 50%. By means of electronic, ultrastructural microscopy, were seen lesions at myosalpinx level, that is, alterations in myofilaments, formation, much fibrosis and descilliation in the adjacent to OTB. It may be concluded that these findings, never seen before, may condition an alteration of tubal motility in patients subjected to rechannelization procedures, that condition an alteration in gametes transportation, avoiding fecundation or a greater incidence ectopic pregnancy incidence.

[Computerized registry of medical procedures and diagnostic codification]

Retrospective analysis of clinical information requires easy access to reliably stored data. We developed a program running on a microcomputer and using codes from the International classification of diseases, to be used on line. The program stores diagnostic codes, medical actions and a summary for each case. It uses inexpensive hardware and is friendly to inexperienced users.

[Nuclear magnetic resonance in the diagnosis of multiple sclerosis. A critical review of the literature]

Nuclear magnetic resonance (NMR) has been proposed to be the best diagnostic test for multiple sclerosis (MS). We performed a critical analysis of 13 papers evaluating the use of NMR in MS. Out of an ideal 17 criteria for validation and reproducibility, a top of 11 (65%) was the maximum found. Foremost deficiencies were a lack of blind analysis and inadequate patient samples. Thus the claim that NMR is the diagnostic tool of choice in MS remains to be proven.

[Medical care to cerebrovascular syndrome]

We analyzed clinical data from all patients with a stroke admitted to the Emergency Service of a General Hospital in Santiago, from 1984 to 1986. 371 patients (196 women and 175 men) were diagnosed as having thrombosis (43%), embolic occlusion (18%), intracerebral hemorrhage (36%) and subarachnoid hemorrhage (3%). CAT scans were performed in 25% and angiography in 16%. The diagnosis was considered proven in 40% of cases. Overall hospital mortality was 46%, raising to 66% for hemorrhages. Prevention of cerebral edema was the main medical treatment. The present data suggest that primary prevention of and technological facilities to treat cerebrovascular episodes are inadequate at a general hospital level in Santiago.

[Incidence of congenital malformations in Chile from 1969 to 1986. Results of a Latin-American collaborative study]

At present, congenital malformations contribute more to infant mortality, given the significant decrease in overall infant mortality rate observed in Chile. A significant and steady increase in the prevalence of congenital malformations was demonstrated at the Clinical Hospital, University of Chile, from 1969 to 1986. Better epidemiologic surveillance is needed to accurately estimate the magnitude of this problem and give orientation for preventive measures.

Smoking, caffeine, and stress: Effects on blood pressure and heart rate in male and female college students

This study examined the independent and joint effects of cigarette smoking and caffeine consumption on blood pressure (BP) and heart rate (HR) reactions to stress in male and female college students. Following an initial physiological baseline, participants received one of four experimental treatments (paced smoking, caffeine, smoking plus caffeine, or neither) and had BP and HR measured before, during, and after two stressful tasks. The results revealed that, compared with the control condition, caffeine ingestion enhanced the magnitude of stress-induced systolic BP and HR reactions. Smoking combined additively with stress, and the joint effect of smoking and caffeine was no greater than either taken alone. Males and females were generally similar in their BP and HR responses to smoking, caffeine, and stress. Inconsistencies with previous research and possible physiological mechanisms underlying the observed effects are discussed.

An abnormal terminal X-Y interchange accounts for most but not all cases of human XX maleness

To determine if human XX maleness results from an abnormal chromosomal X-Y interchange, we studied the inheritance of the paternal pseudoautosomal region in nine patients. Those six patients in whom Y-specific DNA was found (Y(+)) inherited the entire pseudoautosomal region from the paternal Y chromosome and lost that of the paternal X chromosome. Moreover, in three Y(+) cases, we observed the deletion of a paternal Xp locus tightly linked to the pseudoautosomal region. These results definitively show that an abnormal and terminal X-Y interchange during paternal meiosis causes Y(+)XX maleness. In contrast, no abnormal X-Y interchange was observed in any of the three Y(-) cases analyzed, suggesting that maleness can occur in the absence of any Y-specific DNA.

Experimental rabies: ultrastructural quantitative analysis of the changes in the sciatic nerve

To study the pathology of peripheral nerves in experimental rabies infection, street rabies virus ws inoculated into the right footpad of two groups of mice, A and B, which received, respectively, 10(4.5) LD50 and 10(3.5) LD50 of the virus. Paralysis was observed in 60% of animals of group A and 20% of group B. The main ultrastructural abnormality present in the sciatic nerves was degeneration of about 40% of myelinated axons. Only occasional unmyelinated axons were degenerated. Figures were similar for nerves of either side and for both groups. Frequency histograms of axonal diameter showed axons of all sizes to be altered in group A, whereas in group B there was tendency for larger axons to be damaged. Electron microscopy showed no typical bullet-shaped viral particles. Asymptomatic animals which received the higher dose of the inoculum showed a small (less than 1%) percentage of necrotic myelinated axons.

Serum calcitonin after pentagastrin stimulation in patients with bronchogenic and breast cancer compared to that in patients with medullary thyroid carcinoma

Serum immunoreactive calcitonin (iCT) was measured in the peripheral blood of 29 normocalcemic patients with bronchogenic carcinoma of various pathological types and nine patients with breast cancer before and after pentagastrin stimulation. These results were compared to those found in 22 normal subjects and 30 patients with histologically proven medullary carcinoma of the thyroid. Our results revealed that 1) serum iCT levels may be abnormally high in all pathological types of bronchogenic carcinoma and in patients with breat cancer; 2) the basal level of serum iCT may be normal, but it is abnormally high after pentagastrin stimulation; 3) the increment rise of iCT after pentagastrin stimulation in the bronchogenic and breast cancer patients was significantly less than that seen in patients with medullary carcinoma of the thyroid (P less than 0.001).

A case report of a hemolytic transfusion reaction caused by anti-Holley

Clinical and laboratory investigation of a black male patient, who received emergency transfusion of blood incompatible for a high incidence antigen, provided evidence for the pathogenetic importance of high titer anti-Holley antibodies with poor avidity. The red blood cells of the patient and two siblings were remarkable in being negative for two high incidence antigens, Hy and hrS, and weak for a third, Gy.