[Perinatal differences in asphyxic full-term newborns in relation to the presence of hypoxic-ischemic encephalopathy]

OBJECTIVE

To study the perinatal differences of full-term newborn infants with perinatal asphyxia in relation to their neurologic manifestations (postasphyctic encephalopathy).

MATERIAL AND METHODS

Prospective epidemiologic study over perinatal asphyxia in full-term infants born in our hospital between november 1991-february 1995. Perinatal asphyxia was graded as non-severe (first minute Apgar score < or = 6 and/or umbilical artery pH < 7.20, with abnormal fetal heart rate patterns and/or meconium stained amniotic fluid, and the need for immediate neonatal resuscitation) and severe (first minute Apgar score < or = 3 and umbilical artery pH < 7.10). Hypoxic-ischemic encephalopathy was graded as mild, moderate and severe based on classification of Levene and Sarnat & Sarnat. The perinatal variables were graded as prenatal (gestationals and obstetrics), neonatal (resuscitation, general data of the newborn, and organic manifestations of asphyxia) and postneonatal (neurologic sequelae at follow-up).

RESULTS

During the study period there were 3,342 full-term, live births. Perinatal asphyxia developed in 156 (31 severe and 125 non-severe). Neurologic manifestations were present in 25.6% of asphyxiated newborns: 40 cases of hypoxic-ischemic encephalopathy (mild in 30, moderate in 5 and severe in 5). The main differences between asphyxiated newborns with and without hypoxic-ischemic encephalopathy were: chronic maternal diseases, pathologic obstetric antecedents, distocic deliveries, neonatal resuscitation, severity of perinatal asphyxia, sex and weight of newborns, days and origin of admission, birth injury, extraneurologic manifestations (mainly pulmonary, digestive, haemodynamic and cardiologic) during neonatal period, and neurologic sequelae at follow-up.

CONCLUSIONS

The main perinatal differences in relation to postasphyctic encephalopathy are important in the knowledgement of their pathogenic mechanism (interrelation between neurologic and extraneurologic manifestations) and their follow-up (hypoxic-ischemic encephalopathy is the most important prognostic factor of neurologic sequelae in the full-term asphyctic newborn).

[Detection of cognitive deterioration in elderly patients attending an emergency hospital service]

BACKGROUND

An increasing proportion of patients attended at hospital emergence departments (HED) are elderly people.

OBJECTIVES

a) To check the reliability of the usual medical assessment to detect the cognitive deterioration in elderly people attended at HED, compared with that performed systematically by means of an evaluation test of cognitive functions; b) to study the applicability of such a test in HED, on the basis of the time necessary for its administration, and c) to describe the deterioration prevalence in that group of patients and identify the possible associated risks for its detection in patients.

PATIENTS AND METHODS

Prospective study including patients aged > or = 60 years attended at a HED, using the orientation, memory and concentration test (OMC) to perform the cognitive assessment.

RESULTS

A total of 352 patients who had no exclusion criteria out of the 536 attended during the study period were included. Cognitive deterioration was not detected in 111 patients (31.5%); it was mild in 147 (41.8%), moderate in 71 (20.2%) and severe in 23 (6.5%). In patients with moderate-severe deterioration according to the OMC test, such a deterioration was detected by the usual medical evaluation in 7% of cases. The mean time in completing the test was 2.6 +/- 0.9 minutes. An age > or = 80 years was associated with an increased relative risk for detecting moderate-severe cognitive deterioration (1.98; 95% CI, 1.42-2.78; p < 0.001), whereas the discharge diagnosis of respiratory disease was associated with a decrease of the relative risk (0.41; 95% CI, 0.19-0.89; p < 0.05). No association was observed with other factors, such as gender, home residence or final destination from the emergency department.

CONCLUSIONS

The prevalence of cognitive deterioration in elderly people attended at HED is high and increases with age. The OMC test can be administered at HED to detect cognitive deterioration, which is not frequently detected by the usual medical assessment.

[Perinatal asphyxia, hypoxic-ischemic encephalopathy and neurological sequelae in full-term newborns. II. Description and interrelation]

INTRODUCTION

There have been several attempts to relate either perinatal asphyxia at birth or abnormal neurological findings after asphyxia in neonatal period (hypoxic-ischemic encephalopathy), to outcome.

OBJECTIVE

To investigate, in full-term infants, the relation between perinatal asphyxia, hypoxic-ischemic encephalopathy and neurologic sequelae at follow-up, and to define the main neurologic sequelae (cerebral palsy, mental retardation, neonatal death). Material and method. Prospective epidemiologic study over perinatal asphyxia in term neonates born in Universitary Hospital San Juan (Alicante, Spain) between November 1991-February 1995. Perinatal asphyxia was graded as non severe (1-minute Apgar score < or = 6 and/or umbilical artery pH < 7.20, with abnormal fetal heart rate patterns and/or meconium-stained amniotic fluid, and the need for immediate neonatal resuscitation) and severe (1-minute Apgar score < or = 3 and umbilical artery pH < 7.10). Hypoxic-ischemic encephalopathy was graded as mild, moderate and severe based on classification of Levene and Sarnat & Sarnat. The abnormalities on psicomotor development are based in the neurologic 'alert signs' and in the neurologic sequelae; this sequelae was graded as mild, moderate and severe based on classification of Finer and Amiel-Tison. The relationships between these variables are studied by univariant and multivariant analysis (Cox's regression).

RESULTS

The incidence of neurologic sequelae, in 115 asphyxiated full-term infants follow-up at least 12-24 months, was 16.5%; 4 cases of severe sequelae, 4 moderate and 11 mild. The overall asphyxia-related infant mortality rate was 0.87/1.000 live births. The main sequelae detected at follow-up was motor disability, and other disabilities like mental retardation, epilepsy, sensorial defects, were infrequents. The incidence of cerebral palsy was 0.87/1.000 live births, and 2.6% asphyctic term neonates. We found a statistically significant (p < 0.001) association between severity of perinatal asphyxia and/or evidence of hypoxic-ischemic-encephalopathy and the neurological development at follow-up. Of the several factors associated to risk of neurologic sequelae on univariant analysis, only two were independently associated on multivariant analysis: severe perinatal asphyxia (RR = 2.82; IC = 1.07-7.39) and postasphyctic encephalopathy (RR = 4.17; IC = 1.48-11.75).

CONCLUSIONS

Most survivors of perinatal asphyxia do not have adverse sequelae. The best predictive tool for the neurological prognosis at follow-up was severe perinatal asphyxia at birth and evidence of encephalopathy in neonatal period. Our study confirm that perinatal asphyxia is infrequently the cause of cerebral palsy and mental retardation.

[Perinatal asphyxia, hypoxic-ischemic encephalopathy and neurological sequelae in full-term newborns: an epidemiological study (1)]

INTRODUCTION

Perinatal asphyxia, and its neurologic manifestations (hypoxic-ischemic encephalopathy) is the most important cause of brain injury and neurologic sequelae in full-term infants.

OBJECTIVE

The aim of this study was to know the incidence of perinatal asphyxia, hypoxic-ischemic encephalopathy and neurologic sequelae in our full-term infants.

MATERIAL AND METHOD

Prospective epidemiologic study of perinatal asphyxia in full-term infants born in Universitary Hospital San Juan (Alicante, Spain) between November 1991-February 1995. Perinatal asphxyia was graded as non severe (1-minute Apgar score < or = 6 and/or umbilical artery pH < 7.20, with abnormal fetal heart rate patterns and/or meconiumstained amniotic fluid, and the need for immediate neonatal resuscitation) and severe (1-minute Apgar score < or = 3 and umbilical artery pH < 7.10). Hypoxic-ischemic encephalopathy was graded as mild, moderate and severe based on classification of Levene and Sarnat & Sarnat. Neurologic sequelae in 12-24 months follow-up was graded as mild, moderate and severe based on classification of Finer and Amiel-Tison.

RESULTS

During the study period there were 3.342 full-term, live births. Perinatal asphyxia developed in 156 (31 severe and 125 non-severe), with an incidence of 4.66 cases per 100 full-term newborns. Neurologic manifestations was present in 25.6% of 156 term infants with perinatal asphyxia: 40 cases of hypoxic-ischemic encephalopathy (mild in 30, moderate in 5 and severe in 5). The incidence of hypoxic-ischemic encephalopathy was 1.19 cases per 100 full-term infants. The asphyctic newborns were regularly assessed. Ten infants was lost to follow-up. The incidence of neurologic sequelae, in 115 asphyxiated full-term infants follow-up at least 12-24 months, was 16.5%.

CONCLUSIONS

Despite the widespread use of the term perinatal asphyxia, there is little uniformity on the clinical definition of asphyxia, which makes comparison of incidence, treatment and outcome very difficult. The main epidemiologic differences in the studies of perinatal asphyxia and hypoxic-ischemic encephalopathy are due to little agreement on their definition. A consensus is necessary.

[Evaluation of the nutritional status of a rural child population in a Valencia community: the Pego study]

OBJECTIVE

To evaluate the nutritional state of the child population of Pego (Alicante) in order to define the patterns of normality and check the validity of the anthropometric parameters most commonly used in evaluating nutritional status.

DESIGN

A descriptive crossover study.

SETTING

Valls de Pego Primary Care Health Centre.

PATIENTS

943 healthy children and adolescents aged 0 to 17 were studied out of a target population of 2,150 who were seen for treatment at the Health Centre for reasons which had nothing to do with nutritional problems.

INTERVENTIONS

Between july 1989 and december 1990, a simple anthropometric assessment of each patient was carried out: obtaining weight, height, the nutrition or Shukla index and the Quetelet index.

MAIN RESULTS

Nutritional distribution was clearly displaced towards high values on the nutritional scale, with 14% obesity and 15% overweight as against 13% at risk of malnutrition. There was more overweight and obesity at a higher age and in males.

CONCLUSIONS

This prevalence of nutritional disturbances is similar to that in other Spanish studies and confirms both the size of the problem of obesity in the prevention of related pathologies in adults and the relevance of the adult's Nutritional History throughout his/her life. The study made clear the good correlation and utility of the Shukla and Quetelet indexes.

Studies of the specificities of IgE antibodies found in sera from subjects with allergic reactions to penicillins

Penicillins are immunogenic when administered to humans and in some instances they can also be allergenic, inducing specific IgE antibodies. Whilst the major haptenic group, the penicilloyl, is well characterised, less is known about the relative importance of the different parts of the structure for antibody binding and how this can influence the specificity of patients response. In order to investigate this further, sera from subjects who had suffered an IgE-mediated reaction to penicillins were studied using the radioallergosorbent test (RAST) and RAST inhibition. The assays employed reagents related to the penicillins causing the reaction. Using 173 sera, positive RAST results were only found with reagents based on benzyl penicillin (BP) and amoxicillin (AX). Fifty-three positive sera were selected for further studies and categorized into three groups: (A) sera only RAST positive to AX, (B) sera only positive to BP and (C) sera positive to both penicillins. RAST inhibition studies were then carried out using monomeric penicilloyl conjugates and compounds representing parts of the penicilloyl structures of BP and AX. For all three groups, monomeric penicilloyl conjugates were the most efficient inhibitors but there were differences for the other compounds. Group A sera were also inhibited by the side chain amoxicillin, whereas group B sera were poorly inhibited by all other inhibitors. Group C sera showed two patterns of inhibition, both consistent with their more cross-reactive profile.

[Cerebellar hypoplasia in the newborn: association with respiratory control disorders and mental retardation]

Cerebellum malformations are frequently diagnosed since the advent of the neuroradiological studies (computed tomography, magnetic resonance imaging and ultrasonography). Cerebellar hypoplasia is found in association with a wide variety of neurologic and systemic disorders. Clinical picture in newborn may be different than in other periods of life. Two characteristics are interesting in neonatal period: their relation with abnormal respiratory control and mental retardation. The pathophysiology of cerebellar hypoplasia is uncertain, however experimental studies suggest than an abnormality of the Bergman glia may lead to the observed granulle cell layer deficiency in this malformation. It is tempting to speculate that a similar migrational abnormality in the cerebrum accounts for the intellectual impairment seen in some affected patients. Respiration is a complex neural function requiring precise coordination of numerous neural circuits. Cerebellar hypoplasia may be important in the pathogenetic mechanism of abnormal respiratory control due to cerebellar respiratory control disturbance. Also diaphragmatic dysfunction may occur in association with cerebellar atrophy. We report two newborns with cerebellar hypoplasia (vermis and hemispheres) associated with central respiratory and neurological dysfunction, and mental retardation.

Nonimmediate reactions to betalactams: prevalence and role of the different penicillins

In patients treated with penicillins, adverse cutaneous reactions can occur within minutes or may take several days to develop. IgE antibody-mediated reactions are well documented, but other mechanisms may also be involved. In particular, nonimmediate reactions have not been studied extensively, and the purpose of the present work was to establish the incidence of such reactions among a large group of patients and to study the penicillins involved. A total of 380 subjects with a history of a cutaneous reaction following administration of a penicillin antibiotic was included in the study. Skin tests and specific IgE measurements (RAST) were carried out using various penicillins and penicillin-related reagents, and patients were also challenged with various penicillins. In some patients with delayed skin test responses, skin biopsies were carried out. The tests confirmed that 74 subjects (19.4% of total investigated) had suffered a cutaneous reaction to a penicillin derivative, and 29 of these subjects (7.6% of total or 39% of confirmed) showed evidence of having suffered a nonimmediate reaction. The latter group were identified by giving a positive delayed direct challenge, and in 65% of the cases a delayed skin test response was detected. In most cases, these responses were to amino penicillins. Skin biopsies showed a lymphomonocytic cell infiltrate. Nonimmediate reactions to penicillins are a reproducible phenomenon, suggesting that a specific mechanism is responsible. By direct challenge, 93% of responders were positive to amino penicillins (10.3% ampicillin, 82.7% amoxicillin), indicating a major role for these penicillins in nonimmediate reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Variations in cerebral blood flow in various states of severe neonatal hypoxic-ischemic encephalopathy]

The clinical applications of Doppler sonography are numerous in pediatric practice. Of the all the measurements of arterial signals available, the one that has been most useful used and has proved to be of practical benefit is the Pourcelot resistance index (PI). The change in PI is more sensitive than the real-time image for documentation of the cerebral insult in full-term asphyxia. The PI is much lower and stays lower for several days in the more severely asphyxiated infants and is thus extremely useful for predicting outcome as well. But multiple factors affect the waveform and PI, and it is important to understand how physiological and pathological variables influence chances in the Doppler signal in order to better understand changes in newborn with neurological problems. We present the changes of cerebral blood flow by Doppler ultrasound in a newborn with severe perinatal asphyxia and hypoxic-ischemic encephalopathy, associated with other neurological problems; coma, seizures and hydrocephalus.

DSS4-1 is a dominant suppressor of sec4-8 that encodes a nucleotide exchange protein that aids Sec4p function

The protein Sec4p plays an essential role at the final stage of the yeast secretory pathway and belongs to the ras superfamily of GTP-binding proteins, more specifically to a branch that includes Ypt1p in Saccharomyces cerevisiae and rab proteins in mammalian cells. GTP-binding proteins change conformation depending on whether GTP or GDP is bound and can thus act as a regulatory switch. The protein remains in its inactive, GDP-bound form until exchange of GTP for GDP allows it to stimulate a downstream effector. This interaction is curtailed by GTP hydrolysis. The rates of nucleotide exchange and GTP hydrolysis can be regulated by interaction with accessory proteins. Although GDP dissociation stimulators (GDS) have been identified that act on members of the ras and rho branches of the superfamily, less is known regarding GDSs that act on members of the Sec4/Ypt1/Rab subgroup. A preliminary characterization of a Rab3A GDP dissociation stimulating activity has been presented. We report here the use of suppressor analysis to clone a gene, dss4, encoding a 17K protein that aids Sec4p action in vivo by functioning as a GDP dissociation stimulator.

Short-term polycose substitution for lactose reduces calcium absorption in healthy term babies

A vitamin D-independent paracellular and not saturable mechanism important for intestinal calcium absorption turned out to be less effective in lactose-free diets. Twelve normal term babies with identical repletion levels of 25-hydroxyvitamin D (25D) were fed sequentially with starting formulas that differed only in their carbohydrate sources: lactose (control) and polycose. A 3-day test was performed after a 1-week adjustment to the new diet. Fecal excretion of calcium was significantly higher in the lactose-free formula period compared to the control one: 56.6 (13.9) versus 39.6 (12.8) mg/kg/day (p less than 0.02); subsequently, the net retention was considerably higher and statistically significant (p less than 0.01) for the control period versus the lactose-free formula period: 99.4 (15.3) versus 78.1 (14.3). Plasma 25D values were 21.8 (9.1) and 23.7 (7.1) ng/ml at the beginning of the lactose and polycose periods, respectively, and 1,25-dihydroxyvitamin-D values were 64 (62) and 75 (45) pg/ml, not significant. Results suggest that formulas containing polycose as the sole carbohydrate source may reduce the intestinal absorption of calcium in term newborns, but determining long-term biological significance requires further observation.

Interstitial 15q deletion without a classic Prader-Willi phenotype

We report on a newborn boy with pronounced hypotonia, cryptorchidism, minor facial anomalies, congenital heart defect, neurologic anomaly, deafness, renal anomaly, and bifid uvula. The patient has a de novo proximal interstitial deletion of chromosome 15 reaching to band q14, larger than that usually seen in Prader-Willi and Angelman syndromes.

Febrile convulsions induced by microwaves and the alteration in behavior of albino mouse OF1

We studied the effects of microwave (2,440 MHz) induced febrile convulsions (FCs) on the behavior and development of 31 albino mice (OF1 strain), between 25 and 30 days old, in comparison with a group of 33 animals from the same litters. Previously a string test was adapted to measure the neurodevelopment of mice in the first 6 months of life with 82 animals of the same characteristics. The animals submitted to convulsions (fit temperature = 39.2 +/- 0.96 degrees C) showed normal growth, in fact they obtained better results in the test than the control mice (2-way ANOVA, p less than 0.01). FCs have no negative influence on the normal behavior of the mouse.

Hyperimmunoglobulinemia E syndrome of neonatal onset

A case of hyperimmunoglobulinemia IgE with recurrent infections of neonatal onset and unfavourable evolution is described. The first clinical finding was the appearance of maculopapular rash in the skin when the child was fifteen days old. From this period onwards, respiratory and cutaneous infections were continuous, leading to a progressive deterioration of the general condition, and malnutrition, which ended fatally at the age of three years. IgE levels were measured on several occasions, this being 17 IU/ml at the onset of the symptoms; afterwards, the mean value was 17.680 IU/ml (Range: 14.9-32.710 IU/ml).

[Computer analysis of single channel current record by extracellular patch clamp]

Neher and Sakmann had provided the presence of the channel protein by the direct measurement of single channel current from excitable membrane in 1976. The advantage of this method "patch clamp" is to isolate a small part of membrane and pick up electrical excitability. In order to record single channel current the seal resistance between patch electrode and cell membrane must be at least more than gigaohm. To improve this recording condition enzyme treated cell or culture cell is necessary since fibroblast which attaches to a target cell disturbs gigaseal formation. In this study we use the computer to improve the single channel current recorded by low seal resistance.

[The impedance diagram of the nitella]

From olden time the resistance and capacitance of the living body were measured by alternating current bridge and the impedance diagram was made by rend 1/omega c using orthogoual axises, and it showes an arch. But by this research the impedance diagram of the Nitella was a line those are measured by finite alternating current. Formerly the frequencies were from 0.2Kc to 20Kc, but by this research the capacitance are nothing at over 4Kc.

Pseudohyperaldosteronism due to application of an antihemorrhoid cream

Three cases of pseudohyperaldosteronism produced by the application of an antihemorrhoid cream containing 9 alpha-fluoroprednisolone are reported. All three presented edema, hypokalemia and metabolic alkalosis. Two of the patients also exhibited slight arterial hypertension. This iatrogenic possibility must be ruled out in cases of hypermineralocorticoidism, thus avoiding unnecessary and costly examinations.

Improved method for quantifying vitamin D in proprietary infants' formulas and in breast milk

In this new method for quantifying vitamin D in infants' formulas and breast milk, after repeated lipid extraction, samples are further purified by passage through Sep-Pak cartridges, followed by liquid chromatography, then quantified by competitive protein-binding assay. Analytical recovery is estimated by use of added 3H-labeled vitamin D. For repeated assays of a reconstituted proprietary powdered milk formula in two runs, the intra-assay vitamin D values were 9.0 (SD 1.4) (n = 6) and 8.9 (SD 1.6) micrograms/L (n = 7) (t = 0.07). Assay of a proprietary liquid formula yielded values of 14.9 (SD 0.9) micrograms/L (n = 6). For each, the results agreed with the vitamin D content shown on the label. Vitamin D concentrations in breast milk from two groups of lactating mothers of different social class and nutritional status were 2.3 (SD 1.4) (n = 7) and 2.0 (SD 1.7) micrograms/L (n = 7). Overall recoveries ranged from 65 to 75%. Only 2 mL of milk is required, which facilitates sample collection, and the assay is less time-consuming than other current methods.

[Combination of hydantoins and valproate. Evidence of its teratogenic effect in 4 consecutive gestations]

Four siblings are presented with a malformative syndrome. All were born to an epileptic woman treated with phenytoin and valproic acid. A considerable high fetal pathology is found. Perhaps increased teratogenic effects are related with this pharmacological association not previously described.

Expression of immunogenically reactive diphtheria toxin fusion proteins under the control of the pR promoter of bacteriophage lambda

The tox228 gene encoding the non-toxic, immunologically cross-reactive CRM228 mutant diphtheria toxin (DT) has been cloned downstream of the PR promoter and the cro translational initiation region of bacteriophage lambda carried by plasmid pCQV2 (Queen, 1983). Efficient transcription but no appreciable amount of a translational product corresponding to complete DT could be detected in Escherichia coli hosts. Deletion of 320 bp from the C-terminal region of the B-fragment of DT, and fusion of the truncated tox228 gene to lacZ yielded several hybrid beta-galactosidases (beta Gal) in an E. coli lon- strain in addition to beta Gal. The various DT fragments fused to beta Gal were immunologically reactive and were identified with antibodies specifically directed against the A- or the B-fragment of DT. Antibodies raised against the DT-beta Gal fusion proteins in guinea pigs cross-reacted with wild-type DT and its B-fragment and protected Vero cells in tissue culture against the lethal action of DT. Immunized guinea pigs survived upon injection of a five-fold lethal dose of wild-type DT.

Inhibition of coated pit formation in Hep2 cells blocks the cytotoxicity of diphtheria toxin but not that of ricin toxin

It has been recently shown (Larkin, J. M., M. S. Brown, J. L. Goldstein, and R. G. W. Anderson, 1983, Cell, 33:273-285) that after a hypotonic shock followed by incubation in a K+-free medium, human fibroblasts arrest their coated pit formation and therefore arrest receptor-mediated endocytosis of low density lipoprotein. We have used this technique to study the endocytosis of transferrin, diphtheria toxin, and ricin toxin by three cell lines (Vero, Wi38/SV40, and Hep2 cells). Only Hep2 cells totally arrested internalization of [125I]transferrin, a ligand transported by coated pits and coated vesicles, after intracellular K+ depletion. Immunofluorescence studies using anti-clathrin antibodies showed that clathrin associated with the plasma membrane disappeared in Hep2 cells when the level of intracellular K+ was low. In the absence of functional coated pits, diphtheria toxin was unable to intoxicate Hep2 cells but the activity of ricin toxin was unaffected by this treatment. By measuring the rate of internalization of [125I]ricin toxin by Hep2 cells, with and without functional coated pits, we have shown that this labeled ligand was transported in both cases inside the cells. Hep2 cells with active coated pits internalized twice as much [125I]ricin toxin as Hep2 cells without coated pits. Entry of ricin toxin inside the cells was a slow process (8% of the bound toxin per 10 min at 37 degrees C) when compared to transferrin internalization (50% of the bound transferrin per 10 min at 37 degrees C). Using the indirect immunofluorescence technique on permeabilized cells, we have shown that Hep2 cells depleted in intracellular K+ accumulated ricin toxin in compartments that were predominantly localized around the cell nucleus. Our study indicates that in addition to the pathway of coated pits and coated vesicles used by diphtheria toxin and transferrin, another system of endocytosis for receptor-bound molecules takes place at the level of the cell membrane and is used by ricin toxin to enter the cytosol.

[Serum zinc during labor and in the newborn infant at term]

A study of serum zinc by atomic absorption spectrophotometry was carried out in peripheral blood samples form a group of 30 full-term mothers and umbilical cord samples from their newborns. Peripheral blood samples from 15 non-pregnant healthy women and umbilical cord samples collected within the first 24 hours in 20 healthy newborns were also obtained. Serum zinc in non-pregnant women yielded higher values which were significant (p less than 0,01), any way, the level of significance was higher when authors compared full term pregnant women with full term newborns in the first day of life.

[Effects of the administration of a diet with a low content of calcium and vitamin D derivatives on mineralization in pregnant rats and their fetuses]

Calcemia and calcium content of femuri has been determined in 88 female adult Wistar rats, distributed in four groups: Group A was given a normocalcic diet, group B a hypocalcic diet and groups C and D were also given the same hypocalcic diet, but at the same time were administered DHT and vitamin D (CC) respectively (15 mcg 3 times weekly). They were all killed 21 days after having been with a male for 24 hours; four rats were pregnant in each group A, B and C with a total offspring of 26, 22 and 35 fetuses respectively. Three pregnant rats in group C, gave 19 fetuses. Rats on hypocalcic diet showed a lower bone calcium content referred to 100 mg as weight, in comparison with those on a normocalcic diet (F = 5.51; p less than 0.01). Administration of CC or DTH did not hinder bone calcium depletion, which was more noticeable in pregnant rats (p less than 0.05). Concerning to calcemia, no differences existed between pregnant and non pregnant rats, there was a significant lowering of calcemia (F = 14.3; p less than 0.01) in rats on the hypocalcic diet (group B), but when administration of vitamin D (group D) and DHT (group C) was done, calcemia remained respectively equal and higher (p less than 0.001) by comparison to group A. Total calcium content in the ashed fetuses was similar in all groups. Fetuses acted as parasites of their mothers in respect to quantities of calcium deposited in them.

[Anorexia nervosa. Presentation of two cases]

Two patients with anorexia nervosa were studied. One of them showed cerebral atrophy by computed tomography (CT) of the brain. This finding has been reported previously in three cases. No other reports have been found in Spanish literature. This data could be merely a CT finding. Etiopathogenic and therapeutic evolution is discussed. Behavior modification, based in experimental psychology was used in treatment. Hypercaloric and hyperproteic feeding was also used.

[Seasonal variation and diagnostic value of plasmatic levels of 25-hydroxycholecalciferol (author's transl)]

Plasma 25-hydroxycholecalciferol (25OHD3) has been measured by means of gas-liquid chromatography (HPLC) in 23 healthy mothers and their normal full term babies. It was measured as well in twelve infants, nine children of 1.5-5 years and in 57 schoolboys of 5-12 years. Infant population showed a wide variation of plasma 25OHD3 (m +/- SEM) being 16.4 +/- 1.45 ng./ml. Children 1.5-5 years old showed 12.7 +/- 2.3 ng./ml. which is lower than expected. Schoolboys showed a normal values of 22.9 +/- 1.3 ng./ml. These differences are believed to be due to a great sunshine exposition. In perinatal group, births taking place in winter showed a very low level of 25OHD3 (m +/- SEM) in mothers (6.9 +/- 1.8 ng./ml.) and consequently in their newborns (5.3 +/- 1.6 ng./ml.). Those taking place in summer showed significantly higher figures for both mothers (18.9 +/- 2.7 ng./ml.) and newborns (12.9 +/- 2.4 ng./ml.). A good correlation (r = 0.83) between plasma levels of mothers and newborns is found.

A new method for the assessment of bone mass in renal osteodystrophy. Usefulness of computerized tomography in hemodialysis patients

We have designed az method for the assessment of trabecular bone mass (TBM) in a central portion of L4 by means of CT scanning. A total of 29 normal individuals of different ages from both sexes, and 19 hemodialysis patients were studied. 3 selected patients were also studied 1 year later. A good in vivo reproducibility was demonstrated in a dog after repositioning. A positive inverse correlation was observed in the control group between age and TBM supporting the reliability of this method. As reported by others in the postmortem bone mineral analysis of L4, a majority of patients (78.9%) showed a normal or high TBM. From a total of 5 patients with increased TBM only 2 showed radiological osteosclerosis, and 4 of them presented advanced subperiostal resorption suggesting a pathogenetic role of excessive circulating PTH in the genesis of osteosclerosis. A total of 4 had decreased TBM and only 2 of them showed radiological demineralization, 2 patients with decreased TBM, 1 of them under anticonvulsant therapy, experienced a considerable increase in the TBM after 1 year of 25OHD3 therapy. We conclude that this method can be an important help in the early detection of management of renal osteodystrophy.