Expanding contraceptive choice: findings from Brazil

This article presents findings from a participatory action research project in a municipality in southern Brazil that models a new and holistic approach to broadening women's contraceptive choices. The project encourages a collaborative process between researchers, community members, and public health managers to diagnose service-delivery problems, to design and implement interventions, and to evaluate their effectiveness. Findings from the baseline evaluation revealed major constraints in availability of and access to family planning and reproductive health services for women, as well as severe deficiencies in quality of care. Interventions designed to address these weaknesses, bound by the limited resources of the public sector, focused on training, restructuring of providers' roles and service-delivery patterns, the management process, the creation of a referral center, and the introduction of injectables, vasectomy services, and a program for adolescents. Evaluation results show the project's considerable impact in broadening reproductive options, although not all issues, especially those related to sustainability, have been resolved.

[outbreak of invasive pulmonary mycosis in neutropenic hematologic patients in relation to remodelling construction work]

BACKGROUND

An increase was observed in the number of cases of invasive pulmonary mycosis in neutropenic hematologic patients coinciding with construction work being carried out in the Hospital Clínico San Carlos (Madrid, Spain). The aim of this study was to confirm the existence of an outbreak, identify the factors related and adopt adequate control measures.

METHODS

A descriptive, epidemiologic, environmental microbiologic study was performed. The incidence of cases in the study period and a control period was compared. Air samples were collected in the affected area and other areas of hospitalization not related to the construction work. The ventilation system of the Hemalotogy Isolation Unit (HIU) was also sampled. The control measures undertaken included: hermetic sealing of the construction work adjacent to hematology followed by transfer of the patients to another floor of the hospital.

RESULTS

The existence of an outbreak was confirmed (significant increase in the incidence, p = 0.017). Eleven cases and one death by massive hemoptisis were reported. The mean total fungal count and to Aspergillus spp were 120 and 35 UFC/m3, respectively in the hematologic hospitalization area adjacent to the construction work and 37 and 5 UFC/m3 in other areas (p < 0.001). Contamination was detected in the ventilation system of the HIU by A. fumigatus (125 UFC/m3 of air from the interior of the conduct).

CONCLUSIONS

An elevated number of fungal spores found in samples from the hematologic hospitalization area as well as no further new cases being reported following the transfer of the patients suggest that the outbreak was related to the adjacent construction work being carried out.

[Microalbuminuria, lipid changes and coronary heart disease in non-insulin-dependent diabetics]

BACKGROUND

Microalbuminuria could be a possible coronary risk factor:

AIM

To study the association between microalbuminuria, serum lipid levels and coronary heart disease in non-insulin-dependent diabetics.

PATIENTS AND METHODS

We studied 104 non-insulin-dependent diabetics, who were separated in four groups according to the presence of microalbuminuria, defined as a 24 h albumin excretion of 30-300 mg/24 h and according the history of coronary artery disease. Total, HDL and LDL cholesterol, triglycerides, alpha, beta, prebeta lipoproteins, lipoprotein (a), apoproteins A and B were measured in all.

RESULTS

Twenty patients with and 32 without coronary artery disease had normal albumin excretion and the same number of patients had a urinary albumin 30-300 mg/24 h. All four groups were comparable in terms of metabolic control, nutritional status, blood pressure and creatinine levels. Patients with coronary artery disease had higher urinary albumin excretion than patients without the disease 91 (32-173) and 34 (5-97) mg/24 h respectively p < 0.01. Patients with coronary artery disease and microalbuminuria had higher triglycerides, beta, pre beta lipoproteins, Apo B, Lp(a) and lower Apo B and alpha lipoproteins. This group also had a higher frequency of abnormal pre beta and alpha lipoprotein levels, when compared with coronary patients with normal albumin excretion. In coronary patients there was a positive association between urinary albumin levels and triglycerides (r = 0.24), pre beta lipoproteins (r = 0.27) and Apo B (r = 0.3); there was also a negative association with HDL cholesterol (r = 0.25) and alpha lipoproteins (r = -0.41).

CONCLUSIONS

In this group of non-insulin-dependent diabetics, an association among microalbuminuria, abnormal serum lipid levels and coronary artery disease was detected.

Recognizing the reversible nature of child-feeding decisions: breastfeeding, weaning, and relactation patterns in a shanty town community of Lima, Peru

Researchers have normally considered weaning to be a non-reversible event. To determine the validity of this assumption, we interviewed 36 mothers of toddlers who were living in a poor shanty town of Lima, Peru. Data from 32 women were complete and used in this analysis. Mothers described their beliefs, practices, and decisions about breastfeeding, weaning, and relactation (the reintroduction of breastfeeding after weaning). We recorded attempted weaning events if the mother reported (1) purposefully not breastfeeding with the intention to wean, or (2) carrying out an action that was believed to cause the child to stop breastfeeding. Using a constant comparative approach, references to child-feeding decisions were coded, categorized, and analyzed. All mothers breastfed for at least 12 months; the median duration of breastfeeding was 25 months. There were several different patterns of child-feeding. Thirteen women never attempted to wean their children or had weaned on the first attempt. The majority (n = 19) of women, however, attempted to wean their children - some as early as 3 months of age but relactated between less than 1 day and 3 months later. Factors that influenced feeding decisions were primarily related to maternal and child health, and maternal time commitments. Children were weaned when there was a perceived problem of maternal health or time commitments and child health was not at risk of deterioration. Mothers postponed weaning because of poor child health. The primary reason for relactation was a child's negative reaction to weaning (e.g., incessant crying or refusal to eat). Personalities of the mother and child were important determinants of feeding decisions. These results demonstrate that maternal and child factors jointly influence child-feeding decisions and that these decisions are easily reversed. As relactation is culturally acceptable, health practitioners should consider recommending relactation when children have been prematurely weaned and human milk would improve their nutritional and health status.

Daily mortality in Madrid community 1986-1992: relationship with meteorological variables

Daily mortality displays a seasonal pattern linked to weather, air pollution, photoperiod length, influenza incidence and diet, among which temperature ranks as a leading cause. This study thus sought to assess the relationship between temperature, relative humidity, wind speed and mortality in the Madrid Autonomous Region (Spain) for the period January 1986-December 1992, controlling for the effects of air pollution and influenza incidence. Daily data on maximum, minimum and 24-hour mean temperature, relative humidity and wind speed were matched against daily mortality. Transfer function was identified using the Box-Jenkins pre-whitening method. Multivariate time series regression models were used to control for the confounding effects of air pollution and influenza incidence. Separate seasonal analyses were carried out for winter and summer periods. A J-shaped relationship between outdoor temperature, relative humidity and daily mortality was found. Mortality proved to be inversely related to cold temperature (4- to 11-day lag) and directly related to warm temperature (1-day lag). High relative humidity during summer periods was negatively related to mortality. Thermal variation ascribable to Madrid's mesothermal Mediterranean climate was strongly related to daily mortality, even where air pollution and influenza incidence were controlled for.

[Polymerase chain reaction for rapid detection and serotyping of dengue virus in clinical samples]

This study describes the benefits of using reverse transcriptase polymerase chain reaction (RT-PCR) for the rapid detection and typing of dengue virus in clinical samples. Twenty-seven serum specimens from patients with dengue fever and dengue hemorrhagic fever in Colombia, Nicaragua, and Panama were directly subjected to RT-PCR for the detection of dengue virus. The resulting double-stranded DNA product was typed by a second round of PCR amplification (nested PCR) with type-specific primers, viral culture/indirect immunofluorescence (IIF), and enzyme-linked electroimmunoassay for IgM anti-dengue antibodies. The amplified virus genome was detected and typed within 8 hours. Nested RT-PCR, using viral culture and IIF as the gold standard, showed 100% sensitivity; 78% specificity; 69% positive predictive value, and 100% negative predictive value. It is noteworthy that two of the specimens whose results were positive with nested RT-PCR and negative with viral culture showed specific IgM antibodies. The results of the RT-PCR were in close agreement with those obtained through viral culture. This suggests PCR can greatly facilitate the rapid and early diagnosis of dengue infection.

[Prospective randomized trial of meropenem versus cefotaxime and metronidazole in the treatment of intraabdominal infections]

BACKGROUND

The empiric antibiotic treatment of intraabdominal infections is in constant evolution. Monotherapy appears to be a desirable goal because of the simplicity of its administration, lack of toxic effects and wide spectrum.

PATIENTS AND METHODS

A multicentre, prospective, randomized, open study was carried out to compare two antibiotic regimens in the treatment of intraabdominal infections in patients undergoing surgery. Ninety-eight consecutive patients were randomly allocated into two groups. One group (GM, n = 51) received meropenem (1 g/8 h) and the other (GCM, n = 47) a combination of cefotaxime (2 g/8 h) plus metronidazol (0.5 g/8 h). Clinical and bacteriological responses were assessed at the end of treatment and at 2-4 weeks.

RESULTS

The severity of patients as assessed by the APACHE II score was similar in both groups (GM: 7.2 and GCM: 8.1). Three patients in each group could not be evaluated due to premature interruption of treatment or deviation from the protocol. The mean duration of treatment was 7.4 days in GM and 7.9 days in GCM. A satisfactory clinical response was obtained in 95% of patients in both groups. 31 patients (61%) in GM and 26 patients (55%) in GCM were bacteriologically evaluable. Bacteriological erradication was achieved in 94% of patients in GM and in 92% of patients in GCM.

CONCLUSION

Meropenem is a good alternative for single antibiotic therapy in intraabdominal infections of moderate severity.

Histone synthesis in Trypanosoma cruzi

Trypanosoma cruzi is an ancient, parasitic eukaryote which does not undergo chromatin condensation during cell division. This behavior may be explained if one considers the strong amino acid sequence divergence of Trypanosoma histones compared to higher eukaryotes. In the latter organisms histone synthesis is coupled to DNA replication. Considering the nonconserved amino acid sequence of T. cruzi histones, as well as the absence of chromatin condensation in this organism, we have studied histone synthesis in relation to DNA replication in this parasite. We have found that core histones and a fraction of histone H1 are synthesized concomitantly to DNA replication. However, another fraction of histone H1 is constitutively synthesized.

Antigen recognition characteristics and comparative performance in immunoaffinity purification of two monoclonal antibodies specific for the hepatitis B virus surface antigen

In this paper we describe the antigen recognition characteristics, variable region base and amino acid sequence, and performance as immunoaffinity chromatography ligands of two MAb specific to the alpha determinant of the HBsAg, derived from the same fusion. We show that the epitope recognized by CB-Hep.0 (IgM) is probably associated to an intrachain disulfide bond in the antigen. On the other hand, CB-Hep.1 (IgG2b) recognizes a heat-resistant non-conformation dependent antigenic determinant on HBsAg. PCR-cloning and sequencing of the variable regions of these two MAb indicated that both heavy chain variable regions were originated from the usage of the same germinal V and J genes. However, the outstanding differences in the size of the VH CDR3, and the absolute difference in the light chain sequences, suggest that the hybridomas were originated from different precursor B lymphocytes. With respect to their use as immunoaffinity chromatography ligands for the purification of a recombinant HBsAg, we found that the IgM immunogel exhibited increased performance with respect to amount of eluted antigen, and final recovery. This difference in overall performance could be attributed to a series of factors: the higher valence number of IgM, a dissimilar distribution of IgM and IgG in the activated gel particles, and differences in antigen recognition between both MAb. Our results suggest that IgM antibodies may be useful in immunopurification, particularly if the antigen is structurally complex and has a high density of repeating epitopes.

No relationship between the IUD position evaluated by ultrasound and complaints of bleeding and pain

The objectives of this study were to define the "normal" position of the T-shaped intrauterine device (IUD) in the endometrial cavity, using transvaginal ultrasound, and to compare the IUD's position in women with and without complaints of bleeding and/or pain. Vaginal ultrasound was carried out in women who had used a T-Cu 200 or T-Cu 380 for at least 6 months. Of these women, 236 registered bleeding complaints and/or pain and 245 had no complaints. The distances, IUD-endometrium, IUD-myometrium, and IUD-fundus, were measured in each woman. Our results showed that women with and without complaints presented no significant differences in age, parity, type of IUD, duration of use, previous contraceptive method used, hysterometry, uterine position, or period of the cycle in which the ultrasound was performed. The values of the three distances in users without complaints were widely dispersed. The 90th percentile of the IUD-endometrium, IUD-myometrium, and IUD-fundus distances were 7, 11, and 27 mm, respectively. The curve of the values for the three distances among women with complaints was similar to that of the subjects without complaints. Using the generally accepted measurement of 20 or 25 mm as the limits of normality of the distance IUD-fundus, and the 90th percentile of the distance IUD-endometrium as the gold standard, 77% and 43% of the women were false positives for "incorrect IUD position." Similar results were obtained when the 90th percentile of the distance IUD-myometrium was used as a gold standard. We concluded that the 90th percentiles of the distance IUD-endometrium, IUD-myometrium, and IUD-fundus were 7, 11 and 27 mm, respectively, among users without complaints. The ultrasonographic diagnosis of the IUD position was unable to discriminate between women who did or did not have complaints of bleeding and/or pain. If ultrasound were to be performed in T-shaped IUD users, the IUD-myometrium distance is likely to be the most reliable measurement.

Anapsos reverses interleukin-1 beta overexpression and behavioral deficits in nbM-lesioned rats

Rats with neurotoxic lesions, induced by single or double bilateral injections of ibotenic acid into different parts of the nucleus basalis of Meynert (nbM), showed increased psychomotor activity (PMA) and impaired learning in a passive avoidance task. Behavioral deficits were similar in all the groups of lesioned animals, suggesting that the lesion site was not relevant for the ibotenic effects under testing procedures used here. In another experiment, nbM-lesioned rats received acute or daily (5 days) i.p. injections of vehicle or anapsos (100 mg/kg) from the 7th day after surgery. Data indicated that nbM lesions induced an increased production of interleukin-1 beta (IL-1 beta), motor hyperactivity and learning impairment, and that anapsos, a vegetal extract with immunomodulatory activity, reversed brain IL-1 beta overexpression and behavioral alterations in lesioned rats. These results confirm the involvement of IL-1 beta in neurodegeneration associated with cholinergic deficits and the potential utility of compounds with neuroimmunotrophic activity as a new therapeutic strategy in neurodegenerative disorders.

The strategic approach to contraceptive introduction

The introduction of new contraceptive technologies has great potential for expanding contraceptive choice, but in practice, benefits have not always materialized as new methods have been added to public-sector programs. In response to lessons from the past, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction (HRP) has taken major steps to develop a new approach and to support governments interested in its implementation. After reviewing previous experience with contraceptive introduction, the article outlines the strategic approach and discusses lessons from eight countries. This new approach shifts attention from promotion of a particular technology to an emphasis on the method mix, the capacity to provide services with quality of care, reproductive choice, and users' perspectives and needs. It also suggests that technology choice should be undertaken through a participatory process that begins with an assessment of the need for contraceptive introduction and is followed by research and policy and program development. Initial results from Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Vietnam, and Zambia confirm the value of the new approach.

Prevalence of stroke in two samples (rural and urban) of old people in Spain. A pilot door-to-door study carried out by health professionals

The aim of this study was to present the prevalence of stroke from a pilot study in old people. The urban site sample (Madrid) was made up of 397 subjects and the rural site sample (Arévalo, Avila) of 862 subjects. The study was performed with a door-to-door methodology. In the urban sample, the prevalence of stroke was 8.5% (CI 95% = 5.5-11.5%) and that of TIA was 2.1% (CI 95% = 0.6-3.6%). In the rural location the prevalence of stroke was 7.1% (CI 95% = 5.4-8.8%). This prevalence of stroke is higher than in other Spanish studies. These results need to be confirmed in a wider investigation.

Effects of anapsos on the activity of the enzyme Cu-Zn-superoxide dismutase in an animal model of neuronal degeneration

The enzyme Cu-Zn-SOD is a metalloenzyme that catalyzes the dismutation of the superoxide radical into hydrogen peroxide and molecular oxygen, being a defense system against free radical formation. Free radical reactions are implicated in a variety of physiological and pathological processes as aging, apoptosis and neurodegenerative diseases, and abnormalities associated with SOD have been recently documented in several neurodegenerative processes. In this study, we have evaluated the effect of anapsos on Cu-Zn-SOD activity in rats with injections of beta-amyloid protein or water bilaterally into the hippocampus. These injections caused severe cell depletion in the gyrus dentatus. Anapsos is a biological extract obtained from the fern Polypodium leucotomos with immunomodulatory and anti-neoplastic effects tested in animals and humans. Cu-Zn-SOD activity was measured in the hypothalamus, hippocampus, cerebral cortex, liver and spleen of rats treated i.p. with three doses of anapsos for 7 days (4, 20 and 100 mg/kg/day). Control animals were treated with saline solution under the same conditions. Anapsos significantly modified enzyme activity in all the areas tested. Lower doses of anapsos produced decreased SOD activity in the hypothalamus, hippocampus, liver and spleen, while in the cerebral cortex, a significant dose-dependent increase in SOD activity was observed. These results indicate that anapos was able to modify Cu-Zn-SOD activity in this animal model of neuronal degeneration, which may indicate the participation of anapsos in mechanisms of tissue repair after brain damage.

Purification and characterization of an invertase from Candida utilis: comparison with natural and recombinant yeast invertases

A periplasmic invertase from the yeast Candida utilis was purified to homogeneity from cells fully derepressed for invertase synthesis. The enzyme was purified by successive Sephacryl S-300, and affinity chromatography and shown to be a dimeric glycoprotein composed of two identical monomer subunits with an apparent molecular mass of 150 kDa. After EndoH treatment, the deglycosylated protein showed an apparent molecular weight of 60 kDa. The apparent K(m) values for sucrose and raffinose were 11 and 150 mM, respectively, similar to those reported in Saccharomyces cerevisiae. The range of optimum temperature was 60-75 degrees C. The optimum pH was 5.5 and the enzyme was stable over pH range 3-6.

[Evaluation of a rapid method for the identification of the Enterococcus genus]

BACKGROUND

The evaluation of the reliability of a group of three tests: pyrrolidonil-arilamidase, rapid test in NaCl esculin broth and group D antistreptococci agglutination for the rapid identification of the Enterococcus genus were performed.

METHODS

One hundred fifty-eight strains of streptococci: 110 strains of Enterococcus faecalis, 8 E. faecium, 3 E. avium, 16 Streptococcus intermedius, 7 S. salivarius, 4 S. bovis, 4 S. constellatus, 2 S. sanguis and 1 strain of S. equinus, S. mitis, S. uberis and S. mutans were studied. The tests used were: rapid test in NaCl- esculin broth, pyrrolidonyl-arilamidase and antigroup D streptococcus agglutination (Patho Dx Strep D/PYR; Diagnostic Product Corporation). All catalase-negative gram-positive cocci or coccibacilli which were positive in the three tests were considered to belong to the Enterococcus genus. The usefulness of Gram staining in culture in thioglycolate broth was also studied comparing it with the results obtained with solid medium.

RESULTS

The results of the proposed identification scheme were evaluated calculating different parameters: sensitivity 98%, specificity 100%, positive predictive value, 100%, and negative predictive value 94%. No significant differences were observed between the results obtained with Gram staining with thioglycolate broth and those obtained with solid medium except in the case of the Streptococcus mutans strain.

CONCLUSIONS

The application of a combination of tests: pyrroidonyl-arilamidase, antistreptococci group D agglutination and rapid test in NaCl-esculin broth to catalase-negative gram-positive cocci and coccobacilli allows reliable identification in a maximum of three hours of strains belonging to the Enterococcus genus.

Phase II study of cisplatin, 5-fluorouracil, and leucovorin in inoperable squamous cell carcinoma of the esophagus. ONCOPAZ Cooperative Group, Spain

Cisplatin (P) and 5-fluorouracil (5FU) have demonstrated activity for the treatment of squamous cell carcinoma of the esophagus. Previous studies have shown that leucovorin (L) may potentiate the antitumoral activity of 5FU, so we tested the combination P-5FU-L in 31 patients with inoperable squamous cell esophageal carcinoma. Chemotherapy consisted of P 20 mg/m2 in 4 h, followed by L 200 mg/m2 in 2 h and 5FU 600 mg/m2 in 18 h. This schedule was repeated for 5 days every 4 weeks. The treatment plan included three courses of chemotherapy followed by radiotherapy. The overall response rate was 58% (95% CI = 39-76%), with one complete remission (3%), and 61% of patients reported an improvement in dysphagia. Gastrointestinal toxicity was the main side effect: grade 3-4 mucositis appeared in 19% of patients, grade 3-4 nausea/vomiting in 13%, and grade 3-4 diarrhea in 6.5%. There was one toxic death caused by neutropenia and sepsis. Nineteen patients received local radiotherapy after chemotherapy, which increased the overall response rate to 63% (5% complete responses). Dysphagia improved in 75% of them. The median survival for all patients was 11 months. This study shows that sequential therapy with P-5FU-L and radiotherapy achieves a high response rate as well as adequate symptomatic relief in patients with inoperable esophageal cancer. The results justify further evaluation of P-5FU-L in patients with earlier-stage disease.

Purification, characterization and immobilization of proteinase inhibitors from Stichodactyla helianthus

Isolation of proteinase inhibitors from the sea anemone Stichodactyla helianthus was achieved by trichloroacetic acid treatment of the aqueous extract followed by affinity chromatography on trypsin-Sepharose and ion-exchange chromatography on CM-cellulose. The average molecular mass of the major inhibitor (ShPI-I) obtained by fast atom bombardment mass spectrometry (FAB-MS) was 6110.6 Da. The amino acid sequence was determined by FAB-MS combined with manual Edman degradation, digestions with endopeptidases and exopeptidases and automatic sequencing. The sequence of ShPI-I (55 amino acids) was compared with those reported in the SwissProt database for several proteinase inhibitors and significant similarity to inhibitors belonging to the Kunitz family was observed. ShPI-I exhibits a broad specificity for serine, cysteine and aspartic proteinases. The dissociation constants of the complexes formed with different enzymes were determined. The affinity-purified fraction (PI) was immobilized on Sepharose and used in the purification of different classes of proteinases.

Note: comparison of media for the isolation of lactose-positive Salmonella

We studied the capacity of 10 selective media (Rambach agar, RB; salmonella-shigella agar, SS; SM-ID medium, SM; Hektoen enteric agar, HE; modified semisolid Rappaport-Vassiliadis agar, MSRV; bismuth sulphite agar, BS; MacConkey agar, MC; brilliant green agar, BG; novobiocin-brilliant green-glucose agar, NBG; and novobiocin-brilliant green-glycerol-lactose agar, NBGL), and the C8-esterase test (MUCAP test, Biolife, Italy) to detect the growth of 14 strains of lactose-positive Salmonella (12 Salm. virchow and two Salm. montevideo) and 16 Salm. arizonae. Suspensions of pure strain were plated on the aforementioned media and on Mueller-Hinton, used as a control, with inocula of 3 x 10(2) cfu ml-1. The performance of BS was excellent, determining the 30 strains as typical Salmonella colonies (H2S+). On NBG, 27 strains were detected. On MSRV, only some strains grew and only one produced swarming. On the other media, the two Salm. montevideo and the 12 Salm. virchow strains produced coliform colonies. Some of these latter were inhibited on BG and NBGL. The 16 Salm. arizonae strains produced typical colonies on all the media, except on RB, SM and MSRV. On NBGL, two strains did not produce H2S. The C8-esterase test was only successful with Salm. montevideo and Salm. virchow on NBG and RB (with a few exceptions on the latter). However, with Salm. arizonae the test was positive on SS, MC, HE, BG and NBG. In summary, BS was the best medium of those used (all the 30 strains were isolated), followed by NBG (27 isolates).

[Castleman's disease: a histological concept for a wide clinical spectrum]

A literature review about Castleman's disease after a clinical case with different manifestations of this entity was done. Special emphasis on the histological and clinical aspects of the sickness was given. The different pathological patterns and their broader spread do not match necessarily with the different clinical presentations described. Further conclusions regarding their evolution, prognosis and treatment response can not be easily obtained from these data.

[Effects of neurotensin on the development of suckling rats with intestinal resection]

Massive intestinal resection produces malabsorption which, in the suckling rat, reduces growth. Our aim was to determine whether the proliferative action of neurotensin, can reduce the negative effects on growth induced by bowel resection. Fifteen days old suckling Wistar rats were used. Twenty rats underwent 90% midgut resection and twelve were used as controls. Half the animals were treated with neurotensin (600 micrograms/kg-day) until sacrifice 30 days later. Body and bone weight were measured and mucosal samples obtained. All resected animals lost body weight and bone weight. Neurotensin treatment reduced femur weight loss. After bowel resection, significant trophic effects were observed at mucosal level (crypt and villous size) but only in the jejunum of resected animals neurotensin treatment had a trophic effect. In conclusion, neurotensin favors intestinal adaptation after resection without improving mid-term growth in the suckling rat.

Performance of copper intrauterine devices when inserted after an expulsion

A total of 124 women who re-inserted a TCu-200B intrauterine device (IUD) following an expulsion were followed up for 1 year after the IUD re-insertion. The cumulative expulsion rate at 6 months was 21.7 and 31.4 per 100 women at the end of the first year. Women who expelled the first IUD within the first 3 months of use had a significantly higher expulsion rate with the second IUD. Our conclusion is that women who expelled a copper IUD are at a significantly higher risk of expelling the re-inserted IUD than the first IUD. Health workers must also be informed about the high probability of another expulsion when re-inserting an IUD after an expulsion.

[Complete anorectal stenosis due to paracetamol and salicylamide suppositories]

A female patient previously diagnosed of psychiatric disease used a compound of paracetamol-salicilamide-codeine in suppositories, daily, for more than one year, for migraine. She developed a complete recto-anal stenosis and bowel obstruction requiring permanent colostomy. Ulceration and recto-anal stenosis have been described in association with the use of suppositories, mainly ergotamine. However, this is the first case of total recto-anal stenosis.

Systemic infections in three infants due to a lactose-fermenting strain of Salmonella virchow

Three previously healthy children developed gastroenteritis which led within a few days to systemic infections, two cases of bacteremia and one of meningitis. A lactose-fermenting Salmonella virchow strain was isolated from cerebrospinal fluid and blood cultures. In one case, this strain was also isolated from stool cultures. All the children had been fed the same milk formula. There was no other relationship between them. The batch of dried-milk formula was confirmed as the source of the infection by isolation of an identical lactose-fermenting Salmonella virchow strain by the Centro Nacional de Alimentación.

[Primary gastrointestinal lymphomas: clinical and pathological aspects and survival]

This retrospective study evaluated 32 patients with primary gastrointestinal lymphoma managed at Belen Hospital, Trujillo, Peru, from 1966 to 1994 to determine their clinicopathologic findings and identify those prognostic factors that influenced in the 5-year survival. Median age was 44.2 years. The male to female ratio was 1.3:1 and seventh decade was the most involved. Abdominal pain, the predominant symptom, was present in gastric (100%) and intestinal (91%) lymphoma. Small intestine was involved in 62.5% cases, followed by stomach (28.1%). Most common stage was II1E (50%) and predominant histological was high grade-MALT type lymphoma (81.3%). Five year survival rate was 29% for those who received some kind of treatment (n = 30): It was 38% for whom underwent surgery plus chemotherapy and/or radiotherapy compared to those who only underwent surgery (23%) (p < 0.05). Factors as histological type (p < 0.005), stage (p < 0.005) and tumoral size (p < 0.05) were associated with long term survival. We conclude that early diagnosis is important to define management in these patients and post-operatory adjuvant treatment should be considered to obtain a longer survival.

[Changes in plasma levels of intestinal regulatory peptides following colonic resection in the rat]

The colon is considered as an endocrine organ producing regulatory peptides. Colon resection exerts an influence on remnant bowel including proliferative adaptive phenomena. The aim of this work was to determine the modifications of several regulatory peptides after colectomy and its relation with the gastrointestinal proliferative changes. 75% proximal colectomy was performed in Wistar rats. Seven groups were used according to sacrifice times: 24 h, 48 h, 72 h, 7 days, 14 days, 21 days and control group without resection. Results show significant decreases in somatostatin, neurotensin and cholecystokinin plasma levels maintained up to 21 days postsurgery. Gastrin is elevated with a highest peak at 72 h achieving basal levels at 21 day. Peptide YY show significant high levels between 72 h and 7 days. Secretin plasma levels are increased 24 h post-surgery, decreasing significantly at day 14. It is suggested that maintained low plasmatic levels of somatostatin, a known mucosal growth inhibitor, after colectomy may help the proliferative adaptation.

Clinical performance of the Copper T200B IUD after reinsertion following life-span expiration

The purpose of this study was to evaluate the first year clinical performance of the TCu200B IUD in a cohort of women who had the IUD re-inserted immediately after a removal for life-span expiration, compared with a group of initial acceptors, and a cohort of women who continued using the device for more than 60 months. The sample consisted of 1066 users, 339 in each of the two first groups and 388 in the third. Life-table analysis was used to calculate continuation and gross discontinuation rates by reason. Statistical significance of the differences between groups was tested by log-rank method. Pregnancy rates were low, both in the group of re-insertions and first insertions, and no pregnancies occurred in the group using the device beyond the fifth year. The expulsion rate and lost-to-follow-up (LFU) rate were significantly lower in the group of women who used the device beyond the fifth year. In addition, this group showed a significantly higher rate of removal for investigator's choice. These results show that there is no reason to recommend the removal and replacement of the TCu200B before the end of the sixth year of use. When a new IUD is to be inserted after removal for life-span expiration, providers should be instructed to insert it immediately after the removal, because this procedure does not pose additional risks, reduces the number of clinic visits, and relieves the women of the use of a temporary method while waiting for the re-insertion.