[Rupture of the diaphragm caused by closed trauma. Case contributions and review of the literature]

AIM

Retrospective evaluation of 19 diaphragmatic ruptures due to blunt trauma.

MATERIALS AND METHODS

We collected all patients with thoracic and/or abdominal blunt trauma who were admitted to the department of surgery (Clinica Chirurgica and Chirurgia generale C) from 1970 to 1995. We selected patients with ascertained diaphragmatic rupture.

RESULTS

We considered 17 cases of TDR (15 males and 4 females). Mean age was 38 years (range 16-67). Radiologic findings were consistent with TDR in 10 cases out of 17 (58.8%). Right hemidiaphragm was injured in 6 cases (31.6%). 10 patients (52.6%) presented at operation with intrathoracic visceral herniation. 8 patients underwent laparotomy, 7 both laparotomy and thoracotomy, 4 thoracotomy alone. Perioperative mortality was 15.7% (3 patients).

DISCUSSION AND CONCLUSIONS

The clinical features were complicated by a large number of associated lesions; radiologic diagnosis is comparatively easy if visceral herniation into the thorax is present, repeated radiologic examinations facilitate diagnosis. The surgical access is determined by concomitant associated injuries which may require urgent operation.

Mapping in pig of genes involved in sexual differentiation: AMH, WT1, FTZF1, SOX2, SOX9, AHC, and placental and embryonic CYP19

Intersexuality has been reported in pigs and investigations are in progress to identify and physically map the genes involved in sex-reversal. In this study we have mapped on porcine chromosomes seven genes which might be implicated in this developmental pathway. Four genes were mapped by radioactive in situ hybridization: AMH (Anti-Müllerian Hormone) and WT1 (Wilms' Tumor gene 1) were both mapped to pig chromosome 2 (SSC2) in the q14-->q21 and p14-->q11 regions, placental CYP19 (cytochrome P450, subfamily XIX) and FTZF1 (fushi tarazu factor [Drosophila] homolog 1, alias SF1 [steroidogenic factor 1]) to pig chromosome 1 (SSC1) in the q14-->q17 and q210-->q211 regions respectively. Four other genes were regionally located by PCR analysis on a cytogenetically characterized porcine somatic cell hybrid panel: a second CYP19 gene (expressed in embryo) was mapped to porcine 1q12-->q17, AHC (alias DAX1, adrenal hypoplasia congenital) to porcine Xp24, SOX2 and SOX9 (SRY sex determining region Y-box 2 and 9) to 13q23-->q41 and 12p13-->p11 respectively. These results are in global agreement with mapping data available in other mammalian species.

Reliability of environmental, biological and health characteristics of infants from a developing country

BACKGROUND

Although most epidemiological data are gathered by interviews, few studies ascertain their reliability. This study quantified inter-observer reliability of environmental, biological and health characteristics of underprivileged children, in a southern Brazilian state.

METHODS

Five health care professionals who had received extensive standardized interview and observation training interviewed mothers and observed the home environments of a random sample of 102 children. A second interview was conducted by a sixth health professional who had received separate but identical training without the initial interviewer knowing a follow-up interview would be conducted. Data from the two independent interviews and observations were compared for agreement using the kappa statistic.

RESULTS

There was excellent agreement (kappa > 0.75) for most of the household characteristics, such as type of walls, ceiling, floor and windows in spite of the diversity of buildings. Presence of the parents, number of people in the house-hold, age of the mother and health assistance were reliable as well. However, information about skin colour of the mother and the number of cracks in the house only reached fair agreement.

CONCLUSIONS

These results showed that data gathered by observation and interviews generate accurate information about environmental, biological and health care characteristics. Those based on written information, such as birth date, were highly concordant.

[Hemorrhoidal thrombosis and perianal hematoma: diagnosis and treatment]

Thrombosed haemorrhoids and anal haematomas are very usual in patients with haemorrhoids. Conservative treatment and surgery are effective by the features and time of presentation. Authors refer about pathological and clinical findings and discuss the treatment.

[The elderly at the General Hospital and liaison psychiatry]

It is known that in general hospitals there is an increasingly high percentage of elderly patients that frequently develop psychiatric morbidity during hospital stay. This has lead the authors to perform a comparative study involving patients referred to Consultation/Liaison Psychiatry, in order to establish guidelines for a future approach. The first 1.000 referrals to the Consultation/Liaison Psychiatry Unit of the Santa Maria Hospital were analysed by comparing patients aged 65 or above to other observed patients. The results indicate a clearly lower percentage of elderly patients referred and a longer average length of stay at the moment of referral. Medical diagnoses show a preponderance of cardiologic, malignant and respiratory diseases, whereas intoxication, the prime diagnosis in the younger group, is much less represented above the age of 65. Identically, referrals due to suicide attempt were significantly less frequent in this group. Psychiatric diagnoses show a greater prevalence of organic mental disorders, followed by mood disorders, while in the younger the latter prevail. The post-discharge plan shows a higher percentage of elderly patients referred to general practitioners and medical specialties and a lower one for psychiatric care, as opposed to the younger group. The conclusions point towards the need for programs directed to early detection and treatment of psychopathological disorders (organic and depressive mental disorders) of elderly people admitted to a general hospital. This will be achieved through a close collaboration between C/L psychiatrists and medical staff, families and community facilities.

Evaluation of phosphine genotoxicity at occupational levels of exposure in New South Wales, Australia

Phosphine has been claimed to cause chromosomal damage at exposures close to the current time weighted average exposure standard of 0.3 ppm (0.4 mg/m3). The current study involved 31 phosphine fumigators and 21 controls during the high fumigation season. All were volunteers and were evaluated for genotoxicity variables, including micronuclei in peripheral blood lymphocytes and urine mutagenicity. In parallel, all fumigators and 17 controls were evaluated for full haematology, multiple biochemical analysis, whole blood organochlorines, and whole blood and serum cholinesterase activity. The results for micronuclei showed no significant differences between fumigators and controls, but detected a strong association between age and increased frequency of micronuclei. Measurement of urine mutagenicity did not show any significant difference between fumigators and controls, but did show increased excretion of mutagens in smokers. All haematological and biochemical variables were within normal ranges, except for some non-specific changes in biochemistry. At monitored occupational exposures of < 2.4 ppm/h our results show no association between phosphine exposure and genotoxic or toxicological effects in fumigators.

Determination of genotoxic and other effects in mice following short term repeated-dose and subchronic inhalation exposure to phosphine

Phosphine is an important fumigant in the grain industry and has been reported to be genotoxic in occupationally exposed fumigators. This study reports on the effects of phosphine inhalation exposure at up to, and exceeding, occupational relevant levels in a subchronic (0.3, 1.0 and 4.5 ppm, 13 weeks) and a short term repeated-dose (5.5 ppm, 2 weeks) study in both sexes of Balb-c mice. The following end-points were examined: micronucleus induction in bone marrow, peripheral blood, spleen lymphocytes and skin keratinocytes, mutations at the hypoxanthine-guanine phosphoribosyl transferase locus in lymphocytes, and weight gain and relative organ weights (kidneys, lungs, liver, heart, brain and spleen). After subchronic exposure, there was a highly significant negative linear correlation between proportional weight gain and exposure in both sexes (multiple linear regression, r = -0.56, P < 0.0001), with female mice showing a greater effect. Females also showed an increase in relative organ weights at the highest test dose, in contrast to males where there was a slight decrease. A statistically significant increase in micronucleus frequency was seen in the bone marrow and spleen lymphocytes of both sexes, but only at the highest concentration. The short term repeated-dose study revealed a slight decrease in weight gain in both sexes, with a greater effect in females. It is concluded that phosphine is weakly genotoxic in both sexes of mice, and has an effect on weight gain. However, the weak genotoxic effect may not be biologically significant as it was seen only in the subchronic study and only at the highest test concentration of 4.5 +/- 0.8 ppm (approaching the LD50). Although such exposure conditions are unlikely to be encountered in an occupational environment, caution should continue to be exercised in the use of phosphine until more data become available.

[Research on psychosomatic disease. Various theoretical and methodologic aspects]

This article mentions ther present main lines of psychosomatic research either in what concerns the elimination of the concept of psychosomatic illness, or in what concerns its etiological understanding of the peculiar ways of therapeutic approach. We specify some methodological problems resulting from using several instruments to collect data and measure them. We analyse the theoric relevance of the constructs: depressive equivalents and, specially, the alexithymia one. Starting from the consensual phenomonological description of this construct, we explain its psychodynamic understanding, its neurophysiologic basis and sociocultural determination. We question the relationship between alexithymia and psychosomatic illness. We point out the pertinency of its utilization as a risk or maintainance factor and the possibility of its modelling by ambiance factors. We clarify the main heuristic contributions of this construct to psychosomatic investigation and we analyse, critically and concisely, the validity and fidelity of some instruments of measure built to measure it. It is necessary to pay prior attention to psychosomatic investigation in the health area. We propose lines of investigation to be developed in our country that should have a multidisciplinary perspective.

[Effects and complications of Nd YAG laser posterior capsulotomy after ECA + PCI (extracapsular extraction and posterior chamber implantation)]

264 consecutive cases of ECCE are reviewed. In this series 28 cases of Nd YAG laser capsulotomy have been performed. Visual results are excellent: visual acuity is improved in 90% of cases. The rate of complications is low: 1 case of retinal detachment, 2 cases of IOP raise, no clinical CME. Laser therapy is performed when visual acuity decreases, prior to other extra clinical examination.

Experimental infection of Lutzomyia longipalpis fed on a patient with cutaneous leishmaniasis due to Leishmania mexicana amazonensis

The authors were able to infect phlebotomine sandflies on a human case of American Cutaneous Leishmaniasis by feeding females of Lutzomyia longipalpis on a patient with a lesion due to Leishmania mexicana amazonensis.

Influence of early mother-infant contact on dyadic behaviour during the first month of life

An experimental group of 30 newborn infants had contact with their mothers for half an hour in the delivery room, and a control group followed the usual hospital routine, being shown briefly to their mothers before being taken to the nursery. In both groups permanent rooming-in began from the sixth hour of life. The infants' behaviour was assessed one, three and 28 days after birth by means of the Brazelton scale, and the behaviour of the dyad was observed during feeding on the third and 28th day. Infants in the experimental group interacted significantly better on days three and 28, and their mothers had higher scores for affectionate behaviour on the 28th day.