[A case of uterine leiomyoma with pulmonary metastasis]

In a 34-years-old patient complaining about persistent dry cough, multiple bilateral pulmonary nodules were observed. The extremely good condition of the patient and the history of resection four years before of an uterine myoma suggested a pulmonary leiomyomatosis. The hystological study after a pulmonary segmentomy confirmed this diagnostic suspicion. The presence of benign pulmonary metastasis in an uterine leiomyoma is a very rare complication. We review the literature therapeutic aspects of this interesting entity.

[Importance of the colon in intestinal adaptation. Study with the proliferating cell nuclear antigen]

Proliferating cell nuclear antigen (PCNA) is an auxiliary protein to DNA polymerase delta necessary for tissue cellular proliferation. The colon releases several peptides or hormones which are probably related to intestinal proliferation. Colonic resection determines adaptive changes in the remnant bowel. In the present study, proliferative changes after colectomy were studied by means of the murine monoclonal PC10 antibody. A control group (n = 10 rats) and a 75% proximal colon resection group (n = 10 rats) were studied. 14 days after resection, jejunal, ileal and colon samples were taken and assayed for PCNA. Relationship between immunostained nuclei and the total number of nuclei was determined. The three intestinal segments showed statistically significant increases (p < 0.001) in the number of immunostained nuclei. PCNA proliferative index was greater in the remnant large bowel.

Performance of the copper T 200 in parous adolescents: are copper IUDs suitable for these women?

The clinical performance of a cohort of 995 parous adolescents, first-time users of the T-Cu 200B was studied and compared with a cohort of paired controls 10 years older, of the same parity. Life-table analysis showed that pregnancy, expulsion rates, as well as removals for bleeding and/or pain were higher in adolescents but within ranges already reported in the literature on this device. Removals for infection were few and not significantly different. Although the clinical performance of the T-Cu 200B in adolescents is not as good as in older women, the performance is similar or better than that reported for other reversible methods in this age group. Our conclusion is that IUDs should not be contraindicated for parous adolescents as long as adequate counseling, screening of risk factors, skillful insertion and follow-up are provided.

Quality of care in family planning in Latin America

The majority of family planning programs in Latin America have been implemented in response to the region's population growth and aimed mainly at obtaining quantitative results, leaving quality, from the user's point of view, in second place. Recent decades have witnessed an increasing concern for quality of care in family planning because most researchers and service providers began to realize that when contraceptive methods are delivered without maintaining high quality levels, continuation rates are usually low and the image of methods and services is impaired. This paper reviews the level of quality of services in family planning in Latin America following Judith Bruce's framework and proposes, some activities that may improve it. The analysis found severe deficiencies in almost all the elements mentioned by Bruce, mainly in choice, technical competence, and mechanisms for improving continuity. The authors propose that to improve quality, services should (a) generate top management commitment to quality, (b) stay close to the client/user, (c) improve work conditions of providers/health workers, (d) measure quality, and (e) reward quality. The authors' conclusions are that (a) better quality services lead to better program results, (b) high quality is cost-effective, (c) managerial commitment is critical to improvement of quality, and (d) quality of care is not a luxury; it is necessary and possible in all settings.

A Latin American experience with levonorgestrel IUD

The intrauterine contraceptive device is an effective, safe and convenient contraceptive method. Its use in less developed countries has been limited by the increase in menstrual blood loss, an important issue in populations with a high prevalence of anaemia. The levonorgestrel releasing IUD (LNg IUD) is the first device which is at the same time highly effective, long-lasting and reduces the blood loss during menstruation. This device was tested in 200 volunteers in Santo Domingo, Dominican Republic and in 381 in Campinas, Brazil. The cumulative pregnancy rate was 0 up to 7 years of use. The reduced bleeding was confirmed, and ferritin concentration among long-term users of the LNg IUD was significantly higher than among copper IUD users and controls using no contraception. Mean levonorgestrel plasma levels remained above 100 pg/ml until the seventh year of use. Endometrial histology showed mainly a marked reduction in epithelial growth, with variable signs of decidualization of the stroma. The most important reason for discontinuation in the two centres was amenorrhea, with cumulative rates of 10 and 15, respectively. This device should be very well accepted and will have a clear niche among reversible contraceptives, when available.

Evaluation of the clinical performance of a levonorgestrel-releasing IUD, up to seven years of use, in Campinas, Brazil

The clinical performance of a levonorgestrel IUD, releasing 20 mcg/day, used by 293 women at the Family Planning Clinic of the State University of Campinas, was evaluated up to the end of the seventh year of use. No pregnancies occurred in 899 women-years of observation. The cumulative removal rate for amenorrhea or severe hypomenorrhea was 15.7 per 100 women at seven years. The expulsion rate was within ranges observed with copper IUDs in the same clinic. The continuation rate was 49.5% at three years and 23.7 at seven years. The cumulative loss to follow-up rate was 13.7% at seven years. The effectiveness, good continuation rate, and reduction of the amount of blood loss make this device appropriate to be offered to Brazilian women, as an additional contraceptive option.

[Acute-phase reactants in sepsis]

In 71 patients with fever and bacteremia without complications, a prospective study of acute-phase reactants is done. Raises in haptoglobin, ceruloplasmin, alpha-1-antitrypsin, protein C, beta-2-microglobulin, IgA and ferritin serum levels, together with leucocytosis and GSR, were very significant when diagnosis was done. Fibronectin, sideremia and transferrin were lowered. After 3 and 6 days of treatment haptoglobins, alpha-1-antitrypsin, protein C, ferritin, leucocytosis and GSR are lowered, while immunoglobulins, sideremia, transferrin and fibronectin raised, the latter until normalization. Fibronectin as well as changes in iron metabolism were very reliable parameters of inflammation and favorable evolution.

Evaluation of the performance of the copper T380A IUD up to ten years. Is this IUD a reversible but potentially permanent method?

The clinical experience of a cohort of 340 women using a TCu380A IUD for up to 10 years at the Family Planning Clinic of the State University of Campinas, Brazil was evaluated by life-table analysis. Removals for medical reasons were more frequent during the first year of use, while from the third year on, removals for personal reasons were more frequent. Expulsions were concentrated in the first two years of use, and none were detected after the fourth. Gross pregnancy rate accumulated to 2.0, 2.8 and 5.3 and continuation rate was 64.2, 43.4 and 27.8 per 100 women at three, six and ten years of use, respectively. The effectiveness of the device did not decrease significantly after the eighth year of use and it could be considered a reversible but potentially permanent method.

Primary cardiac paraganglioma. Case report and review of surgically treated cases

A 58 year old man with an infiltrating non-resectable left atrial paraganglioma was diagnosed by sternotomy and open biopsy. The patient remains symptom free 16 months after the operation. No evidence of an increase in the size of the tumour has been detected by echocardiography. The literature regarding surgically treated patients with cardiac paragangliomas is reviewed.

[Study of thyroid function in the organ donor during brain death]

OBJECTIVE

To determine the thyroid function in organ donors undergoing cerebral death and evaluate the effects that these possible alterations may exert on the early function of renal graft.

DEVELOPMENT

Prospective study. Hormonal analysis when: 1) the diagnosis of cerebral death was made and 2) before organ extraction.

PATIENTS

Fifteen organ donors with cerebral death. Twenty-nine patients who received the kidneys of these donors.

PLACE

Neurotraumatologic Unit at the University Hospital Marques de Valdecilla. Referring center.

MEASUREMENTS AND RESULTS

All donors showed low T3 and T4 values. Values of T4 and IT4L were significantly lower during the second determination (p < 0.05). Eighty percent of donors showed increased T3r values. TSH was low in 73% of cases. Dopamine requirements in donors or the incidence of acute tubular necrosis in recipients were not significantly higher in donors with lowest T3 values.

CONCLUSION

The hormonal picture observed in the donors of this study is more characteristic of a "ill euthyroid syndrome" than a real hypothyroidism. The low values of T3 in donors is not associated with higher requirements of inotropic agents, nor with a higher incidence of acute tubular necrosis in renal grafts.

[The use of the Gott shunt in the surgical repair of a dissecting aneurysm of the descending thoracic aorta]

A 49-years-old man was operated on of a descending thoracic dissecting aneurysm by means of a heparin-less external Gott shunt. A review of spinal irrigation, neurological deficits postclamping of the descending thoracic aorta and methods of spinal preservation in aortic surgery are presented.

[A preliminary report on penile cancer in the Instituto Oncológico Nacional from 1982 to 1990]

Cancer of the penis is not to common disease and its incidence varies between 0.5 and 5%. In Panama, 70 cases were registered from 1982 to 1990 and it is considered an important social problem in the rural population. Phimosis and poor hygiene are important factors in its etiology. Of 70 cases seen at the National Institute of Oncology from 1982 to 1990, 51 cases were analyzed comparing two approaches in regard to lymph node metastasis: (1) an expectant approach in those without clinically suspected lymph node metastasis, and (2) lymph node biopsy using the Cabañas technique in those clinically suspected followed by lymphadenectomy if the biopsy was positive. The high percentage biopsies (Cabañas technique) as well as the significant morbidity (31.6%) in these patients, compared with no morbidity and the high accuracy of the expectant approach (90%) lead the authors to recommend the Cabañas biopsy technique only for patients of low educational level and difficult follow-up as outpatients. Others patients should be followed clinically for signs of tumor activity.

Long-term evaluation of the clinical performance of the TCu200B and the TCu380A in Campinas, Brazil

The clinical performance of the TCu200B and TCu380A was evaluated by life table analysis in a cohort of women who wore an IUD from July 1979 to July 1982. This paper presents the results up to five years of use. No significant differences in age and parity were found between the users in the two groups. Overall performance was very good with both models. The cumulative continuation rate was 83.6, 60.9 and 46.1 at one, three and five years with the TCu200 and 84.0, 64.7 and 49.3 with the TCu380A in the same periods. Differences between both IUDs were not significant. The pregnancy rate was lower with the TCu380A and reached statistical significance from the fourth year on. The authors conclude that both IUDs presented very good performance, the TCu380A being more effective, the only significant difference observed.

[Simultaneous coronary and carotid surgeries]

Two patients with severe coronary artery disease and significant stenosis of the left internal carotid artery were operated upon. A combined or simultaneous operation was performed in both, carotid endarterectomy plus coronary artery bypass surgery was performed. The patients are symptoms-free after the operation and with evidence of satisfactory reconstruction in the carotid and coronary arteries. A review of the topic simultaneous revascularization of the carotids and coronary arteries in presented.

[Tuberculosis in 34 patients with HIV infection]

The clinical and microbiological finding of 34 patients with HIV infection and tuberculosis (30 were men), 32 were intravenous drug addicts. Fever, adenopathies, hepatomegaly and splenomegaly were the most encountered manifestations on admittance. 61.8% had a disseminated form of tuberculosis; the main locations were lymphatic (73.5%) and lung (64.7%). The detection of circulating viral antigen was associated with disseminated form of tuberculosis.

Comparison of local signs and symptoms after the insertion of Norplant implants with and without a scalpel

The study compares NORPLANT subdermal implants acceptors enrolled randomly for two different insertion procedures. One group (420 women) received the implants with the use of a scalpel according to the manufacturer's instructions. The other group (423 women) received the implant without an incision, directly through a sharpened trocar. The local signs and symptoms were observed at 7 and 30 days after insertion. Pain, tenderness, edema/swelling, ecchymosis and defective scar were considered. Complication rates were low and no significant differences were found between the two procedures. Based on the data of this study, we recommend inserting NORPLANT implants without the use of a scalpel.

[Epidemiological study of prisoners at risk for AIDS in a Spanish prison]

Different proportions of the several AIDS risk practices in a Spanish prison during 1988 were studied. Also a epidemiologic study of the infectious diseases of the prisoners with some risk of this type was carried out. Of 135 prisoners with risk of AIDS, it was found that 91.2% of them were drug addicts. The index of positive HIV in all the population study was of 65.2%. 81.5% of the sample had at least one B hepatitis marker and 11.1% had HBs-Ag. 15.4% of the last group also showed HBe-Ag positive. Histories of non-A, non-B hepatitis were not evaluated in 9.6% of all the patients studied. 53.3% had sexually transmitted diseases. It is important to mention the high index of active tuberculosis found (12.6% of the sample), which is higher than the maximum values found in various similar papers. We did not find any differences in the grade of affectation between HIV+ and HIV-.

[Severe ischemia of the hand. Treatment with regional intravenous sympathicolysis with reserpine]

Treatment of severe hand ischemia a associated to progressive systemic sclerosis and other disorders is controversial. We studied prospectively 45 patients, 41 female and 4 males, over an 11 year period. Age ranged from 16 to 73 years, mean 46. Underlying disease was systemic sclerosis in 30, CREST in 8, overlapping syndrome in 4, systemic lupus in 1 and non rheumatic vasculitis in 2 patients. Treatment consisted of intravenous injection of reserpine, 1 mg, at a superficial arm vein after controlled local circulatory block for 15 min. Regional anesthesia was required in 38 patients. Adequate follow up was obtained in 32 females and 2 males, receiving a mean of 3.1 therapy sessions (range 1 to 13). Morphologic improvement from 3.09 +/- 0.16 to 1.57 +/- 0.13 and functional improvement from 3.6 +/- 0.12 to 1.75 +/- 0.14 (5 grade scoring system), was observed (p < 0.001). These results correlate with adequate rehabilitation confirmed clinically.

[New criteria for the classification of the popliteal artery entrapment syndrome. Our experience with 14 extremities]

Authors explain their experiences with eight patients (14 affected limbs) with a popliteal artery entrapment syndrome. Classification, diagnosis and treatment were reviewed. Six limbs, with any malformation and presenting as a unique sign an important hypertrophy of their intern gastrocnemius muscle, couldn't be classified. As a result, a new classification of this pathology is presented being based on the anatomical and arteriographic aspects as well as oh the surgical indication. The important correlation between anomaly, physical complexion typus athletic and sports is noted.

[Epidemic human fascioliasis. Cuba 1983. VI. Clinical study of 40 children in the Hospital Provincial of Sagua la Grande]

We studied forty children with "Febrile-eosinophilic-Syndrome". They presented Fasciola Hepatic infection confirmed by: Fever, high eosinophils and abdominal pain. 82% used to eat watercress. All of them had positive biopsies-laparoscopies-intradermo-reaction and also reaction to Fasciola antigen. We present the results of and epidemic in Cuba during 1983.

[Etiological research on acute gastroenteritis in the city of Cádiz]

We researched the microbial etiology of 5,836 diarrheal processes in outpatients and inpatients at the Social Security Hospital in Cádiz, for the purpose of evaluating their microbiological and epidemiological characteristics. Bacterial gastroenteritis accounted for 51.6% of the cases, while 31.7% were viral and 16.6% were protozoal in origin. Salmonella enterica (35.6%) is the most frequently involved microorganism, especially in the summer, followed very closely by Rotavirus (31.7%). The incidence of Campylobacter jejuni (13.8%) and Cryptosporidium (7.1%) is also important. Due to the influx of tourists and their consumption of seafood, eggs and derivatives, acute gastroenteritis is a frequent pathology in our city. The number of cases has increased in recent years, and those of an infectious nature represented 27.2% of all cases recorded for the period 1988-1989.

[Arteriovenous fistula of the cecum diagnosed by digital angiography]

We report the case of a 69 year-old female, with cardiac disease, hypertension, and chronic renal failure treated by hemodialysis; she had several episodes of gastrointestinal hemorrhage, which could not be diagnosed by conventional methods. Digital angiographic study demonstrated the exact cause: it allowed to localize an arterio-venous malformation. A right hemicolectomy was performed and the pathologic study showed the presence of an arteriovenous fistula. Three years later the patient is free of symptoms. We recommend digital angiography in cases of gastrointestinal hemorrhage of unknown or unclear etiology, particularly in patients in chronic renal failure, on the basis of the association of hemodialysis and arteriovenous malformation.

[The effects of a dietary fiber (white lupine bran) in the treatment of non-insulin-dependent diabetes]

We evaluated the effect of dietary fiber from sweet lupine hull (SLH) upon metabolic control in 16 non insulin dependent diabetics (11 males, mean age 52). Body mass index was 23 +/- 2 and non fasting glucose levels were < 200 mg/dl. Following a 2 month control period, patients received SLH, 10 g th 3rd month and 20 g the fourth. Eleven patients received in addition oral hypoglycemic drugs. Intake of crude dietary fiber increased from 4.1 +/- 1.7 to 8.4 +/- 2 and 13.1 +/- 1 g from control to the 3rd and 4th month. Blood glucose increased and cholesterol level decreased in the 3rd month (p < 0.05). During the 4th month, blood glucose decreased to control levels. No changes were observed in body mass, HDL cholesterol, triglycerides, glycosylated Hb and non-fasting glucose and insulin levels in relation to fiber intake. We conclude that dietary fiber intake is low in our patients but a supplement of 10 to 20 g of this particular fiber did not improve metabolic control.

Specific location of penicillin-binding proteins within the cell envelope of Escherichia coli

This communication deals with the location of penicillin-binding proteins in the cell envelope of Escherichia coli. For this purpose, bacterial cells have been broken by various procedures and their envelopes have been fractioned. To do so, inner (cytoplasmic) and outer membranes were separated by isopycnic centrifugation in sucrose gradients. Some separation methods (Osborn et al., J. Biol. Chem. 247:3962-3972, 1972; J. Smit, Y. Kamio, and H. Nikaido, J. Bacteriol. 124:942-958, 1975) revealed that penicillin-binding proteins are not exclusively located in the inner membrane. They are also found in the outer membrane (A. Rodríguez-Tébar, J. A. Barbas, and D. Vásquez, J. Bacteriol. 161:243-248, 1985). Under the milder conditions for cell rupture used in this work, an intermembrane fraction, sedimenting between the inner and outer membrane, can be recovered from the gradients. This fraction has a high content of both penicillin-binding proteins and phospholipase B activity and may correspond to the intermembrane adhesion sites (M. H. Bayer, G. P. Costello, and M. E. Bayer, J. Bacteriol. 149:758-769, 1982). We postulate that this intermembrane fraction is a labile structure that contains a high amount of all penicillin-binding proteins which are usually found in both the inner and outer membranes when the adhesion sites are destroyed by the cell breakage and fractionation procedures.

Testicular peptides and their endocrine and paracrine functions

A number of testicular peptides appear to have endocrine and/or paracrine functions. Most, if not all, of these peptides are secreted by the Sertoli cells into the tubular fluid. Although their physiological role has not been fully clarified, these secretory products are believed to play an important role in the local regulation of testicular functions, particularly the spermatogenic process. Presence of high affinity, specific binding sites for transferrin and androgen binding protein, both secreted by the Sertoli cells, has been demonstrated on the round spermatids and/or pachytene spermatocytes. Since within the seminiferous tubules, only the Sertoli cells respond directly to follicle stimulating hormone and testosterone, they could mediate the hormonal effects on spermatogenesis by providing certain products which may be essential during specific stages of germ cell differentiation.

Randomized clinical study of the T-Cu 380A and the Lippes loop C, in Campinas, Brazil

The copper IUD model T-Cu 380A has shown the best performance when compared with other copper and inert IUDs in studies carried out in the U.S.A., but it had not been tried out in developing countries yet. T-Cu 380A and Lippes loop C were inserted at random in 328 healthy parous women, in Campinas, SP, Brasil. Forty-five percent of the T-Cu 380A insertions and 40% of the Lippes loop insertions were performed by trained midwives. No pregnancies occurred in 1419 woman-months of use of T-Cu 380A, against 5 pregnancies in 1454 woman-months of use of Lippes loop. The difference was significant at the 5% level. No other significant differences were found. The continuation rate after one year of use was 82.5 for the T-Cu 380A and 75.1 for the Lippes loop. These results suggest that the performance of the T-Cu 380A in developing countries could be similar to the one observed in the United States, provided that the users are carefully selected and that an adequate insertion technique is followed.

[Studies on the release of dopamine-beta-hydroxylase by nicotine (author's transl)]

Comparative studies were made on the release of DBH by adrenal medullary slices after colinomimetic stimulation with acetylcholine, DMPP or nicotine. The in vivo effects of nicotine on the circulating plasma dopamine-beta-hydroxylase were tested in habitual and non habitual smokers after five cigarettes (12.5 mg of nicotine). The rise of plasma enzyme activity may reflect the increased catecholamine release from adrenal and peripheral adrenergic nerves.