[Color-coded Doppler in the diagnosis of vascular complications following heart catheterization]

To determine the value of color Doppler in the diagnosis of vascular complications resulting from cardiac catheterization 5 consecutive patients, with the clinical suspicious of vascular iatrogenesis potentially requiring surgical repair, were analyzed. In 2 patients a femoral mass developed after a diagnostic catheterization but 3 patients underwent previously an interventional catheterization technique. In 3 patients color Doppler readily visualized a systolic jet originated in the femoral artery entering an anterior echo-free cavity, and a reversal flow in diastole, suggesting a femoral pseudoaneurysm. In 1 patient the clinical diagnosis of arteriovenous fistulae was confirmed by color Doppler which demonstrated a continuous turbulent flow within the femoral vein. In the remaining patient a diagnosis of simple femoral haematoma was made after the demonstration of a relatively echogenic structure overlying the femoral artery and vein but not interfering with their flows. In the 3 patients with femoral pseudoaneurysms and in the patient with arteriovenous fistulae the diagnosis was confirmed by angiography and during surgery. Our preliminary findings underscore the value of color Doppler, using the technology currently available in echocardiographic laboratories, in the differential diagnosis of vascular complications after cardiac catheterization.

Characterization of Trypanosoma cruzi isolates from Paraguay, using restriction enzyme analysis of kinetoplast DNA

Eleven Paraguayan strains of Trypanosoma cruzi, from Chagas' disease patients and the bug vectors, were examined by restriction endonuclease analysis of kinetoplast DNA using Hae III, Msp I, Eco RI, HinfI, Taq I and Rsa I. Four schizodeme-profile groups were identified. Group 1 had much simpler profiles than groups 2, 3 and 4 and, although there were homogeneous profiles in the latter three groups, each group could be distinguished from the others. The profiles of group 1 could not be matched with any of the standard strains from Brazil, Chile and Columbia included in the schizodeme comparison. The profiles of groups 3 and 4 shared most features with those standards of the Brazilian Z2 zymodeme.

[Prevalence of human immunodeficiency virus infection, hepatitis B virus and syphilis in full term pregnancy]

BACKGROUND

The estimation of the frequency of infection by HIV, hepatitis B virus and syphilis in unselected populations of full-term pregnancy is useful for epidemiologic surveillance of these diseases and for decision marking in prenatal detection.

METHODS

A transversal study of 3,193 women who gave birth in the Hospital General de Elche between March 1989 and February 1990 was carried out. A blind survey was developed to avoid ethic problems and bias derived from the undertaking of HIV test without patient consent.

RESULTS

The prevalence of HIV was 0.5/1,000 women (CI 95%, 0-1.5); HBV 8.9/1,000 (CI 95%, 4.6-13.2) and syphilis 1.5/1,000 (CI 95%, 0.9-2.1).

CONCLUSIONS

The diffusion of the AIDS epidemic in Spain to the general population does not at present seems important although studies should be performed in the future to monitor the trend. The prevalence of syphilis in Spain is low in this study in comparison with the results of other Spanish studies which may be explained by greater quality of care in to pregnancy. The prevalence of HBV suggests the need for detection and vaccination of newborns.

[Genetic evidence corroborates Negme's hypothesis about the greater mildness of American trypanosomiasis in Chile]

Chagas disease is present in northern and central Chile. Not more than 25% of infected individuals have had a pathologic condition presumably due to Trypanosoma cruzi. The majority of individuals with chronic infectious Chagas disease in Chile are asymptomatic in contrast to what has been observed in other South American countries. Historic and paleopathologic evidences suggest that this particular behavior could be explained by a genetic adaptation of Chilean aborigines to T cruzi. Associations between ethnic admixture, presence of Chagas disease, associated cardiac pathology and 4 blood groups (ABO, MNSs, Rh and Duffy) were investigated among inhabitants of San Pedro de Atacama in northern Chile. Cardiac pathology was determined by positive serologic reactions in individuals with abnormal electrocardiographic findings. Individuals with negative serologic results had a significantly greater aboriginal admixture (88%) compared to those with positive serology (66%). This findings supports the hypothesis of genetic adaptation explaining mildness of Chagas disease in Chile.

[Poisoning at a polyvalent intensive care unit]

A retrospective analysis was made concerning 1340 admissions to a multidisciplinary Intensive Care Unit over four years (1986-1989), because of acute poisoning. In 666 patients occurred 735 drug overdoses and in 674 patients, 691 non-drug intoxications. The drugs with main action in central nervous system were the most frequent in drug overdoses and the organophosphates insecticides in the non-drug intoxications. During the considered period there was an absolute and relative fall in the number of admissions for acute poisoning (480 vs 244, 15.1% vs 9.9%). The patients admitted were 698 men (289 in drug-overdoses and 409 in non-drug group) with a statistically significant difference between the type of intoxication and sex (p less than 0.001). Age mean was 40.2 +/- 19.6 years, almost the same in the two groups of intoxications. The peak incidence occurred from March to October. From the hospital area of Lisbon came 814 patients and outside of Lisbon 495 patients. The mean duration of stay in the ICU was 3.90 +2- 6.15 days, being 2.71 +/- 3.80 in the drug overdoses and 5.08 +/- 7.62 in non-drug intoxications (p less than 0.001). From the therapeutic measures we emphasize mechanical ventilation (29.5%), total parenteral nutrition (18.5%), dialysis (2.9%), Swan-Ganz catheter (2.8%) and pacemaker (1.2%). The mortality rate was 13.7%, higher in non-drug intoxications (23.0%) than in drug overdoses (4.4%) (p less than 0.0001).

Sequence identification of 2,375 human brain genes

We recently described a new approach for the rapid characterization of expressed genes by partial DNA sequencing to generate 'expressed sequence tags'. From a set of 600 human brain complementary DNA clones, 348 were informative nuclear-encoded messenger RNAs. We have now partially sequenced 2,672 new, independent cDNA clones isolated from four human brain cDNA libraries to generate 2,375 expressed sequence tags to nuclear-encoded genes. These sequences, together with 348 brain expressed sequence tags from our previous study, comprise more than 2,500 new human genes and 870,769 base pairs of DNA sequence. These data represent an approximate doubling of the number of human genes identified by DNA sequencing and may represent as many as 5% of the genes in the human genome.

Determination of Cd, Cr, Cu, Pb and Zn in human semen by graphite furnace atomic absorption spectrometry after microwave sample dissolution

Human semen samples were analyzed by graphite furnace atomic absorption spectrometry, using L'vov platforms and the method of standard additions, to determine their Cd, Cr, Cu, Pb and Zn content. The samples were analyzed directly and after conventional and microwave wet acid dissolution. Matrix modification, using magnesium and palladium nitrates and ammonium biphosphate solutions, was evaluated for the analysis of the microwave-digested samples. The best results were obtained for Cr, Cu and Zn using Pd(NO3)2, and a mixture of Mg(NO3)2 and Pd(NO3)2 solutions. The direct analysis of water-diluted semen produced inaccurate results with unacceptably high standard deviations. The results obtained for the microwave-dissolved samples showed relative standard deviation values within the range 0.63-8.4%. The analysis of spiked semen solutions showed recoveries of the added analytes ranging from 96 to 104%. The accuracy of the measurements was checked against the NIST 1,577a, bovine liver, standard reference material. Sample dissolution time was drastically reduced from 3-4 hours, using the conventional method, to approximately 8 minutes using the microwave-assisted wet acid digestion procedure.

Functional restoration for chronic low back pain: Changes in depression, cognitive distortion, and disability

In the present study, 107 patients (72 males and 35 females) completed self-report measures of depression, distortion, disability, and pain intensity at three points during their rehabilitation: (1) admission to a 3-week comprehensive functional restoration program, (2) discharge from the comprehensive phase, and (3) 4-6 weeks later at their first post-program evaluation. Various range-of-motion measures were also collected at these same times using inclinometry. Results demonstrated significant improvements on all measures which were maintained into follow-up. Patients were also subsequently grouped into depressed and non-depressed at admission, and both groups demonstrated significant improvement across time. Additionally, patients were divided into high and low distortion groups. High general cognitive distortion patients did not show improvement on 3 of the 5 range of motion, or pain intensity scores, although they did improve on their depression, distortion, and disability scores. Findings also suggested thatlow back pain-related cognitive distortion may be considered a state or situational factor, whereasgeneral cognitive distortion appears to be more of a trait characteristic.

Aortography delays surgery of CT proven acute traumatic rupture of the thoracic aorta. Case report

A case of acute traumatic rupture of the thoracic aorta was diagnosed by dynamic CT. Angiographic conformation was required, delaying surgical repair and contributing to the fatal outcome. If reliable findings of acute traumatic rupture of the thoracic aorta are shown by CT, we question the usefulness of angiographic confirmation in such cases.

Nasal retinal dragging in X-linked retinoschisis

X-linked retinoschisis is a disorder characterized by the presence of foveal schisis and often peripheral splitting of the retina in the nerve fiber layer. The accompanying complications include vitreous hemorrhage and retinal detachment, which can lead to blindness. In this report five patients who presented during infancy or early childhood had nasal retinal dragging.

[Bacteremia caused by Streptococcus agalactiae in adults. Presentation of 6 cases]

The incidence of Streptococcus agalactiae (SA) bacteremia in adults has increased in recent years, particularly in patients with severe underlying diseases. However SA is still an unusual pathogen in adults. We report 6 cases of SA bacteremia in adults, seen during 18 months. The microorganism was only isolated from the blood in 3 cases, and from blood and other locations in the remaining three cases. The age of the patients ranged from 35 to 70 years. Both sex were affected in the same proportion. In all cases except in one there was a previous underlying disease.

A method for estimating the Young's modulus of complete tracheal cartilage rings

Cartilage is primarily responsible for maintaining the stability of the large airways; yet very little is known about the mechanical properties of airway cartilage. This work establishes a technique whereby average values for the equilibrium modulus of excised tracheal cartilage rings can be obtained. An apparatus was designed to apply preset deformations to a tracheal segment and to monitor the deforming force. Segments of four human tracheae obtained postmortem and containing three rings were mounted in the apparatus after being stripped of posterior membrane. The load-deformation behavior was analyzed with a model on the basis of thin curved beam theory. Agreement between predicted deformed shapes and those observed was good in three of the four cases and in the case of a short length of longitudinally split rubber tube. The technique is suitable for comparing mechanical properties of cartilage before and after an intervention.

[Frequency and characteristics of genetic morbidity in a pediatric hospital]

Frequency and characteristics of patients discharged with recognized genetic diseases by current technical literature available in 1988 (GD) from a pediatric hospital at Santiago, Chile, are described. On the last three months of year 1988, a prospective study on 2,987 hospital admissions corresponding to 1,196 patients was done. Prevalence and incidence of GD were 62.5% and 17% among hospital admissions as a whole and 49.75% and 47.7% respectively when only individual patients were considered. No sex differences were found between patients with and without GD, but the frequency of GD was significantly higher in patients staying 7 or more weeks in hospital (12% vs. 3.4%), as among those who required two or more admissions (10.9% vs. 4.3%) or were referred from outside metropolitan Santiago (37.3% vs. 5.1%). First ten more frequent GD, in decreasing order of importance, were cardiac malformations, leukemias, cleft lip and/or palate, congenital dislocation of the hip, epilepsy and convulsions, idiopathic scoliosis, Down's syndrome, anal malformations, aganglionic megacolon and cystic fibrosis. The importance of diseases with genetic background is thus emphasized in a pediatric hospital.

[Penetrating corneal transplants: experience with 114 grafts]

A series of 114 penetrating corneal transplants performed in a public hospital in Santiago de Chile by the first author is reported. The first cause of corneal grafting was herpes simplex keratitis (37%), the second keratoconus (22%). Signs of rejection were observed in 32.5% of the grafts and of these, 32% lost transparency. Graft clarity was good in 74% of the grafts and poor in 17.5%. Poor transparency was due to graft rejection in 65% of the cases. Phakic eyes had good transparency in 81% of cases and aphakic eyes only in 48%. Preoperatively the visual acuity was 0.1 or less in 79% of cases and post-operatively it was better than 0.5 in 50% and better than 0.1 in 82% of the cases. The mean postoperative astigmatism was 4.4 diopters. Results in graft clarity were classified according to preoperative prognosis.

A model of the mechanics of airway narrowing

To examine the interaction between airway smooth muscle shortening and airway wall thickening on changes in pulmonary resistance, we have developed a model of the tracheobronchial tree that allows simulation of the mechanisms involved in airway narrowing. The model is based on the symmetrical dichotomous branching tracheobronchial tree as described by Weibel and uses fluid dynamic equations proposed by Pedley et al. to calculate inspiratory resistance during quiet tidal breathing. To allow for changes in lung volume, we used the airway pressure-area curves developed by Lambert et al. The model is easily implemented with a spreadsheet and personal computer that allows calculation of total and regional pulmonary resistance. At each airway generation in the model, provision is made for airway wall thickness, the maximal airway smooth muscle shortening achievable, and an S-shaped dose-response relationship to describe smooth muscle shortening. To test the validity of the model, we compared pressure-flow curves generated with the model with measurements of pulmonary resistance while normal subjects breathed air and 20% O2-80% He at a variety of lung volumes. By simulating progressive airway smooth muscle shortening, realistic pulmonary resistance vs. dose-response curves were produced. We conclude that this model provides realistic estimates of pulmonary resistance and shows potential for examining the various mechanisms that could produce excessive airway narrowing in disease.

Weekly cuirass ventilation improves blood gases and inspiratory muscle strength in patients with chronic air-flow limitation and hypercarbia

We studied the effects of an 8-h, once-a-week schedule of cuirass ventilation (CV) in 5 patients with advanced chronic air-flow limitation and chronic hypercarbia (PaCO2, 58.6 +/- 10.1 mm Hg; mean +/- SD). Repeated measurements of arterial blood gases, maximal inspiratory mouth pressure (P1max), 12-min walking distance, and respiratory cycle were performed during a 1-month run-in period. Quality of life and transdiaphragmatic pressure were measured once. All patients completed the planned 4-month study. Four of them were ventilated for longer periods because CV could not be discontinued at the end of the study. PaCO2 showed a significant fall starting during the first month; PaO2 significantly increased from the second month, whereas P1max significantly rose from the third month on. Maximal transdiaphragmatic pressure increased in the 2 patients with abnormal baseline values. The fall in PaCO2 was associated with an increase in tidal volume because of a longer inspiratory time. Significant improvements in quality of life and in the 12-min walking distance were observed. We conclude that weekly CV improves blood gases, inspiratory muscle strength, and clinical conditions of patients with chronic air-flow limitation and chronic hypercarbia, probably because of correction of chronic inspiratory muscle fatigue.

Plant regeneration from protoplasts of Capsicum annuum

Leaf protoplasts were isolated from axenic shoot cultures of four varieties of Capsicum annuum (Americano, Dulce Italiano Florida Gynat and Nigrum) and a wild species C. chinense. Protoplasts of both species, cultured in KM8P medium and using agarose bead culture, entered division with the exception of the variety Nigrum. Cell colonies formed callus in agar-solified MS medium supplemented with zeatin and for C. annuum v. Dulce Italiano shoots were regenerated when protoplast-derived calli were transferred to MS medium with 6-BAP. Excised shoots were rooted on MS medium which lacked phytohormones.

A rabbit model of hypersensitivity to plicatic acid, the agent responsible for red cedar asthma

We describe a rabbit model for the study of the immunogenicity and allergenicity of plicatic acid (PA), the small molecular weight compound in western red cedar responsible for occupational asthma in exposed workers. Specific anti-PA IgE as well as IgG antibodies could be raised, depending on the method of immunization. The sensitized rabbits reacted to antigenic challenge with PA-protein conjugates intravenously, with increases in respiratory frequency and pulmonary resistance. This animal model may be used for the further elucidation of the mechanism of occupational asthma induced by small molecular weight chemical compounds.

In vivo human tracheal pressure-area curves using computerized tomographic scans. Correlation with maximal expiratory flow rates

In order to develop a simple technique to measure in vivo pressure-area (P-A) curves of the extrathoracic trachea in humans, we studied 14 normal male subjects. Valsalva and Mueller maneuvers were performed at FRC, and tracheal cross-sectional area (TXSA) was measured using computed tomography. Extrathoracic tracheal transmural pressure (TMP) was obtained as airway opening minus atmospheric pressure (Pat). Tracheal "compliance" (TC) was measured on the "inflation" limb of the P-A curve. Tracheal compliance was not a significant predictor of maximal expiratory flow rates, and TXSA at zero TMP was a significant predictor of peak expiratory flow rate but not of FEV1 or Vmax50. P-A curves showed an unexpected configuration characterized by a plateau or an increase in TXSA with TMP lower than -15 cm H2O. P-A curves obtained in 5 subjects using extrathoracic esophageal pressure as tracheal external pressure instead of atmospheric pressure did not show a plateau or an increase in TXSA with Mueller maneuvers. In these 5 subjects, TC using esophageal pressure rather than Pat did not aid in the prediction of flow. We conclude that extrathoracic tracheal external pressure is not Pat because this pressure is probably affected by transmission of pleural pressure to the cervical interstitial tissue as well as by the contraction of cervical accessory inspiratory muscles. Therefore, true tracheal compliance cannot be simply measured since it requires placement of an esophageal balloon.

Inspiratory muscle function in unilateral diaphragmatic paralysis

Pulmonary function has been extensively studied in unilateral diaphragmatic paralysis (UDP), but there is scarce information regarding inspiratory muscle function in this condition. We therefore studied inspiratory muscle function in 8 patients with UDP (Group 1: age 48.3 +/- 2.1 yr of age, means +/- SD) as well as in 7 patients with UDP and concomitant cardiopulmonary disease (Group 2: 60.6 +/- 13 yr of age). Twelve young normal subjects were also studied (32.3 +/- 7.7 yr of age). Maximal static transdiaphragmatic and inspiratory mouth pressure were measured at FRC. Gastric (Pga), esophageal (Pes), and transdiaphragmatic (Pdi) pressure swings were measured during quiet breathing. There was no difference in inspiratory muscle function in left-sided versus right-sided UDP. Paradoxical gastric pressure swings were observed in 4 patients from Group 1 and in 5 from Group 2. In 2 patients from Group 1 and 1 from Group 2, Pga did not change during quiet breathing. In the remaining 3 patients, Pga swings were similar to those observed in the normal subjects. Maximal Pdi was reduced in half of the patients from Group 1 and in all of the patients from Group 2. Maximal inspiratory pressure was below normal values in 2 patients from Group 1 and in all patients from Group 2. We conclude that unilateral diaphragmatic paralysis is associated with an abnormal pattern of use of respiratory muscles during quiet breathing, characterized by the use of intercostal and accessory inspiratory muscle or compensatory use of abdominal expiratory muscles. Inspiratory muscle strength was impaired in some of the patients, and it worsened when cardiopulmonary disease was present.

Acute effect of ketotifen on the dose-response curve of histamine and methacholine in asthma

This study was designed to assess the acute effect of 1 mg of orally administered ketotifen on the dose-response curve to both histamine and methacholine, in 15 patients with bronchial asthma. From this curve we measured the concentration that produced a 20% fall in FEV1 (PC20) and reactivity, defined as the slope of the curve beyond the threshold dose. Results were analysed comparing the change in log PC20 and in reactivity before and after a double-blind administration of ketotifen and placebo. Ketotifen, compared to placebo, significantly increased the histamine PC20 (P less than 0.001) and reduced reactivity (P less than 0.001). After adjusting for starting FEV1 the difference of effect between ketotifen and placebo was still significant, although to a lesser degree (P less than 0.01). In contrast, ketotifen did not modify the methacholine dose-response curve. No significant changes were observed in FEV1 after ketotifen. The results suggest that acute administration of ketotifen has a selective action on histamine-activated pathways of bronchoconstriction.

Inspiratory muscle dysfunction and unexplained dyspnea in systemic lupus erythematosus

The role of inspiratory muscle dysfunction in lung volume restriction and unexplained dyspnea was studied in 16 consecutive patients with systemic lupus erythematosus. Maximal mouth inspiratory pressure (PIM) and maximal transdiaphragmatic pressure (Pdi max) were measured. Pdi and its components were determined during quiet breathing. No significant association was found between the activity of the disease, several serologic markers, and the inspiratory muscle dysfunction. No specific anti-skeletal muscle antibody was found in these patients. Significant correlations were found between the degree of dyspnea and PIM (r = -0.69, P less than 0.01) and Pdi max (r = -0.75, P less than 0.001); however, dyspnea did not correlate with specific lung compliance. Vital capacity correlated significantly with the degree of dyspnea (r = -0.813, P less than 0.001) and with Pdi max (r = 0.544, P less than 0.05). No correlation was found between vital capacity and specific lung compliance. We conclude that inspiratory muscle dysfunction can be an important mechanism in the pathogenesis of the lung volume restriction and dyspnea in patients with systemic lupus erythematosus.