[Mucormycosis: Study of five cases found in San Juan de Dios hospital and Sor Maria Ludovica hospital in La Plata, Argentina]

Hospital San Juan de Dios and Sor María Ludovica in La Plata, between 1980 and 1997. Mucormicosis is a frequently fatal, opportunistic fungal infection, that affects immunocompromised patients. The risk factors include diabetes mellitus, leukemia, lymphoma, burns, etc. We present three cases of cutaneous mucormicosis in children 3, 10 and 11 years old, who had been sent to the hospital due to compound fractures in a car crash; one case of pulmonary mucormicosis in an adult 28 years old with prolonged corticotherapy and rhinocerebral mucormicosis in a patient 38 years old with a diagnosis of acute lymphoid leukemia.

[Genograms and the vital cycle of a family]

OBJECTIVES

To evaluate the importance of the genogram in order to identify the family vital cycle stages and demographic aspects related to the first two phases of this cycle. To study frequency of the vital cycle stages in families from 2 health centers and their relationships with behavioral and emotional traits and with health problems.

DESIGN

Transversal descriptive study. LOCALE: Primary Health Care; Health Care Centers in Cartuja and Almanjayar.

PATIENTS AND OTHER PARTICIPANTS

347 genograms were compiled and analyzed by 6 licensed nurses.

RESULTS

The reading of genograms made it possible to identify the vital family cycle stages in 97% of those studied. We discovered that 28.6% of the families were in Stage IV; 20% in Stage II-A; and 15% in Stage V. It appears that the contraction stage occurs more frequently in the Cartuja Health Center. The starting age of the formative stage has been reducing since the 1960s; at present it is at 21.7 years for males and 19 for females. The average duration which couples took to pass on to the II-A extension stage was 1.62 years.

CONCLUSIONS

We believe that a genogram is an excellent tool to use to classify families according to the vital family cycle stages. Furthermore, to be able to identify the point where a family lies in this cycle is an important piece of data in a nurse's work.

Potentiation by isoniazid of relaxation induced by nitrovasodilators in rat aorta

The influence of isoniazid (ISO) preincubation on the relaxant effects of a group of nitrovasodilators was examined in norepinephrine-contracted rat aortic rings with and without endothelium. ISO displaced to the left the dose-response curves to all nitrovasodilators and increased the negative logarithm of their median effective concentration (EC50) values. Potentiation was minimal with sodium nitrite and increased progressively with sodium nitroprusside, nitroglycerin (NTG), and isosorbide dinitrate. The phenomenon occurred in rings with and without endothelium and was not seen with the nitric oxide-releasing agent acetylcholine or with the nonspecific vasodilator hydralazine. These results confirm previous observations of potentiation of NTG vasorelaxation by ISO and extend them to other nitrovasodilators. Potentiation is attributed to the previously postulated inhibition by ISO of pyridoxal-requiring enzymes involved in the breakdown of homocysteine, leading to its intracellular accumulation. Increased availability of this sulfhydryl donor would lead in turn to enhanced bioactivation and vasorelaxant effects of nitrovasodilators. The different degrees of potentiation observed would be related to the sulfhydryl requirement of each compound for bioactivation. Alternatively, enhanced bioactivation of the nitrovasodilators could be due to induction by ISO of P-450 enzymes involved in this process.

Hippocampal malformation as a cause of familial febrile convulsions and subsequent hippocampal sclerosis

OBJECTIVE

One hypothesis proposes that a pre-existing alteration of medial temporal lobe structures contributes to febrile convulsions and subsequent hippocampal sclerosis (HS) in patients with temporal lobe epilepsy (TLE) and antecedent febrile convulsions. It is possible that such a structural alteration does not always lead to convulsions and may also be present in clinically unaffected relatives.

METHODS

We tested this hypothesis by MRI investigation of 23 members of two families, of whom 13 had experienced febrile convulsions and 10 had not. One member of each family with febrile convulsions subsequently developed TLE. We compared the right/left ratios of hippocampal volumes (RHV) with 23 age- and sex-matched controls. Additionally, two independent raters assessed hippocampal signal intensity and pattern in T2- and fluid-attenuated inversion recovery images.

RESULTS

Both TLE patients showed left HS. All subjects with febrile convulsions who did not develop epilepsy and six clinically unaffected relatives also showed asymmetric RHV (>3 standard deviation) but a normal hippocampal signal intensity. In all of these subjects, the left hippocampus was smaller. Visual inspection of these smaller hippocampi revealed blurred internal pattern or flat hippocampal bodies or both in one family and smaller hippocampal heads in the other. The pattern of HS in TLE patients showed a structural correlation with the abnormalities seen in their relatives. One subject with febrile convulsions had additional subcortical heterotopias.

CONCLUSION

These findings suggest a subtle, pre-existing hippocampal malformation that may facilitate febrile convulsions and contribute to the development of subsequent HS.

Successful verbal encoding into episodic memory engages the posterior hippocampus: a parametrically analyzed functional magnetic resonance imaging study

The medial temporal lobe (MTL) is essential for episodic memory encoding, as evidenced by memory deficits in patients with MTL damage. However, previous functional neuroimaging studies have either failed to show MTL activation during encoding or they did not differentiate between two MTL related processes: novelty assessment and episodic memory encoding. Furthermore, there is evidence that the MTL can be subdivided into subcomponents serving different memory processes, but the extent of this functional subdivision remains unknown. The aim of the present functional magnetic resonance imaging (fMRI) study was to investigate the role of the MTL in episodic encoding and to determine whether this function might be restricted to anatomical subdivisions of the MTL. Thirteen healthy volunteers performed a word list learning paradigm with free recall after distraction. Functional images acquired during encoding were analyzed separately for each participant by a voxel-wise correlation (Kendall's tau) between the time series of the T2*-signal intensity and the number of subsequently recalled words encoded during each particular scan. Of the 13 participants, 11 showed voxel clusters with statistically significant, positive correlations in the posterior part of the hippocampus. Across participants, an ANOVA on the number of voxels with significant, positive correlations within individually defined volumes of interest confirmed a statistically significant difference in activation for anterior versus posterior regions of the hippocampus. However, no differences between left and right hippocampal activation were revealed. Thus, these findings demonstrate that successful encoding into episodic memory engages neural circuits in the posterior part of the hippocampus.

Atrial natriuretic factor modifies the biosynthesis and turnover of norepinephrine in the rat adrenal medulla

In the present work we investigate atrial natriuretic factor (ANF) effects on the endogenous content, utilization and turn over of norepinephrine (NE), on tyrosine hydroxilase (TH) activity, on cAMP and cGMP levels, and on phosphatidylinositol hydrolysis in rat adrenal medulla in order to assess the possible mechanisms underlying ANF effects on NE metabolism. Results showed that ANF (5 microg/kg) increased NE endogenous content (44%) and diminished the amine utilization. On the other hand, the atrial factor (10 nM) inhibited both spontaneous and evoked, by 100 mM KCl TH, activity (48% and 59%, respectively). When second messenger systems were studied results showed that 10 nM ANF increased cGMP levels in adrenal medulla (51%), while it modified neither cAMP levels nor phosphatidylinositol hydrolysis. These results suggest that ANF may play an important role in the modulation of the sympathoadrenergic system function, behaving as a putative neuromodulator.

Safety of intrahippocampal depth electrodes for presurgical evaluation of patients with intractable epilepsy

PURPOSE

Intracerebral depth electrodes are used in preoperative evaluation of selected patients with intractable epilepsies. In spite of their usefulness, safety of depth electrodes is disputed, and the number of insertions is decreasing. This study examined retrospectively possible deleterious effects such as perioperative complications, induction of epileptogenesis, and neuropsychologic deficits.

METHODS

Clinical course and neuroradiologic findings of 115 patients with bilaterally inserted longitudinal intrahippocampal depth electrodes (IDEs) were analyzed. Hippocampal resection specimens were examined histopathologically. To detect newly developed epileptogenic areas, EEG recordings, seizure control, and semiology after standardized resection procedures were compared between patients who received IDEs and those who did not. To demonstrate functional deficits caused by IDE insertion into an unaffected hippocampus of the speech-dominant hemisphere, changes of verbal learning and memory performances before and after right amygdalohippocampectomy were compared between patients evaluated with and without IDEs.

RESULTS

Five significant complications without any permanent neurologic deficit were noted, and only one was specifically linked to IDE insertion. The tissue damage associated with the insertion was minimal and sharply circumscribed. No differences of seizure outcome after standardized resections were identified between patients with and without IDEs. In postoperative EEG recordings, there was no evidence of new epileptogenic areas. No verbal memory deficit caused by IDE implantation into the hippocampus of the speech-dominant hemisphere was detectable.

CONCLUSIONS

Results indicate that it is safe to implant these IDEs in selected patients.

Genetic parameters for linear udder traits of dairy ewes

An animal model was used to estimate the repeatabilities and genetic parameters of linear udder traits of Churra ewes (5265 records from 2015 ewes). In addition, the phenotypic correlations were examined between log SCC and udder traits. Heritabilities of udder depth (0.16), udder attachment (0.17), teat placement (0.24), teat size (0.18), and udder shape (0.24) were similar to those for dairy cattle, making it feasible to use data from the proposed linear system in a breeding program to improve the machine milkability of ewes. Genetic correlations among udder traits were generally favorable, implying that selection for improvement of one trait would result in improvement of others. A notable exception was the genetic correlation between teat placement and teat size of 0.62. Vertical placement of teats was associated with larger teats. Also, genetic correlations between udder and yield traits (milk and protein yields) were small, except for udder depth and teat placement. These exceptions predict worsening udder morphology from selection based solely on milk yield. Phenotypic correlations between udder traits and log SCC indicate that present handling routines led to a greater likelihood of infections for deep udders with large teats.

The menopause: women's psychology and health care

Menopause has often been described as a time of loss and decay in the lay and medical literature. The present research aims at defining women's perception of themselves and their health care needs in this period of life. Through a community-based sample of women, participative assessments were performed and their conclusions contrasted with the opinions of male and female gynecologists. Though both groups coincided concerning the relevance of loneliness, partnership, beauty and the "empty nest" syndrome, several items showed a marked difference between both groups. Gynecologists tended to perceive women as much more striving for an active sex-life, depressed, lacking projects for the future and worried about their health care than they actually were. Women, instead, stressed the relevance of menopause as a life crisis laden with opportunities for self-accomplishment and positive changes in life-style towards greater autonomy.

[Children's accidents treated at health centers]

OBJECTIVES

To find the characteristics of accidents to children treated at our Health Centres.

DESIGN

A descriptive crossover study.

SETTING

Almanjayar and Cartuja Health Centres, Granada.

PATIENTS

The 0 to 14 age-group treated at our centres because of an accident.

MEASUREMENTS AND MAIN RESULTS

The number of accidents to children treated at our health centres during 1994 was 217. The most common accidents were, in descending order: falls, 27%; burns, 20.7%; traffic accidents, 17%; poisoning, 15%; inhalation of foreign bodies, 10.5%; bites and aggressions, 9.2%. 48.3% of the accidents occurred at home, 37.7% in the street and 13.8% at school. In the relation of type of accident to age group, we found that burns affected children under 5 to a greater extent. Poisoning was more common between 5 and 9. Traffic accidents and falls affected children between 10 and 14 more. The relationship between age and type of accident is significant (p < 0.005). There is no significant connection between gender and type of accident.

CONCLUSIONS

Age and some types of accident are directly related. The majority of accidents tend to occur at home and in the street. We consider that prevention is the best way of decreasing accidents to children. Programmes involving children, parents and teachers should be set up.

[Aortic intramural hematoma. An atypical pattern equivalent to aortic dissection]

A case is presented of a hypertensive woman who had suffered a stabbing back pain for some three hours, with mild irradiation to precordium and accompanied by vegetative signs. A sinusal rhythm and negative T waves of little depth were seen on the ECG. A transthoracic bidimensional echocardiogram (TTE) showed a normal left ventricle with a somewhat dilated aortic root and the existence of a double echo running parallel to the anterior wall of the aorta but non-ondulating and without a visible intimal flap. Because of suspected aortic dissection an urgent contrasted CAT and a transesophageal echocardiogram were performed. These were informed as an aneurysm of the aortic root with mural thrombus from the ascending to descending aorta, but with no existing intimal flap suggesting dissection. A cardiac catheterization showed a mildly some dilated aortic root without dissection signs and normal left ventricle and coronary arteries. The patient was presented for surgical evaluation but, since no dissection was present, was not considered urgent surgery; she was admitted to the coronary unit and died 48 hours later in a situation of acute pericardial tamponade, documented by TTE, surely due to rupture of the aortic root to pericardial sack. This way of presenting threatened aorta rupture that has been only recently recognized is discussed, as well as some misconceptions which must be avoided.

Potency control of foot-and-mouth disease vaccine in cattle. Comparison of the 50% protective dose and the protection against generalization

Potency tests of a total of 658 foot-and-mouth disease (FMD) vaccine batches by bovine protective dose (PD50) showed that 22% of the tests did not follow the expected theoretical model and the results could not be interpreted because of the lack of a dose-response relationship. The protection against generalization (PG) method, using undiluted vaccine, proved to be highly reliable from the analysis of the results of 65 replicate potency tests of three hydroxide-saponin (HS) vaccines and two oil-adjuvanted (OL) vaccines. The PG results were consistent in 64 out of the total of 65 tests. The data obtained indicated that, with regard to direct tests in cattle, the PG test is the preferred method for FMD vaccine potency control. This study also showed that the incorporation of a reference vaccine in routine potency tests is essential to ensure normality of the test system and that good quality HS and OL FMD vaccines may maintain immunogenic stability for at least 27 and 36 months, respectively, when stored at 2-8 degrees C.

Neurotransmitter regulation of somatostatin secretion by fetal rat cerebral cortical cells in culture

Extensive studies exploring the regulation of hypothalamic somatostatin GHRIH release have been reported, but the factors regulating GHRIH release in the cerebral cortex have not been well defined. We have studied the effects of central neurotransmitters on GHRIH secretion by cultured fetal rat cerebral cortical cells and on intracellular GHRIH levels. Cells maintained in vitro for 15-20 days were incubated with dopamine (DA), acetylcholine (ACh), gamma-aminobutyric acid (GABA), norepinephrine (NE), serotonin (SE) or histamine (His) (10(-11) M to 10(3) M) for 30 minutes. Following incubation, immunoreactive GHRIH was measured by RIA in cell extracts and incubation media. DA increased intracellular GHRIH content but have no effect on GHRIH in the media. Both media and intracellular GHRIH content were significantly reduced by GABA and SE. The effect of NE was stimulatory at low (10(-9) M) and inhibitory at high (10(-5) M to 10(-3) M) concentrations. ACh was found to increase media GHRIH and to decrease intracellular GHRIH content; 30 min exposure to His did not significantly modify either media or intracellular GHRH. Our findings with fetal rat cerebral cortical cells in culture demonstrate that endogenous neurotransmitters do have the capacity to directly influence GHRIH regulation.

[Nutrition in pregnant women: a study of dietary habits in two base health areas]

OBJECTIVE

To analyse the dietary habits of pregnant women in two base Health areas and to propose modifications in any damaging patterns found.

DESIGN

A descriptive study of a crossover type using weekly dietary questionnaires on food consumption and a 24-hour record.

SETTING

Almanjayar and Cartuja Health Centres in Granada.

PARTICIPANTS

Pregnant women being monitored at the Health Centres who were chosen by randomized sampling (N = 52).

MEASUREMENTS AND MAIN RESULTS

We studied the following variables: total energy consumption; intake of carbohydrates, lipides, proteins, fibre, Ca, Mg, Zn, Fe and hydrosoluble and liposoluble vitamins. Average energy consumption was 2516 Kcal per day, although 14.46% of the pregnant women consumed less than 2200 Kcal and in 9.6% average consumption was below 1800 Kcal per day. The energy percentages of total consumption are excessive in the case of proteins (21%), lightly increased in Carbohydrates (51.8%) and acceptable in Lipides (27.2%). In the following there were notable intake deficiencies: Ca (69%), Fe (38.4%), Mg (53.8%), Vit D (49.7%), Folic Acid (81%) and Fibre (33%). On the question of how often food was consumed, we should note the scant consumption of vegetables and alcohol and excessive consumption of refined Carbohydrates.

CONCLUSIONS

There are no big nutritional imbalances. The following are necessary: to maintain energy intake between 2200 and 2600 Kcal per day; to find a new equilibrium between animal and vegetable protein consumption, to diminish the intake of complex and refined Carbohydrates and to increase the intake of Fe, Ca, Folic acid and Vitamin D.

Large-scale use of liquid-phase blocking sandwich ELISA for the evaluation of protective immunity against aphthovirus in cattle vaccinated with oil-adjuvanted vaccines in Argentina

Specific serum activity levels against four reference strains of foot-and-mouth disease virus (FMDV) were evaluated from 1634 animals vaccinated with commercial quadrivalent oil vaccines and from 746 unvaccinated, naive animals, using the liquid-phase blocking sandwich ELISA (lpELISA) test. Cows from the FMDV-free area of Argentina were tested for the absence of specific FMDV antibodies (sp FMDV Abs) and those showing lpELISA titres < 1.0 were grouped in lots of 16 animals. They were vaccinated and challenged at 90 days postvaccination (DPV) with one of four virus strains used for vaccine production and control (prototype strains). Serum samples from vaccinated and control cattle were collected 60 and 90 DPV and the level of sp FMDV Abs was determined by lpELISA. Animals were examined for clinical signs of disease. Results show that serum lpELISA titre levels directly correlate with the percentage of protected animals. It was seen that 100, 98, 93 and 87% of the vaccinated cattle with antibody titre levels > or = 2.1 were protected against challenge with serotypes C85, A87,01 Cas and A79, respectively. Evidence is also presented of seroconversion in a sample of 3-5-month-old calves vaccinated in the field, showing lpELISA titres compatible with protection against the four vaccine viruses as long as 150 DPV. Results reported in this paper strongly support the use of the lpELISA test for a rapid and reliable evaluation of the efficacy of FMDV commercial vaccines as well as for the assessment of the immunological status of cattle in FMDV-free and enzootic regions of South America.

Regulation of somatostatin and growth hormone-releasing factor by gonadal steroids in fetal rat hypothalamic cells in culture

The mechanism underlying the sexually dimorphic pattern of growth hormone (GH) secretion in the rat has not been clearly elucidated. In the present study, we assayed the possible direct effect of gonadal steroids on both somatostatin (SS) and growth hormone-releasing factor (GRF) in fetal rat hypothalamic cells in culture. Hypothalamic cells, obtained by mechanical dispersion, were maintained as monolayer cultures in serum-supplemented medium. After 20 days in culture, cells were incubated with serum free medium containing testosterone (T, 10, 20, 40 ng/dl) or estradiol (E, 0.1, 1, 10 ng/dl) for 48 h. At the end of the experiments, immunoreactive SS (IR-SS) and immunoreactive GRF (IR-GRF) were measured by specific radioimmunoassays (RIAs) in media and cell extracts. After 48 h of incubation with testosterone, somatostatin in both media and cells was significantly reduced. On the contrary, this treatment lead to a dose-dependent increase in media and cell GRF content. When cells were incubated with estradiol for 48 h, a significant inhibition in medium SS release was observed, whereas intracellular SS slightly increased at the highest concentration of 10 ng/dl. Estradiol treatment resulted in an inconsistent decrease in media and cells IR-GRF. Our results indicate that both SS and GRF are under the influence of testosterone and estradiol acting at the hypothalamic level, and furthermore suggest that at this stage of brain development, gonadal steroids may regulate GH secretion through their ability to modulate hypothalamic SS and GRF.

Thyroid hormones regulate release and content of vasoactive intestinal peptide in cultured fetal cerebral cortical cells

The effects of thyroid hormones (TH) on brain immunoreactive-vasoactive intestinal peptide (IR-VIP) secretion and content in cultured fetal rat cortical cells were studied. Cerebral cortical cells were maintained as monolayer cultures for 14-18 days. T3 or T4 (10(-7) M) caused a time-dependent decrease in total IR-VIP. Significant suppression was observed following treatment periods of 6 h or longer (24 and 48 h). Depending on the length of time cells had been deprived of TH prior to the addition of exogenous T3 or T4, these two thyroid hormones had different effects on IR-VIP accumulation. Both T3 and T4 caused a dose-dependent suppression or IR-VIP accumulation when there was no deprivation period or when it lasted 4 h. However, a biphasic effect was observed when cells were deprived of TH for 17 and 24 h: low doses of T3 or T4 (from 10(-12) to 10(-10) M) significantly increased (p less than 0.05) total IR-VIP, while high T3 or T4 doses (10(-8) and 10(-7) M) caused a significant decrease (p less than 0.01). The TH action was furthermore shown to be reversible. After T3 (10(-7) M) removal and subsequent incubation in serum-free medium for 6, 24 and 48 h, T3-treated and control cells exhibited similar levels of IR-VIP release and content. At this time, a new exposure to T3 (10(-7) M) again had a suppressive effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of hypothyroidism duration on developmental changes in the hypothalamic factors implicated in growth hormone secretion in the male rat

The effects of hypothyroidism duration on several factors implicated in GH secretion control were studied in the male rat at different maturity stages, ranging from the peripuberal period to adulthood. Thyroid ablation was performed on 22-day-old Wistar male rats maintained on a low iodine diet (T group). Age-paired controls (C group) were fed with the same diet, supplemented with potassium iodide. Subgroups of T and C animals (aged 32, 42, 52, 82 and 112 days) were studied 10, 20, 30, 60 and 90 days after surgery. After pentobarbital anesthesia, jugular blood was withdrawn before and 5 min after an intravenous TRH stimulus, for GH assay. Hypothalamic and pituitary tissues were obtained in order to measure GH, immunoreactive somatostatin (IR-SRIF) and growth hormone-releasing factor (IR-GRF). Growth rate and serum testosterone confirmed that C rats reached sexual maturity by day 30 of the study. Mean +/- SE serum GH (ng/ml) increased (p less than 0.05) in C animals from day 10 (38.5 +/- 5) to day 30 (67.4 +/- 7.3), with no significant variations thereafter. The same time sequence pattern was observed in pituitary GH concentrations. In T rats, both serum and pituitary GH decreased progressively from day 10 to 90, being significantly lower than in C at all times of the study. No GH response to TRH could be found in C groups. In contrast, GH increased significantly (p less than 0.05) in T animals after TRH at days 20 and 30.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo and in vitro evidence of growth hormone-releasing factor-like produced locally in the adenohypophyseal cells of the rat

In order to characterize immunocytochemically the existence of GRF in the rat adenohypophysis and the origin of this hormone, an immunocytochemical and morphometric study was made of r-GRF-immunoreactive cells from the adenohypophysis of untreated adult rats, adult rats treated intraventricularly with colchicine and in primary cultures of adult rat adenohypophyseal cells that had been incubated with serum devoid of GRF. r-GRF immunoreactive cells were observed in untreated rat pituitaries, both male and female, although the numbers of positive cells were greater in the males (p less than 0.05) and were found to increase in number following treatment with colchicine (p less than 0.01). These cells appeared dispersed throughout the anterior lobe, without forming clusters, and were often close to blood vessels. Additionally, immunoreactive cells appeared in the cultures at 7 days of incubation. The presence of GRF-immunoreactive cells in the adenohypophysis of rats previously treated with colchicine suggests the existence of a non-hypothalamic origin for r-GRF; this is confirmed by the findings obtained in the in vitro studies which would corroborate the hypothesis that the origin of the neuropeptide is in the rat adenohypophysis itself.

Onychomycosis treated with itraconazole or griseofulvin alone with and without a topical antimycotic or keratolytic agent

An open, comparative, randomized study was conducted using griseofulvin or itraconazole for the treatment of onychomycosis of the foot. Group I (45 patients) received itraconazole and Group II (45 patients) received griseofulvin. Each group was divided into three subgroups that received different topical treatment: antimycotic cream (isoconazole 1%), keratolytic cream (urea 40%), or placebo cream. The itraconazole group showed complete clearance in combination with isoconazole cream in 73.3% (11 of 15 patients), in combination with keratolytic cream in 78.5% (11 of 14 patients), and in combination with placebo cream in 91.6% (11 of 12 patients). The griseofulvin group showed complete clearance in combination with isoconazol cream in 46.1% (7 of 15 patients), in combination with keratolytic cream in 42.8% (6 of 15 patients), and in combination with placebo cream in 26.6% (4 of 15 patients). The itraconazole group showed better results compared with the griseofulvin group when the chi-square statistical method was used.

[Venous stasis and panniculopathy: a semiologic study]

The relevant role played by the microcirculation on several pathologies and on the genetic evolution of rarely known diseases as the panniculopathy with venous stasis have been explained. It represent a support on the concept for new research of microcirculation's injuries as a primary factor on macrophlebopathies.