[Complicated intestinal tuberculosis]

Differential diagnosis concerning Crohn's Disease and intestinal tuberculosis is often difficult. The authors present an illustrative case with ileal tuberculosis and secondary amyloidosis. Diagnostic tools and therapeutic measures are described. Literature review and theoretical discussion of both pathologies are included.

[Echo Doppler in abdominal aortic dissection]

The authors present a case of abdominal aorta dissection--type B. The diagnosis was made by Doppler ultrasound and computerized tomography (CT). The use of Doppler ultrasound in the diagnosis and assessment of abdominal aorta dissection and visceral arterial involvement is discussed. Doppler ultrasound is also a useful imaging technique in follow-up evaluation if conservative treatment is employed.

Ultrastructural data on the sporogenesis of Myxidium giardi, cépède 1906 (Myxozoa, Myxosporidia), parasite of Anguilla anguilla (Teleostea)

Ultrastructural study of Myxidium giardi showed that pluricellularity is maintained by the formation of septate desmosomes. The polar capsule is formed from helicoidal depositions of banded material in the initial vacuole. This process makes possible not only the formation of the rigid capsular body but also of the flexible polar filament which is evaginable and reversed in the capsule. The special feature of the genus Myxidium is the ornamentation of the valvogenic cells of the spores in the form of longitudinal ribs. An ultrastructural study showed that the morphogenesis of this cell relief in Myxidium giardi involves a special process based on the development of fusiform macrovesicles whose bases are connected to a cytoskeleton formed of special microtubules 14 nm in diameter. The latter seem to determine the future rigidity of the valvar epicyte.

Critical analysis of methods of reconstruction of exenterated orbits

Reconstructive procedures were used on 14 patients who had undergone orbital exenteration and radiotherapy for malignant tumours. All patients were tumour free after a follow-up of between 5 and 18 years. Reconstruction was carried out in 3 stages. In the first operation the orbit was filled, in the second the orbital rims and eyelids were shaped, and in the third a cavity for a static eye prosthesis was created. Critical assessment of results showed that the first stage alone produced a marked improvement in appearance and occluded existing fistulae. The subsequent procedures improved aesthetic results further. Difficulties were encountered from retraction of the tissues and insufficient tissue mobility.

Diagnosis of sputum smear-negative forms of pulmonary tuberculosis by transthoracic fine-needle aspiration

We reviewed 25 patients submitted to transthoracic fine-needle aspiration (TFNA) who had a final diagnosis of pulmonary tuberculosis. In all cases, bacteriological stains and cultures of sputum and bronchial washing had been performed before admission and were negative. According to the material obtained from the procedure, the aspirates were divided in three groups: diagnostic (Ziehl-Neelsen and/or culture positive, n = 8, 32%), suggestive (granulomatous inflammatory changes, n = 10, 40%) and inconclusive (nonspecific inflammatory changes, isolated giant cells and/or blood, n = 7, 28%). On chest X-ray, 12 patients had opacities with the greatest diameter not exceeding 4 cm. All aspirates in the diagnostic group were from patients with this type of lesion, while all the inconclusive aspirates belonged to patients with larger lesions. As complications, 1 patient needed thoracic drainage for pneumothorax and 3 patients had haemoptyses. Thus TFNA has a place in the diagnosis of suspected pulmonary tuberculosis when more simple methods have failed, and its effectiveness seems to be increased when the lesions do not exceed 4 cm in diameter.

Abdominoplasty: modified plication

The authors present an addition to standard abdominoplasty techniques. Transverse plication of the aponeurotic layer in the epigastrium corrects the prominence in this area and helps the flap to reach the pubic region.

[Acute pancreatitis: inflammatory effusions--course and prognosis]

Ten to twenty per cent of Acute Pancreatitis (AP) attacks are severe and their evolution depends on regional or systemic complications and medical of surgical management applied. Three hundred and twelve cases of AP were retrospectively studied, 51 of which had pancreatic or peripancreatic effusions (early fluid effusion--14%; pseudocyst--14%; phlegmon--43% abscess--29%). Mortality in this group (33%) was greater than in the overall population (5.9%): Alcoholic etiology, concomitant systemic complications and early surgery were determinant factors. Prognostic criteria evaluated had a predictive value of about 80%. Fifty per cent of patients with phlegmon had spontaneous resolution after medical intensive care management. Diagnosis of secondary infection of pancreatic and peripancreatic necrosis is determinant for optimal surgical management. Mortality in abscess was 40%, greater when surgical drainage was done in the first two weeks of disease.

[Acute lithiasic pancreatitis. Usefulness of a multiple quantitative index]

The authors present a prospective study of early diagnosis of biliary etiology in Acute Pancreatitis, using a Multiple Quantitative Index. A positive diagnosis was achieved in more than a 80% of cases if female, age over or equal 55 years, and serum alanine-aminotransferase over or equal twice normal. Some questions concerning usefulness and therapeutical implications of an early diagnosis of Biliary Pancreatitis is already present in discussion.

Effects of ethanol on rat brain (Na + K)ATPase from native and delipidized synaptic membranes

The role of lipids in the effect of ethanol on synaptosomal (Na + K)ATPase was studied using native and partially delipidized synaptosomal membranes from control and alcoholic rats. A biphasic effect of alcohol was observed with the (N + K)ATPase from control membranes. Ethanol at low concentrations (less than 100 mM) appears to enhance the enzyme activity, but at higher concentrations (greater than 300 mM) was inhibitory. The biphasic response to ethanol was also observed with the (Na + K)ATPase isolated from alcoholic animals; however, in this case the enzyme showed a resistance to the inhibitory effect of ethanol. Delipidization of synaptic membranes with Lubrol WX or phospholipase A practically abolishes the effects of alcohol on (Na + K)ATPase from both control and alcoholic animals. It thus seems that the effects of ethanol are due mainly to their interaction with the lipids surrounding the enzyme. Furthermore, addition of ethanol to native membranes did not change the Vmax and Km for K+. However, when ethanol at the same concentration was added to delipidized membranes, a decrease in Km with no change in Vmax was observed. Ethanol under these conditions apparently interacts also with the enzyme protein. On the other hand, chronic ethanol intake produces an increase of both Vmax and Km for K+. However, when alcohol was added in vitro, there were no changes in the kinetic parameters of either native or delipidized membranes. These data indicate that although the effects of ethanol on synaptosomal (Na + K)ATPase are mainly due to its interaction with the lipid microenvironment of the enzyme, a direct ethanol action on the enzyme protein also occurs. Our data further suggest that chronic ethanol treatment alters enzyme sensitivity to the effect of ethanol which may be related to the membrane-lipid composition and/or to changes in the conformation of the enzyme protein.

Lens transmission and autofluorescence in renal disease

Autofluorescence and transmission values of the lens for blue-green light were determined at two locations with the use of identical fluorophotometers: in Coimbra, Portugal, in 44 healthy controls, 15 haemodialysis and 11 renal failure patients, and in Leiden, The Netherlands, in 57 healthy controls, 23 haemodialysis and 47 renal transplant patients. The increase in lens autofluorescence as a function of age was 42% higher in the Portuguese controls than that in the Dutch controls (p less than 0.001), but the lens transmission did not differ significantly (p = 0.21). Significant differences were found between the autofluorescence values of the Portuguese haemodialysis and renal failure patients and those of age-matched local controls (+18%, p = 0.009, and +26%, p = 0.03, respectively), as well as between the lens transmission values of the Portuguese renal failure patients and those of age-matched local controls (-2%, p = 0.03). In the renal transplant patients the average autofluorescence and lens transmission values were equal to those of the local controls (within 3%) and independent of the number of anti-rejection treatments administered.

Chronic ethanol consumption affects filipin-cholesterol complexes and intramembranous particles of synaptosomes of rat brain cortex

To assess the effect of ethanol on the planar distribution of cholesterol as well as on the surface architecture of presynaptic terminals of rats, synaptosomes isolated from cerebral cortex of rats chronically exposed to alcohol were incubated with filipin, a cytochemical marker for beta-hydroxycholesterol, and analyzed using both conventional (qualitative and quantitative) and freeze-fracture electron microscopy. Synaptosomes incubated in the absence of filipin were used as cytochemical controls. Biochemical determination indicates a 12% increase of cholesterol in synaptosomal membranes from alcohol treated rats. This increase was confirmed by a significant increment in the number of filipin-cholesterol complexes. Synaptosomes of treated rats showed a reduction in the total number of synaptic vesicles (SV) as well as a decrease in the density and total number of intramembranous particles (IMP) per synaptosome. In control rats, most synaptosomal IMP were distributed in clusters whereas in those of rats exposed to alcohol they were distributed at random. These changes in distribution of IMP were also observed in presynaptic terminals analyzed "in situ." These findings indicate that ethanol acts on the presynaptic terminals. The variations in cholesterol content as well as in the density and distribution of IMP appear to be related to alcohol-induced changes in the physicochemical properties of components of the synaptosomal membrane.