Tap water versus sterile saline solution in the colonisation of skin wounds

Irrigating wounds with tap water does not increase colonisation, but controlled studies are required for further evidence. Microbial colonisation was assessed in skin wounds, before and after irrigation with tap water, and was compared with irrigation using 0·9% sodium chloride sterile solution. The study included 120 subjects with chronic, traumatic, vascular, pressure or neuropathic wounds. A total of 60 wounds were randomly assigned to be irrigated with tap water (tap water group) and another 60 to be irrigated with 0·9% sodium chloride sterile solution (saline group), at a pressure of 0·46-0·54 PSI. Samples were collected from the centre of each wound using Levine's technique, before and after irrigation, and cultivated in thioglycollate, hypertonic mannitol agar, eosin methylene blue (EMB) agar, blood agar and Sabouraud agar at 37°C for 72 hours. There was concordance (kappa test) and discordance (McNemar test) regarding the count of positive and/or negative samples before and after irrigation in each group. The proportion of reduction of positive samples was similar for both groups in all cultures. Colony-forming unit count before and after irrigation was similar in both groups and in all cultures, except for the culture in hypertonic mannitol agar from the tap water group, for which the count was lower after irrigation (Wilcoxon z = 2·05, P = 0·041). It is concluded that skin wound irrigation with tap water leads to further reduction of Gram-positive bacteria compared with 0·9% sodium chloride sterile solution, with no difference in colonisation of haemolytic bacteria, Gram-negative bacteria and fungi.

Sensitivity of the Nipple-Areola Complex and Sexual Function Following Reduction Mammaplasty

BACKGROUND

The sensitivity of the nipple-areola complex (NAC) is very relevant to female sexuality.

OBJECTIVE

To evaluate NAC sensitivity and sexual function after breast reduction, and to assess whether altered NAC sensitivity is related to sexual dysfunction.

METHODS

The study included 80 patients, who were allocated to a control group with eutrophic breasts (CG, n = 20), a hypertrophy group without surgery (HG, n = 20), or a mammaplasty group (MG, n = 40). The MG was assessed preoperatively and 6 months postoperatively. The HG and CG were evaluated once. NAC sensitivity was assessed for touch, temperature, vibration, and pressure in four areola quadrants and the nipple. Sexual function was assessed with the Brazilian version of the Female Sexual Function Index, which has six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and a total score that indicates the presence or absence of sexual dysfunction.

RESULTS

Compared to the CG, the MG had worse sensitivity to temperature and pressure in the nipple and areola medial quadrants postoperatively (P < 0.01). Compared to their preoperative assessment, the MG had reduced temperature and pressure sensitivity in the nipple and areola medial quadrants postoperatively (P < 0.05). Compared to the CG and HG, patients in the MG had higher postoperative scores of excitation (P = 0.0001), lubrication (P = 0.0004), orgasm (P < 0.0001), and satisfaction (P < 0.0001). There was an association between sexual dysfunction and low NAC sensitivity to temperature and vibration (P ≤ 0.041) in the MG's preoperative and postoperative scores, and to touch, temperature, and pressure across all three groups.

CONCLUSIONS

Breast reduction with a superomedial pedicle reduced NAC sensitivity but did not interfere with sexual function.

A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis

Autoimmunity has been associated with vitamin D deficiency and resistance, with gene polymorphisms related to vitamin D metabolism frequently described in affected patients. High doses of vitamin D3 may conceivably compensate for inherited resistance to its biological effects. This study aimed to assess the efficacy and safety of prolonged high-dose vitamin D3 treatment of patients with psoriasis and vitiligo. Nine patients with psoriasis and 16 patients with vitiligo received vitamin D3 35,000 IU once daily for six months in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya “milk”) and hydration (minimum 2.5 L daily). All psoriasis patients were scored according to “Psoriasis Area and Severity Index” (PASI) at baseline and after treatment. Evaluation of clinical response of vitiligo patients required a quartile grading scale. All patients presented low vitamin D status (serum 25(OH)D3 ≤ 30 ng/mL) at baseline. After treatment 25(OH)D3 levels significantly increased (from 14.9 ± 7.4 to 106.3 ± 31.9 ng/mL and from 18.4 ± 8.9 to 132.5 ± 37.0 ng/mL) and PTH levels significantly decreased (from 57.8 ± 16.7 to 28.9 ± 8.2 pg/mL and from 55.3 ± 25.0 to 25.4 ± 10.7 pg/mL) in patients with psoriasis and vitiligo respectively. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. Fourteen of 16 patients with vitiligo had 25–75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.

Feeding Induced by Increasing Doses of Neuropeptide Y: Dual Effect on Hypothalamic Serotonin Release in Normal Rats

Endogenous neuropeptide Y (NPY) levels increase during fasting and before dark onset in rats. The feeding that follows these states elicits the release of serotonin in the lateral hypothalamus (LH), as part of the physiological mechanisms controlling satiety. With the hypothesis that exogenous NPY-induced feeding should also stimulate serotonin, we measured its release in the LH of non-fasted rats, which received a single intracerebroventricular injection of either 1.0, 2.0, or 5.0 microg of NPY. After 1.0 microg, the cumulative 2-h intake was of 13 g and serotonin release significantly increased (54% peak). These feeding and serotonergic responses were highly similar to the ones we observed in a previous study, in which feeding followed an overnight fast. Thus, the 1.0 microg NPY dose stimulated intake while preserving the normal serotonergic activation. Contrarily, as the NPY dose was increased to either 2.0 or 5.0 microg, the cumulative 2-h intakes were of 18 g, but the serotonergic stimulation was absent. It is suggested that this dual NPY effect relies on a finely tuned control mechanism, reflecting the existence of a narrow range of NPY levels within which the serotonergic stimulation resembles those seen in physiological states.

A prospective study of nutrition education and oral nutritional supplementation in patients with Alzheimer's disease

BACKGROUND

Weight loss in patients with Alzheimer's disease (AD) is a common clinical manifestation that may have clinical significance.

OBJECTIVES

To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD.

METHODS

A randomized, prospective 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups: Control Group (CG) [n = 27], Education Group (EG) [n = 25], which participated in an education program and Supplementation Group (SG) [n = 26], which received two daily servings of oral nutritional supplementation. Subjects were assessed for anthropometric data (weight, height, BMI, TSF, AC and AMC), biochemical data (total protein, albumin, and total lymphocyte count), CDR (Clinical Dementia Rating), MMSE (Mini-mental state examination), as well as dependence during meals.

RESULTS

The SG showed a significant improvement in the following anthropometric measurements: weight (H calc = 22.12, p =< 0.001), BMI (H calc = 22.12, p =< 0.001), AC (H calc = 12.99, p =< 0.002), and AMC (H calc = 8.67, p =< 0.013) compared to the CG and EG. BMI of the EG was significantly greater compared to the CG. There were significant changes in total protein (H calc = 6.17, p =< 0.046), and total lymphocyte count in the SG compared to the other groups (H cal = 7.94, p = 0.019).

CONCLUSION

Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status.

Comparative study of the changes in partial pressure of plasma carbon dioxide during carbon dioxide insufflation into the intraperitoneal and preperitoneal spaces

BACKGROUND

We aimed to compare plasma concentrations of carbon dioxide (CO(2)) in dogs that underwent intra- and preperitoneal CO(2) insufflation.

MATERIALS AND METHODS

Thirty dogs were studied. Ten formed a control group, 10 underwent intraperitoneal CO(2) insufflation, and 10 underwent preperitoneal CO(2) insufflation. General anesthesia with controlled ventilation was standardized for all dogs. After stabilizing the anesthesia, blood samples were collected at predetermined times and were sent for immediate gasometric analysis. Analysis of variance was used for comparing variables.

RESULTS

The plasma CO(2) concentration in the intraperitoneal insufflation group increased significantly more than in the preperitoneal insufflation group and was significantly greater than in the control group (P < 0.05). The pH values in the intraperitoneal group were lower than in the preperitoneal group (P < 0.05).

CONCLUSION

The data from this study suggest that a greater plasma concentration of CO(2) is achieved by insufflation at constant pressure into the intraperitoneal space than into the preperitoneal space.

Eating attitudes and body image in ethnic Japanese and Caucasian adolescent girls in the city of São Paulo, Brazil

OBJECTIVE

Despite investigations into the rapid increase in eating disorders across diverse ethnic groups, conclusions concerning ethnicity and eating disorders are contradictory. The objective of the present study was to investigate eating attitudes in ethnic Japanese and Caucasian adolescents in Brazil. The influence of body mass index (BMI), menarche and social-affective relationships on the development of eating disorders was also assessed.

METHODS

Questionnaires evaluating the incidence of eating disorders and the influence of social-affective relationships were applied to 544 Japanese-Brazilian and Caucasian adolescent girls: 10 to 11-year-old Japanese-Brazilian (n = 122) and Caucasian (n = 176) pre-menarcheal adolescents, and 16 to 17-year-old Japanese-Brazilian (n = 71) and Caucasian (n = 175) post-menarcheal adolescents.

RESULTS

Caucasian girls obtained higher scores on the Eating Attitudes Test (EAT-26), showed greater body image dissatisfaction, dieted more often and had more diet models introduced by their mothers and peers than the Japanese-Brazilian girls. CONCLUSION The Caucasian adolescents overall appeared to be more sensitive to aesthetic and social pressures regarding body image than the Japanese adolescents. The high incidence of EAT-26 scores above 20 in the Caucasian pre-menarcheal group indicates that individual body image concerns are developing at an earlier age. Multiple logistic regression revealed several associations between mother-teen interactions and the development of abnormal eating attitudes.

Anthropometry and body composition in ethnic Japanese and Caucasian adolescent boys

BACKGROUND

The effect of environmental conditions on development, including growth, maturation and the fulfillment of genetic potential, can be identified through the study of the variations found among different ethnic groups in the same population. The objectives of the present study were: (i) to compare the various anthropometric and body composition parameters based on ethnicity and maturation stage in 31 Japanese and 99 Caucasian prepubescent boys and 50 Japanese and 98 Caucasian post-pubescent boys; and (ii) to assess body mass index (BMI) and its relationship with other methods of body fat evaluation.

METHODS

The percentage of body fat was measured using bioelectrical impedance, near-infrared interactance and Slaughter cutaneous skinfold equations.

RESULTS

Weight and height were statistically lower for the Japanese than the Caucasian subjects. There were no differences in body fat between the ethnic groups, but the Japanese subjects had statistically lower levels of fat-free mass. The gain in fat-free mass and the loss in body fat when attaining maturation were greater in the Caucasian subjects. The agreement of BMI with other methods was good in all of the groups but lower for the Japanese than for the Caucasian subjects.

CONCLUSION

Height and weight differences between the ethnic groups indicated distinct genetic potential ranges. The body fat mass did not differ between the ethnic groups, but the degree of changes when attaining maturation in the Caucasian subjects was greater. If this difference were to be maintained between the groups then years later there would be a greater accumulation of fat in the Japanese subjects.

Use of papain gel in disabled patients

PURPOSE

This study's purpose was to evaluate complete caries removal time (CCR) and patient acceptance of the chemomechanical caries removal agent and papain gel Papacárie in disabled patients.

METHODS

Fifty-one consecutive patients entered a prospective, controlled, randomized, open study. Patients were divided into 2 groups: (1) group 1=28 children 3 to 10 years old with or without visual or hearing impairments, motor disability on upper limbs, and inability to respond to simple orders; and (2) group 2=23 children, without visual or hearing impairments, with motor disability on the upper limbs and the ability to respond to simple orders. CCR time was measured in both groups. Patients' acceptance was assessed only in group 2 by using the visual analogy of face scale. The visual scale was presented in phase A--after the radiography with the child sitting on the dental chair before the beginning of the treatment, phase B--during the treatment, after total removal of the carious tissue and phase C--after the restoration was complete (treatment was finished).

RESULTS

The total CCR average time was 8 minutes for each tooth when groups 1 and 2 were considered. Group 2 patients' acceptance in the first treatment was not statistically significant in all stages.

CONCLUSIONS

Papacárie gel had a completed caries removal time of 8 minutes per tooth and is well accepted by the patients in all phases and in the first and subsequent visits.

Resistência à insulina com a suplementação de creatina em animais de experimentação

INTRODUÇÃO E OBJETIVO: A suplementação de creatina tem sido usada para melhorar o desempenho muscular. Esta afeta o metabolismo da glicose e estimula a secreção de insulina in vitro e in vivo. No entanto, a hipersecreção de insulina em longo prazo pode induzir também resistência à insulina. O presente trabalho analisou os efeitos da suplementação oral de creatina para avaliar a possibilidade da ocorrência de resistência à insulina in vivo. MÉTODOS: Quarenta e oito ratos Wistar (24 fêmeas/24 machos) foram divididos em dois grupos de 24 (controle e estudo) e subdivididos em seis grupos de oito. Por quatro semanas, foram alimentados com ração padrão, tendo livre acesso a água. Além disso, o grupo de estudo recebeu dieta suplementar de creatina (0,4g de creatina para 30mL de água por rato/dia). Nos 7º, 14º, 21º e 28º dias do experimento, 12 ratos foram anestesiados (tiopental sódico 0,15mL/100g), após jejum de seis horas, sendo submetidos ao teste intravenoso de tolerância à insulina (0,5mL de uma solução de 30% de insulina humana regular e 70% de salina). As amostras de sangue foram coletadas das veias dos rabos dos ratos, nos tempos basal, três, seis, nove, 12 e 15 minutos após a administração da insulina. A mensuração da glicose foi feita pelo método da glicose-oxidase. O trabalho foi previamente aprovado pelo Comitê de Ética em Pesquisa do CCMB- PUCSP. RESULTADOS: A média da constante de decaimento da glicose (K ITT) foi calculada pela fórmula 0,693/T1/2. O grupo de estudo, quando comparado com o grupo controle, apresentou resistência insulínica no 21º dia (p < 0,0004) e 28º dia (p < 0,0001). CONCLUSÃO: Este trabalho mostra que a suplementação prolongada de creatina pode levar à resistência à insulina e que deveria ser usada com cautela em indivíduos com distúrbios do metabolismo da glicose.

[Lipid profile and nutrition counseling effects in adolescents with family history of premature coronary artery disease]

OBJECTIVE

To assess lipid profile and nutritional parameters from adolescents with family history of premature coronary artery disease (CAD) and assess the effects of nutritional counseling.

METHODS

The study included 48 adolescents of both gender and with ages ranging from 10 and 19 years old (case group, n=18; control group, n=30).

RESULTS

Offspring of young individuals with coronary artery disease showed higher values of total cholesterol (189 +/- 30 vs. 167 +/- 26 mg/dl, p < 0.01), LDL-C (144 +/- 20 vs. 100 +/- 27 mg/dl, p < 0.001) and apoB (80 +/- 15 vs. 61 +/- 18 mg/dl, p = 0.001) and lower values of HDL-C (45 +/- 9 vs. 51 +/- 13 mg/dl, p < 0.02) than control young individuals. Differences were not found for triglycerides and apoA-I. With a dietotherapeutic counseling, we obtained a reduction in alimentary consumption of saturated fatty acids (pre: 15.5 +/- 4.7% vs. post: 6.6 +/- 3.7%, p = 0.003) and an improvement in lipid profile: TC (-8%, p = 0.033), LDL-C (-18.2%, p = 0.001), TG (-53%, p = 0.002) rates in offspring of premature CAD patients who showed hyperlipidemia.

CONCLUSION

The presence of dyslipidemia was more prevalent among offspring adolescents of premature CAD patients, but it was responsive to nutritional intervention.

Phytate technetium-99m versus dextran 500 technetium-99m in the sentinel lymph node biopsy

PURPOSE

To study which of the two most used radiopharmaceutical drugs for the sentinel lymph node (SLN) biopsy procedure (dextran 500 99mTc and phytate 99mTc) best defines the SLN and migrates less to other lymph nodes.

MATERIAL AND METHODS

Thirty-two rats, separated into two groups, underwent lymphoscintigraphy examination with either dextran or phytate followed by sentinel (popliteal), lumbar, and inguinal lymph node biopsy. Radiation was detected with a gamma probe.

RESULTS

The statistical study indicated count rates significantly higher in the SLN than in the other basins for both the dextran (P<0.01) and phytate groups (P<0.001). There was no statistically significant difference concerning SLN absorption in either group (P=0.2981). In the dextran group, migration occurred to 1.5 lymphatic basins with counting higher than 10% of that found in the SLN versus 0.8 in the phytate group (P=0.0023). Migration was thus higher in the dextran group (P=0.0207).

CONCLUSION

There was no statistically significant difference between dextran and phytate in the SLN identification, but the phytate migrated to fewer lymphatic basins beyond the SLN and with less intensity.

Relationship between the diameter of great saphenous vein and body mass index

OBJECTIVE: This study has been designed to correlate the diameter of the greater saphenous vein in different levels of the lower limbs with the body mass index of each individual to determine a possible relation between them. METHODS: Fifty-two lower limbs in 26 volunteers (six males and 20 females) without a chronic venous disease record, aged 21-68 were evaluated. Prior to color-flow duplex scanning the body mass index was defined. The deep and superficial venous systems and perforator veins were assessed as described in the literature. The diameter of the greater saphenous vein was measured with ultrasound longitudinal imaging in seven different levels. For the statistical analysis, Student t test for paired data and Spearman test were used. RESULTS: The difference observed in saphenous venous in the second and third levels when compared to the lower right and left limbs was not considered significant and a single group was formed to correlate with body mass index. The correlation was considered statistically irrelevant. CONCLUSION: By correlating the diameters of the greater saphenous vein with the body mass index of each individual it was noted that the relation between them is not significant, therefore it can be assumed that tall thin individuals can have greater saphenous vein with similar diameter as short fat individuals.

[Clinical-epidemiological study of toxocariasis in a pediatric population]

OBJECTIVE

The variety of toxocariasis clinic manifestations and its relationship with asthma motivated this study. The aim was to study T.canis seropositivity at a public pediatric service and its association with laboratory, epidemiological and clinical factors.

METHODS

This study was cross-sectional and controlled. Two hundred and eight children, from 1 to 14 years old and treated at the University of Santo Amaro Pediatric Department s Immunology and Pneumology clinic between January 2000 and January 2001, underwent serology testing. Antibodies were detected by ELISA testing for the larval excretory-secretory antigen of T. canis. We used the chi-square test for T.canis seropositivity (titers > or = 1:320) associations with: puppies at home, contact with soil, geophagia, onicophagia, mother's educational level, asthma, chronic cough, repetitive pneumonia, skin manifestations, rhinitis, hepatomegaly, splenomegaly, abdominal pain, anemia, eosinophilia, immunoglobulins, parasitosis and stunted growth. The Kruskal-Wallis variance analysis method was used for mean comparisons between seropositive and seronegative groups. Significance was set at p < or = 0.05.

RESULTS

Seroprevalence was 54.8%, with a mean age of 6.5 years while for seronegative children the mean age was 5.8 years, showing no significant difference. There was also no difference between sexes. Seropositivity was significantly associated with puppies at home, contact with soil, hepatomegaly, asthma, eosinophilia, increased serum immunoglobulin (Ig) E levels and stunted growth.

CONCLUSION

Seroprevalence was elevated in this study . T.canis infection must be considered in at-risk children, such as those with puppies at home, who have had contact with soil, who have hepatomegaly and/or asthma with eosinophilia and increased serum IgE.

Prevalence of varicose veins and venous anatomy in patients without truncal saphenous reflux

OBJECTIVES

To determine the prevalence and distribution of primary venous reflux in the lower limbs in patients without truncal saphenous reflux.

DESIGN

Prospective cohort study.

PATIENTS AND METHODS

One thousand and seven hundred and twelve patients with suspected venous disease were examined by duplex ultrasonography. Seven hundred and thirty-five patients had primary varicose veins with competent saphenous trunks. Limbs with truncal saphenous reflux, deep vein reflux or obstruction, previous injection sclerotherapy or vein surgery, arterial disease and inflammation of non-venous origin were excluded from further consideration. The CEAP classification system was used for clinical staging. Systematic duplex ultrasound examination was undertaken to assess the distribution of incompetent saphenous tributaries.

RESULTS

The prevalence of primary reflux with competent saphenous trunks was 43%. Reflux of GSV calf tributaries was the most common. The majority of the limbs (96%) belonged to chronic venous disease classes C1 and C2 of the CEAP classification.

CONCLUSIONS

Superficial venous reflux causing varicose veins in the presence competent saphenous trunks is very prevalent in this series in contrast to other studies, presumably reflecting differing patient populations. Our data clearly show that varicose veins may occur in any vein and do not depend on truncal saphenous incompetence. Careful duplex ultrasound evaluation allows the pattern of venous reflux to be established in this group of patient ensuring appropriate management of varices.

Human toxocariasis: a seroepidemiological survey in schoolchildren of Sorocaba, Brazil

A seroepidemiological survey for toxocariasis, among 180 schoolchildren of the public schools of Sorocaba City, state of São Paulo, Brazil, was carried out from August 2000 to July 2001. ELISA test was performed using excretory and secretory antigens for the detection of IgG anti-Toxocara antibodies. Information regarding the children was obtained from the parents or legal guardians. The results showed that the mean age was 5.4 +/- 1.4 years, the infection coefficient (IC) was 38.3 and the infection risk was higher among the children living in the city outskirts (IC = 47.4) where the socioeconomic conditions were worse than in the central region of the city (IC = 11.1). There was an association between higher frequency of seroreactivity in the ELISA test and the condition of living in a house with a yard and/or unpaved street. The same was observed in relation to a history of enteroparasitism. There was also an association between a seronegative ELISA test and previous treatment of pet dogs and/or cats with vermifuge. Based on these results, the authors propose that public health programs should include anthelmintic for dogs and cats during the antirabies vaccination campaigns, in order to diminish environmental contamination with Toxocara spp. eggs and consequently human infection.

Quality of life outcomes after pedicled TRAM flap delayed breast reconstruction

OBJECTIVES

To evaluate the impact of TRAM flap delayed breast reconstruction on health related quality of life in patients who had undergone mastectomy.

METHODS

Twenty-five patients following mastectomy were selected consecutively from the Plastic Surgery/Mastology Units of two university hospitals. All subjects underwent breast reconstruction with the use of pedicled TRAM flap. The patients' health related quality of life was assessed by a validated instrument, the SF-36 Health Survey Questionnaire. This was applied preoperatively and postoperatively at 3, 6 and 12-months follow-up. A group of 20 women with mastectomies who have not undergone breast reconstruction was used as a control. To assess patients' satisfaction with breast reconstruction we used Alderman's modified general satisfaction subscale.

RESULTS

There was a progressive improvement in all dimensions of the SF-36, and this was statistically significant for seven of the eight dimensions. The scores were significantly higher on 'role emotional' and 'mental health' at 3 months postoperatively, on 'health perception' and 'role physical' at month 6 and on 'physical function', 'pain', health perception and 'social function' at postoperative month 12. Despite the increase in scores, no significant changes in 'vitality' were found. There was no significant preoperative difference between the control group and studied patients, and the control group's scores were significantly lower in all dimensions when compared to postoperative month 12, except on 'physical function'. The level of patients' satisfaction with the TRAM flap breast reconstruction was high.

CONCLUSIONS

The data of this study suggest that delayed breast reconstruction with the use of the pedicled TRAM flap provides an improvement in health related quality of life of patients who have undergone mastectomy.

Anthropometry and body composition in ethnic Japanese and Caucasian adolescent girls: considerations on ethnicity and menarche

OBJECTIVE

This study aimed to compare the various anthropometric and body composition parameters based on the ethnicity and the absence or presence of menarche.

DESIGN

A cross-sectional study with incomplete sampling, using the subject as the evaluation unit.

SUBJECTS

The final sample of 550 subjects was composed of 122 Japanese and 179 Caucasian premenarcheal adolescents, and 72 Japanese and 177 Caucasian postmenarcheal adolescents.

METHODS

The variables of body composition were measured through the following methods: bioelectrical impedance analysis, near-infrared interactance (NIR), Slaughter cutaneous skinfold equations and body mass index. Weight, height and sitting height were also evaluated.

RESULTS

The Japanese pre- and postmenarcheal girls presented lower weight and height values when compared with the Caucasian girls. In general, the Japanese premenarcheal girls presented less fat and fat-free mass than the premenarcheal Caucasian girls. This fact was demonstrated through NIR results. Conversely, the Japanese postmenarcheal adolescents accumulated more fat than their Caucasian counterparts. However, significant differences were solely encountered in the values of cutaneous skinfold percent body fat. With regard to menarche, it was verified that, regardless of ethnicity, all the anthropometric and body composition variables reached higher values among postmenarcheal adolescents when compared with premenarcheal adolescents.

CONCLUSION

Different results of weight and height between the ethnic groups may bring back the discussion concerning separate growth curves for different ethnic groups. The results of the body composition analysis indicated high adiposity levels among postmenarcheal adolescents.

Estudo de variáveis demográficas, ocupacionais e co-carcinogenéticas no carcinoma espinocelular da base de língua nas mulheres

Avaliar a relação entre carcinógenos e o carcinoma espinocelular no sexo feminino. FORMA DE ESTUDO: Retrospectivo não randomizado. OBJETIVO: Determinar a relação entre carcinógenos (álcool e fumo) e o carcinoma espinocelular no sexo feminino na base da língua. MATERIAL E MÉTODOS: Estudo retrospectivo de 31 pacientes do sexo feminino realizado no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis, Hosphel, São Paulo (1977 a 2000). Foram analisados variáveis como etnia, idade, profissão, tabagismo, etilismo, queixa principal, o intervalo de tempo entre o início da queixa e a procura do médico e o estadiamento clínico. Quanto ao tratamento estatístico, foram utilizados os Testes de Kappa e o de Mc Nemar. RESULTADOS: Houve predomínio da raça branca (58,1%) sobre a negra (35,5%) e a amarela (6,4%), bem como da 6ª décadade vida; sendo profissionais do lar (83,9%) trabalhadoras na agricultura 6,4%). Indústria (3,2%), comércio e liberais (3,2%). Houve mais consumo isolado do tabagismo (48,4%), ambos (45,2%) e nenhum (6,4%). Quanto à sintomatologia, odinofagia (48,4%), nódulo no pescoço (19,3%), disfagia (12,9%); otalgia (9,7%), ferida na língua (6,4%) e rouquidão (3,2%). Quanto ao estadiamento, T3-4 (74,1%), T1-2 (25,8%), N0 (29,0%), N1(29,0%), N2-3 (42,0%). CONCLUSÕES: O carcinoma espinocelular em mulheres predominou na 6ª década, na raça branca, tendo como principais sintomas odinofagia e linfonodo cervical metastático. Houve predomínio do tabagismo sobre o etilismo, em paciente T3-4, sendo que a maioria já portador de metástase linfonodal à 1ª consulta.

Effect of lung resection and sham surgery on the frequency of infection in alloxan-diabetic rats

The present study was carried out in order to determine the effect of lung resection on the frequency of infections in alloxan-diabetic rats. Adult female Wistar rats were injected with alloxan (40 mg/kg, iv) to induce diabetes mellitus (group D; N = 45) or with vehicle (1.0 ml/kg, iv) to be used as controls (group C; N = 45). Thirty-six days after receiving alloxan both groups were randomly divided into three subgroups: no operation (NO; N = 15), sham operation (SO; N = 15), and left pneumonectomy (PE; N = 15). The rats were sacrificed 36 days after surgery and their lungs were examined microscopically and macroscopically. The occurrence of thoracic wall infection, thoracic wall abscess, lung abscess and pleural empyema was similar in groups D and C. In contrast, the overall infection rate was higher (P<0.05) in the diabetic rats (SO-D and PE-D subgroups, but not in the NO-D subgroup). Considering that the overall infection rate was similar in the SO-D and PE-D subgroups, we suggest that surgery but not pneumonectomy was related to the higher prevalence of infection in diabetic rats.

Changes in the lower urinary tract in continent women and in women with stress urinary incontinence, according to menopausal status

The aim of this study was to assess the impact of the postmenopausal period on clinical and urodynamic parameters and on the mobility of the bladder neck in continent women and in women with stress urinary incontinence. Fifty-seven postmenopausal women were studied: 30 were continent and 27 had stress urinary incontinence. They were subdivided according to postmenopausal stage into groups A (<5 years) and B (>5 years). Five years was a good marker to separate those women with mild and severe estrogen deficiency. Fifteen premenopausal incontinent women were selected for bladder neck ultrasound as controls. All underwent history, general physical and gynecologic examinations, LH and FSH determinations, type 1 urine and uroculture, circadian voiding diary, cotton-swab test, bladder neck ultrasound and urodynamic investigations. Analysis of the voiding diaries revealed a higher frequency of daytime micturition in both groups of incontinent patients than in the continent ones. Increased bladder neck mobility was also found, both in the cotton-swab test and an ultrasound, in group A and an ultrasound in the premenopausal incontinent women. Urodynamic investigation showed decreased bladder capacity at the first micturition urge, as well as decreased urinary volume in the group A patients compared to the continent ones. Decreased urethral closure maximum pressure was also found in group B patients in relation to the continent ones. We concluded that the effect of hypoestrogenism, manifested postmenopause, causes changes in the lower urinary tract of women, particularly those who are incontinent.

A comparison of shaping ability using ProFile, GT file, and Flex-R endodontic instruments in simulated canals

A total of 160 resin-simulated canal blocks with 20-degree or 30-degree curvature were prepared by ProFile rotary instruments, GT rotary files, and the balanced force technique with Flex-R files. Using an image analysis computer application, the pre- and postoperative images were stored and superimposed, and then the amount of material removed from the preoperative inner and outer curved walls was measured at five levels in the apical 5 mm of the canal. The time required for canal preparation, including irrigation, and the time taken to change instruments was recorded. At 1 mm from the apical end, the directions of canal transportation were most frequently toward the outer aspect of the curvature, with the only exception being the canals shaped by the balanced force technique in which more was removed from the inner aspect. The balanced force technique required more preparation time than the rotary instrumentation.

[Results of nutritional intervention in children and adolescents with cystic fibrosis]

OBJECTIVE

Few studies have verified longitudinally the evolution of the nutritional status of patients with cystic fibrosis. The objective of this study is to follow the evolution of the nutritional status, body composition and energy consumption, macronutrients and micronutrients ingested by children and adolescents by means of nutritional interventions at the Clinic of Cystic Fibrosis/Pediatric Pneumology of the Department of Pediatrics of Universidade Federal de São Paulo.

METHODS

18 patients were involved in this study, thirteen males and five females with ages ranging from 0.3 to 18.4 years. We performed three evaluations: evaluation 1 (M1--prenutritional intervention), M2 after 6 months, and M3 after 12 months. In these three instances we verified: the z score for weight/age, weight/height and height/age and the calculation of a 3-day diet record. We verified the body composition (anthropometry) in M1 and M3. The nutritional interventions were hypercaloric, hyperproteic, with adequate amount of ingested macronutrients and micronutrients.

RESULTS

We observed an increase in the z score for height/age (M1=-1.07; M2=-0.69; M3=-0.50) and fat-free mass after the nutritional interventions, without improvement in the z score for weight/height and fat mass. We verified an increase in the energy intake during M2 (139%) and M3 (132%) compared to M1 (106%). Remarkable increase in the intake of protein, calcium, iron and vitamin C by the patients was found. The occurrence of anemia was found in 44% (8/18) of the patients.

CONCLUSION

The improvement of the z score in height/age and fat-free mass was probably due to the increase in energy consumption after the nutritional intervention. A significant improvement in the z score for weight/height and fat mass was not found, probably due to a gain in height and fat-free mass.

Thermolabile and calcium-dependent serum factor interferes with polymerized actin, and impairs anti-actin antibody detection

The detection of anti-actin (AAA) by immunofluorescence is hindered by the presence of a serum factor. To better understand how it interferes with AAA detection, we tested sera from 20 patients with autoimmune hepatitis, and from 21 healthy adults, diluted 1:10 and prepared as follows: (A) diluted with PBS; (B) inactivated at 56 degrees C, and diluted with PBS; (C) diluted with 34 mM EDTA/PBS; (D) heated and diluted with EDTA/PBS. To reveal AAA, a fluorescein-labelled anti-human IgG was used in the process of indirect immunofluorescence. In a parallel assay, the substrate, acetone-fixed human fibroblasts, was preincubated with sera prepared as if it were to identify AAA, but instead, a rhodamine-phalloidin was used to identify F-actin, by direct immunofluorescence. All sera from patients were reactive to AAA when heat-inactivated and/or calcium-chelated, and 60% of them when diluted with unmodified sera (P=0.004). F-actin continued to be present after preincubation with heat-inactivated or calcium-chelated sera from patients and healthy controls, and in 41.5% of reactions with unmodified serum (P=0.0000001). The heat inactivation and the calcium chelation were both efficient procedures for maintaining the microfilament structure intact after serum incubation and, therefore, for identifying AAA.

A comparison of mesial molar root canal preparations using two engine-driven instruments and the balanced-force technique

The purpose of this study was to compare the effects of two engine-driven, nickel-titanium instrument systems with hand files in the final shape of slight and moderately curved canals. A total of 72 mesial roots of extracted human mandibular molars were divided into three groups: ProFile .04 taper, Pow-R rotary systems, and Flex-R hand-filing technique. The roots were mounted and cross-sectioned at two different horizontal levels using a modified Bramante technique. Pre- and postinstrumented cross-sectional roots were imaged, recorded, and computer analyzed. Results showed that, at the middle third, in almost all groups, there was a tendency of cutting more toward the mesial side with only one exception: Pow-R cut more to the distal side (danger zone) (p < 0.02). At the apical third, Flex-R (p < 0.03) and ProFile (0.001) transported to the mesial side (danger zone) when the curvature increased. When the three techniques were compared analyzing each side and considering the two groups of curvature, at the middle third in the moderately curved-canal group, Flex-R cut statistically more than Pow-R toward the lingual side. The other comparisons showed no statistically significant difference. When the techniques were compared in relation with the degree of curvature, in the apical third, ProFile .04 cut statistically more toward the mesial side in the moderately curved canal group than in the slightly curved canal group. The other comparisons showed no statistically significant difference. Canal preparation time was shorter with hand instrumentation (p < .05) in a few instances.

Comparison of the body mass index to other methods of body fat evaluation in ethnic Japanese and Caucasian adolescent girls

OBJECTIVE

The aim of this study was to assess the body mass index (BMI) and its relationship with other methods of body fat evaluation in pre- and post-menarcheal, Japanese and Caucasian female adolescents, using two different cut-off points for obesity: 28% and 30%.

DESIGN

A cross-sectional study with incomplete sampling, using the subject as the evaluation unit.

SUBJECTS

A total of 436 Japanese and Caucasian female adolescents in two age groups: 10-11 (pre-menarcheal adolescent); and 16-17 (post-menarcheal adolescents).

METHODS

For the BMI the cut-off point for thinness was set at the 5th percentile of the BMI distribution of the NCHS reference population and the cut-off point for overweight and obesity was set at the 85th percentile. Body composition was assessed using foot-to-foot bioelectrical impedance analysis (BIA), near-infrared interactance (NIR) and Slaughter skinfold equations (SKI). The statistical comparison of the methods was performed using the kappa agreement test and the McNemar disagreement test.

RESULTS

In the 10- and 11-y-old girls, the BMI was considerably and significantly correlated with the other methods. The major agreements were: in Japanese adolescents BMI x NIR=82.3% (cut-off point of 28%), BMI x BIA=85.7% (cut-off point of 30%); in Caucasian adolescents BMI x NIR=80.7% (cut-off point of 28%), BMI x BIA=87.4% (cut-off point of 30%). The disagreement above the diagonal between BMI x NIR was higher within the two groups for both the cut-off points, revealing that the girls identified as obese by the BMI were considered eutrophic by NIR. In the 16- and 17-y-old adolescents, the BMI demonstrated low or no correlation with the other methods. Furthermore, it presented disagreements below the diagonal, revealing that the BMI identified fewer obese subjects than the other methods.

CONCLUSION

Among the 10- and 11-y-olds, the BMI presented a good correlation with the other methods, independent of ethnicity. The BMI can therefore be used in place of these methods, although it may underestimate obesity. Among the 16- and 17-y-olds, the BMI presented low or no agreement with the other methods, suggesting that it is probably not a suitable index for this age-group in studies focusing on the identification of obesity. In such cases the choice of one of the other methods, depending on availability, cost or technical experience, may represent a better approach.

F-waves and conduction velocities range

A controversial aspect in F-wave studies is if these potentials are generated preferentially by large motoneuron or by motoneuron of all sizes. The purpose of this work is to compare the maximum and minimum conduction velocities of the fibers that generate the M-wave with the maximum and minimum conduction velocities of the F-waves elicited by ulnar nerve stimulation. There were no significant differences between maximum velocities. However, minimum F-wave velocity was significantly higher than minimum conduction velocity, suggesting that the F-waves registered were preferentially generated by the fastest conducting axons.

[Acute appendicitis. Experimental model in rabbits]

The evolving phases of acute appendicitis were studied experimentally. Sixty female rabbits (Oryctogalus cuniculus) of New Zealand lineage weighing about 2510 to 3040 g were divided in two groups: a control group and experimental group. The experimental group was divided into three subgroups for observation after 12, 24 and 48 hours of the operation, that consisted on a 4-0 polypropylene circular suture at 8 cm from the distal part of the cecal appendix. The control group was sham operated. The macroscopic exam (increase of the appendix volume, necrosis, perfuration, adherence and secretion in the abdominal cavity) and the microscopic finding showed a progression in the anatomopathological alterations. There was a close relationship between the histopathological findings and time after the appendiceal obstruction. We conclude that the method causes acute appendicitis and that the anathomo pathological alterations depends on the time elapsed between the operation and the postoperation findings.

[Effects of partial colonic resection in rats]

In order to study the effects of partial colectomy, 30 rats Wistar were divided into three groups: GI and GII had the cecun and the ileo cecal valve resected and proximal colectomy was performed in GI and distal in GII. GIII had distal colectomy without cecum resection. The length of the remain colon was of 5 cm in all groups. Colostomy was performed in GI, GII and GIII. Parameters evaluated: body weight, fecal composition concerning to water, lipids and proteins on preoperative time and on the 10th, 20th, 30th, 40th, 50th and 60th days of postoperative time. All statistical tests were conducted at a 5% two-sided risk level. The evaluation was made by analysis of variance techniques.

CONCLUSIONS

Concerning to body weight, there is no significant difference on the late postoperative time in any group or when comparing the three groups on this same period. On late postoperative time, GI and GII had a large amount of fecal water, lipids and proteins when compared to the preoperative time and to GIII. On the 60th day there's no significant difference on the quantity of fecal water when comparing the three groups and the same occurs on the 50th day when considering the quantity of fecal proteins.

Sample size and the study of F waves

Ulnar nerve F waves were studied in 23 healthy volunteers and 27 diabetic patients. Latencies and chronodispersion were analyzed in each group for different sample sizes. Significant differences were not detected with the different sample sizes for mean latencies, with samples above 16 stimuli or 10 waves for minimum and maximum latencies and above 20 stimuli or 16 waves for chronodispersion. These findings suggest that these limits may be adequate for group comparison. However, for the analysis of individual patients, the evidence suggests that larger samples are required for the determination of the minimum and maximum latencies and chronodispersion.

[A hysteroscopic and anatomicopathological study in women with breast cancer]

OBJECTIVE

To study the uterine mucosa of women with breast cancer in order to evaluate the frequency of endometrial diseases.

EXPERIMENTAL DESIGN

Prospective, controlled study carried out from January to December 1996. SURROUNDINGS: Patients with breast cancer and normal controls from 4 out-patient university services in Porto Alegre, Brazil.

PATIENTS

Postmenopausal women without hormonal therapy were compared: 67 of them with breast cancer and 101 normal controls.

METHODS

Hysteroscopy followed by endometrial biopsy carried out in both groups as an out-patient procedure.

RESULTS

In patients with breast cancer, 29.85% abnormal biopsies were found as follows: 10 endometrial polyps (15.0%), 8 with proliferative changes (11.9%), 1 case of cancer (1.5%), and one case of hyperplasia (1.5%). In the control group 8% abnormal morphological findings were found, as follows: 4 (4%) with endometrial polyps and 4 (4%) with proliferative changes. The differences in abnormal biopsies were statistically significant, mainly in patients with corporal mass index above 27.3. The sensibility of hysteroscopy was 82.14%; its specificity 97.16%; its predictive positive value 85.18% and its predictive negative value 96.48% in detecting endometrial activity, for a prevalence of 16.7% of endometrial activity.

CONCLUSIONS

Endometrial evaluation must be included in the initial evaluation of patients with breast cancer, mainly if they were obese. Hysteroscopy, performed in out-patient basis, showed to be an adequate method to evaluate the uterine mucosa, helping to select the area of this cavity for biopsy.

[Early and late physiological effects of balloon mitral valvuloplasty]

PURPOSE

To evaluate the early and late cardiorespiratory responses after balloon mitral valvuloplasty.

METHODS

Nine female patients aged 35 +/- 9 years with mitral stenosis, in class II or III (NYHA) underwent up-right ergoespirometric test, resting electrocardiogram and echocardiogram before, 3 to 5 days (early evaluation) and 8 to 12 months (late evaluation) after mitral valvuloplasty. All patients were treated with digitalis and diuretics.

RESULTS

During late evaluation, 44% patients were in class II and 56% were in class I (NYHA). The resting heart rate decreased (87 +/- 11 bpm vs 85 +/- 7 bpm vs 75 +/- 9 bpm) and the number of steps increased (4 +/- 1 steps vs 5 +/- 2 steps vs 6 +/- 1 steps); the peak oxygen uptake improved only in the late evaluation (16 +/- 3 mL/kg/min vs 18 +/- 4 mL/kg/min vs 22 +/- 7 mL/kg/min). The anaerobic threshold, minute ventilation (VE) and ventilatory equivalent for oxygen showed no change. The heart rate (1st step: 124 +/- 18 bpm vs 112 +/- 13 bpm vs 87 +/- 15 bpm), O2 uptake (1st step: 10 +/- 2 mL/ kg/min vs 8 +/- 2 mL/kg/min vs 8 +/- 2 mL/kg/min) and VE decreased during submaximal exercise in early and late phases. The mitral valve area decreased in the late evaluation (0.94 cm2 vs 1.66 cm2 vs 1.20 cm2).

CONCLUSION

Although partial restenosis tended to occur in these patients, they improved the functional class and cardiorespiratory performance and cardiocirculatory load during submaximal exercise.

An evaluation of new circle system of anesthesia. Quantitative anesthesia with isoflurane in new zealand rabbits

A small circuit system of anesthesia was developed by Fonseca and Goldenberg in 1993. The authors used in this study New Zealand White (NZW) rabbits under closed system anesthetic regiment by insoflurane. Twenty male adult New Zealand rabbits were distributed in two groups of ten animals. No premedicant drugs were given. Endotraqueal intubation was made after intravenous administration of propofol (10mg/kg). Insoflurane was used to anesthesia management, administred by lowflow closed system technique with cooper kettle vaporizer, fixed by pre-calculated vaporizing flow in double times intervals. The group II underwent surgical periostal scratching in the medial tibial surface at the proximal shaft. Rabbits breathed spontaneously. Hypotensio, hypercapnia and respiratory acidosis were characteristic of the cardiopulmonary effects of the anesthesia. The corneal reflex and pinch reflex was useful as reliable indicators of anesthesic depth. Manual or mechanical ventilation should be considered as a way of improving alveolar ventilation and normalize blood-gas values. The system developed by Fonseca and Goldenberg was considered suitable for anesthesic management in rabbits.

Estrogenic activity of tamoxifen on normal mammary parenchyma in the luteal phase of the menstrual cycle

OBJECTIVES

Tamoxifen, an anti-estrogenic drug used in the adjuvant treatment of breast cancer, deserves more investigation for the determination of its efficacy as a prophylactic agent against breast cancer in high risk women. Thus, the action of tamoxifen on the human mammary gland was studied by measuring the number of lysosomes in normal mammary epithelium during the administration of tamoxifen.

METHODS

Tamoxifen was administered only during the luteal phase of the menstrual cycle to avoid interference with corpus luteum formation. A fragment of breast tissue adjacent to a fibroadenoma was obtained during surgery from 35 premenopausal women aged 15 to 37 years who had been eumenorrheic for at least 6 months; 18 of these patients were treated with tamoxifen and 17 were used as controls. Lysosome counts were performed under the light microscope on slides submitted to the acid phosphatase cytochemical technique and the data were analyzed statistically by the Mann-Whitney test.

RESULTS

The fragments from the group treated with tamoxifen showed a significant decrease in lysosome numbers.

CONCLUSIONS

Tamoxifen administered after ovulation significantly decreases the number of lysosomes in the cells of normal mammary epithelium, demonstrating the antiestrogenic effect of the drug on this target tissue.

Effectiveness of the Canal Finder and hand instrumentation in removal of gutta-percha root fillings during root canal retreatment

The purpose of this study was to quantify the amount of remaining gutta-percha/sealer on the canal walls when the Canal Finder system, hand instrumentation and a combination of both (hybrid technique) were used to remove these materials. The amount of apically-extruded debris and the time required for removal were also recorded. Sixty extracted maxillary anterior teeth were prepared using a stepback technique and obturated with gutta-percha. Reinstrumentation of all groups was done in conjunction with a solvent, chloroform. The teeth were split longitudinally and photographed, and the total area of the root canal and the area of the debris were traced and quantified using a computerized image analysis system. The ratio of remaining obturation material to root canal surface was derived and analysed statistically. Hand instrumentation resulted in less debris remaining than did the other two techniques (P < 0.05). The differences in the amount of apically extruded debris were not significant among the techniques (P > 0.05). The hybrid technique required significantly less time for filling material removal. The Canal Finder system alone was not superior to hand instrumentation.

Facial electroneurography in Bell's palsy. Variability in the early stage and comparison between interpretation methods

To determine the variability of the abnormalities found in the electroneurography (ENG) of the facial nerve in cases of Bell's palsy during the initial two week period was one of the objectives of the authors. A second one was to investigate the value of ENG as a tool to determine an early prognosis of recovery utilizing two different methods. In the first one the amplitude of the compound muscular action potential (CMAP) obtained on the paralyzed side was compared to this potential on the opposite (normal) side. The second method compared the CMAP on the paralyzed side to normal standardized data from normal individuals. A group of 33 patients with Bell's palsy was followed until total recovery of for at least 4 months, if the recovery was not achieved earlier. It was observed that amplitude of the CMAP become stable towards the sixth day of palsy and this is a good time to establish the prognosis. Another conclusion is that both methods were equivalent to determine the prognosis in Bell's palsy.

Heat serum inactivation as a mandatory procedure for antiactin antibody detection in cell culture

In autoimmune hepatitis (AIH), the smooth-muscle antibody is specific for polymerized actin. Detection of antiactin antibody (AAA) has been hampered by technical problems. We have investigated AAA in 30 sera from patients with liver diseases and smooth-muscle antibody. AAA was detected by indirect immunofluorescence in 1:40, 1:80, and 1:160 dilutions. Five techniques were performed using fibroblasts: with vinblastine (A); without drugs (B); with sodium citrate (C); without drugs but with heat serum inactivation (D); and with sodium citrate and heat serum inactivation (E). For comparative analysis, we considered: the total number of AAA-positive sera regardless of the dilution in which reactivity was observed, as well as in each dilution separately; and the comparison of AAA intensity between 1:40 x 1:80, 1:40 x 1:160, and 1:80 x 1:160 dilutions. AAA was more positive in techniques B, C, D, and E than in A (P < .001) in general, and in each dilution separately. AAA was more positive in technique D than in B in 1:40 (P = .0005) and 1:80 dilutions (P = .03), as well as in E than in C (P = .0001) in 1:40 dilution. Techniques B and D yielded results similar to C and E, respectively. AAA staining was significantly more intense in 1:80 and 1:160 than in 1:40 dilution in A, B, and C; it was both significantly less intense in 1:80 and 1:160 than in 1:40 dilution and in 1:80 than in 1:160 in techniques D and E. We concluded that heat inactivation increased AAA seropositivity/intensity in 1:40 and 1:80 dilutions, preventing false-negative results; actin polymerization with sodium citrate did not enhanced AAA seropositivity/intensity. The technique with vinblastine was the least effective.

The progestogen challenge test in postmenopausal women: clinical and morphologic aspects

The clinical aspects and anatomopathological patterns of 150 postmenopausal women were studied using the progestogen challenge test. An endometrial biopsy was obtained and submitted to the progestogen test. A histopathological analysis of the uterine mucosa from women with a positive progestogen test revealed that the endometrium was active in 44 percent of cases and atrophic or inactive in 56 percent. In contrast, among women with a negative response, the endometrium was atrophic in 94 percent of cases and active in 6 percent. Analysis of clinical aspects did not show significant differences between groups in terms of age; age at menarche and at menopause; fasting blood glucose levels; or body mass. However, postmenopausal time was significantly shorter for women with a positive test, with a correlation between postmenopausal time of one to two years and test positivity. The progestogen challenge test for the detection of atrophic endometrium presented 78.57 percent sensitivity, 77.05 percent specificity, 44 percent positive predictive value, and 94 percent negative predictive value. Thus, when negative, the test is highly valuable, indicating the presence of atrophic endometrium in 94 percent of cases. False-negative results occurred in only 6 percent of the subjects, with no case of hyperplasia detected. However, when the response to the test was positive, the endometrium was atrophic in 56 percent of the cases. We suggest that, in order to avoid invasive procedures, the progestogen challenge test be combined with other methods such as transvaginal ultrasonography.

[A comparative study of the sodium, potassium, urea, creatinine, and uric acid concentrations in the human amniotic fluid between weeks 15-20 and 38-42]

The amniotic fluid physiology is a dynamic process involving maternal and fetal compartments and depends on gestational age.

PURPOSE

To analyze the concentration of sodium, potassium, urea, creatinine, and uric acid in the amniotic fluid of normal pregnant women in the second and third trimester. Also, to evaluate the influence of maternal age, race, parity, and fetal sex on those elements.

METHOD

Fifty samples obtained by genetic amniocentesis (15-20 weeks, group I) and fifty obtained by elective cesarean section (38-42 weeks, group II) were analyzed. According to the variables we used the following statistical tests: Analysis of variance; Test t Student: Chi-square test; Mann-Whitney test (a 0.05 pounds).

RESULTS

In group II, urea, creatinine and uric acid levels were significantly higher than in group I. The sodium level was significantly lower in group II compared with group I. The potassium concentration did not show any significant difference in both groups. There was no significant interference of maternal age, race, parity and fetal sex in any of the five studied variables.

CONCLUSION

These findings were emphasized for prenatal diagnosis purposes and analysis of renal function. The authors suggest future comparisons of obtained "normal" data with pathological situations.

Effects of almitrine on the ventilatory control, breathing pattern and maximal exercise tolerance in hypoxemic patients with chronic obstructive pulmonary disease

Almitrine bismesylate improves arterial blood gases in patients with chronic obstructive pulmonary disease (COPD), but side effects such as increase of ventilatory drive and dyspnea have been reported in some studies. We studied 18 COPD patients (mean age = 59.1 years; mean FEV1 = 0.92 1; mean PaO2 = 58.6 mmHg) in a double-blind randomized study using placebo or almitrine 50 mg twice a day by mouth, for 60 days. In contrast to the placebo group, 40% of the patients in the almitrine group presented a significant increase in PaO2 and a decrease in P(A-a)O2 > or = 5 mmHg during submaximal exercise after 60 days of treatment. Ventilatory drive and the breathing pattern were measured at rest and during submaximal exercise. Both groups showed high levels of ventilatory drive and a tachypneic breathing pattern before drug treatment and no modification was found 30 and 60 days after treatment. Metabolic, cardiovascular and ventilatory variables were studied during an incremental to maximum exercise symptom-limited test (cycloergometry). Maximal VO2 ranged from 46 to 52% and heart rate from 76 to 78% in relation to the predicted values. The percent ratio of ventilation at maximal exercise to maximal voluntary ventilation at rest ranged from 86 to 94%. These results show that the reduction of ventilatory capacity was the main factor decreasing the aerobic performance of our COPD patients. Maximal exercise tolerance (VO2 max) did not change after almitrine treatment. Negative factors like an increase in neuromuscular drive did not occur, and positive factors like an increase in PaO2 and oxygen transport had no critical influence on exercise performance in our ventilatory-limited COPD patients.

[Serial ultrasonography of the endometrium and endocervix during the normal menstrual cycle in women]

Articles on ultrasound of the human endometrium are in the majority of the cases based on studies of patients who have infertility and are taking drugs to induce ovulation. Such investigations do not include histological study of the endometrium and have focused on the ovulatory period. There is controversy in the interpretation of the images. PURPOSE--To evaluate the sonographic appearance of the endometrium during the normal menstrual cycle. METHODS--We studied 15 multiparous women with normal cycles, and who were not under drugs for ovulation induction, had neither IUD, nor were having oral hormonal contraceptives. They were seen on the first, seventh, fourteenth, and twentieth-first days of the menstrual cycle. The sonographic aspects were compared with the histological findings. RESULTS--We could see the images of the endometrium on the first day of the cycle in 66.66% of the patients. On the other visits we could study properly its features very well in all the patients. The endometrial image thickness increased in a linear pattern and the hypoechogenic halo was seen in 93.33% of the patients on the twentieth-first day of the menstrual cycle. CONCLUSION--The cyclic changes of the endometrium were shown with the sonography. The cyclic changes of the endocervix were evaluated too with the sonogram although they are not as remarkable as the endometrial ones.

[Chlamydia trachomatis infection and risk factors in pregnant women]

INTRODUCTION

In order to assess the frequency of Chlamydia trachomatis infection in pregnancy in São Paulo (Brazil), a group of 122 successive pregnant women (80 adults and 42 adolescents) attending the pre-natal care clinic of the Department of Obstetrics were studied.

MATERIAL AND METHODS

The exam consisted of an epidemiological survey, a complete obstetrical clinical examination and the assessment of the presence of C. trachomatis in the vagina by ELISA (Chlamydiazyme).

RESULTS

A total of 11 women (9%) were positive, being 8 (10%) of them adults and 3 (7%) adolescents.

CONCLUSION

In São Paulo the age of the patient as well as the marital status, the number of sexual partners, the existence of other sexually transmitted diseases, the presence of cervicitis or the occurrence of abortions could not be considered as risk factors for the presence of the Chlamydia trachomatis.

Short latency median nerve somatosensory evoked potential (SEP): increase in stimulation frequency from 3 to 30 Hz

Somatosensory evoked potentials were obtained by electrical stimulation of the median nerve in 10 normal subjects at 3 and 30 Hz. At the higher rate of stimulation, a reduction was observed in amplitudes and prolongation of latencies of the N9, N/P13 and N20 components as well as increase of the interpeak latency N9-N/P13. A significant increase between the onsets of the N11 and N20 components was also seen; however, no significant increase of the N/P13-N20 interpeak latency was observed. Analysis suggested that an important reason for this last finding was related to the fact that in some cases different fast frequency components (FFC) determined the N20 peak in the different situations. It was further observed that, in those cases in which at least 3 peaks in the fast frequency components were detected (7/10), a significantly different increase in latency between the first and the third peaks was noted. A possible thalamo-cortical generation of the FFC is discussed.

Chronic effects of azidothymidine and acyclovir on pregnant rats

1. The antiviral effect of azidothymidine (AZT) can be potentiated by acyclovir (ACV), and this drug association has been used in the management of HIV-infected patients. In the present study we examined the effects of such an association on rat pregnancy. 2. AZT (60 mg/kg b.w.) and ACV (60 mg/kg b.w.) were given to groups of pregnant rats once a day from the 1st to the 20th day of gestation. 3. Maternal body weight gain was severely affected by ACV; this effect was attenuated in rats treated with AZT+ACV and was virtually absent with AZT alone. 4. The abortive action of ACV was markedly diminished in the group treated with the association AZT+ACV. 5. The deleterious effects of ACV on rat pregnancy are presumably due to its extraplacental actions, and these are, at least in part, counteracted by concomitant treatment with AZT.

Cell kinetics of the human mammary lobule during the proliferative and secretory phase of the menstrual cycle

We evaluated the mitotic index and nuclear volume of the epithelium of the human mammary lobule during the menstrual cycle. Thirty patients were selected and divided at random into two groups, i.e., 15 women in the proliferative phase and 15 in the secretory phase. Normal mammary tissue was obtained on the occasion of fibroadenoma enucleation. Mitotic indices (/1000) and nuclear volume (micron 3) were 0.0 and 53.8, respectively, during the proliferative phase, and 11.6 and 130.0, respectively, during the luteal phase, the difference being statistically significant (p < 0.05). These data indicate that the proliferative stimulus of the mammary lobule is more intense during the luteal phase of the normal cycle and may probably be due to a synergistic action between progesterone and estradiol.