Metallic: A Bivalent Ambimodal Material Property?

Many metallic visual stimuli, especially the so-called precious metals, have long had a rich symbolic meaning for humans. Intriguingly, however, while metallic is used to describe sensations associated with pretty much every sensory modality, the descriptor is normally positively valenced in the case of vision while typically being negatively valenced in the case of those metallic sensations that are elicited by the stimulation of the chemical senses. In fact, outside the visual modality, metallic would often appear to be used to describe those sensations that are unfamiliar and unpleasant as much as to refer to any identifiable perceptual quality (or attribute). In this review, we assess those sensory stimuli that people choose to refer to as metallic, summarising the multiple, often symbolic, meanings of (especially precious) metals. The evidence of positively valenced sensation transference from metallic serviceware (e.g., plates, cups, and cutlery) to the food and drink with which it comes into contact is also reviewed.

Methylation of OPRL1 mediates the effect of psychosocial stress on binge drinking in adolescents

BACKGROUND

Nociceptin is a key regulator linking environmental stress and alcohol drinking. In a genome-wide methylation analysis, we recently identified an association of a methylated region in the OPRL1 gene with alcohol-use disorders.

METHODS

Here, we investigate the biological basis of this observation by analysing psychosocial stressors, methylation of the OPRL1 gene, brain response during reward anticipation and alcohol drinking in 660 fourteen-year-old adolescents of the IMAGEN study. We validate our findings in marchigian sardinian (msP) alcohol-preferring rats that are genetically selected for increased alcohol drinking and stress sensitivity.

RESULTS

We found that low methylation levels in intron 1 of OPRL1 are associated with higher psychosocial stress and higher frequency of binge drinking, an effect mediated by OPRL1 methylation. In individuals with low methylation of OPRL1, frequency of binge drinking is associated with stronger BOLD response in the ventral striatum during reward anticipation. In msP rats, we found that stress results in increased alcohol intake and decreased methylation of OPRL1 in the nucleus accumbens.

CONCLUSIONS

Our findings describe an epigenetic mechanism that helps to explain how psychosocial stress influences risky alcohol consumption and reward processing, thus contributing to the elucidation of biological mechanisms underlying risk for substance abuse.

Discriminating between virilizing ovary tumors and ovary hyperthecosis in postmenopausal women: clinical data, hormonal profiles and image studies

BACKGROUND

The presence of virilizing signs associated with high serum androgen levels in postmenopausal women is rare. Virilizing ovarian tumors (VOTs) and ovarian stromal hyperthecosis (OH) are the most common etiologies in virilized postmenopausal women. The differential diagnosis between these two conditions is often difficult.

OBJECTIVE

To evaluate the contribution of clinical features, hormonal profiles and radiological studies to the differential diagnosis of VOT and OH.

DESIGN

A retrospective study.

SETTING

A tertiary center.

MAIN OUTCOME MEASURES

Clinical data, hormonal status (T, E2, LH and FSH), pelvic images (transvaginal sonography and MRI) and anatomopathology were reviewed.

PATIENTS

Thirty-four postmenopausal women with a diagnosis of VOT (13 women) and OH (21 women) were evaluated retrospectively.

RESULTS

Clinical signs of hyperandrogenism were more prevalent in the VOT group than the OH group. Although the VOT group showed higher T and E2 levels and lower gonadotropin levels than the OH group, a great overlap occurred among the hormone levels. A pelvic MRI provided an accurate differentiation of these two conditions.

CONCLUSION

In this group of patients, the main features contributing to the differential diagnosis of VOT and OH were serum levels of testosterone and gonadotropins and the presence of an ovarian nodule identified on the MRI. Although the association of clinical, hormonal and radiological features contributes to the differential diagnosis of these two conditions, histopathological analysis remains the gold standard for the diagnosis of ovarian hyperandrogenism in postmenopausal women.

GABRB1 Single Nucleotide Polymorphism Associated with Altered Brain Responses (but not Performance) during Measures of Impulsivity and Reward Sensitivity in Human Adolescents

Variations in genes encoding several GABA_A receptors have been associated with human drug and alcohol abuse. Among these, a number of human studies have suggested an association between GABRB1, the gene encoding GABA_A receptor β1 subunits, with Alcohol dependence (AD), both on its own and comorbid with other substance dependence and psychiatric illnesses. In the present study, we hypothesized that the GABRB1 genetically-associated increased risk for developing alcoholism may be associated with impaired behavioral control and altered sensitivity to reward, as a consequence of altered brain function. Exploiting the IMAGEN database (Schumann et al., 2010), we explored in a human adolescent population whether possession of the minor (T) variant of the single nucleotide polymorphism (SNP) rs2044081 is associated with performance of tasks measuring aspects of impulsivity, and reward sensitivity that are implicated in drug and alcohol abuse. Allelic variation did not associate with altered performance in either a stop-signal task (SST), measuring one aspect of impulsivity, or a monetary incentive delay (MID) task assessing reward anticipation. However, increased functional magnetic resonance imaging (fMRI) blood-oxygen-level dependent (BOLD) response in the right hemisphere inferior frontal gyrus (IFG), left hemisphere caudate/insula and left hemisphere inferior temporal gyrus (ITG) during MID performance was higher in the minor (T) allelic group. In contrast, during SST performance, the BOLD response found in the right hemisphere supramarginal gyrus, right hemisphere lingual and left hemisphere inferior parietal gyrus indicated reduced responses in the minor genotype. We suggest that β1-containing GABA_A receptors may play a role in excitability of brain regions important in controlling reward-related behavior, which may contribute to susceptibility to addictive behavior.

Time-Perception Network and Default Mode Network Are Associated with Temporal Prediction in a Periodic Motion Task

The updating of prospective internal models is necessary to accurately predict future observations. Uncertainty-driven internal model updating has been studied using a variety of perceptual paradigms, and have revealed engagement of frontal and parietal areas. In a distinct literature, studies on temporal expectations have also characterized a time-perception network, which relies on temporal orienting of attention. However, the updating of prospective internal models is highly dependent on temporal attention, since temporal attention must be reoriented according to the current environmental demands. In this study, we used functional magnetic resonance imaging (fMRI) to evaluate to what extend the continuous manipulation of temporal prediction would recruit update-related areas and the time-perception network areas. We developed an exogenous temporal task that combines rhythm cueing and time-to-contact principles to generate implicit temporal expectation. Two patterns of motion were created: periodic (simple harmonic oscillation) and non-periodic (harmonic oscillation with variable acceleration). We found that non-periodic motion engaged the exogenous temporal orienting network, which includes the ventral premotor and inferior parietal cortices, and the cerebellum, as well as the presupplementary motor area, which has previously been implicated in internal model updating, and the motion-sensitive area MT+. Interestingly, we found a right-hemisphere preponderance suggesting the engagement of explicit timing mechanisms. We also show that the periodic motion condition, when compared to the non-periodic motion, activated a particular subset of the default-mode network (DMN) midline areas, including the left dorsomedial prefrontal cortex (DMPFC), anterior cingulate cortex (ACC), and bilateral posterior cingulate cortex/precuneus (PCC/PC). It suggests that the DMN plays a role in processing contextually expected information and supports recent evidence that the DMN may reflect the validation of prospective internal models and predictive control. Taken together, our findings suggest that continuous manipulation of temporal predictions engages representations of temporal prediction as well as task-independent updating of internal models.

Mouse and Human Genetic Analyses Associate Kalirin with Ventral Striatal Activation during Impulsivity and with Alcohol Misuse

Impulsivity is associated with a spectrum of psychiatric disorders including drug addiction. To investigate genetic associations with impulsivity and initiation of drug taking, we took a two-step approach. First, we identified genes whose expression level in prefrontal cortex, striatum and accumbens were associated with impulsive behavior in the 5-choice serial reaction time task across 10 BXD recombinant inbred (BXD RI) mouse strains and their progenitor C57BL/6J and DBA2/J strains. Behavioral data were correlated with regional gene expression using GeneNetwork (www.genenetwork.org), to identify 44 genes whose probability of association with impulsivity exceeded a false discovery rate of < 0.05. We then interrogated the IMAGEN database of 1423 adolescents for potential associations of SNPs in human homologs of those genes identified in the mouse study, with brain activation during impulsive performance in the Monetary Incentive Delay task, and with novelty seeking scores from the Temperament and Character Inventory, as well as alcohol experience. There was a significant overall association between the human homologs of impulsivity-related genes and percentage of premature responses in the MID task and with fMRI BOLD-response in ventral striatum (VS) during reward anticipation. In contrast, no significant association was found between the polygenic scores and anterior cingulate cortex activation. Univariate association analyses revealed that the G allele (major) of the intronic SNP rs6438839 in the KALRN gene was significantly associated with increased VS activation. Additionally, the A-allele (minor) of KALRN intronic SNP rs4634050, belonging to the same haplotype block, was associated with increased frequency of binge drinking.

Genomic architecture of human neuroanatomical diversity

Human brain anatomy is strikingly diverse and highly inheritable: genetic factors may explain up to 80% of its variability. Prior studies have tried to detect genetic variants with a large effect on neuroanatomical diversity, but those currently identified account for <5% of the variance. Here, based on our analyses of neuroimaging and whole-genome genotyping data from 1765 subjects, we show that up to 54% of this heritability is captured by large numbers of single-nucleotide polymorphisms of small-effect spread throughout the genome, especially within genes and close regulatory regions. The genetic bases of neuroanatomical diversity appear to be relatively independent of those of body size (height), but shared with those of verbal intelligence scores. The study of this genomic architecture should help us better understand brain evolution and disease.

Association of Protein Phosphatase PPM1G With Alcohol Use Disorder and Brain Activity During Behavioral Control in a Genome-Wide Methylation Analysis

OBJECTIVE

The genetic component of alcohol use disorder is substantial, but monozygotic twin discordance indicates a role for nonheritable differences that could be mediated by epigenetics. Despite growing evidence associating epigenetics and psychiatric disorders, it is unclear how epigenetics, particularly DNA methylation, relate to brain function and behavior, including drinking behavior.

METHOD

The authors carried out a genome-wide analysis of DNA methylation of 18 monozygotic twin pairs discordant for alcohol use disorder and validated differentially methylated regions. After validation, the authors characterized these differentially methylated regions using personality trait assessment and functional MRI in a sample of 499 adolescents.

RESULTS

Hypermethylation in the 3'-protein-phosphatase-1G (PPM1G) gene locus was associated with alcohol use disorder. The authors found association of PPM1G hypermethylation with early escalation of alcohol use and increased impulsiveness. They also observed association of PPM1G hypermethylation with increased blood-oxygen-level-dependent response in the right subthalamic nucleus during an impulsiveness task.

CONCLUSIONS

Overall, the authors provide first evidence for an epigenetic marker associated with alcohol consumption and its underlying neurobehavioral phenotype.

Single nucleotide polymorphism in the neuroplastin locus associates with cortical thickness and intellectual ability in adolescents

Despite the recognition that cortical thickness is heritable and correlates with intellectual ability in children and adolescents, the genes contributing to individual differences in these traits remain unknown. We conducted a large-scale association study in 1583 adolescents to identify genes affecting cortical thickness. Single-nucleotide polymorphisms (SNPs; n=54,837) within genes whose expression changed between stages of growth and differentiation of a human neural stem cell line were selected for association analyses with average cortical thickness. We identified a variant, rs7171755, associating with thinner cortex in the left hemisphere (P=1.12 × 10(-)(7)), particularly in the frontal and temporal lobes. Localized effects of this SNP on cortical thickness differently affected verbal and nonverbal intellectual abilities. The rs7171755 polymorphism acted in cis to affect expression in the human brain of the synaptic cell adhesion glycoprotein-encoding gene NPTN. We also found that cortical thickness and NPTN expression were on average higher in the right hemisphere, suggesting that asymmetric NPTN expression may render the left hemisphere more sensitive to the effects of NPTN mutations, accounting for the lateralized effect of rs7171755 found in our study. Altogether, our findings support a potential role for regional synaptic dysfunctions in forms of intellectual deficits.

Oxytocin receptor genotype modulates ventral striatal activity to social cues and response to stressful life events

BACKGROUND

Common variants in the oxytocin receptor gene (OXTR) have been shown to influence social and affective behavior and to moderate the effect of adverse experiences on risk for social-affective problems. However, the intermediate neurobiological mechanisms are not fully understood. Although human functional neuroimaging studies have reported that oxytocin effects on social behavior and emotional states are mediated by amygdala function, animal models indicate that oxytocin receptors in the ventral striatum (VS) modulate sensitivity to social reinforcers. This study aimed to comprehensively investigate OXTR-dependent brain mechanisms associated with social-affective problems.

METHODS

In a sample of 1445 adolescents we tested the effect of 23-tagging single nucleotide polymorphisms across the OXTR region and stressful life events (SLEs) on functional magnetic resonance imaging blood oxygen level-dependent activity in the VS and amygdala to animated angry faces. Single nucleotide polymorphisms for which gene-wide significant effects on brain function were found were then carried forward to examine associations with social-affective problems.

RESULTS

A gene-wide significant effect of rs237915 showed that adolescents with minor CC-genotype had significantly lower VS activity than CT/TT-carriers. Significant or nominally significant gene × environment effects on emotional problems (in girls) and peer problems (in boys) revealed a strong increase in clinical symptoms as a function of SLEs in CT/TT-carriers but not CC-homozygotes. However, in low-SLE environments, CC-homozygotes had more emotional problems (girls) and peer problems (boys). Moreover, among CC-homozygotes, reduced VS activity was related to more peer problems.

CONCLUSIONS

These findings suggest that a common OXTR-variant affects brain responsiveness to negative social cues and that in "risk-carriers" reduced sensitivity is simultaneously associated with more social-affective problems in "favorable environments" and greater resilience against stressful experiences.

Seeing with the eyes shut: neural basis of enhanced imagery following Ayahuasca ingestion

The hallucinogenic brew Ayahuasca, a rich source of serotonergic agonists and reuptake inhibitors, has been used for ages by Amazonian populations during religious ceremonies. Among all perceptual changes induced by Ayahuasca, the most remarkable are vivid "seeings." During such seeings, users report potent imagery. Using functional magnetic resonance imaging during a closed-eyes imagery task, we found that Ayahuasca produces a robust increase in the activation of several occipital, temporal, and frontal areas. In the primary visual area, the effect was comparable in magnitude to the activation levels of natural image with the eyes open. Importantly, this effect was specifically correlated with the occurrence of individual perceptual changes measured by psychiatric scales. The activity of cortical areas BA30 and BA37, known to be involved with episodic memory and the processing of contextual associations, was also potentiated by Ayahuasca intake during imagery. Finally, we detected a positive modulation by Ayahuasca of BA 10, a frontal area involved with intentional prospective imagination, working memory and the processing of information from internal sources. Therefore, our results indicate that Ayahuasca seeings stem from the activation of an extensive network generally involved with vision, memory, and intention. By boosting the intensity of recalled images to the same level of natural image, Ayahuasca lends a status of reality to inner experiences. It is therefore understandable why Ayahuasca was culturally selected over many centuries by rain forest shamans to facilitate mystical revelations of visual nature.

Potential economic impact of the 21-gene recurrence score in Brazil

Abstract #6102

Objective: The 21-gene recurrence score (RS) may be useful for decisions regarding the use of chemotherapy (CT) in patients with lymph-node-negative (LNN), estrogen-receptor (ER)+ early breast cancer (BC). We investigated the potential impact of using RS in private practice in Brazil, from the perspective of third-party payers, in terms of main direct medical expenses.&#x2028; Methods: We conducted a web-based survey with 30 (of a total of ∼700) Brazilian medical oncologists, who were stratified by State according to the proportion of patients with BC and private insurance. Such physicians represented States and cities in which approximately 80% of new BC cases are diagnosed each year. The questionnaire evaluated the treatment of first choice for patients with LNN, ER+ BC, regardless of menopausal status. Interviewees were initially invited by telephone and were not aware of the objective of the study. The responses allowed a quantitative assessment of the patterns of care regarding CT regimen according to disease stage (T1b, T1c, T 2-4 cm, T &gt; 4 cm), type of premedication, use of G-CSF and in-hospital treatment for febrile neutropenia (rates taken from the literature). Medication costs were calculated using the manufacturer's recommended prices, and the cost for RS testing, which is currently available in Brazil, was set at BR$ 3,900.00 (US$ 2,294.00). Other direct medical expenses, indirect medical costs, and non-medical costs were not considered. We estimated costs for two hypothetic cohorts of patients (without and with RS), whose stage distribution and RS results followed those reported by Paik et al (NEJM 2004). The model assumed that patients with access to RS testing would receive CT if their RS was intermediate or high, whereas patients with a low RS would receive no CT.&#x2028; Results: For a hypothetic cohort of 100 patients with no access to RS testing, the survey showed that 84 patients would receive CT (of note, 43% of patients with T1b tumors and adverse features would not receive CT). Reclassifying patient eligibility to CT according to RS would bring this number to 49. For a hypothetic cohort of 100 patients, BR$ 134,958.00 (∼US$ 79,400.00) would be saved in main direct medical expenses.&#x2028; &#x2028; Conclusion: Considering the current price for the exam, our economic analysis suggests that RS testing is cost-saving in Brazil, from the perspective of third-party payers. Prospective studies are awaited for validating CT decisions based on the RS.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6102.

Utility of STR markers for the molecular diagnosis of a large Brazilian family with Charcot-Marie-Tooth disease

Charcot-Marie-Tooth type 1A disease (CMT1A) is most frequently caused by a tandem DNA duplication of a 1.4-Mb genomic fragment in the 17p11.2-12 chromosomal region. The disease is probably the product of a dosage effect of the peripheral myelin protein 22 gene located within the duplicated segment. We sought to study the largest reported Brazilian family with suspected diagnosis of CMT1A using eight short tandem repeat microsatellite markers. In addition, we analyzed the informativeness of these markers in the normal Brazilian population. The duplication was found in 12 members of the family. In two patients with CMT1A symptoms, the duplication was not detected, and one asymptomatic subject showed the duplication. D17S2230, D17S9B, D17S2220, D17S2227, D17S9A, and D17S4A markers showed the highest heterozygosity rates, and D17S2228 and D17S2224 markers were the least informative in our analysis.

Modifications of the sympathetic skin response in workers chronically exposed to lead

The long-term effects of low-level lead intoxication are not known. The sympathetic skin response (SSR) was evaluated in a group of 60 former workers of a primary lead smelter, located in Santo Amaro, BA, Brazil. The individuals participating in the study were submitted to a clinical-epidemiological evaluation including questions related to potential risk factors for intoxication, complaints related to peripheral nervous system (PNS) involvement, neurological clinical examination, and also to electromyography and nerve conduction studies and SSR evaluation. The sample consisted of 57 men and 3 women aged 34 to 69 years (mean +/- SD: 46.8 +/- 6.9). The neurophysiologic evaluation showed the presence of lumbosacral radiculopathy in one of the individuals (1.7%), axonal sensorimotor polyneuropathy in 2 (3.3%), and carpal tunnel syndrome in 6 (10%). SSR was abnormal or absent in 12 cases, representing 20% of the sample. More than half of the subjects (53.3%) reported a history of acute abdominal pain requiring hospitalization during the period of work at the plant. A history of acute palsy of radial and peroneal nerves was reported by about 16.7 and 8.3% of the individuals, respectively. Mean SSR amplitude did not differ significantly between patients presenting or not the various characteristics in the current neurological situation, except for diaphoresis. The results suggest that chronic lead intoxication induces PNS damage, particularly affecting unmyelinated small fibers. Further systematic study is needed to more precisely define the role of lead in inducing PNS injury.

Mucinous ovarian tumors associated with pseudomyxoma peritonei of adenomucinosis type: immunohistochemical evidence that they are secondary tumors

Pseudomyxoma peritonei (PMP) is a clinical condition initially thought to be related to ovarian mucinous tumors; however, immunohistochemistry and molecular biology techniques have convincingly made the link to appendiceal mucinous neoplasms, resulting in changes in histologic and clinical approaches. The objective of this study was to compare the immunohistochemical profile of ovarian tumors associated with PMP and intestinal mucinous ovarian neoplasms without PMP. The study was retrospective and included 28 intestinal ovarian mucinous tumors selected from the files of the Division of Surgical Pathology of the University of Sao Paulo Medical School, from 1996 to 2005. Seven cases were associated with PMP of disseminated peritoneal adenomucinosis-type and all presented borderline histology. Immunohistochemical staining for mucin genes products (MUC1, MUC2, MUC5AC, and MUC6), CK7, CK20, CA19.9, and CA125 were performed in tissue microarrays. Of note, we detected differences in the expression of MUC2 and CK20 between cases with and without PMP. Comparisons of borderline histology with that of benign/malignant tumors also revealed differences in MUC2 and CK20. Our results confirm that there is a distinct profile of intestinal ovarian tumors associated with pseudomyxoma, particularly with respect to the expression of the gel-forming mucin MUC2. The profile of borderline tumors, even in cases without PMP, was distinct from that of other primary mucinous tumors of the intestinal type, suggesting that borderline histology may represent a secondary tumor or a less aggressive variant of PMP. An appendiceal origin seems the most probable for this group of neoplasias.

Molecular cytogenetic analysis of a ring-Y infertile male patient

In the present study, we report on the case of a 43-year-old male patient seeking for fertility assistance, who showed a seminal analysis and testicular biopsy of complete azoospermia. Peripheral blood culture for chromosome studies revealed a karyotype of 46 chromosomes with a ring-Y-chromosome that lost the long arm heterochromatin. Molecular analysis of genomic DNA from the patient detected the presence of the sex-determining region of the Y-chromosome (SRY) but the complete absence of regions involved in spermatogenesis (AZFa, AZFb, AZFc). Several molecular markers distributed along the Y-chromosome were tested through PCR amplification, and a breakpoint was established close to the centromere, predicting the deletion of the growth control region, in agreement with the short stature observed in this patient. All results obtained through molecular cytogenetic characterization are in accordance with the clinical features observed in this patient.

Correlation between phosphorylation level of a hippocampal 86kDa protein and extinction of a behaviour in a model of Wernicke-Korsakoff syndrome

The effects of chronic ethanol and thiamine deficiency, alone or associated, on hippocampal protein phosphorylation profiles ranging in molecular weight from 30 to 250kDa molecular weight, in stimulated (high K(+) concentration) and unstimulated (basal) conditions were investigated. These treatments significantly changed the phosphorylation level of an 86kDa phosphoprotein. Thiamine deficiency, but not chronic ethanol, induced a decrease in a behavioural extinction index, which is significantly correlated to the phosphorylation level of the p86 protein. These data add to and extend previous findings by our laboratory implicating the involvement of hippocampal neurotransmission components in extinction of a behaviour which involves learning of environmental spatial cues.

Thiamine deficiency decreases glutamate uptake in the prefrontal cortex and impairs spatial memory performance in a water maze test

Using an animal model of Wernicke-Korsakoff syndrome, in which rats were submitted to a chronic ethanol treatment with or without a thiamine deficiency episode, the glutamate uptake in the prefrontal cortex and spatial memory aspects were studied. It was found that (i) thiamine deficiency, but not chronic ethanol consumption, induced a significant decrease of glutamate uptake; (ii) thiamine-deficient subjects showed an impaired performance in the water maze spatial memory test though these animals were able to learn the task during the acquisition. In spite of the fact that thiamine deficiency affects both glutamate uptake and spatial reference memory, there was no significant correlation between these two data. The present results show that, although prefrontal cortex is considered by some authors a not vulnerable area to lesions caused by thiamine deficiency, this vitamin deficiency does cause a neurochemistry dysfunction in that region.

Body mass index and waist circumference in non-alcoholic fatty liver disease

OBJECTIVE

To evaluate the association of anthropometric indexes (body mass index and waist circumference) in patients with non-alcoholic fatty liver disease (NAFLD), and its association with insulin resistance (IR), metabolic syndrome (MS) and histological findings.

METHODS

From August 2003 to July 2004 a case series of 81 outpatients with clinic and/or histological diagnosis of NAFLD were selected at the Bahia University Gastro-Hepatology Clinic, Brazil. Liver function tests, lipid profile, glucose and insulin were performed in all patients. Body mass index (BMI) and waist circumference (WC) were determined according to WHO criteria. IR was measured by means of the homeostasis model assessment (HOMA) and IR was considered with HOMA > or =3. MS was defined according to the Adult Treatment Panel III (ATP III). Liver biopsy was performed in 37 cases.

RESULTS

Body mass index > or = 30 kg m(-2) (obesity) was found in 39% of the cases and BMI > or = 25-29.9 kg m(-2) (overweight) in 53%. BMI was correlated with IR (r = 0.29; P = 0.02) and WC with ALT (r = 0.02; P = 0.03). Increased WC also was related to IR and to MS. The presence of steatohepatitis with fibrosis on liver biopsy was associated with overweight (68%) and increase of WC (41%).

CONCLUSIONS

Body mass index and WC are frequent associated with MS, IR and histological findings (steatohepatitis and fibrosis) in patients with NAFLD.

Breast cancer metastatic to uterine leiomyosarcoma. A case report and review of the literature

An unusual case of breast cancer metastatic to leiomyosarcoma of the uterus is reported. The patient had multiple metastases from the breast carcinoma and presented a pelvic mass in its evolution. A laparotomy with total hysterectomy and bilateral oophorectomy was performed to give pain relief. A review of the world literature about these uncommon sites of breast metastases is presented.

Histological classification of endometriosis as a predictor of response to treatment

OBJECTIVES

To evaluate the usefulness of the histological classification of endometriosis in predicting responses to treatment.

METHODS

We evaluated 412 biopsy specimens from 241 patients with pelvic endometriosis. Pain and infertility were evaluated before surgery. Disease location and stage of development were analyzed according to the 1985 American Society of Reproductive Medicine (ASRM) classification. Histological findings were classified as stromal, well-differentiated, undifferentiated, and mixed endometriosis. Clinical response to pain or infertility was evaluated.

RESULTS

Histological findings, disease location and stage of development, and response to treatment were compared. Undifferentiated endometriosis was more frequently associated with stages III/IV than the well-differentiated and stromal histological types. Pure or mixed undifferentiated patterns were more frequently associated with rectovaginal endometriosis. When considering pain symptoms, patients presenting well-differentiated or stromal histological patterns responded better to therapeutic treatment than those who presented undifferentiated histological patterns. There were no significant differences in cases related to sterility.

CONCLUSIONS

The histological categorization of endometriosis can help predict the behavioral patterns of the disease.

Atypical glandular cells on cervical smears

OBJECTIVES

A standardized propaedeutic research to determine the clinical significance of cervical smears with atypical glandular cells.

METHODS

Of the 8,807 women seen at the Division of Lower Genital Tract Pathology and Colposcopy, São Paulo, Brazil, during a 5-year study, 57 (0.65%) had atypical glandular cells. Forty-two of them underwent colposcopy and hysteroscopy with 12-month follow-up. Conization and/or hysterectomy were performed if both exams were negative. The chi-square test and Fisher's exact test were used for statistical analysis.

RESULTS

A clinically significant lesion of the cervix and endometrium was diagnosed in 59.5% of the cases. The lesion was restricted to the cervix in women younger than 40 years, but could also be located in the body of the uterus in women older than 40 years.

CONCLUSIONS

Colposcopic evaluation in all women and study of the uterine cavity in women aged 40 years or older is necessary in the presence of this cytologic finding.

Squamous cell vulvar carcinoma associated with Fanconi's anemia: a case report

Fanconi's anemia (FA) is a rare autosomal recessive syndrome associated with a strong predisposition to cancer, particularly squamous cell carcinoma (SCC) of various organs. A few cases of lower genital tract neoplasia have been described. We present a 14-year-old black girl with an advanced squamous cell vulvar carcinoma treated with cisplatin chemotherapy plus radiation therapy. The patient died because of fungal sepsis. Polymerase chain reaction (PCR) was positive to human papillomavirus (HPV)-16. Vulvar carcinoma is a very rare condition in teenagers, but the association of Fanconi's anemia and SCC of many sites is common. Vulvar carcinoma when associated with Fanconi's anemia is a great treatment challenge.

Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia

PURPOSE

We tested the role of frozen section examination of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia.

METHODS

Twenty-five patients with cervical intraepithelial neoplasia underwent conization followed by frozen section examination and planned hysterectomy. The results of the definitive paraffin exam were compared with frozen section examination.

RESULTS

In the evaluation of the margins by frozen section examination, 16 patients (64%) had positive cone margins and 9 (36%) had negative margins. The definitive paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in 5 cases, and 1 of these was microinvasive. Among the remaining 20 cases, we detected 2 additional microinvasive carcinomas after paraffin study, so the diagnosis of the frozen section examination was concordant with the paraffin sections in 23/25 cases (92%). Two cases of microinvasive carcinoma were diagnosed as cervical intraepithelial neoplasia by frozen section examination and had less than 2 mm stromal invasion.

CONCLUSIONS

In high-grade cervical intraepithelial neoplasia, frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure. In early microinvasive disease, frozen section examination fails to detect the area of invasion but reliably detects clear resection margins.

[Arterial hypertension among oil-drilling workers exposed to noise]

A cross-sectional study with a retrospective component was conducted to evaluate occupational noise exposure as a potential risk factor for arterial hypertension among 775 workers from an oil-drilling industry. Hypertension was defined as >/= 140/90mmHg. Occupational noise exposure was measured as: (1) exposure to sound pressure levels >/= 85dbA for 10 years or more and (2) moderate-to-severe noise-induced hearing loss (NIHL). The effects of age, education, shift work, and obesity were evaluated by stratification and logistic regression analysis. A positive association between occupational noise exposure and hypertension was found, using both the level/duration of noise exposure (RP = 1.8; 95% CI: 1.3-2.4) and NIHL (RP = 1.5; 95% CI: 1.1-2.0) as exposure indicators. Considering the study limits, long-term occupational noise exposure thus appears to be a risk factor for arterial hypertension.

Molecular analysis of SRY gene in Brazilian 46,XX sex reversed patients: absence of SRY sequence in gonadal tissue

BACKGROUND

The importance of the Y chromosome in male determination has been well established for a long time. The presence of a translocation of chromosomal material encoding the Testis-Determining Factor from Y to another chromosome has been one of the hypothesis to explain testicular development in XX sex-reversed patients.

MATERIAL AND METHODS

In the present study, we searched for SRY sequence in genomic DNA isolated from peripheral leukocytes in eleven 46,XX true hermaphrodites and four 46,XX males (only one with ambiguous genitalia). We also analyzed the presence of SRY sequence in fresh gonadal tissues from two 46,XX true hermaphrodites.

RESULTS

SRY sequence was absent in DNA blood samples of all true hermaphrodites and in testicular and ovarian tissues of two cases studied. Of the four 46,XX males, two with normal male external genitalia were SRY positive.

CONCLUSIONS

We did not identify the SRY gene in 46,XX true hermaphrodites and 46,XX males with ambiguous genitalia, therefore SRY translocation to X chromosome or autosome is unlikely. Hidden Y mosaicism in gonadal tissues was also ruled out in two cases, suggesting that cryptic SRY mosaicism in gonadal tissues is not the usual mechanism responsible for testicular development in patients with 46,XX true hermaphroditism. However, SRY gene was identified in two 46,XX males with male external genitalia showing that SRY gene determined their male phenotype. Despite the recent advances in the knowledge of the role of several genes involved in sexual determination we are still unable to explain the cause of most of Y-chromosome-negative 46,XX sex-reversed patients.

No evidence of somatic activating mutations on gonadotropin receptor genes in sex cord stromal tumors

OBJECTIVE

To search for somatic activating mutations of gonadotropin receptor (FSH-R and LH/chorionic gonadotropin receptor [CG-R]) genes as a cause of sex cord stromal tumors.

DESIGN

Molecular studies in human tissue.

SETTING

University hospital. SPECIMEN(S): Eight granulosa cell tumors collected from paraffin-embedded tissue, eight Leydig cell tumors, and three thecomas collected from fresh-frozen or paraffin-embedded tissue.

INTERVENTION(S)

Tumor samples were used for DNA extraction. The entire exon 11 of the LH/CG-R gene and a hot spot for gonadotropin receptor activating mutations on exon 10 of the FSH-R gene were amplified by polymerase chain reaction. The former was analyzed by denaturing gradient gel electrophoresis and automatic direct sequencing, and the latter by automatic direct sequencing.

MAIN OUTCOME MEASURE(S)

Results of denaturing gradient gel electrophoresis and automatic direct sequencing.

RESULT(S)

No somatic activating mutation was detected in exon 11 of the LH/CG-R gene in eight Leydig cell tumors and three thecomas. In addition, no mutations were detected in eight granulosa cell tumors in the hot spot for activating mutations in exon 10 of the FSH-R gene.

CONCLUSION(S)

Somatic activating mutations of gonadotropin receptors seem to play no relevant role in the development of sex cord stromal tumors.

[Intervertebral disk disease among oil drilling workers]

A cross-sectional study among 1,026 oil drilling workers in Northeast Brazil found a prevalence rate of 5% for intervertebral disk disease, varying from 1.8% (activities without heavy lifting) and 4.5% (occasional lifting) to 7.2% (routine lifting). Disease prevalence was 10.5% among drilling workers with more than 15 years in the industry and 11.3% among those over 40 years of age. Prevalence ratio (PR) for the association between working in oil drilling operations and intervertebral disk disease was 2.3 (95% CI: 1.3-4.0). Retrospective information about exposure was collected to minimize the healthy worker survival effect. Using information on current occupation instead of occupational life history would cause an underestimated PR of 1.1 (95% CI: 0.6-1.9). Logistic regression showed results similar to the tabular analysis. Neither confounding nor interaction was evident. Growth of the Brazilian oil industry and recent changes in the work force contract and management, involving changes in risk management and health control, indicate a need for prompt ergonomic intervention in order to control intervertebral disk disease among oil drilling workers.

Endometrial prolactin in hyperprolactinemic women

OBJECTIVE

To observe the behavior of endometrial prolactin in hyper- and normoprolactinemic women.

METHOD

Forty women were selected due to alterations in menstrual cycle and/or galactorrhea and/or sterility. Patients were divided into two groups: Group A, 19 hyperprolactinemic women; and Group B, 21 normoprolactinemic women. Their mean age was 28.3 years. Laboratory assessments were carried out in the initial follicular phase (days 3-9), initial luteal phase (days 15-21), and late luteal phase (days 22-29) in menstruating women (samples 1, 2 and 3, respectively). In the non-menstruating women, samples were collected on days 1, 14 and 21 after the initial appointment (samples 1, 2 and 3, respectively). LH, FSH, prolactin and estradiol were measured in sample 1, while prolactin and progesterone were measured in samples 2 and 3. All women were submitted to two biopsies of the endometrium for observing the menstrual cycle, dating, and immunohistochemical detection of endometrial prolactin. Biopsies were obtained simultaneously to samples 2 and 3. To compare the two groups, Student's t-tests or Mann-Whitney statistics were performed.

RESULT

Results showed that the mean percentage of endometrial prolactin were higher in the late luteal phase compared to the initial one in hyper- and normoprolactinemic women.

CONCLUSION

The data allowed us to conclude that serum prolactin is not correlated to endometrial prolactin, and that the synthesis of the latter is directly correlated to the differentiation of stromal cells, that is induced by progesterone in a decidualized endometrium.

Origin of an ovarian steroid cell tumor causing isosexual pseudoprecocious puberty demonstrated by the expression of adrenal steroidogenic enzymes and adrenocorticotropin receptor

Ovarian steroid cell tumors are rare neoplasms composed of typical steroid hormone-secreting cells. Most ovarian steroid cell tumors, however, cannot be appropriately classified on a morphological basis, because the neoplastic cells closely resemble adrenal cortical cells. Nevertheless, the true adrenal origin of such tumors has been difficult to demonstrate. Here we report a 3-yr-old girl with isosexual pseudoprecocious puberty due to an ovarian steroid tumor whose adrenal cell origin was determined by the presence of messenger ribonucleic acid (mRNA) of adrenal-specific steroidogenic P450 enzymes (P450c11 and P450c21) and ACTH receptor (ACTHR). Her height was +2.3 SD, and she had Tanner stage III breast development, Tanner stage II pubic hair, and a normal clitoris. Bone age was 5 yr. Basal gonadotropin levels were undetectable (<0.6 U/L for LH and <1.0 U/L for FSH) and remained undetectable after stimulation with 100 microg GnRH, i.v. Basal serum testosterone and 17-hydroxyprogesterone levels were slightly elevated, whereas basal serum androstenedione, estradiol, and dehydroepiandrosterone sulfate levels were clearly elevated. Pelvic ultrasound disclosed an enlarged uterus and an adnexal multicystic mass in the right ovary, and pathological studies disclosed an ovarian steroid cell tumor. To establish the cellular origin of the tumor we determined the presence of mRNA for P450c11, P450c21, and ACTHR in tumor tissue and normal adrenal and ovarian tissue. Detection of ACTHR, P450c21, and P450c11 mRNAs isoforms was achieved in tumoral and adrenal control tissue, but not in the ovary control tissue. The RT-PCR products of P450c11 from adrenal control tissue were composed by both BglI-sensitive and -resistant complementary DNAs, indicating the presence of both P450c11AS and P450c11beta, whereas RT-PCR product from the tumor was resistant to BglI digestion, indicating only the presence of P450c11beta. We conclude that the histological origin of so-called adrenal rest tumor could be reliably determined by assessing the expression of specific genes in the tumor as P450c11beta and P450c21. The use ofthese molecular tools will allow a more precise classification of an important subset of the ovarian steroid cell tumors and can help to identify ectopic adrenal tissue in ovary and testis.

Müllerian adenosarcoma of the uterus with sarcomatous overgrowth following tamoxifen treatment for breast cancer

Müllerian adenosarcoma with sarcomatous overgrowth presented by a 52-year-old female patient after adjuvant tamoxifen treatment for breast carcinoma is described. The diagnosis was made on histological basis after curettage and complementary total hysterectomy with bilateral salpingo-oophorectomy. The immunohistochemical study showed high expression of estrogen receptors in the epithelial component of the lesion and irregularly positive findings in the stroma. The proliferative activity evaluated by Ki-67 immunoexpression was higher in the stroma than the epithelium. Some of the stromal cells showed rhabdomyoblastic differentiation. The association of tamoxifen use and development of mesenchymal neoplasms is discussed.

[Arterial hypertension and alcoholism among workers in an oil refinery]

The role of alcohol ingestion in the incidence of arterial hypertension has not been completely established. In addition, there are few studies addressing this point in relation to populations of workers. The objective of this study was to evaluate the association between alcoholism and arterial hypertension among workers in an oil refinery in Mataripe, Bahia, Brazil, from 1986 to 1993. We designed a retrospective cohort study with a 7-year follow-up in a stratified systematic sample of 335 workers from the refinery. Arterial hypertension was diagnosed based on blood pressure measurements done during routine medical examinations. At the beginning of follow-up, three groups were defined using the CAGE test of alcohol dependency: nondrinkers (n = 121), CAGE-negative workers (n = 116), and CAGE-positive workers (n = 98). In comparison with the CAGE-negative group, the CAGE-positive group had both greater relative risk and greater attributable risk for developing arterial hypertension (RR = 2.58; AR = 24.95 per 1,000 person-years). The CAGE-positive group also had greater risks compared to nondrinkers (RR = 2.06; AR = 20.97 per 1,000 person-years). The attributable fractions for the same two comparisons of groups were 61% and 51%, respectively. Rate standardization by age or smoking habit did not substantially change the results. Alcoholism is an important risk factor for arterial hypertension.

Endometriosis in the presacral nerve

OBJECTIVE

The authors report a case of extremely aggressive endometriosis involving a 32-year-old woman.

METHODS

Different types of medication were used and various surgical procedures applied in order to reduce the clinical signs and symptoms. Among the surgical procedures employed was presacral neurectomy when endometriosis was identified in the presacral nerve.

RESULTS

Receptor determination in the surgical piece was negative.

CONCLUSIONS

The etiopathogenic and therapeutic aspects of this process are discussed.

Activating mutation of the stimulatory G protein (gsp) as a putative cause of ovarian and testicular human stromal Leydig cell tumors

Activating mutations of the G protein genes have been associated with the development of several endocrine neoplasms. Such activating mutations, gip2, affecting the alpha-subunit of the G alpha i2 protein were previously described by a single group in 30% of ovarian sex cord stromal tumors. Other activating mutations of the alpha-subunit of the Gs (gsp) have been identified in GH-secreting and nonfunctioning pituitary tumors, autonomous thyroid adenomas, and all affected McCune-Albright tissues, but not in sex cord stromal tumors. In the present study, we investigated the presence of gip2 and gsp mutations in 14 human sex cord stromal tumors. Six Leydig cell tumors (4 ovaries and 2 testes), 2 thecomas, 2 granulosa cell tumors, 3 androblastomas, and 1 gonadoblastoma (sex cord and germ cell) were included in this study. Genomic DNA was obtained from either fresh-frozen tumor tissues or paraffin-embedded sections and in some cases from blood samples. Using PCR, denaturing gradient gel electrophoresis, and direct sequencing, we detected 4 tumors (66.6%) with the gsp mutation (R201C) in our series of ovarian and testicular Leydig cell tumors. In contrast, no gip2 mutations were found in any of the sex cord stromal tumors studied. In conclusion, our findings suggest that the putative oncogene gsp may play a significant role in the molecular mechanism of these tumors.

[The knowledge of pediatricians in Salvador, Brazil about measles vaccine]

The success of international initiatives for the eradication of measles depends in large part on knowledge about vaccination. In 1992, a cross-sectional study was carried out to evaluate knowledge about measles vaccine among pediatricians in the Brazilian city of Salvador, Bahia. Of the 506 pediatricians residing in the city, 299 (59%) could be located and responded to a questionnaire containing 15 questions that posed hypothetical situations regarding indications and contraindications for this vaccine. The average number of correct responses was 9.3 out of 15, which illustrates the pediatricians' poor knowledge of measles vaccine. Conditions commonly seen in pediatric practice in Brazil--malnutrition, upper respiratory tract infection, diarrhea, and prematurity--were often erroneously considered contraindications for immunization. More than half (62%) of the pediatricians did not know the correct way to administer the vaccine. Knowledge about the vaccine did not differ according to the length of time that had elapsed since the physicians' university training in pediatrics or as a result of working in health centers operated by the State Health Secretariat. University professors, pediatricians with a postgraduate degree, and those pursuing postgraduate studies scored slightly higher than the rest. These results point to the need to strengthen training on measles vaccination in medical schools and programs of continuing education for pediatricians.

A virilizing Leydig cell tumor of the ovary associated with stromal hyperplasia under gonadotropin control

A 34-yr-old nulliparous black woman presented with hair loss, facial hirsutism, irregular menses and infertility associated with greatly increased serum total testosterone levels. The adrenal glands and the ovaries were normal on radiological and ultrasonographic investigation. Catheterization of the veins draining from the adrenal glands and the ovaries yielded testosterone levels of 20.3 nmol/L and 20.0 nmol/L in the right and the left adrenal veins, respectively, and 17.9 nmol/L and 27.4 nmol/L in the right and left ovaries venous plexus, respectively. Sequencial dexamethasone and ethynyl estradiol suppression test showed a decrease in cortisol level with no change in total testosterone level on dexamethasone while an increase in testosterone from 10.5 nmol/L to 20.1 nmol/L was observed ten days after ethynil estradiol had been associated to dexamethasone. When a gonadotropin-releasing hormone agonist (gonadorelin 3.5 mg i.m.) was administered for 2 months, serum gonadotropins levels decreased to less than 2 IU/L, total testosterone to 3.8 nmol/L and estradiol to less than 36 pmol/L. The patient was submitted to a pelvic exploratory laparotomy and a left salpingo-oophorectomy was performed. A solid and circumscribed ovarian tumor of 1.0 cm in diameter was found. The pathological diagnosis was a Leydig cell tumor with surrounding stromal hyperplasia. These findings may suggest that this tumor was gonadotropin-dependent being indirectly stimulated by ethynil estradiol, through a sensitization of the pituitary gonadotropes and increase in gonadotropin levels and suppressed by a gonadotropin-releasing hormone agonist.

Ovarian resistance to luteinizing hormone: a novel cause of amenorrhea and infertility

OBJECTIVE

To report the clinical, hormonal, and histopathological features of a woman with ovarian resistance to LH.

DESIGN

Clinical study.

SETTING

University hospital.

PATIENT(S)

A woman with amenorrhea, sister of a patient with male pseudohermaphroditism due to Leydig cell hypoplasia.

INTERVENTION(S)

Blood drawing before and after GnRH stimulation and also after dexamethasone and hCG administration, pelvic ultrasound, and ovarian biopsy.

MAIN OUTCOME MEASURE(S)

Karyotype, gonadotropin and steroid measurements, follicular diameter, ovarian histology, and sequencing of the LH receptor gene.

RESULT(S)

Patient had normal female external genitalia, normal breast development at puberty, rare episodes of vaginal bleeding, and infertility. The karyotype was 46,XX. She had elevated serum LH levels, whereas E2 and P concentrations were in the range seen in the early follicular phase. Pelvic ultrasound revealed a slightly hypoplastic uterus and enlarged polycystic ovaries. A normal follicular reserve for age, antral follicles, and absence of corpora lutea or albicans were observed on ovarian biopsy. Exon 11 of the LH receptor gene had a normal sequence.

CONCLUSION(S)

In our patient with ovarian resistance to LH, FSH stimulated follicular development until the preovulatory stage, but E2 levels remained in the early follicular phase range, still sufficient for normal pubertal feminization. Apparently, LH is necessary for ovulation and corpus luteum formation.

[Lead poisoning: Zinc protoporphyrin in blood of children from Santo Amaro da Purificação, Bahia, Brazil]

A cross-sectional epidemiological study has investigated lead poisoning among all the 101 children aged 1 to 5 years, living at less then 500 m from a lead smelter which has been operating since 1960 in Santo Amaro da Purificação, State of Bahia, Brazil. Lead poisoning was evaluated by determining the concentrations of zinc protoporphyrin (ZPP) in whole blood. Results were compared with those obtained from 98 children of the same age range, in a nursery from Salvador, capital of the State of Bahia. In Santo Amaro, ZPP geometric mean was 65.5 mg/dl (geometric S.D. = 1.7), much higher, therefore, than the normal threshold of 30 microg/dl recommended by the CDC-USA. A child was excluded from statistical analyses because of very high ZPP level: 789 mg/dl. In Salvador, ZPP geometric mean was 31.0 mg/dl (geometric SD = 1.6). "Extremely elevated" ZPP levels (above 156 mg/dl) were observed in 8% of the children from Santo Amaro and in none (0%) of the children from Salvador, this statistical difference being highly significant. Anaemia was present among 35.0% of the children from Santo Amaro and among 25.5% of those from Salvador. One year-old children showed the highest levels of ZPP and anaemia. No marked statistical association was found between ZPP levels and anaemia. Lead contamination of this children population remained in a permanently high level during, at least, the period from 1980 to 1992. In December, 1993 the lead smelter has definitively ceased its industrial activities in Santo Amaro da Purificação.

Lead poisoning among children of Santo Amaro, Bahia, Brazil in 1980, 1985, and 1992

A cross-sectional epidemiologic survey conducted at the beginning of 1992 evaluated the status of lead intoxication among children from 1 to 5 years of age living within 500 meters of a primary lead smelter in the Brazilian city of Santo Amaro, Bahia. A total of 103 children in this age group were initially enrolled in the study; however, 2 were later excluded because they could not be located, and 1 was excluded from the statistical analyses for reasons noted below. The results were compared with those from similar surveys made in 1980 and 1985 in the same area with children of the same age. A blood sample was obtained from each child, the child's hematocrit and zinc protoporphyrin (ZPP) level were determined, and an interview questionnaire was used to collect information of clinical or epidemiologic interest from the child's mother or guardian. The geometric average ZPP was 65.5 micrograms/100 mL (geometric standard deviation = 1.7), a level far exceeding the upper limit of normality established by the U.S. Centers for Disease Control and Prevention of 30 micrograms/100 mL. One child was excluded from the statistical analyses because it exhibited an extremely high ZPP level (789 micrograms/100 mL). Higher average ZPP levels were found for girls, children with darker-skinned racial backgrounds, children from homes where smelter slag was commonly used around the house, children presenting pica, and children of smelter workers. Of the symptoms of lead poisoning investigated, only nervousness and easy irritability exhibited high frequencies among the children studied. However, the prevalence of above-normal ZPP levels suggestive of lead poisoning was 92.2% in 1980, 98.4% in 1985, and 97.0% in 1992. Hence, the apparent prevalence of lead poisoning continued very high in 1992, indicating that the control measures adopted were ineffective or that other unidentified and uncontrolled risk factors were playing an important role. Overall, however, the proportion of children with very high ZPP levels fell sharply, and that of children with moderately high levels also declined notably, indicating that the severity of the problem had been reduced even though new cases of intoxication continued to occur. The Santo Amaro smelter closed its doors in December 1993.

Erythrocyte protoporphyrin versus blood lead: relationship with iron status among children exposed to gross environmental pollution

The dose-response relationship between erythrocyte protoporphyrin (EP) and blood lead (PbB) was investigated among children with different subgroups of iron status. The data bank from Santo Amaro City, Brazil, was taken to study 490 children aged 1-9 years who lived at less than 900 m from a primary lead smelter. Mean PbB was 58.9 +/- 25.3 micrograms/dl and mean EP was 87.1 +/- 68.1 micrograms/dl. At PbB levels lower than 60 micrograms/dl, the dose-response curve for EP versus PbB followed the classical pattern; children with low iron status showing greater EP "response" than those with typical iron status and those with high iron status, after controlling for the effects of age and racial group. Among children with PbB > or = 60 micrograms/dl, EP response increased according to the following order: typical < low < high iron status.

Morphologic hysteroscopic criteria suggestive of endometrial hyperplasia

OBJECTIVES

To evaluate the morphologic hysteroscopic criteria leading to a diagnosis of endometrial hyperplasia and compare their accuracy with that of histology.

METHODS

A total of 95 hysteroscopic examinations were evaluated. Of these, 37 had a histologic diagnosis of normal endometrium and the remaining 58 of simple or complex endometrial hyperplasia. We compared the morphologic hysteroscopic criteria for the two groups using Pearson's chi-squared and Fisher's exact test.

RESULTS

Only the presence of endometrial glands presenting a cystic pattern at hysteroscopy gave statistically significant results (P < 0.05), with low sensitivity (15.79%), high specificity (97.29%) and a relative risk of 6.75. With a prevalence of endometrial hyperplasia of 22.97% in a population of women with metrorrhagia, the positive predictive value was 63.53% and the negative predictive value was 79.40%.

CONCLUSION

Additional, prospective studies are needed to determine the real value of the diagnostic morphologic parameters under consideration.

A baixa qualidade do soro caseiro em Salvador, Brasil

Durante o ano de 1988 foi realizada uma campanha de âmbito nacional com o objetivo de informar a população brasileira sobre o preparo e utilização do soro caseiro (solução sal/açúcar para reidratação oral). A campanha foi intensivamente divulgada pelos meios de comunicação de massa. Este estudo preliminar avaliou a qualidade do soro caseiro preparado por 23 mães de crianças internadas num hospital pediátrico de Salvador, Bahia. Catorze (60,9%) dentre as 23 mães prepararam soluções, contendo concentrações de Na na faixa de 30-80mmol/L, recomendada pela Organização Mundial da Saúde. Onze (47,8%) soluções continham glicose dentro da faixa recomendada, de 30-112 mmol/L. Apenas seis (26%) das 23 mães prepararam soluções com concentrações adequadas de Na e glicose simultaneamente e, destas, somente três (13%) apresentavam, também, balanço adequado das concentrações dos eletrólitos. Características potencialmente iatrogênicas devido a elevadas concentrações de Na e glicose foram encontradas em 30,4% e em 43,5% das soluções, respectivamente. Os resultados revelam grande dificuldade das mães em preparar o soro caseiro com características adequadas para sua utilização numa campanha de controle da diarréia.