Congenital anomalies of the pulmonary arteries: spectrum of findings on computed tomography

OBJECTIVE

Congenital anomalies of the pulmonary arteries are uncommon. They can occur in isolation or in association with congenital heart defects. Isolated congenital anomalies remain undiscovered until they are reported as incidental findings on imaging tests, usually not until adolescence. We review the embryological development and normal anatomy of the pulmonary arteries as well as the spectrum of computed tomography findings for various congenital anomalies: unilateral interruption of the pulmonary artery, anomalous origin of the left pulmonary artery (pulmonary artery sling), idiopathic aneurysm of the pulmonary artery, and other anomalies associated with congenital heart defects.

CONCLUSION

Congenital anomalies of the pulmonary arteries represent a diagnostic challenge for clinicians and radiologists. Computed tomography is useful for their diagnosis, and general radiologists need to be familiar with their imaging appearance because they are often discovered incidentally.

Cytotoxic and NF-κB inhibitory sesquiterpene lactones from Piptocoma rufescens

Six new (1-6) and eight known germacranolide-type sesquiterpene lactones, along with several known phenylpropanol coumarates and methylated flavonoids, were isolated from the leaves of Piptocoma rufescens, collected in the Dominican Republic. The new compounds were identified by analysis of their spectroscopic data, with the molecular structure of 3 being established by single-crystal X-ray diffraction. The absolute configurations of the sesquiterpene lactones isolated were determined from their CD and NOESY NMR spectra, together with the analysis of Mosher ester reactions. Bioassay screening results showed the majority of the sesquiterpene lactones isolated (1-13) to be highly cytotoxic toward the HT-29 human colon cancer cell line, with the most potent compound being 15-deoxygoyazensolide (10, IC(50), 0.26 µM). In addition, several of the sesquiterpene lactones exhibited NF-κB (p65) inhibitory activity.

Preoperative Risk Factors Associated With Mortality in Lung Biopsy Patients With Interstitial Lung Disease

The objective of this study was to evaluate the risk factors associated with mortality in interstitial lung disease patients. We performed a retrospective study of 722 consecutive patients submitted for lung biopsy during the 1986-1990 period. Twenty-two (3%) died within the 30 days following surgery. Forty-four patients who survived after the surgery for the same time span were randomly chosen as control group. Dyspnea at rest was present in 18/44 of surviving group (SG) and in 18/22 of the nonsurviving group (NSG) (OR 6.5, 95% CI 1.8-22.4,p = .001). Systemic diseases (i.e., diabetes, systemic arterial hypertension)were mainly present in the NSG (OR 7.2, 95% CI 2.3-22.8, p < .001). The SG displayed significantly less respiratory insufficiency with a PaO2 of 52.2 + 8.4 versus 38.5 i 9.4 mm Hg, and PaCO2 of 28.8 i 4.5 versus 38.5 +/- 9.2 mm Hg, respectively (p < .001). Likewise, the SG exhibited a PaCO2/PaO2 ratio of 0.5 - 0.1, while in the NSG it was of 1 +/- 0.4 (p < .001), showing a sensitivity of 84% and specificity of 93% for mortality. Multiple logistic regression analysis for these variables showed that log likelihood was still significant for PaCO2 > 34 mm Hg, PaO2 <48 mm Hg, and comorbid diseases. Logistic regression analysis of these three variables showed the greatest sensitivity and specificity (84 and 750/0,respectively) for prediction of mortality. However, the strongest association was found when PaCO2/PaO2 ratio was analyzed alone (OR 21,073,CI 95% 28-15,946,357, p < .005). These data suggest that PaCO2/PaO2 ratio appears to be a predictor of mortality in this subset of patients. Its prospective use has reduced early mortality after surgery less than 1% in the last decade.

Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease

Pigeon breeders disease (PBD) is caused by the exposure of a susceptible host to avian antigens. However, genetic factors determining individual predisposition are unknown. In this work, polymorphisms of the major histocompatibility complex (MHC) class II alleles and tumor necrosis factor alpha (TNF-alpha) promoter were evaluated in 44 patients with PBD, 99 healthy unrelated controls (HC), and 50 exposed but asymptomatic subjects (EAS). MHC typing was performed by PCR-specific sequence oligonucleotide analysis, and TNF-alpha polymorphism at -238 and -308 positions by amplification refractory mutation system-PCR. PBD patients showed a significant increase of the alleles HLA-DRB1*1305 (p < 0.001, OR = 15.4, 95% CI = 3.18-102.6 [HC], and OR = 17.05, 95% CI = 2.25-357.8 [EAS]) and HLA-DQB1*0501 (p < 0.05, OR = 2.93, 95% CI = 1.21-7.15 [HC], and OR = 2.96, 95% CI = 1.0-9.14 [EAS]). A decrease of HLA-DRB1*0802 was also noticed in patients when compared with both control groups (p < 0.05). Haplotype analysis revealed an increase of DRB1*1305-DQB1*0301 and a decrease of DRB1*0802-DQB1*0402. PBD patients had an increased frequency of TNF-2(-)(308) compared with both control groups (p < 0.05). Patients exhibiting the TNF-2(-)(308) allele were younger (33.9 +/- 14.6 versus 44.2 +/- 10.4 yr; p < 0.05), and displayed more lymphocytes in their bronchoalveolar lavages (88.0 +/- 12.1 versus 68.9 +/- 17.2; p < 0.05). These results suggest that genetic factors located within the MHC region contribute to the development of PBD.

Increase of lung neutrophils in hypersensitivity pneumonitis is associated with lung fibrosis

Hypersensitivity pneumonitis (HP) is characterized by a T-cell-mediated alveolitis, and the putative role of other inflammatory cells in its pathogenesis remains unclear. In this study we determined whether increased quantities of neutrophils were present in HP lungs, and if they were positive for gelatinase B and collagenase-2. Fifteen nonsmoking patients with subacute/chronic active HP were included. Lung samples were analyzed using myeloperoxidase antibody, and neutrophil/total cell ratio was evaluated by digital processing. All HP tissue samples exhibited variable quantities of neutrophils located inside vessels, and in the interstitial and alveolar spaces. Lung neutrophil percentage ranged from 0.7% to 4.8% (2.1 +/- 1.4%). There was a positive correlation between the percentage of lung neutrophils and the percentage of lung fibrosis (r = 0.6, p < 0.02). Tissue neutrophils showed intense immunoreactive collagenase-2 and gelatinase B staining. Additionally, gelatinolytic activities corresponding to progelatinases A and B and their activated forms, were several-fold increased in the bronchoalveolar lavage fluid (BALF) from patients with HP as compared with control subjects. These findings suggest that in HP lungs there is a persistent traffic of neutrophils loaded with gelatinase B and collagenase-2 that may play a role in the lung damage and in the fibrotic response.

Cytotoxic constituents of the roots of Ekmanianthe longiflora

Bioactivity-directed fractionation of the CHCl(3) extract of the roots of Ekmanianthe longiflora resulted in the isolation of three new natural products, (2R,3R,4R)-3,4-dihydro-3, 4-dihydroxy-2-(3-methyl-2-butenyl)-1(2H)-naphthalenone (1), (2S,3R, 4R)-3,4-dihydro-3, 4-dihydroxy-2-(3-methyl-2-butenyl)-1(2H)-naphthalenone (2), and (2R, 3aR,9R,9aR)-9-hydroxy-2-(1-hydroxy-1-methylethyl)-2,3,3a,4,9 , 9a-hexahydro-naphtho[2,3-b]furan-4-one (3), together with the known compounds 2-(1-hydroxyethyl)naphtho[2,3-b]furan-4,9-quinone (4), 2-acetylnaphtho[2,3-b]furan-4,9-quinone (5), dehydro-iso-alpha-lapachone (6), alpha-lapachone (7), catalponol, and epi-catalponol. The structures of 1-3 were determined using a combination of NMR spectroscopic techniques, and the absolute configurations of compounds 1 and 2 were obtained using Mosher ester methodology. Compounds 4-6 showed significant cytotoxicity in a panel of human cancer cells. alpha-Lapachone (7) exhibited only marginal activity, and catalponol and epi-catalponol were inactive in this regard. When tested at 72 mg/kg/injection in an in vivo mouse P-388 leukemia system, compound 4 was inactive (110% T/C).

[Gastroesophageal reflux in asthmatic patients: an incidence study and clinical correlation]

The prevalence of gastroesophageal reflux (GER) in asthmatic patients is elevated, but the exact frequency remains unknown. The relationship between GER and asthma has not been investigated in Mexico. The objective of this study is to know the frequency of GER in Mexican asthmatic patients and the possible relationship with the severity of asthma. Fifty patients with adult-onset asthma were studied. AII of them fulfill the diagnostic criteria of the National Institutes of Health, U.S. The evaluation included a symptoms questionnaire, spirometry, esophageal manometry, 24-h esophageal pH-recording, and an upper gastrointestinal endoscopy. Twenty-three patients had mild asthma (46%), 16 moderate (32%) and 11 had severe asthma (22%). Twenty-seven (54%) reported heartburn and regurgitation at least twice a week. The esophageal pH-recording showed pathologic GER in 37 subjects (74%) and endoscopic esophagitis was found in 7 cases (14%). The pH-recording showed pathologic GER in 13 patients with mild asthma (57%), in 13 with moderate asthma (81%) and in all patients with severe asthma (100%). The frequency of GER in Mexican asthmatic patients is high and increases proportionately with the severity of asthma. This factor must be considered in the integral evaluation of these patients.

[Hiatal hernia in asthmatic patients: prevalence and its association with gastroesophageal reflux]

INTRODUCTION

Evidence of a high prevalence of hiatal hernia (HH) and gastroesophageal reflux (GER) in asthmatic patients has been found. However, the relationship between these entities has not been studied in our country.

OBJECTIVES

1) To inform the prevalence of hiatal hernia in asthmatic patients, 2) To compare the prevalence of hiatal hernia in asthmatic vs. non-asthmatic patients, 3) To establish a possible association between hiatal hernia and GER in asthmatic patients.

MATERIALS AND METHODS

In order to detect and to compare the prevalence of hiatal hernia in asthmatic and non-asthmatic patients, upper gastrointestinal endoscopy was performed. To establish the association between asthma and GER, data obtained from a gastrointestinal symptoms questionnaire, an esophageal manometry and an ambulatory pH recording in asthmatics with or without hiatal hernia were compared.

RESULTS

Hiatal hernia was more frequently observed in asthmatics than in non-asthmatics (62% vs. 34%, p = 0.02). The frequency of typical symptoms of GER was similar in both asthmatics with or without hiatal hernia (54 vs. 43%, p = 0.3). Lower esophageal sphincter incompetence was similar in asthmatics with hiatal hernia (35%) vs. asthmatics without hiatal hernia (22%), as detected by manometry. Pathological GER was diagnosed by pH recording in 81% of the asthmatics with hiatal hernia and in 65% of asthmatics without hiatal hernia (p = 0.1).

CONCLUSIONS

There is a high prevalence of hiatal hernia in asthmatics, which in turn results to be greater than in non-asthmatic patients. The presence of hiatal hernia does not correlate with the detection of pathological GER as determined by pH recording in this group of patients.

Effects of continuous ivermectin treatment from birth to puberty on growth and reproduction in dairy heifers

The effect of continuous ivermectin treatment from birth to puberty on growth and reproductive performance was studied in Holstein heifer calves grown on pastures in comparison to naturally nematode-infected, untreated animals. Ivermectin effectively abated the presence of nematode eggs in feces. Eggs per gram (EPG) in parasitized animals increased rapidly from wk 12 to 18 of age and then decreased. Animals treated with ivermectin grew faster than untreated ones, and differences in body weight became significant at 6 wk of life, even before eggs appeared in the feces of either treatment group. Ivermectin-treated heifers reached puberty 3 wk earlier than infected ones as assessed with serum progesterone concentrations (ivermectin, 30.4 +/- .8 vs untreated, 33.7 +/- 1.3 wk of age). This delay was not directly related to body weight. In addition, pelvic area at 39 wk and at 15 mo of age was increased in treated heifers (8 and 11%, respectively) compared with parasitized animals. No differences in the wither heights were observed. We conclude that ivermectin treatment in dairy heifers may increase growth rate during development, advance the onset of ovarian function, and positively affect yearling pelvic area.

[First two years of an external quality assurance program for urinalysis]

OBJECTIVE

To analyze the first two years of a strip uroanalysis quality assurance scheme operating in Mexico.

METHODS

The participants received 8 shipments of four controls each as dried tablets to be dissolved and analyzed with urine strips. The number of participants increased from < 50 in the 1st shipment to > 200 in the 8th. They assayed 6-10 analytes depending on the strip used and sent in 763 reports. For each report we calculated a score per analyte (n = 4), per shipment (n = 24 to 40) and a global score in the 8 shipments (n = 707 to 763 reports). The scores ranged from zero (excellent accuracy) to a maximum of 400 and were calculated by comparison with the modal value of about 600 American and Canadian laboratories which assayed the same controls using exclusively Bayer strips and instrumental readings.

RESULTS

The best score was for nitrites (global score of 3 in 741 reports) and the worst for specific gravity (58 in 744 reports); the other analytes had scores from 11 to 19 (Table 1). The scores of four types of methods (Table 2) showed the best results with Bayer strips and instrumental readings (score of 13 in 469 reports) and the worst with strips of other suppliers (scores of 28 for visual and 31 for instrumental readings) and intermediate with visual readings of Bayer strips (score of 21).

CONCLUSIONS

1. Our results led us to the decision to exclude from the program participants who do not use Bayer strips as our program may disorient them instead of helping to improve their assays. 2. We confirmed that instrumental readings perform better than visual readings. 3. The causes of suboptimal performance in specific gravity need to be explored.

[What information can radiodiagnostic media give us when recurrent urinary infections in childhood are caused by functional pathology and anatomic anomalies?]

OBJECTIVE

To analyze the alterations of the radiologic studies in children with recurrent urinary tract infection without urinary tract organic abnormalities.

METHODS

The present study comprised 50 children (8 boys, 42 girls) aged 4 to 36 months (mean 16 months). Patient evaluation included diagnostic voiding cystourethrogram, ultrasonography and intravenous urography.

RESULTS

Voiding and filling cystourethrography were performed in all cases, which demonstrated a trabeculated bladder (like fringes in the bladder wall); 35 of the 50 children had small bladders; 15 of the 50 children had a normal or bigger, but flaccid bladder. Forty-four children showed signs of intermittent obstruction in the posterior urethra during the voiding phase. The intravenous urogram showed a small bladder with different degrees of trabeculation and residual urine in 15 of 38 cases.

CONCLUSIONS

Radiologic diagnostic studies can discard organic abnormalities of the urinary tract and can be useful un detecting a possible functional disorder.

Bronchiolitis in chronic pigeon breeder's disease. Morphologic evidence of a spectrum of small airway lesions in hypersensitivity pneumonitis induced by avian antigens

We analyzed 36 open lung biopsy specimens from patients with chronic pigeon breeder's disease (PBD) to assess bronchiolar involvement and its relationship to the parenchymal pathologic abnormalities. Likewise, 21 biopsy specimens obtained from patients with usual interstitial pneumonia (UIP) were also examined. The bronchiolar abnormalities were scored by the method of Wright et al using a panel of photographs. In addition, the severity of lung fibrosis was evaluated in all samples and expressed as percentage in multiples of ten. A variable degree of epithelial cell metaplasia, bronchiolar inflammation and fibrosis, smooth muscle hypertrophy, extrinsic small airways narrowing, and intraluminal macrophages was observed in both diseases. Occasionally, hyperplasia of lymphoid follicles was also present. Bronchiolar changes were proportional in type and severity to the parenchymal damage. Spearman's nonparametric correlation between fibrosis in parenchyma and fibrosis in membranous bronchiole for the complete group (including patients with UIP and with PBD) showed a moderate but significant association (R = 0.51; p < 0.01). A significant association was also demonstrated when the score for bronchiolar fibrosis and inflammation was evaluated in relation to lung fibrosis divided in high degree (> 50%) and low degree (< 50%), respectively. In the case of patients with PBD, the correlation between bronchiolar and parenchymatous fibrosis was of 0.33 (p < 0.05). In general, bronchiolar fibrosis was less severe and inflammation more severe in PBD lungs compared with patients with UIP. Fibrosis in membranous bronchioles correlated with increased mortality in the complete group of patients, but the impact on mortality disappeared after correcting for overall fibrosis in the biopsy sample. Our findings demonstrate that a spectrum of bronchiolar lesions is usually observed in chronic PBD lungs, although the predominant pattern is similar to that found in the surrounding parenchyma, suggesting that the damage occurs in parallel.

[Validity of the Gram and Lendrum stains in conjunctival smears for the identification of Chlamydia trachomatis]

With the objective of finding reliable, valid, and economic diagnostic tests to identify Chlamydia trachomatis in conjunctival smears, the sensitivity, specificity, and positive and negative predictive values of Lendrum and Giemsa stains were evaluated using direct immunofluorescence as the gold standard. In addition, inter- and intraobserver reproducibility were estimated through the use of two independent observers, who were blinded to the results during their readings. The prevalence of ocular chlamydiosis in the study area was around 50%. In all, 103 persons (206 eyes) were studied. Three smears from each eye were taken for each subject. The kappa statistic was used to estimate the reproducibility of the stains. Interobserver reproducibility was null, and intraobserver reproducibility ranged between 0.35 and 0.79. The sensitivity of the Giemsa stain was a bit higher than that of the Lendrum stain (28% and 22%, respectively), and the specificity was similar (82% and 85%, respectively). Based on these results, the ability of both stains to detect positive cases was judged to be low, as was their reliability. The Lendrum and Giemsa stains are not adequate tests for the diagnosis of ocular chlamydiosis. For this purpose the use of direct immunofluorescence is recommended.