Invasive Plant Species Driving the Biotic Homogenization of Plant-Frugivore Interactions in the Atlantic Forest Biodiversity Hotspot

Although biological invasions are a common and intensively studied phenomenon, most studies often ignore the biotic interactions that invasive species play in the environment. Here, we evaluated how and why invasive plant species are interconnected within the overall frugivory network of the Brazilian Atlantic Forest, an important global biodiversity hotspot. To do this, we used the recently published Atlantic Frugivory Dataset to build a meta-network (i.e., a general network made of several local networks) that included interactions between 703 native and invasive plant species and 331 frugivore species. Using tools derived from complex network theory and a bootstrap simulation approach, we found that the general structure of the Atlantic Forest frugivory network (i.e., nestedness and modularity) is robust against the entry of invasive plant species. However, we observed that invasive plant species are highly integrated within the frugivory networks, since both native and invasive plant species play similar structural roles (i.e., plant status is not strong enough to explain the interactive roles of plant species). Moreover, we found that plants with smaller fruits and with greater lipid content play a greater interactive role, regardless of their native or invasive status. Our findings highlight the biotic homogenization involving plant-frugivore interactions in the Atlantic Forest and that the impacts and consequences of invasive plant species on native fauna can be anticipated based on the characteristics of their fruits.

Global trends in the trophic specialisation of flower-visitor networks are explained by current and historical climate

Trophic specialisation is known to vary across space, but the environmental factors explaining such variation remain elusive. Here we used a global dataset of flower-visitor networks to evaluate how trophic specialisation varies between latitudinal zones (tropical and temperate) and across elevation gradients, while considering the environmental variation inherent in these spatial gradients. Specifically, we assessed the role of current (i.e., net primary productivity, temperature, and precipitation) and historical (i.e., temperature and precipitation stability) environmental factors in structuring the trophic specialisation of floral visitors. Spatial variations in trophic specialisation were not explained by latitudinal zones or elevation. Moreover, regardless of network location on the spatial gradient, there was a tendency for higher trophic specialisation in sites with high productivity and precipitation, whereas historical temperature stability was related to lower trophic specialisation. We highlight that both energetic constraints in animal foraging imposed by climate and resource availability may drive the global variation in trophic specialisation.

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data.

Mexico ants: incidence and abundance along the Nearctic-Neotropical interface

Mexico is one of the most biodiverse countries in the world, with an important proportion of endemism mainly because of the convergence of the Nearctic and Neotropical biogeographic regions, which generate great diversity and species turnover at different spatial scales. However, most of our knowledge of the Mexican ant biota is limited to a few well-studied taxa, and we lack a comprehensive synthesis of ant biodiversity information. For instance, most of the knowledge available in the literature on Mexican ant fauna refers only to species lists by states, or is focused on only a few regions of the country, which prevents the study of several basic and applied aspects of ants, from diversity and distribution to conservation. Our aims in this data paper are therefore (1) to compile all the information available regarding ants across the Mexican territory, and (2) to identify major patterns in the gathered data set and geographic gaps in order to direct future sampling efforts. All records were obtained from raw data, including both unpublished and published information. After exhaustive filtering and updating information and synonyms, we compiled a total of 21,731 records for 887 ant species distributed throughout Mexico from 1894 to 2018. These records were concentrated mainly in the states of Chiapas (n = 6,902, 32.76%) and Veracruz de Ignacio de la Llave (n = 4,329, 19.92%), which together comprise half the records. The subfamily with the highest number of records was Myrmicinae (n = 10,458 records, 48.12%), followed by Formicinae (n = 3,284, 15.11%) and Ponerinae (n = 1,914, 8.8%). Most ant records were collected in the Neotropical region of the country (n = 12,646, 58.19%), followed by the Mexican transition zone (n = 5,237, 24.09%) and the Nearctic region (n = 3,848, 17.72%). Native species comprised 95.46% of the records (n = 20,745). To the best of our knowledge, this is the most complete data set available to date in the literature for the country. We hope that this compilation will encourage researchers to explore different aspects of the population and community research of ants at different spatial scales, and to aid in the establishment of conservation policies and actions. There are no copyright restrictions. Please cite this data paper when using its data for publications or teaching events.

First International Public Health Film Competition 2016-reflections on the development and use of competition judging criteria

Background

Film competitions can be a helpful method to understand issues of quality in health films. In this paper, we describe the development and use of explicit quality criteria to identify the 'best' films for the first ever international public health film competition.

Methods

A film selection committee encompassing a range of stakeholders was compiled. The committee drew up 10 explicit quality criteria to judge films drawing upon other film festival's selection criteria. These criteria were then applied to a broad range of health-related films entered into a film competition to select the 'best' film to screen.

Results

Eighty-four films from 20 different countries were submitted to the public health film competition. The originality of the subject covered by the film, the public health importance of the issue and story-telling approach in the film were found to be the most discriminatory criteria to select films.

Conclusion

Selection of health films for festivals can be undertaken using explicit quality criteria. There are a number of advantages to such an approach; however, explicit selection involves a large commitment of resources from film festival organizers and there is further research required to test the validity of the quality criteria applied to health-related films.

Free volatile compounds in red and purple roselle (Hibiscus sabdariffa) pomace from Indonesia

Manual headspace solid-phase microextraction (HS-SPME) coupled to gas chromatography-mass spectrophotometry (GC-MS) was used for the qualitative analysis of the aromas of several tropical fruits from Indonesia i.e. two different cultivars of roselle pomace (Hibiscus sabdariffa purple and red cultivar. Pomace was used as samples as a part of valorization application of agroindustry by-product. The analytes identified included aroma compounds that can be derived from several aroma precursors. A total of 16 major volatile compounds were identified from purple roselle pomace, whereas 11 major volatile compounds were identified from red roselle pomace using HS-SPME. The major free volatile compounds were dominantly derived from fatty acid compounds. PCA analysis showed the difference in the aroma profile of two different cultivars of pomace based on the cultivar. PC1 can differentiate 86.4% between two roselle pomace cultivar whereas PC2 can differentiate 9.4% between two roselle pomace cultivar. This study also provides the map for free volatile compounds of pomace in two different roselle cultivars.

Impact of a training course on the quality of chest radiography to diagnose pulmonary tuberculosis

SETTING

Socio-economically underprivileged urban areas in the Philippines.

OBJECTIVE

To assess the performance of radiological technicians (RTs) 3 years after their participation in a training course to improve the quality of chest X-ray (CXR) and to test a monitoring visit after the course.

DESIGN

A cross-sectional and observational study including on-site monitoring of X-ray facilities in Manila and Quezon City and assessment of CXR films taken by 23 RTs who previously attended a training course in 2009 or 2010. The sum of the assessment scores for each of six assessment factors at four points, i.e., before and after the training course that had been previously analysed, and before and after the monitoring visits that were currently analysed, were compared.

RESULTS

Two assessment sum scores, identification mark or patient positioning, did not show significant differences. However, assessment of density, contrast, sharpness and artefact significantly improved after the training course, and before and after the monitoring visit, compared with before the training. There were no significant differences in any of the assessment factors before and after the monitoring visits.

CONCLUSION

The training course appears to have had a long-term effect on maintaining CXR quality. The post-training monitoring visit did not significantly improve CXR quality.

348 ANTI-MÜLLERIAN HORMONE AND SUPEROVULATORY RESPONSE IN DONOR COWS MANAGED IN 2 SEMIARID ENVIRONMENTS IN NORTHWEST MEXICO

An embryo transfer program in cows relies on the superovulatory (SPO) response after receiving a hormonal treatment. Anti-Müllerian hormone (AMH) has been proposed as an endocrine marker associated to superovulation; however, the SPO response of donors has also been influenced by the environment. Thus, objective herein was to evaluate effects of serum AMH levels on number of ovarian follicles (NOF), corpora lutea (CL), and transferable embryos (TE) in superovulated donor cows managed under summer or winter conditions in northwest Mexico. Fifty-two cows in a random stage of the oestrous cycle were used in this study. All cows received an Eazi-Breed CIDR cattle insert (1.384 g of progesterone; Zoetis, USA), and 2.76 mg of oestradiol benzoate (Sigma-Aldrich, St. Louis, MO, USA) plus 50 mg of progesterone (Vetoquinol, Canada) given i.m. to synchronize follicular wave emergence (Day 0). The SPO treatment started on Day 4 with decreasing doses (120, 80, 40, and 20 mg) of Folltropin-V (Vetoquinol, Canada) injected twice daily until Day 7. Artificial insemination was performed on days 8 p.m. and 9 a.m. and ova/embryos were collected on Day 15. Transrectal ultrasonography was done on Days 8 and 15 to determine the number of follicles >9 mm in diameter on Day 8 and CL on Day 15, respectively. Blood samples were collected on the first day of SPO treatment (Day 4) to measure serum AMH concentrations, which served to classify cows as high- (>400; n = 29) and normal-AMH donors (100–400 pg mL–1; n = 23). A mixed effects model was used to analyse SPO response in cattle including level of AMH and season as fixed effects, age as covariate, and sire as random. Level of AMH, season, and their interaction resulted as significant (P < 0.05) sources of variation. Pearson correlations were determined between serum AMH concentrations and SPO response for summer and winter. Average serum levels of AMH were 471.5 ± 70.4 and 1194.2 ± 57.3 pg mL–1 during summer and winter, respectively. The SPO response differed in high- and normal-AMH donor cows (P < 0.05). Mean (± s.e.m.) NOF, CL, and TE were 19.8 ± 1.0, 12.8 ± 0.6, and 7.3 ± 0.5 for high-AMH donors, and 10.9 ± 1.6, 6.5 ± 1.9, and 3.8 ± 1.1 for normal-AMH donor cows, respectively. Environment of donor cows also influenced SPO response as NOF, CL, and TE increased 42, 50, and 45%, respectively, during winter compared with summer (P < 0.05). Correlations among NOF, CL, and TE with serum AMH levels were moderate for donor cows managed during winter (0.657, 0.523, and 0.431, respectively; P < 0.01), and low in cows managed during summer (0.309, 0.195, and 0.085, respectively; P > 0.05). Results from this study indicated that SPO response in donor cows is associated with serum concentrations of AMH; however, the relationship among these variables appears to be affected in the summer when drought and severe heat stress are common. We concluded that under winter conditions of northwest Mexico, the serum levels of AMH should be considered as an endocrine marker associated with ovarian traits indicative of the SPO response in donor cows.

Fabry disease in Argentina: an evaluation of patients enrolled in the Fabry Registry

AIMS

Fabry disease (FD) is an X-linked inborn error of metabolism caused by alpha-galactosidase A deficiency. The Fabry Registry is an ongoing, global observational database that compiles clinical data from patients with FD.

METHODS

Demographic and baseline clinical characteristics of Fabry Registry patients enrolled in Argentina were analysed and compared with patients enrolled in the rest of the world (ROW). Baseline clinical parameters included chronic kidney disease (CKD) stage, urine protein-to-creatinine ratio and left ventricular posterior wall thickness. Only data from untreated patients were included.

RESULTS

As of 1 October 2010, 3752 patients were enrolled in the Registry, 70 patients from Argentina and 3682 from the ROW. Argentinean male subjects were younger than Fabry Registry male subjects enrolled in ROW: mean current age 32.5 years vs. 39.0 years for men (p = 0.0257 by t-test). The current age (mean ± standard deviation) of female subjects enrolled in Argentina was not significantly different from that of female subjects enrolled in the ROW: 40.1 ± 17.28 vs. 43.2 ±17.95 years respectively (p = 0.2967). Overall, a smaller percentage of patients from Argentina received ERT compared with patients in the ROW (54% vs. 58% respectively). When evaluated by gender, more men and fewer women in Argentina received ERT compared with ROW (85% vs. 79% for men and 27% vs. 38% for women). A larger proportion of patients in ROW had severe CKD (stage 4 or 5) compared with Argentina (9.8% vs. 0%), most likely because of the older age of the ROW population.

CONCLUSIONS

The enrolment of Argentinean patients into the Fabry Registry has steadily increased, as has the inclusion of female and paediatric patients with FD. The medical community in Argentina should be aware of FD in these populations, as awareness will facilitate prompt diagnosis and initiation of treatment, thus leading to improved outcomes.

Drugs for pH control in upper gastrointestinal bleeding

A few years ago, patients with bleeding peptic ulcers were referred to the surgeon if the bleeding did not stop. Today we have two promising new approaches to prevent emergency surgery. One is endoscopic intervention, the other is the pharmacological approach of blocking the proton pump. The endoscopical techniques of adrenaline injection fibrin-'glue' injection, polidocanol injection and heat coagulation can stop active bleeding in over 90% of cases. Pharmacologically, proton pump inhibitors can quickly achieve the optimal pH condition for support of the physiological cascade of haemostasis. The aim is to keep the intragastric pH above 6.0 for a few days. For the first time this aim can be achieved quickly and reliably by infusion of proton pump inhibitors. The optimal form of application is continuous infusion. Repeated bolus injections do not give optimal results. The optimal dosing was found to be the continuous infusion of 8 mg/h omeprazole or pantoprazole after an initial loading dose of 40-80 mg.

Differences in oxidation kinetics between conjugated and non-conjugated methyl linoleate

The oxidation kinetics of conjugated methyl linoleate was compared with that of non-conjugated methyl linoleate under mild oxidation conditions (30 degrees C in the dark). Samples of methyl 9-cis,11-trans-linoleate, methyl 10-trans,12-cis linoleate and methyl 9-cis,12-cis linoleate were assayed separately and in mixtures. For comparative purposes, methyl alpha-linolenate and methyl oleate were also used. Two complementary analytical approaches were selected to monitor the progress of oxidation, (1) the traditional follow-up of residual substrate by gas liquid chromatography, and (2) an analytical procedure by high-performance size-exclusion chromatography (HPSEC) for direct measurement of the oxidation compounds formed. The HPSEC method enabled us to quantitate oxidized monomers, dimers and polymers concomitantly in a rapid and direct analysis. Results showed that conjugated methyl linoleate samples oxidized later than their non-conjugated counterparts, and showed a very different oxidation pattern. Thus, formation of oxidized monomers was negligible and the first and major compounds formed were polymerization products. Also, under the conditions used, non-conjugated and conjugated methyl linoleate samples in 1:1 mixtures led to decreased oxidation rate of non-conjugated methyl linoleate and increased oxidation rate of conjugated methyl linoleate. This study supports the view that oxidation kinetics of conjugated dienes differ substantially from that of methylene-interrupted dienes.

Validation of a Rapid Milk Fat Separation Method to Determine the Fatty Acid Profile by Gas Chromatography

An improved rapid method for separating lipids from milk to determine the fatty acid composition using 2 centrifugations at room temperature (20 degrees C) was compared with the ISO-IDF reference procedure based on solvent extraction. The new method is useful for research and routine quality control and has a number of advantages over the reference procedure--mainly no solvents are required and it saves time. Applicability of the rapid separation method was confirmed in fats with different physical characteristics from ewe and goat milk samples. Minor differences were found in the proportions of some fatty acids in the reference and centrifugation methods. Milk fat separated by centrifugation at room temperature did not differ in fatty acid composition from milk centrifuged at 4 degrees C.

[A new method for detection and erradication of Helicobacter pylori infection by stool antigens test]

Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests.

[Absence of bleeding recurrence of peptic ulcer after long term follow-up of successful eradication of Helicobacter pylori]

Helicobacter pylori (HP) eradication reduces dramatically the peptic ulcer relapse rate, but information regarding recurrence of peptic ulcer bleeding after eradication is still scanty. Available data show rebleeding rates of 0-3% per year in successfully eradication patients, compared with figures between 12 and 33% among the non eradicated ones. The aim of this study was to determine the rebleeding rate among successfully eradicated patients with a prior history of rebleeding peptic ulcer. 42 patients (34 male, mean age 49, range 18-74) hospitalised for Hp positive bleeding peptic ulcer undergoing conservative treatment, were given as soon as oral route was re-established, a one-week eradication treatment, followed by the same proton pump inhibitor for three or five weeks for duodenal and gastric ulcer healing respectively. No maintenance antiulcer therapy was indicated. Patients were advised not to take nonsteroideal anti-inflammatory drug. Ulcer healing and Hp eradication was confirmed in all 42 patients by means of endoscopy and biopsies for urease rapid test and histology four weeks after completion of the treatment. After this patients were invited to enter a long-term follow-up program with periodical visits. End point of the study was occurrence of rebleeding. Further endoscopies were planned when rebleeding or symptomatic relapse. Median follow-up time was 24.02 months, ranging from 3 up to 27 months. All patients were compliant with the follow-up visits. None of the patients presented with symptoms suggestive of ulcer relapse or upper gastrointestinal bleeding. Our data suggest, that Hp eradication can prevent bleeding relapses in patients with Hp positive bleeding peptic ulcers.

Brief communication: childhood leukemia in a residential small town near Barcelona

Between March 1991 and May 1995, physicians diagnosed four cases of acute lymphoblastic leukemia, one case of Hodgkin's disease, and one case of aplastic anemia among children who resided in a small town near Barcelona that contained 4,237 inhabitants. The four cases of acute lymphoblastic leukemia represented a significant excess of observed cases (26.4/100,000 for children age 0-14 y [p < .005]). The authors conducted an epidemiological study of the population to explore the possible "local" role of agents hypothesized or known to be potentially associated with acute lymphoblastic leukemia, as well as with other hematopoietic diseases. The small town in which the cases lived is a residential area without known or suspected industrial exposures associated with leukemia. However, it is located in a county ("Maresme") that boasts having the most flower-growing and agricultural undercover producing area in Catalonia; consequently, copious amounts of herbicides and pesticides are used. The small number of cases limited the testing of the hypothesis of a causal relationship between environmental pesticide exposure or a viral infection (the only factors common to the cases) and the excess of leukemia cases. Despite the weaknesses inherent in our study, the information gleaned from our research may be useful to researchers who define local health-related problems.

[Vaginal evisceration following radiotherapy and surgery for cervico-uterine cancer. Report of a case]

A 60-year-old woman with past history of perineorrhaphy due to vaginal prolapse; squamous cell carcinoma of the uterine cervix stage IIB, treated with radiation theraphy at doses of 7500 rads administered as teletherapy and brachytherapy with Cesium 137. Ten weeks later a Piver II hysterectomy was performed, her posoperative morbidity was a vaginal abscess. Twelve years later, she developed a pulmonary metastasis. One year thereafter she had vaginal discharge of cetrinous fluid and prolapse of greater omentum through the vagina. She was treated by a midle exploratory celiotomy, primary closure of the vaginal defect and the pelvic floor was covered with an omental pedicle flap. The postoperative period was unremarkable.

[Hematological differences between the effects of roller vs, centrifugal pump]

A secondary complication in the utilization of the CPB (cardiopulmonary bypass) is post-op bleeding due to alterations in the red blood cells and the activation sequences between coagulation, fibrinolysis and complement. We did this study with the objective to evaluate the behavior of the blood cells and coagulation factors using centrifugal pump (n = 12) roller pump (n = 12); we evaluated the consumption of blood products as well as measuring the amount of blood products used. There were no demographic differences between the two groups, the time on CPB was less than 85 minutes, blood flow in the centrifugal pump was maintained at an average of 3.6 l Vs 3.37 l in the roller pump, this being statistically significant. The blood values were compared in each group there were no statistically significant differences, however factor VIII, fibrinogen and platelets presented a tendency (p < 0.05) to be higher in the centrifugal pump group than in the control group (roller pump). Thus 1. In patients in whom we used centrifugal pump there was a tendency for preservation of factor VIII, platelets and fibrinogen. 2. There was no significant difference in the number of blood units transfused between the centrifugal vs roller pump. 3. patients in the centrifugal group were better perfused during CPB.4. 24 hrs. post-op, both groups showed no difference in post-op bleeding.

Optimizing the intragastric pH as a supportive therapy in upper GI bleeding

Acid inhibitory therapy has long been considered of no benefit for upper GI bleeding. The reason was that achlorhydria in the stomach could not be achieved with any single or combination of acid inhibitory drugs. The introduction of proton pump inhibitors has, for the first time, allowed the physician to temporarily achieve achlorhydria by large doses of intravenously applied proton pump inhibitors. The first placebo-controlled clinical trials have shown that, indeed, an intragastric pH of near 7 can significantly improve the clinical outcome of upper GI bleeding. Pharmacokinetic studies with proton pump inhibitors have shown that a bolus of 80 mg pantoprazole or omeprazole followed by immediate continuous infusion of eight mg per hour will result in an intragastric pH of 7 within 20 minutes. This intragastric pH optimizes the different steps of hemostasis in the stomach.

Acute myocardial infarction during pregnancy and puerperium in athletic women. Two case reports

The authors present 2 cases: 1 of a thirty-two-year-old woman and another of a thirty-eight-year-old woman, both Hispanic and athletic, with no identifiable precipitating or coronary risk factors, such as previous heart disease, hypertension, diabetes mellitus, cigarette smoking, hyperlipoproteinemia, oral contraceptive use, coagulation disorders, thyroid disease, collagen tissue disorder, or family history of premature myocardial infarction, who both developed an acute posteroinferior wall myocardial infarction with normal coronary arteries, one during pregnancy, from which normal twin girls were born, and another, during the postpartum period. After reviewing the literature the authors consider the present cases as unique due to the rare association of pregnancy with intrapartum and postpartum acute myocardial infarction with normal coronary arteries in athletic women.

L'utilità del color doppler nella patologia prostatica: Nostra esperienza

The authors report their experience with color Doppler (CD), associated with endorectal US in the study of prostatic diseases. They examined 35 patients with benign prostatic hyperplasia, 27 with prostatitis, 21 with prostatic carcinoma and 5 young healthy volunteers. In the 35 cases of benign prostatic hyperplasia, CD proved to be of limited usefulness, although ruling out concurrent, inflammatory or neoplastic disease. In the 27 cases of prostatitis, CD proved to be particulary useful in acute or chronic recurrent cases. In those cases the method showed marked color increase at the periurethral site or in the area close to the seminal vesicles, also allowing follow-up after therapy. In the 21 patients with prostatic carcinoma, CD allowed the demonstration of 2 tumours that were isoechoic at endorectal US with grey scale. In both cases it was possible to make a “color guided” biopsy.

Perspectives in colorectal cancer

This paper presents an overview of recent developments pertaining to colorectal adenocarcinoma. It is aimed toward the practicing clinician. Topics discussed include epidemiologic observations; genetic predispositions; molecular biology findings; screening and early detection programs; endoscopy; principles of surgical resection; laser and radioimmunoguided surgery; staging; selection of patients for adjuvant chemotherapy; and considerations regarding biologic response modifiers and pain control in the advanced-disease setting.

[Transesophageal echocardiography. General principles and applications]

A new echocardiographic technique is described, which allows cardiovascular ultrasonic exploration by means of a transducer mounted on the distal tip of a gastroscope. The transducer is moved along the esophagus and from time to time into the stomach, which permits real-time visualization of the different cardiac segments and the great arteries. This technique is of special utility in the exploration of posterior structures as are the left atrium and its appendage, the pulmonary veins, etc. The most important views in the transverse plane are described, as well as the technical aspects, the limitations and the possible complications.

[Perioperative management of the diabetic patient in cardiac surgery with extracorporeal circulation]

The hyperglycemia usually observed in patients undergoing heart surgery with extracorporeal circulation (EC) represents a difficult therapeutic problem. We studied the effects of several regimens of insulin therapy on serum glucose (SG) in 24 noninsulin dependent diabetic patients (NIDDs). The patients were randomly divided in five groups; group A received on IV bolus of 10.0-50.0 U/h according to glycosuria; groups B, C, D and E were given a continuous iv insulin infusion of 2.5, 5.0, 7.5 and 10.0 U/h respectively. In 10 non-diabetic patients (NDP) SG levels were also measured, but insulin was not given. A mean of 5.0 l/m2 of body surface of fluids containing 300 g of glucose were administered to all patients during surgery. At the operations SG levels rose progressively soon after the anesthesia was started, reached the highest values during the period of EC, and decreased slowly in blood samples taken after the EC phase and by 24h. This patterns was shown by all groups studied statistically significant lower SG levels, however, were observed in patients of group C, whose values were similar to those seen in the NDP group. Groups D and E had slightly higher SG levels than those of group C. An additional NIDDM patient with advanced chronic renal failure (CRF), had a tendency to hypoglycemia even during the EC period in response to relatively low doses of insulin (2.5 U/h), given by a continuous iv infusion and, although the insulin administration was stopped, his SG levels remained well below the mean values of the other patients for the rest of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Trans and postoperative myocardial infarct in heart surgery]

1. A study was made of 34 cases (33%) of myocardial infarction trans and immediately postoperative which occurred in 11,210 surgical interventions with and without extracorporeal circulation. 2. This presents a statistical relation of the frequency of myocardial infarction in realtion to the heart disease acquired with or without extracorporeal circulation with the mitral, aortic, and double prosthesis of the mitral and aortic valves. A correlation was also made with the ischemic heart disease subjected to revascularization. The same analysis was carried out in the congenital heart disease with or without extracorporeal circulation. 3. In all cases the antecedents, precipitating factors, and the clinical picture were studied and in 12 cases the necropsy was analized. The principal finding was transmural myocardial infarction with electrocardiographic proof and serial enzymes. 4. The group was divided into two sub-groups; Group "A" with acute myocardial infarction transoperative, and Group "B" with acute myocardial infarction in the first eight postoperative days. The electrical and mechanical complications were analized. 5. A correlation was made of the causes of mortality related to the type of congenital or acquired heart disease with or without extracorporeal circulation. 6. The frequency of this entity was studied with the total time of aortic clamping, and the complications such as the low cardiac output syndrome, rupture of the wall, aneurysms, acute pulmonary edema, and with the disturbances of rhythm and conduction. 7. The presence of 33.3% of normal coronaries in these of necropsy was emphasized. 8. The importance of the coronary profile of this group in relation to the consequences of a stress from anesthesia, surgery, extracorporeal circulation, and aortic clamping is mentioned. 9. The diagnostic parameters such as arterial hypotension with or without the low cardiac output syndrome, enzyme levels, and the action of the potassium ion are mentioned. 10. An analysis is made of the possible etiological factors of the precipitation of the myocardial necrosis in the cases with normal coronaries and those in which there was no important obstruction of the coronary macrocirculation. 11. In the subgroup "A" it was found that the frequency of myocardial infarction was less than in the subgroup "B", but there was greater mortality in group "A". The possible causal factors are analized.