Neuroimaging and Biosample Collection in the Toronto Adolescent and Youth Cohort Study: Rationale, Methods, and Early Data

BACKGROUND

The Toronto Adolescent and Youth (TAY) Cohort Study will characterize the neurobiological trajectories of psychosis spectrum symptoms, functioning, and suicidality (i.e., suicidal thoughts and behaviors) in youth seeking mental health care. Here, we present the neuroimaging and biosample component of the protocol. We also present feasibility and quality control metrics for the baseline sample collected thus far.

METHODS

The current study includes youths (ages 11-24 years) who were referred to child and youth mental health services within a large tertiary care center in Toronto, Ontario, Canada, with target recruitment of 1500 participants. Participants were offered the opportunity to provide any or all of the following: 1) 1-hour magnetic resonance imaging (MRI) scan (electroencephalography if ineligible for or declined MRI), 2) blood sample for genomic and proteomic data (or saliva if blood collection was declined or not feasible) and urine sample, and 3) heart rate recording to assess respiratory sinus arrhythmia.

RESULTS

Of the first 417 participants who consented to participate between May 4, 2021, and February 2, 2023, 412 agreed to participate in the imaging and biosample protocol. Of these, 334 completed imaging, 341 provided a biosample, 338 completed respiratory sinus arrhythmia, and 316 completed all 3. Following quality control, data usability was high (MRI: T1-weighted 99%, diffusion-weighted imaging 99%, arterial spin labeling 90%, resting-state functional MRI 95%, task functional MRI 90%; electroencephalography: 83%; respiratory sinus arrhythmia: 99%).

CONCLUSIONS

The high consent rates, good completion rates, and high data usability reported here demonstrate the feasibility of collecting and using brain imaging and biosamples in a large clinical cohort of youths seeking mental health care.

Systematic review of mitochondrial genetic variation in attention-deficit/hyperactivity disorder

The global prevalence of attention-deficit/hyperactivity disorder (ADHD) is estimated to be between 6% and 7% in children worldwide. The pathophysiology of this heterogeneous neurodevelopmental disorder remains unknown. Mitochondrial dysfunction has been proposed as a possible contributing factor to the etiology of ADHD. There is limited literature available to help our understanding of this hypothesis, and thus we conducted a systematic review of the number and quality of studies pertaining to mitochondrial genetic alterations in ADHD. A systematic search was conducted in the relevant databases Medline (PubMed) and Embase up to March 2021. Inclusion criteria included randomized control trials, cross-sectional studies, and case-control studies. This search resulted in a total of 507 articles that emerged from the search criteria. Of these results, 10 primary research articles were selected for in depth review based on the inclusion and exclusion criteria. These studies all reported on mitochondrial genetic variation in ADHD cases such as increased copy number, single-nucleotide polymorphisms, and haplogroup associations. This initial review of the experimental literature suggests mitochondrial genetic variation, in both the mitochondrial DNA and nuclear-encoded mitochondrial genes, may indeed contribute to ADHD pathophysiology. The studies reviewed here provide promising evidence for future research to further examine the mitochondrial genetics contributing to ADHD pathophysiology. We suggest that expansion of investigations into mitochondrial mechanisms may have potential to inform new treatment options for ADHD.

AB1543-HPR WAITING ROOM PROJECT: IMPROVING HEALTHCARE OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background

Systemic lupus erythematosus (SLE) prognosis is determined by a wide range of factors, such as the severity of the disease manifestations, the psychosocial aspects of patients, the proper management of comorbidities, adoption of a healthy lifestyle and adherence to treatment. Studies on chronic diseases highlight the value of patient education to foster treatment adherence and improve prognosis.

Objectives

To promote health education to SLE patients and their families providing accessible and comprehensive scientific information, in order to improve adherence to treatment and the patient’s prognosis.

Methods

The Waiting Room Project is linked to the Extension Health Care Program for SLE patients and their families of Universidade Federal de Minas Gerais, Brazil, since 2011. A total of 700 patients under SLE treatment at the Rheumatology Unit of the University Hospital are involved. Medical students and rheumatology fellows, altogether, developed high-quality informative texts, with clear content and layman language appropriate for the patient, under the supervision of the rheumatology professors. The texts are illustrated by the team of the Communication Department of the Medical School and medical students, and are printed in a leaflet format. The material is handed out to the patients, while they wait for their medical appointment, by the students and the care team. The content of the leaflets is discussed, making sure that all the concerns and doubts are properly addressed

Results

The Waiting Room Project has produced 17 leaflets, addressing different aspects of SLE, comorbidities, and treatment. The texts approach the traditional cardiovascular risk factors (Smoking, Arterial Hypertension, Diabetes, Obesity, Physical Activity), and some medical conditions related to general health and SLE treatment (Sun Protection, Healthy Food, Oral Care, Vaccination, Pregnancy, Osteoporosis). In 2020 and 2021, two leaflets about Covid-19 were produced in order to clarify important aspects of this disease, its impact on lupus patients and to solve questions about SLE medications: one regarding the association between Lupus and Covid-19 and another about the treatment of lupus and Covid-19. Other four leaflets were produced concerning SLE treatment, including Adherence to Treatment, the use of Antimalarials, Corticosteroids, and Immunosuppressants. Information about the drugs, general importance on lupus treatment, recommendations and possible adverse events were described. Futhermore, additional content is currently in production with themes such as Intravenous Corticosteroid and Cyclophosphamide, Human Papillomavirus Infection, Malignant Neoplasm, and specific cancers frequently affecting women, such as Colorectal Cancer, Cervical Cancer, and Breast Cancer. The leaflets are also available online on the Medical School website in Portuguese and in English (medicina.ufmg.br/alo/material-didatico/), on the Minas Gerais Rheumatology Society website (reumatologia.org.br/orientacoes-ao-paciente/), and on the Instagram page @lupusufmg

Conclusion

The leaflets have been an important source of information and health education for SLE patients and their families, improving student/physician-patient communication. Despite the adversities caused by the coronavirus pandemic, the Waiting Room Project has kept its purpose to make each patient with SLE an agent of their healthcare. Improving the patients’ access to evidence-based information must be a goal of healthcare professionals that treat patients with SLE

References

[1]Koehn CL, Esdaile JM. Patient education and self-management of musculoskeletal diseases. Best Pract Res Clin Rheumatol. 2008; 22: 395-405.

[2]Navarra SV, Zamora LD, Collante MaTM. Lupus education for physicians and patients in a resource-limited setting. Clinical Rheumatol. 2019; 39:697–702.

[3]Zhang L, Luan W, Geng S, et al. Lack of patient education is risk factor of disease flare in patients with systemic lupus erythematosus in China. BMC Health Serv Res. 2019; 19: 378.

Disclosure of Interests

None declared

Examining the role of mitochondrial genetic variation in nicotine dependence

Nicotine dependence (ND) has a heritability rate of ∼50%, suggesting genetic factors contribute to underlying mechanisms. Here, we aimed to examine variants within both mtDNA and the nuclear genome to determine if mitochondrial genes are associated with ND. A total of 129 mtDNA SNPs and 1136 nuclear-encoded mitochondrial genes in a sample of N = 374 Caucasians were selected for analysis. Age of onset of first, occasional, and daily smoking and Fagerström Test for Nicotine Dependence were used as outcomes for the analysis. Linear regression was used to test common variants. Gene analyses were performed using MAGMA. One nuclear mitochondrial SNP, rs78417112 found in the HSD17B4 gene, was significantly associated with the age of onset of occasional smoking. Additionally, one nuclear mitochondrial gene, PRKACA, was significantly associated with age of onset of both first and occasional smoking. Replication testing of the mtDNA m.1700T>C SNP, nominally associated with age of onset of daily smoking, was available in the PNAT2 clinical trial (N = 930 Caucasians). A meta-analysis showed this SNP was associated with age of onset of daily smoking (p-value = 0.004). Overall, the findings suggest mitochondrial genetic variation may contribute to variability in smoking phenotypes, although replication in larger samples is required.

MON-403 Osteoporosis: A Frequently Neglected Consequence of Cushing's Disease

INTRODUCTION: Osteoporosis is often associated with states of hypercortisolism such as Cushing’s Disease (CD). It occurs through different mechanisms: decreased intestinal calcium absorption, bone formation and renal calcium reabsorption and increased bone resorption. Our aim is to emphasize osteoporosis as a serious complication of CD and the need to screen all patients with hypercortisolism. CASE REPORT: Fifty three years old man, referred to the endocrinology department for follow up after gastric bypass performed one year earlier. He had history of gastric banding with weight regain. No Endocrine cause for obesity, prior to both surgical procedures, was evaluated. The patient complained of bone pain with gait and other activities limitation. At physical examination, he presented several signs suggestive of CD: facial plethora, centripetal obesity, vinous striae, acanthosis nigricans and proximal myopathy. 24-hour urine cortisol was elevated (> 600ug / 24h). Confirmatory tests were also suggestive of the diagnosis of CD (Liddle test with cortisol of 20 ug/dl), and Magnetic Resonance demonstrated the presence of a pituitary macroadenoma with 9.6x22.3mm. The patient performed osteodensitometry of the lumbar spine and femur which showed a T-score of -3.4, compatible with osteoporosis, and a CT scan that revealed "bilateral fractures of practically all costal arches". Pharmacological treatment for osteoporosis was initiated and the patient underwent transphenoidal surgery without complete removal of the lesion. CONCLUSION: The contribution of bariatric surgery in the treatment of obesity is undeniable. The present case illustrates the importance of an appropriate endocrine evaluation of all patients enrolled for this procedures and emphasizes the need for timely diagnosis of osteoporosis in patients with hypercortisolism, in order to prevent its potentially incapacitating and irreversible consequences.

MON-417 Is There a Cut-Off of Ki-67 Indicative of Pituitary Carcinoma?

Introduction: Carcinomas represent a small percentage (0.1-0.2%) of all pituitary tumours. Several histological, immunocytochemical and ultrastructural characteristics are currently used to classify these tumors. Proliferation and invasion were proposed as prognostic markers. A Ki‐67 proliferation index of ≥3%, as well as strong and diffuse immunopositivity to p53 and invasion of surrounding structures are associated with aggressive clinical behaviour, although no clear morphological difference or specific biomarkers can conclusively differentiate adenomas from pituitary carcinomas. Case: 68 years-old man presented to our department with diplopia, palpebral ptosis, decreased visual acuity, increased weight and easy bruising. On physical exam he presented anisocoria L>R, mild left ptosis and hyperpigmentation. MRI revealed a macroadenoma invading the left cavernous sinus and with posterior growth. The patient underwent transphenoidal surgery resection and the biopsy showed a Ki-67 index of 25%, marked p53 positivity and high mitotic activity. After radiosurgery he was treated with 17 cycles of temozolamide without significant clinical response, then treatment with ketoconazole was initiated and later, in association, pasireotide. The patient developed hepatic dysfunction, with midnight serum cortisol of 73.1 μg/dL (n 1.7-8.9 μg/dL), midnight salivary cortisol of 4910 μg/dL (n <0.320), morning cortisol 69.9 μg/dL (n 6.2-19,4 μg/dL) and ACTH 290.5 ng/L (n <63.3ng/L). Sodium and potassium levels remained within the normal range. An abdominal CT scan showed a hypodense hepatic lesion, with a hypercaptive ring measuring 25 mm and a nodule in the lower lobe of the right lung, suggestive of metastatic lesions. An octreoscan was performed but did not reveal any pathological uptake. The patient underwent liver biopsy which revealed hepatic involvement by a carcinoma with ACTH expression, compatible with pituitary metastasis. Meanwhile metyrapone was initiated with clinical and analytical improvement. Conclusion: The invasive behaviour, a Ki-67 ≥ 10%, strong p53 immunopositivity and high mitotic activity have been proposed as strong predictors of pituitary carcinoma. New data is needed and future research should focus on early identification of this type of tumours in order to improve treatment and prognosis of these patients.

Ivermectin does not interfere with seminal and hormonal parameters in male rabbits

Ivermectin (IVM) is a macrocyclic lactone used as a broad spectrum antiparasitic agent against nematodes and arthropods. It is mainly used in the control of parasitic infections of domestic animals, and recently has been used in humans to treat onchocerciasis, scabies, and pediculosis. In mammals, evidence has indicated that macrocyclic lactones interact with gamma-aminobutyric acid (GABA)-mediated chloride channels. The GABAergic system is known to be involved in the manifestation of sexual behavior, and previous studies have shown that IVM impaired sexual behavior in both male and female rats. Thus, considering that IVM may interfere with the sexual sphere, this study evaluated the temporal (1 up 60 days) effects of exposure to IVM (0.2 and 1.0 mg/kg, administered subcutaneously) on seminal and hormonal parameters of male rabbits. In male rabbits, the spermatozoa concentration, motility and morphology, the integrity of the plasmatic, acrosomal and mitochondrial membranes of the spermatozoa, the organ weights, gonadosomatic index, serum testosterone concentrations, histopathological findings were evaluated and hematological and serum biochemical analysis was conducted. No changes were observed in male seminal parameters evaluated by spermatozoa concentration, motility, and morphology, nor the potential for fertilization evaluated by the integrity of the plasmatic, acrosomal, and mitochondrial membranes of the spermatozoa; there was also no interference in serum testosterone concentration, serum biochemistry and hematological parameters. The findings of this study using the artificial vagina for collection of semen and computer-assisted semen analysis showed that IVM at doses of 0.2 and 1.0 mg/kg of SC did not alter any of the semen parameters of rabbits evaluated for up to 60 days after administration.

Aviation mental disorders – An in-flight case of mania

Introduction

Due to recent aviation accidents, like German Wings flight 9525, aviation related mental health disorders have recently received much attention. Several psychological disorders have been associated with aviation ever since its beginning, both in passengers and aviation professionals. A clinical case is revised of a 33 years old air hostess, without previous psychiatric history, who was admitted twice in a manic state, and a third time abroad in Nice, France, after prolonged sleep privation due to consecutive transatlantic flights.

Objectives

Scientific revision of psychological disorders in passengers (flight related psychological stress, flight phobia, post-traumatic stress disorders after plane crashes…), aviation professionals (mood changes, sexual function disorders, jet lag, sleep disorders), ground staff, and populations living within close distance to airports (burnout, circadian rhythms disorders due to high noise levels…).

Methods

Research in Pubmed, Medscape, scientific literature and other publications, with the following research terms: aviation related mental health disorders, flight related psychological disorders, flight phobia, aerophobia, aviophobia, flight related anxiety, flight related mood disorders, flight induced mania, psychological stress and air travel; articles in English, Portuguese and Spanish.

Results

Fifty-eight articles, one book and four publications were considered relevant; the case of the patient is thoroughly described with data retrieved from the clinical file.

Conclusions

Several important issues concerning both mental and physical health are highlighted by this clinical case, yet, surprisingly, scientific knowledge has progressed at a rather slow pace and mental health professionals have not given much attention to this issue.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Gossypol was not detected in the longissimus muscle of lambs fed several forms of cottonseed

The aim of this work was to evaluate the growth performance, carcass characteristics, 12th rib tissue composition, haematological and serum biochemical parameters, as well as the presence of gossypol residues in the meat of Santa Inês lambs fed cotton crop by-products. For an experimental period of 90 days, 24 intact male Santa Inês lambs (bodyweight (BW): 20.6 ± 1.9 kg; 4 months old) were fed a 50 : 50 forage : concentrate diets fed ad libitum. Chopped Coast cross (Cynodon dactylon (L.) Pers) hay was used as forage. The animals were then allocated into four treatments, according to the cotton crop by-product included in the concentrate formulation: Control (CON) – No cotton crop by-product used in formulation; Whole cottonseed (WCS); Cottonseed cake (CSC); and Cottonseed meal (CSM). The animals were weighed and blood collected every 15 days. At the end of the experimental period, the lambs were slaughtered and the evaluations of carcass characteristics, 12th rib tissue composition and presence of gossypol residues in the meat were carried out. Dry matter intake was higher (P < 0.05) for the diets containing cotton crop by-products, but BW gains were not different (P > 0.05). Despite these results the animals fed the highest level of gossypol (WCS) had lower (P < 0.05) carcass yield resulting in lower (P < 0.05) carcass weight, suggesting a possible negative effect of gossypol on carcass development. Serum urea was elevated on all treatments including CON, otherwise haematological and biochemical parameters were within reference ranges. No gossypol residues in meat were detected by the method used here, which had a minimum detection limit of 20 ppb. It is concluded that the cotton crop by-products may have impaired carcass production but did not leave gossypol residues in lamb meat.

Unveiling the effects of the secretome of mesenchymal progenitors from the umbilical cord in different neuronal cell populations

It has been previously shown that the secretome of Human Umbilical Cord Perivascular Cells (HUCPVCs), known for their mesenchymal like stem cell character, is able to increase the metabolic viability and hippocampal neuronal cell densities. However, due to the different micro-environments of the distinct brain regions it is important to study if neurons isolated from different areas have similar, or opposite, reactions when in the presence of HUCPVCs secretome (in the form of conditioned media-CM). In this work we: 1) studied how cortical and cerebellar neuronal primary cultures behaved when incubated with HUCPVCs CM and 2) characterized the differences between CM collected at two different conditioning time points. Primary cultures of cerebellar and cortical neurons were incubated with HUCPVCs CM (obtained 24 and 96 h after three days of culturing). HUCPVCs CM had a higher impact on the metabolic viability and proliferation of cortical cultures, than the cerebellar ones. Regarding neuronal cell densities it was observed that with 24 h CM condition there were higher number MAP-2 positive cells, a marker for fully differentiated neurons; this was, once again, more evident in cortical cultures. In an attempt to characterize the differences between the two conditioning time points a proteomics approach was followed, based on 2D Gel analysis followed by the identification of selected spots by tandem mass spectrometry. Results revealed important differences in proteins that have been previously related with phenomena such as neurl cell viability, proliferation and differentiation, namely 14-3-3, UCHL1, hsp70 and peroxiredoxin-6. In summary, we demonstrated differences on how neurons isolated from different brain regions react to HUCPVCs secretome and we have identified different proteins (14-3-3 and hsp70) in HUCPVCs CM that may explain the above-referred results.

Crystal violet staining to quantify Candida adhesion to epithelial cells

In vitro studies of adhesion capability are essential to characterise the virulence of Candida species. However, the assessment of adhesion by traditional methods is time-consuming. The aim of the present study is the development of a simple methodology using crystal violet staining to quantify in vitro adhesion of different Candida species to epithelial cells. The experiments are performed using Candida albicans (ATCC 90028), C. glabrata (ATCC 2001), C. parapsilosis (ATCC 22019) and C. tropicalis (ATCC 750). A human urinary bladder epithelial cell line (TCC-SUP) is used. Yeast and epithelial cells were stained with crystal violet, epithelial cells were then destained using intermediate washing, and the dye in the yeast cells was extracted with acetic acid. The method was validated for the different Candida reference species by comparison with traditional microscope observation and enumeration. The method was then used to assess Candida adhesion to epithelial cells and also to silicone. For all Candida spp. high correlation values (r2= 0.9724-0.9997) between the number of adherent yeasts (microscope enumeration) and absorbance values were obtained for an inoculum concentration >10(6) cells/mL. The proposed technique was easy to perform and reproducible, enabling the determination of adhesion ability of Candida species to an epithelial cell line.

Antibiotic use and knowledge in the community in Kalamoon, Syrian Arab Republic: a cross-sectional study

Antibiotic misuse contributes to the growing problem of microbial resistance. To understand the current knowledge and practices regarding antibiotic use among Syrians, we conducted a cross-sectional study of 430 randomly selected adult residents of Kalamoon in the Syrian Arab Republic using a questionnaire. A high proportion (85%) had taken antibiotics in the past 4 weeks and 34% were not aware of the dangers of antibiotics. Of 365 participants, only 43% were prescribed the antibiotic by a physician to treat the condition, while 57% used an old prescription or took someone else's advice. Males, younger individuals, and those with low and medium income and lower educational status showed poorer practice and lower knowledge towards antibiotics. Educational efforts are needed to reduce patient demand for antibiotics.

A longitudinal investigation of psychological morbidity in patients with ovarian cancer

Ovarian cancer patients may experience psychological disorders due to the aggressive nature of the illness and treatment. We investigated the presence of psychological disorders longitudinally in women with a new diagnosis of ovarian cancer and the factors that predicted development and maintenance of these disorders. Patients were assessed in a prospective longitudinal study at the beginning of chemotherapy treatment, mid-treatment, end of treatment and 3 months follow-up for depression, anxiety, perceived social support, neuroticism and cognitive strategies to control unwanted thoughts. A total of 121 patients were recruited and 85 patients were assessed at all four time points. Three different longitudinal profiles of anxiety and depression caseness were found: non-cases (never cases), occasional cases (cases on at least one but not all four occasions) and stable cases (cases on all four occasions). Most of the women were occasional cases of anxiety (52%, 44), whereas for depression, the majority of women were non-cases (55%, 47). A subset of patients were stable cases of anxiety (22%, 19). Neuroticism and marital status were significant independent predictors of anxiety caseness profile. Neuroticism and use of anti-depressants were independent predictors of depression caseness profile. Social support was not related to psychological morbidity.

Effect of stimulation of sublobule IX-b of the cerebellar vermis on cardiac function

Activation of sublobule IX-b of the cerebellar vermis evokes hypotension, bradycardia and decrease of the phrenic nerve activity in the anesthetized animal. Cardiac performance during the isovolumic phases of systole and relaxation can be evaluated by dP/dtmax, Vpm, dP/dt/DP40 and tau, respectively. In the present study, we evaluated the changes on cardiac function evoked by the stimulation of sublobule IX-b. New Zealand white rabbits were anesthetized, paralyzed and artificially ventilated. A posterior craniotomy was made to reveal and stimulate the cerebellar uvula (4 s train; 50 Hz; 1 ms; 20 microA). The femoral artery and veins were cannulated and a Swan-Ganz catheter was advanced in the upper abdominal aorta to control afterload when inflating the balloon. The left ventricle was catheterized with a Millar catheter. Blood pressure, heart rate, left ventricular pressure were monitored. Results showed a significant decrease on sublobule IX-b stimulation of all the indices of systolic function and an increase of tau indicating a decrease in the speed of the relaxation. These data provide the first evidence of the influence of sublobule IX-b on cardiac function. They may contribute to the understanding of the origin the cardiovascular changes that were observed in two patients with vermian and paravermian hemorrhage.

Comparison of the efficacy and tolerability of solifenacin succinate with or without previous use of trospium chloride

Overactive bladder syndrome (OBS) is described as urinary urgency with or without incontinence, usually with increased daytime frequency and nocturia in the absence of another identifiable pathological process. Nowadays and despite other alternative therapies, the mainstay of OBS is still the pharmacological approach, mainly with anti-muscarinic drugs. To compare the efficacy of a 30-day solifenacin succinate (5 mg OD) treatment with or without previous medication with trospium chloride, a prostective open, two-arm, parallel group study was conducted for 5 weeks in 40 patients with OBS. The primary endpoint was patient self-assessment of improvement after 30 days of medication. Secondary endpoints included the reduction of the daily number of voids and urgency or involuntary leakage episodes. Adverse reactions and therapeutic stoppage were also evaluated. To be included in the trospium chloride treatment group, patients were required to have been treated with such drug for 1 to 6 months before the present study. Evaluation and efficacy assessment were accomplished using a 3-day bladder diary and an urgency severity scale (USS). Safety assessment was done by recording all the patients' complaints after starting medication. A total of 40 patients were enrolled for this study, 19 without previous medication and 21 who had already tried trospium chloride. Two patients from the non-previous medication group were excluded. Globally, there was a statistically significant reduction for the USS (2.73-->1.73), the daily number of voids (9.5-->7.0), of urgency episodes (9.1-->4.0) and of involuntary leakage episodes (3.6-->1.0) over the 24 h. Six patients had no improvement, four from the previous trospium chloride group and two from the non-previous medication group. Three patients reported side effects, two cases of dry mouth and one case of constipation. One patient dropped out of the treatment due to an unspecified intolerance. Solifenacin succinate 5 mg seems to be effective concerning patients' self-assessment of improvement and decrease in the mean number of daily voids, urgency episodes and incontinence episodes. This was reported both in patients who have already been medicated with trospium chloride and those who have never taken any kind of medication. Regarding side effects, solifenacin is quite well-tolerated in both groups.

Novel MLH1 mutations and a novel MSH2 polymorphism identified by SSCP and DHPLC in Portuguese HNPCC families

Mismatch repair genes MSH2 and MLH1 are the two major genes implicated in hereditary nonpolyposis colorectal cancer. For the past years, we have successfully searched for mutations in both genes in affected Portuguese families, by SSCP and DNA sequencing analysis but because of the advantages that DHPLC offers, we have established conditions in our laboratory to use this new method. While screening for mutations by both methods, in 35 individuals belonging to HNPCC Portuguese families, 4 novel MLH1 mutations (c.307-1G>C; c.1023delG [p.R341fsX366]; c.2154_2155delCA [p.H718fsX721], c.2154_2155dupCA [p.I719fsX782]), an unclassified variant (c.-28A>T) and one silent MSH2 polymorphism (c.2766T>C) have been identified.

[Burch colposuspension]

OBJECTIVE

This study was undertaken to evaluate the subjective success rates, and complications, of Burch colposuspension.

DESIGN

A retrospective review.

SAMPLE

Fortynine women undergoing surgery - Burch colposuspension - for genuine stress incontinence, between 1994 and 2000, were reviewed.

METHODS

Choice of surgical procedure was made on the basis of clinical and urodynamic findings and physician preference. The subjective cure rate was determined by means of historical report and defined as no or occasional stress or urge incontinence (< one episode per week). Clinical follow-up started six weeks after the surgical procedure and continued for one to seven years.

RESULTS

Thirty-six (73.5%) of the 49 women submitted to Burch colposuspension were subjectively cured of the stress urinary incontinence and three (6,1%) had improvement with mainly urge incontinence, while ten (19.2%) operations failed (n= 52).

CONCLUSION

Burch colposuspension is an effective and safe procedure for women with urinary stress incontinence (even after retropubic continence surgery).

AIDS does not alter the total number of neurons in the hippocampal formation but induces cell atrophy: a stereological study

Although cognitive dysfunction is a common finding in patients with acquired immunodeficiency syndrome (AIDS) its pathogenesis remains controversial. Given the involvement of the hippocampal formation in the processing of cognitive information and the scarcity of quantitative studies in this brain region, we have examined, using stereological methods, the hippocampal formations of AIDS patients. The study was performed in ten AIDS patients and ten age-matched controls. All cases were male. The Principle of Cavalieri was applied to estimate the volume of the layers of the dentate gyrus and of the CA3 and CA1 hippocampal fields. The fractionator and the nucleator were used as estimators of the total number, and mean somatic and nuclear volumes of the neurons in the cell-containing layers of all hippocampal subdivisions. No cell death was detected in AIDS patients but the global volume of their hippocampal formations was significantly decreased due to the reduced volume of its layers, mainly the cell-containing layers. Furthermore, the somatic and nuclear volumes of the neurons in the hippocampal formation were significantly decreased in AIDS patients. No correlation was found between the estimates obtained and the presence or absence of neurological involvement. Our results show that neurons in the hippocampal formation of AIDS patients display marked morphological changes, despite the maintenance of their total number. These alterations are likely to lead to dysfunction of the hippocampal circuitries and, thus, might contribute to explaining the dementia features which occur in this condition.

[Tubo-ovarian abscess. An analysis of 20 cases]

The authors make a 3-year retrospective analysis of the tubo-ovarian abscess cases admitted to the Gynecology Ward of Dr Alfredo da Costa Maternity Hospital. In the period studied (1991 through 1993) there were 20 such cases. The incidence in nulliparous patients was 25%. A significant percentage (30%) of the patients had recently undergone uterine instrumentation. A prior history of pelvic inflammatory disease was obtained in only 15% of the cases. In the IUD users the incidence of unilateral and bilateral abscesses was identical. Most patients (85%) became apyretic within 48 hours of instituting intravenous antibiotics. In most cases (90%) the patients underwent surgical therapy. The mean time elapsed between instituting antibiotics and the surgical procedure was 3 days. There was one case of intra-abdominal rupture of the abscess. Intraoperatively, an appendiceal abscess was found in 3 (15%) patients. In 30% of the cases a total hysterectomy with unilateral or bilateral adnexectomy was performed. One of the 2 (10%) patients treated solely with medical therapy presented abscess recurrence one month after hospital discharge. Although the management of tubo-ovarian abscesses has become more conservative it still includes, in most cases, surgical drainage or extirpation after appropriate antibiotic therapy.

[Pregnancy in women with neural tube fusion defects. Report of 3 cases with different clinical course]

The advances in surgical technique for closure of myelomeningocele and its complications, mainly neurogenic bladder, have resulted not only in a increased lifespan and a better quality of life for these patients, but also a progressively higher number of women are reaching childbearing age and becoming pregnant. The reports of pregnancy in these women are still sporadic. In spite of that, obstetricians must be aware of this situation in order to manage it accordingly. In the course of these pregnancies major complications seldom occur. However there are problems (high-risk of neural tube defects in the offsprings, urinary tract complications, muscular-skeletal disorders and psychosociological problems) that should not be ignored and that may influence the prognosis of these pregnancies. The authors present three case reports with different outcomes.

Acute tuberculous perforation of the small bowel during antituberculosis therapy

An acute, free perforation of a tuberculous ileal lesion occurred in a 25-year-old man during antituberculous therapy. The increasing incidence of extrapulmonary tuberculosis and the rarity of some of the related symptoms and complications, as presented by this patient, emphasize the importance of an early diagnosis. This case report also points out the importance of obtaining endoscopic biopsy material for bacterial culture, even if an apparently normal mucosa is seen, for the diagnosis of tuberculous intestinal disease.

Coma of vascular aetiology: evaluation and prognosis

The authors have done a revision of 450 patients admitted during the last 3 years to the emergency service of the Hospital de S. José with the diagnosis of CVA. In this retrospective study were included the patients of greater than or equal to 3 degree of the RLS/85 coma scale, the diagnostic being confirmed by CAT, angiography and/or autopsy, and simultaneously evaluated by the Glasgow coma scale. The studied population was grouped into: SAH; ICH with or without ventricular drowning, cerebellar haematoma, brainstem haematoma, ischaemic CVA. The factors of vascular risk: diabetes and hypertension, the age of the patients and coma level were correlated with the degree of cerebral disability of discharge in all patients. The following factors are clearly related with bad prognosis: coma of degree greater than or equal to 4 in the RLS/85 scale; ischaemic aetiology; intraventricular haemorrhage.

Human leptospirosis--a review of 50 cases

Epidemiological and clinical aspects of 50 consecutive patients, 47 adults and three children, hospitalized between 1977 and 1987 for human leptospirosis, were reviewed. 45 (90%) of the patients were from rural regions. 32 (64%) cases occurred in individuals at occupational risk for the infection. 35 (70%) cases were registered in the warm season. The source of infection was known in 34 (68%) cases. Weil's disease was diagnosed in 31 (62%) patients, aseptic meningitis in 12 (24%) and acute unexplained fever in seven (14%). Haemodialysis was required for 11 (35%) patients with Weil's disease. Three (6%) patients died. Cause of death was massive gastrointestinal haemorrhage in two and renal failure in one. Leptospira icterohaemorrhagiae was responsible for 39 (78%) cases, Leptospira canicola for six (12%), Leptospira grippotyphosa for two (4%), and Leptospira australis, Leptospira ballum and Leptospira sejroe, for one case each. A muscle biopsy was performed in six patients and a renal biopsy in three. Focal necrotic muscular changes, with mild mononuclear infiltrate, were found. Pigmented casts in distal convoluted tubules, mild interstitial inflammatory infiltrate and mesangial enlargement of some glomeruli were observed in kidney biopsies. A good knowledge of the protean clinical manifestations of leptospirosis and an accurate laboratory study are required for a correct diagnosis.

Hodgkin's disease with predominant infradiaphragmatic involvement and massive invasion of the bone marrow. A necropsic study of nine cases

The authors report the results obtained in the necropsic study of nine cases of the so-called acute, visceral form of Hodgkin's disease (HD). Most of the patients (six men and three women, ranging from 42 to 74 years of age) lacked peripheral lymphadenopathies and had fever, weight loss, abnormality of hepatic function, and pancytopenia. Mixed cellularity was diagnosed in two, diffuse fibrosis in four, and reticular subtype of lymphocyte depletion in three cases. Despite the predominant infradiaphragmatic involvement, supradiaphragmatic lymph nodes were involved in six and tonsils in three cases. Spleen and bone marrow were involved in eight cases and the liver was involved in seven cases. In four cases there were also lesions in other extralymphoid organs. The involvement of the bone marrow was widespread and showed concurrent myelofibrosis and/or other signs of hematopoietic disturbance. There was a close relationship between the presence of vascular invasion (seven cases) and the extent of HD spread. It is concluded that despite its peculiarity, this form of HD fits the classic model of unicentric origin, lymphogenic contiguous spread, and hematogeneous dissemination, and should not be identified with any particular histologic type of HD.

Cellophane perinephritic hypertension in the dog: some biochemical, hemodynamic and pathological characteristics

Perinephritic hypertension was induced in mongrel dogs by cellophane encapsulation of one kidney and simultaneous contralateral nephrectomy. Systolic blood pressure began to rise before diastolic blood pressure and both reached maximal values 3 weeks after surgery, their levels becoming stable thereafter up to the end of the study (20 weeks). Cardiac contractility, measured by the index dp/dt/P40 (rate of rise of isovolumic left intraventricular pressure at a developed left ventricular pressure of 40 mm Hg) was not altered during the evolution of hypertension; heart weight and left ventricular thickness were increased. Plasma renin activity markedly decreased in the chronic phase and plasma urea and creatinine levels rised initially in a moderate but significant way, thereafter remaining stable. The structure of the wrapped kidney remained normal 20 weeks after surgery, when microscopic arterial lesions were seen in other organs. The comparison of the evolution of this hypertensive model with other more commonly used renal experimental hypertension types allows us to conclude that cellophane perinephritic hypertension in the dog must be considered as an individual entity.

Pathological findings in one of two siblings with Sjögren-Larsson Syndrome

The clinical features of 2 new cases of Sjögren-Larsson syndrome are described. Histopathological examination of the skin in 1 of the cases revealed an ichthyosis vulgaris, which does not agree with the clinical and genetic classification. In the same case, a neuroblastoma was the cause of death, and neuropathological examination showed a symmetrical demyelination of some ascending and descending long tracts in the medulla and spinal cord.

Latent thyroid carcinoma at autopsy: a study from Oporto, Portugal

Thirty-nine (6.5%) latent thyroid carcinomas were found in 600 thyroid glands removed at autopsy in Oporto Medical School Laboratory of Pathology. The prevalence of latent thyroid carcinomas was significantly higher in women (sex ratio 4.3:1) and in elderly people (p less than 0.005) and appeared to be independent from the existence of another malignant neoplasm. The mean thyroid weight and the concurrent thyroid pathology of patients with thyroid carcinomas were not significantly different from those of patients without them. The study of cervical lymph nodes in the first 400 autopsies did not show any significant difference concerning histologic pattern, number of germinal centers and sinus histiocytosis between patients with thyroid carcinomas and those without them. Further investigation is required to evaluate the role of host factors on the peculiar characteristics of latent thyroid carcinomas.

Nucleolar abnormalities in human papillary thyroid carcinomas

The nuclei of 17 occult and common papillary thyroid carcinomas were studied with an electron microscope. In most of the nuclei, numerous clusters of large interchromatin granules were seen. Nucleoli with a microfibrillar cortex and segregation of their components were observed in some tumors. Dense RNA containing microspherules were found in altered nucleoli and in complex nuclear bodies. These ultrastructural features seem to reinforce the advanced involvement of a disturbed RNA metabolism in human papillary thyroid carcinomas.

A morphometric study of nuclei, nucleoli and nuclear bodies in goitres and papillary thyroid carcinomas

Significant positive correlations were found between the nuclear surface-to-volume ratio and the volumetric density of nucleoli, as well as between the volumetric density of nucleoli and the volumetric and numerical densities of complex nuclear bodies in goitres and papillary thyroid carcinomas.

Comparative morphometric study of the cells of the third proximal segment of the rat kidney under different conditions of fixation

The morphometric study of the P3 segment of rat proximal tubule has shown that neither the method of fixation, nor the fixative itself, significantly change the relative and absolute volumes of the cell compartments, provided that the fixation media are made approximately isotonic.