Ancho de distribución plaquetaria como predictor de preeclampsia severa / Platelet distribution width as a marker for the development of severe preeclampsia

Resumen Introducción: La fisiopatología de la preeclampsia no está dilucidada por completo, diferentes índices plaquetarios dentro de los que se incluye el ancho de distribución plaquetaria (ADP) podrían ser utilizado para predecir la severidad en esta condición. Objetivo: Analizar el comportamiento del ADP en el desarrollo de severidad en preeclampsia en mujeres atendidas en la unidad de medicina materno-fetal del Hospital Simón Bolívar de Bogotá, Colombia. Materiales y métodos: Estudio de corte trasversal analítico en 105 pacientes con trastorno hipertensivo asociado al embarazo, preeclampsia y preeclampsia severa. Se analizó el comportamiento del ADP en una población de mujeres hipertensas con preeclampsia mediante una curva de análisis ''Receiver Operating Characteristic'' (ROC) para estimar la sensibilidad, tasa de falsos positivos, razón de probabilidad positiva y negativa de la prueba como marcador de desarrollo de severidad Resultados: El ADP tuvo un ascenso significativo mayor en pacientes donde su progresión de enfermedad desarrollaron características de severidad. En la curva ROC el área bajo la curva para del ADP como predictor de severidad en la preeclampsia fué de 0.68 Conclusión: El ADP es un índice plaquetario que aumentó significativamente en las mujeres con preeclampsia con características de severidad. El ADP podría ser un marcador para la predicción de severidad de la preeclampsia.

Abstract Introduction: The pathophysiology of preeclampsia is not completely elucidated. Different platelet indices, including the platelet distribution width (PDW), could be used to predict the severity of this condition. Objective: To analyze the behavior of PDW in the severity development of preeclampsia in women treated in the maternal-fetal medicine unit of Hospital Simón Bolívar in Bogotá, Colombia. Materials and methods: This is an analytical cross-sectional study in 105 patients with hypertensive disorder associated with pregnancy, preeclampsia and severe preeclampsia. We analyzed the behavior of PDW in a population of hypertensive women with preeclampsia using a curve of analysis '' Receiver Operating Characteristic '' (ROC) to estimate the sensitivity, false positive rate, positive and negative likelihood ratio of the test as a marker of development of severity Results: PDW had a higher significant increase in patients where their disease progression developed severity characteristics. In the ROC curve, the area under the curve for PDW as a predictor of severity in preeclampsia was 0.68. Conclusion: PDW is a platelet index that increased significantly in women with preeclampsia with severity characteristics. PDW could be a marker for the prediction of severity of preeclampsia.

Inclusão de cloreto de amônia na dieta pré-parto de ovelhas leiteiras e sua influência nos metabolismos do cálcio e energético / Inclusion of ammonium chloride in the pre-partum diet in dairy sheep and its influence on calcium and energetic metabolism

Esta pesquisa foi realizada com o objetivo de avaliar o efeito da inclusão de cloreto de amônia na dieta pré-parto de ovelhas leiteiras sobre o pH urinário, cálcio sérico e metabolismo energético dos animais. Foram utilizadas vinte fêmeas ovinas da raça Lacaune, separadas em dois grupos: o Grupo Controle (GC, n=10) que recebeu a dieta pré-parto sem adição de cloreto de amônia e o Grupo Tratado (GT, n=10) que recebeu a dieta pré-parto com a inclusão de 0,4% de cloreto de amônia do total de matéria seca (MS) consumida por animal/dia. As coletas de urina e sangue ocorreram aos 120 (M0), 127 (M1) e 135 (M2) dias de gestação. Foram avaliados o pH urinário e os níveis séricos de cálcio, cetonas, glicose e colesterol. Houve redução no pH urinário no GT nos dias 127 e 135 de gestação. Os valores de cetonas séricas foram inferiores no GT no dia 135 de gestação enquanto que os níveis de cálcio e colesterol foram superiores neste grupo no mesmo momento tempo avaliado. Não houve diferença nos valores de glicose entre os grupos. Desta forma, conclui-se que a inclusão de 0,4% de cloreto de amônia do total de matéria seca consumida por animal/dia na dieta pré-parto de ovelhas leiteiras foi eficiente na manutenção da calcemia neste período e que esta pode estar associada à não redução do status energético em ovelhas gestantes.

This research was done to evaluate the effect of inclusion of ammonium chloride in the pre-partum diet in dairy sheep over the urinary pH and in calcium and energetic metabolism of these animals. Twenty ewe of Lacaune breed were separated into two groups, the Control Group (CG, n = 10) that received pre-partum diet without ammonium chloride and Treated Group (TG, n = 10) that received the diet pre-partum with 0.4% of ammonium chloride in total dry matter (DM) consumed per animal/day. The samples of urine and blood were collected in 120 (M0), 127 (M1) and 135 (M2) days of gestation. The parameters assessed were the urine pH and serum levels of calcium, ketones, glucose and cholesterol. In the urinary pH assay occurred a reduction in the GT on 127 and 135 days of gestation. The values were lower in the serum ketones in GT on 135 of gestation on the day whereas calcium levels and cholesterol levels were higher in this group at the same experimental time. There was no difference in glucose values between groups. Thus, it is concluded that inclusion of 0.4% of ammonium chloride to the total dry matter intake per animal/day in the pre-partum diet of milk sheep was effective in maintaining calcium levels over this period. And yet, this maintenance of calcium levels may be associated with no reduction in energy status in pregnant ewes.

Prepartum administration of recombinant bovine somatotropin (rBST) on adaptation to subclinical ketosis of the ewes and performance of the lambs / Administração pré-parto de somatotropina bovina recombinante (rBST) na adaptação da cetose subclínica de ovelhas e no desempenho dos cordeiros

The aim of this study was to determine the effect of prepartum rbST injection on the metabolic profile of pregnant ewes induced to subclinical ketosis, as well as the metabolism until seven days of life and weight gain until seven weeks of life of the lambs. Twenty seven pregnant ewes of the pantaneiro genetic group were used, divided into two groups: rbST group (n = 14) and control group (n = 13). The rbST group received two applications of 1 mg/kg of rbST, at 97 and 111 days gestation, while the control group received placebo injections. There were significant differences between groups in levels of GGT in the ketosis post induction period and BHB concentrations in the postpartum period. Concentrations of glucose, urea, phosphorus, albumin, cholesterol, AST, NEFA and insulin were not different between dams from the two groups in different periods of the study (P>0.05). There was an effect of rbST on body weight observed already at fourteen days of life (P<0.0001), there was an increase in serum phosphorus levels at birth of lambs (P=0.0014), and albumin at seven days of life (P = 0.0014) of the lambs, with no difference between groups for the other metabolites. Therefore, the use of rbST was effective in increasing the weight of the lambs until the seventh week of life. In addition, rbST treatment had positive effects on the dam metabolism with reduction of liver overload, as indicated by decreased GGT after ketosis induction and decreased BHB at the postpartum period.

O objetivo deste estudo foi determinar o efeito da administração pré-parto de rbST sobre o perfil metabólico de ovelhas induzidas à cetose subclínica, assim como sobre o metabolismo até sete dias de vida e ganho de peso até sete semanas de vida dos cordeiros. Vinte e sete ovelhas prenhas do grupo genético pantaneiro foram divididas em dois grupos: grupo rbST (n = 14) e grupo controle (n = 13). O grupo rbST recebeu duas aplicações de 1mg/kg de rbST, aos 97 e 111 dias de gestação, ao passo que o grupo controle recebeu injeções de placebo. Houve diferenças significativas entre os grupos nos níveis de GGT no período de pós-indução de cetose e concentrações de BHB no período pós-parto. As concentrações de glicose, ureia, fósforo, albumina, colesterol, AST, NEFA e insulina não foram diferentes entre os grupos nos diferentes períodos do estudo (P>0,05). Houve um efeito de rbST no peso corporal dos cordeiros já observado nos 14 dias de vida (P<0,0001), verificou-se um aumento dos níveis séricos de fósforo ao nascimento de cordeiros (P=0,0014) e albumina de sete dias de vida (P=0,0014 ), e não houve diferença entre os grupos para os outros metabólitos. Portanto, a utilização de rbST foi eficaz em aumentar o peso dos cordeiros até a sétima semana de vida. Além disso, a aplicação de rbST teve efeitos positivos no metabolismo com a redução da sobrecarga do fígado, como indicado pela diminuição da GGT após a indução da cetose e diminuição de BHB no período pós-parto.

Prolapso vaginal e uterino em ovelhas / Uterine and vaginal prolapse in ewes

O presente trabalho objetivou realizar um estudo retrospectivo sobre os prolapsos vaginal e uterino em ovelhas atendidas no Serviço de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6%). O prolapso vaginal total foi o de maior frequência (72%). As ovelhas acometidas, em sua maioria, possuíam idade superior a quatro anos (64%), eram sem raça definida (44%) ou da raça Ile de France (40%). As manifestações clínicas observadas durante a maioria dos atendimentos foram: taquipnéia, taquicardia, mucosas oculares avermelhadas indicando estado de toxemia, decúbito esternal ou lateral, apatia e anorexia. O tratamento instituído para todos os casos foi a limpeza, desinfecção e reintrodução do órgão prolapsado. A sutura de Bühner foi feita em 84% dos casos e a histeropexia em um caso (4%). A evolução foi satisfatória em 80% dos casos atendidos, nos demais casos (20%) observou-se óbito da fêmea acometida. Do total de óbitos, os prolapsos vaginais foram responsáveis por 60% (3/5) e os prolapsos uterinos por 40% (2/5). A etiologia dos prolapsos não foi definida nos casos atendidos, sendo esses associados com o período pós-parto em sua maioria (56%), provavelmente associados com quadros de hipocalcemia, altas concentrações séricas de estrógeno e hipertonia uterina. Além disso, a predisposição genética não pode ser descartada.

This study aimed to conduct a retrospective study on vaginal and uterine prolapse in sheep seen at the Clinic and Surgery on Cattle and Small Ruminants (CBPR) at University of São Paulo, from 2000 to 2010. During this period, 56 sheep were treated with problems of the reproductive system. Of these, 25 ewes had vaginal or uterine prolapse (44.6%). The total vaginal prolapse was the most frequently (72%). The majority of sheep that was affected were 4 years old (64%); most were mixed breed (44%) and 40% were Ile de France. Main clinical signs were increased cardiac and respiratory rates, congested ocular mucosa, sternal or lateral recumbence, apathy and anorexia, suggesting toxemia. The treatment of all cases was the cleaning and disinfection of the prolapsed organ and its reintroduction. The Bühner suture was made in 84% of the cases. The uterus fixation was made in one case (4%). Recovered was observed in 80% of the cases and 20% of the patients died. Vaginal prolapse corresponded to 60% of the deaths and uterine prolapse to 40%. The etiology of the prolapses had not been defined, but most cases (56%) occurred during the postpartum period, probably associated with hypocalcaemia, high serum concentrations of estrogen or uterine hypertonia. Furthermore, a genetic predisposition on affected sheep cannot be discharged.

Chronic pyometra due to bilateral ovarian tumors in a South American sea lion / 동물의과학연구지

A 14-year-old female South American sea lion (Otaria byronia) with persistent vaginal secretion and chronic hemorrhagic diarrhea was encountered. During postmortem examination, the uterus was found to resemble a balloon with mucosal congestion and was filled with grayish milky material. The ovaries also had abnormal features, including necrotic surface lesions and multiple whitish foci in the cut section. Hemorrhages and ulcerated changes due to toxemia were observed in other organs, including the liver, spleen, lung, intestines, and lymph nodes. Microscopically, the left ovary contained interlacing fascicles of fibroblast-like cells with blunt-end nuclei showing cytoplasmic positive immunoreactivity against alpha-smooth muscle actin and desmin. The right ovary contained cells with round to cigar-shaped nuclei showing cytoplasmic positive immunoreactivity against vimentin. In conclusion, based on classification of bilateral ovarian tumors as a leiomyoma in the left region and a fibroma in the right region, this sea lion was diagnosed with chronic closed pyometra.

Medicamentos anti-hipertensivos na gestação e puerpério / Antihypertensive medications in pregnancy and puerperium

A toxemia gravídica é uma doença multissistêmica, que ocorre principalmente no final da gravidez, caracterizada por manifestações clínicascomo hipertensão, edema e proteinúria. É a complicação médica maiscomum da gravidez e a principal causa de morbimortlidade materna eperinatal. O objetivo deste artigo é rever os principais aspectos concernentesao uso de agentes antihipertensivosna gravidez e puerpério. Osdados foram coletados no Pubmed e Bireme, período de 2006 a 2010utilizando-se os descritores “anti-hipertensivo e gravidez” e “antihypertensive and pregnancy”. O conhecimento da hipertensão durante a gestação e sua terapêutica está em evolução; a busca por medicações quepossam proteger a mãe dos perigos agudos e garantir um recém nascidosaudável deve ser o foco. Faltam evidências sobre a melhor terapia aser adotada, período de início, duração e resultados. Apesar do avançofarmacológico, ainda não há fármacos totalmente isentos de comprometimentopara a mãe e ao concepto.

Pregnancy toxemia is a multisystemic disease, which occurs mainly atthe end of pregnancy, characterized by clinical manifestations such ashypertension, edema and proteinuria. It is the most commonly occurredmedical complication in pregnancies and the main cause for perinataland maternal morbimortalities. The purpose of this article is to reviewthe main aspects concerning the use of antihypertensive agents duringpregnancy and puerperium. The data has been collected from Pubmedand Bireme, from 2006 to 2010 using the words “anti-hipertensivo egravidez” and “antihypertensive and pregnancy”. The knowledge regardinghypertension during pregnancy and its therapy is evolving; the searchfor medication that could protect the mother from acute dangers and to ensure a healthy newborn must be the focus. Evidence is still lacking regarding the best therapy, beginning period, duration and results. In spite of the pharmacological advances, there are still no drugs completely exempt of compromises to the mother and the conceptus.

Preeclampsia severa: restricción del crecimiento intrauterino y desenlaces perinatales en gestaciones pretérmino / Severe pre-eclampsia: intrauterine growth restriction and perinatal outcome in preterm gestations

Describir la frecuencia de complicaciones perinatales en gestaciones pretérmino de madres con preeclampsia severa con y sin restricción del crecimiento intrauterino (RCIU). Materiales y métodos: estudio descriptivo en embarazo único, preeclampsia severa y parto entre 24 y 34 semanas, con y sin RCIU, entre enero 2007 y diciembre 2009. Se realizó monitoría fetal cada 48 horas, perfil biofísico fetal (PBF) dos veces por semana y Doppler fetoplacentario semanal. Resultados: se estudiaron 55 pacientes con edad promedio de 29.6 (DE 6.4) años, media de edad gestacional de 29.9 (DE 2.9) semanas, menor en el grupo con RCIU 28.8 (DE.3.1) vs 31.2 (DE 2.0). Hubo RCIU en 30 (54,5%) gestaciones, la mortalidad perinatal fue de 17 casos (31%), 15 en embarazos con RCIU. La mayoría ocurrió en gestaciones por debajo de 28.6 semanas. Conclusiones: la mortalidad perinatal en preeclampsia en edad gestacional temprana es alta en nuestro hospital, en especial en presencia de RCIU. Es probable que esta asociación actúe en forma sinérgica sobre las complicaciones por prematurez. Al mejorar la atención pre y neonatal esperamos superiores resultados perinatales...

To describe frequency of perinatal complications in preterm gestations associated to severe preeclampsia, with or without intrauterine growth restriction (IUGR). Materials and methods: this is a descriptive study of single pregnancies, severe preeclampsia and preterm birth between weeks 24 and 34, with and without IUGR, conducted between January 2007 and December 2009. Fetal monitoring was conducted every 48 hours, fetal biophysical profile testing (BPP) twice a week and fetal and placental Doppler every week. Results: 55 patients with mean age 29.6 (SD 6.4) years were assessed; mean gestational age was 29.9 (SD 2.9) weeks, lower in the group with IUGR [28.8 (SD.3.1) vs 31.2 (SD 2.0)]. IUGR was present in 30 (54.5%) pregnancies. Perinatal death occurred in 17 cases (31%) 15 with IUGR. Most perinatal deaths occurred in pregnancies of less than 28.6 weeks. Conclusions: perinatal mortality rate in preeclampsia in early gestational age is high in our hospital, especially associated with IUGR. This association may act in a synergic manner on complications caused by prematurity. We expect better perinatal results as we improve prenatal and neonatal care delivery...

Factors affecting the utilization of evidence- based practices for pregnant women with toxemia

The study aimed to determine the factors that affect nurse utilization of evidence based practices for nursing care of pregnant women with toxemia. Research questions of the study are there barriers that affecting the utilization of the evidence-based practices for pregnant women with toxemia? A descriptive study design was conducted at inpatient units and intensive care unit in [Ain Shams and Suez Canal] Maternity University Hospitals. Convenient sample was used to recruit 110 nurses' according to criteria of the study. Two tools were used for data collection. First tool: Arabic structured interviewing questionnaire sheet to assess: First part, demographic characteristics of study sample and second part, assess factors that affect nurse utilization of evidence based practices. Third part, knowledge assessment sheet to assess nurse's knowledge regarding EBP. Second tool observational check list: for assess nurse's practices regarding EBP. The duration of data collection started from October 2009 and completed by October 2010. Result of the present study revealed that, about slightly more than one third of nurses [36.4%] were has unsatisfactory knowledge about EBP ,Most of studied nurses [80%] didn't utilize EBP process, these results due some factors as lack of technological skills in find evidence [96.4%] and resistance to change are represented by [80%] between studied nurses. In addition, the present study revealed that, Positive significant correlation was found between both nurses' [Knowledge's and Practices] of EBP in relation to their qualification [highly qualified nurse], while there is negative significant correlation with their experience [< 10 years], from The present study concluded that, still there is a gap between EBP and toxemia care for pregnant women due to many barriers as lack of communication skills with technology, inability to read and analysis the EBP researches, not interested with changes or new scientific evidence, insufficient time to apply EBP in clinical area with patient. In the light of the study findings the researchers can recommend that enhance obligatory and motivation system for nursing staff to inform and apply EBP In their specialties bedside, improve awareness of nurses about the importance of application of EBP on health filed through training program for nurses, in different maternity services. In the light of the study findings the researcher can recommend that enhance obligatory and motivation system for nursing staff to inform and apply EBP. In their specialty bedside, improve awareness of nurses about the importance of application on health filed through training program for nurses, about nursing care of patient in different maternity services

Febre sem sinais localizatórios: avaliação de um protocolo de atendimento / Fever without source: evaluation of a guideline

OBJETIVO: Avaliar a aplicabilidade de um protocolo de atendimento padronizado para crianças de até 36 meses de idade com febre sem sinais localizatórios (FSSL). MÉTODOS: Estudo de coorte prospectivo em crianças com FSSL atendidas no Pronto-Socorro do Hospital Universitário da Universidade de São Paulo, São Paulo (SP), de junho de 2006 a maio de 2007. O protocolo estratifica o risco de infecção bacteriana grave (IBG) de acordo com a presença ou não de toxemia, idade e valor da temperatura. Conforme avaliação de risco, indicava-se triagem laboratorial: hemograma, hemocultura, sedimento urinário, urocultura e, se necessário, radiografia torácica, liquor e coprocultura. RESULTADOS: Foram estudadas 251 crianças das quais 215 foram acompanhadas até o diagnóstico final. Vinte crianças apresentavam toxemia, e 195 estavam em bom estado geral (30 com idade de até 3 meses, e 165, de 3 a 36 meses). Nas crianças de 3 a 36 meses não toxêmicas, 95 tinham temperatura axilar > 39 ºC. Em 107 crianças (49,8 por cento), houve melhora espontânea do quadro febril; em 88 (40,9 por cento), foi identificada doença benigna autolimitada; e em 20 (9,3 por cento), IBG. Dentre as IBG, identificamos 16 infecções urinárias, três pneumonias e uma bacteremia oculta. Das 215, 129 (60 por cento) não receberam qualquer antibioticoterapia, e 86 receberam antibiótico em algum momento (45, empiricamente). O antibiótico empírico foi mantido por, em média, 72 horas. CONCLUSÃO: O protocolo aplicado mostrou-se adequado para o seguimento destas crianças que fizeram coleta de exames simples e passíveis de serem realizados na maioria dos serviços. A infecção urinária foi a IBG mais frequente nas crianças com FSSL.

OBJECTIVE: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). METHODS: Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. RESULTS: We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8 percent) children, there was spontaneous resolution of fever; in 88 (40.9 percent), benign self-limited disease was identified; and in 20 (9.3 percent), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60 percent) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. CONCLUSION: The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.

The investigation of HEV epidemiology, inferior clinical infection and viral-toxemia in blood donors in Quzhou area / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the infection of HEV in Quzhou area of Zhejiang Province.</p><p><b>METHODS</b>All sera from blood donors in the central blood bank of Quzhou from April 2006 to April 2007 were used. Anti-HEV IgG and anti-HEV IgM were measured by EIA. RT-PCR was also performed to the samples with positive anti-HEV IgM. Genotype and sequence homology were analyzed after sequencing.</p><p><b>RESULTS</b>The positive ratio of anti-HEV IgG was 40.60%, in which the male infection ratio was higher than the female significantly (43.09% VS 36.09%; chi2=22.6; P < 0.01). The infection ratio was increased with age. The positive ratio of anti-HEV IgM was 0.43%. The positive ratio of anti-HEV IgG and the titers of antibody were higher in the inferior clinical infectors with positive anti-HEV IgM than the negative ones (P < 0.05). Two samples were positive in HEV PCR among 21 samples with positive anti-HEV IgM. The toxemia ratio was 0.4% of all the donors. And the genotype of the two samples with toxemia were both HEV-IV.</p><p><b>CONCLUSION</b>The HEV infection was correlation with age and sex significantly and the infection occurred in the adults mainly in Quzhou area. HEV toxemia was not infrequency in the blood donors.</p>

Doenças do sistema nervoso central em caprinos e ovinos no semi-árido / Diseases of the central nervous system in goats and sheep of the semiarid

O conhecimento das doenças dos animais domésticos, nas diferentes regiões do Brasil é importante para determinar formas eficientes de profilaxia e controle. Este trabalho tem como objetivo descrever a epidemiologia, sinais clínicos e patologia das enfermidades do sistema nervoso central (SNC) de caprinos e ovinos, que ocorreram de janeiro de 2000 a maio de 2006 no semi-árido, principalmente do estado da Paraíba. Durante o período, 365 casos ou surtos foram diagnosticados em caprinos e 270 em ovinos. Desses, 63 (9,92 por cento) eram doenças do SNC, sendo 34 (9,31 por cento) em caprinos e 29 (10,7 por cento) em ovinos. As principais enfermidades foram abscessos (19,04 por cento), tétano (15,9 por cento), raiva (9,52 por cento) intoxicação por Ipomoea asarifolia (7,93 por cento), listeriose (6,34 por cento), trauma (6,34 por cento), polioencefalomalacia (4,77 por cento), toxemia da prenhez (3,17 por cento), ataxia enzoótica (3,17 por cento) e meningite (3,17 por cento). Outras doenças diagnosticadas numa única oportunidade (1,59 por cento) foram intoxicações por Crotalaria retusa, Ipomoea carnea, Ipomoea sericophylla e Prosopis juliflora, otite com encefalite, malformação, linfossarcoma linfoblástico, meduloblastoma e necrose simétrica focal. Em 6,34 por cento dos casos o diagnóstico foi inconclusivo.

The knowledge of the diseases of domestic animals in the different Brazilian regions is important to determine measures for their control and prevention. The objective of this paper is to report the epidemiology, clinical signs and pathology of the diseases of the central nervous system (CNS) of goats and sheep in the Brazilian semiarid, mainly in the state of Paraíba, diagnosed at the Veterinary Hospital of the Federal University of Campina Grande, from January 2000 to May 2006. During the period, 365 cases or outbreaks were diagnosed in goats and 270 in sheep. From these, 63 (9.92 percent) were of diseases of the CNS, being 34 (9.31 percent) in goats and 29 (10.7 percent) in sheep. The main diseases were abscesses (19.04 percent), tetanus (15.9 percent), rabies (9.52 percent) poisoning by Ipomoea asarifolia (7.93 percent), listeriosis (6.34 percent), traumatism (6.34 percent), polioencephalo-malacia (4.77 percent), pregnancy toxemia (3.17 percent), enzootic ataxia (3.17 percent), and meningitis (3.17 percent). Other diseases diagnosed in only one opportunity (1.59 percent) were intoxications by Crotalaria retusa, Ipomoea carnea, Ipomoea sericophylla and Prosopis juliflora, otitis with encephalitis, malformation, lymphoblastic lymphosarcoma, medulloblastoma, and focal symmetric necrosis. In 6.34 percent of the cases diagnosis was unknown.

Trombose do seio cavernoso: revisão da literatura e relato de caso / Cavernous sinus thrombosis: review of the literature and case report

A trombose séptica do seio cavernoso é uma complicação encefálica decorrente de infecções faciais ou cranianas como sinusites, otites, infecções odontogênicas, oftalmológicas, entre outras. Apesar de rara, apresenta grande importância devido ao alto percentual de óbitos e seqüelas. As infecções odontogênicas, embora não ocupem posição destacada entre os fatores etiológicos dessa doença, podem atuar como focos primários situando o cirurgião-dentista entre os profissionais capazes de elaborar não só o diagnóstico, como sua profilaxia e o correto encaminhamento para tratamento médico especializado. O diagnóstico clínico dessa condição é dificultado pela semelhança com algumas infecções da órbita como a celulite orbital. Esse trabalho revisa a literatura e procura atualizar conceitos que facilitam o diagnóstico, a profilaxia e o tratamento da trombose do seio cavernoso. O trabalho também relata um caso dessa grave doença, originada de uma acne na região do mento, cuja rápida evolução levou o paciente ao óbito em três dias de tratamento. Após essa revisão, podemos afirmar que o diagnóstico dessa condição é clínico, com confirmação em exames de imagem, e quanto mais precoce o tratamento, melhor a chance de sobrevida. Infere-se também a importância da profilaxia antibiótica em cirurgias orais e faciais, atribuindo a ela redução significativa dessa infecção nos últimos tempos.

Effects of Preconceptional Sperm Exposure to Female Genital Tract on the Development of Hypertensive Diseases During Pregnancy / 대한산부인과학회잡지

OBJECTIVE: This study was performed to know whether toxemia occurred more frequently in pregnancy which is achieved despite of azoospermia or severe oligospermia. METHODS: We selected 31 women who underwent surgical sperm aspiration and ICSI at Seoul National University Hospital (SNUH) from 1995 to 2001 and pregnancy continued over 20 gestational age as study group. And as a comparison group, 19 women who underwent ICSI at SNUH from 1995 to 2001 with no semen analysis abnormality and pregnancy continued over 20 gestational age were selected. The incidence of toxemia in both groups was observed. RESULTS: There were no differences in the incidence of gestational hypertension and preeclampsia between groups (RR=3.46, 95%CI 0.37-32.18) (RR=0.91, 95%CI 0.14-6.02). CONCLUSION: No association was observed between preconceptional sperm exposure to female genital tract and the incidence of toxemia.

Effects of Bupivacaine and Magnesium on Serotonin-induced Vasocontraction in an Isolated Human Umbilical Artery / 대한마취과학회지

BACKGROUND: Serotonin is found in the blood of the umbilical cord at birth in concentrations sufficiently high to affect vascular tone. Serotonin has been suggested to be involved in the pathogenesis of preeclampsia. Magnesium sulfate (MgSO4) is used to treat convulsions and hypertension in patients with preeclamptic toxemia. Bupivacaine is used in the epidural anesthesia for a cesarean section. The effects of magnesium and bupivacaine on serotonin-induced vasocontraction in a human umbilical artery was investigated. METHODS: Experiments were performed on 52 human umbilical arteries. The rings were suspended in an organ bath to record isometric mechanical activity. The concentration-contraction responses to bupivacaine, magnesium and serotonin were measured respectively. Vessels were pretreated with bupivacaine (10(-5) M) or magnesium (2 mM or 6 mM), and then serotonin (10(-9) M - 10(-6) M) was added cumulatively. Data analysis was assessed by an unpaired t test, one-way ANOVA and a Kruskal-Wallis test. RESULTS: Bupivacaine induced a contraction of umbilical arterial rings, and showed a maximal contraction (51.8 +/- 6.1%) at a concentration of 43nM. Magnesium induced relaxation of the umbilical artery in a concentration dependent manner. Pretreatment with bupivacaine (10(-5) M) potentiated significantly the concentration response to serotonin (P < 0.05). Pretreatment with MgSO4 (2 mM or 6 mM) significantly suppressed the contractile response to serotonin (P < 0.05). CONCLUSIONS: Bupivacaine, magnesium and serotonin are vasoactive on human umbilical arteries. Magnesium exerts a strong relaxant effect on serotonin induced vasocontraction in the human umbilical artery. Potentiation of serotonin induced vasoconstriction by bupivacaine may play a significant role in the reduction of umbilicoplacental blood flow.

Hematologic Findings of Toxemia Mothers and Their Babies / 대한주산의학회잡지

OBJECTIVE: Hematologic abnormalities in toxemia mothers and their babies have been documented. The purpose of this study was to explore the hematologic findings in mothers with toxemia and postnatal hematologic findings in their babies. The relationship of hematologic findings between toxemia mothers before delivery and their babies immediately after birth was also examined. METHODS: Forty-six pairs of singleton toxemia mothers and their babies born by C-section with 28 to 35 weeks of gestation from Jan. 1995 to Dec. 1999 were enrolled. Fifty pairs of singleton normotensive mothers and their babies with the same gestational period and delivery method were matched for control group. Blood samples of mothers were performed before delivery, and those of their babies, were done immediately after birth, day 3 and 7 of life. Hemoglobin(Hb) concentration, total white blood cell(WBC) count, absolute neutrophil count(ANC), and platelet count were examined. RESULTS: Toxemia mothers have significantly lower platelet count compared with controls(191,000+/-83,200/mm3 vs. 252,000+/-92,700/mm3, p<0.05). There were no difference between both groups in Hb, WBC and ANC. On the first day of life, Hb was significantly higher(16.97+/-2.36g/dL vs 14.32+/-1.5g/dL, p<0.05), but WBC, ANC and platelet count were significantly lower in babies born to toxemia mothers than those of control group(p<0.05 for all). In babies born to toxemia mothers, Hb was significantly decreased until the seventh day of life(16.97g/dL, 15.48g/dL, 14.61g/dL, p<0.05), however, WBC and platelet count were significantly decreased until the third day of life and then incresed until the seventh day of life(11,832/mm3, 8,334/mm3, 10,104/mm3 for WBC, p<0.05, and 152,220/mm3, 144,720/mm3, 214,090/mm3 for platelet, p<0.05, respectively). CONCLUSION: Hemoglobin concentration was significantly higher, whereas WBC, ANC and platelet were significantly lower in babies of toxemia mothers than those of control group. In babies born to toxemia mothers, Hb was significantly decreased until the seventh day of life, however, WBC and platelet count were significantly decresed until the third day and then increased until the seventh day of life. There was no relationship between hematologic findings of toxemia mothers and their babies.

Significance of Blood TNF-alpha and Interleukin 10 Levels in Vibrio Vulnificus Cytolysin Toxemia / 대한피부과학회지

BACKGROUND: Pro-inflammatory cytokines, such as tumor necrosis factor(TNF)-alpha and interleukin (IL)-1, have been incriminated in the pathogenesis of septic shock in animals and humans. IL-10 reduces the release of pro-inflammatory cytokines, nitric oxide and reactive oxygen species. IL-10 prevents endotoxin-induced toxicity. OBJECTIVE: The aim of this study was to investigate the relation between IL-10 and TNF-alpha in toxemic mice according to concentrations of V. vulnificus cytolysin. METHODS: First, after administration of V.vulnificus cytolysin(2, 4, 6, 8, 10 hemolytic units; HU) and physiologic saline through a mouse tail vein, we obtained blood samples from the heart at 60 minutes which was a peak time of IL-10 and TNF-alpha release. We measured serum concentration of circulating TNF-alpha and IL-10 using commercially available enzyme-linked immunosorbent assay methods. Second, after administration of 1,000U recombinant mouse IL-10 through a mouse tail vein 30 min before infusion of the lethal dose(8HU) of V. vulnificus cytolysin. We obtained blood samples from the heart at 60 minutes and measured serum concentration of circulating TNF-alpha level. RESULTS: Both IL-10 and TNF-alpha levels were significantly correlated with V. vulnificus cytolysin concentration(P=0.002). TNF-alpha levels were 76.9+/-9.5 pg/ml in 2HU, 315.8+/-39.8 pg/ml in 4HU, 426.1+/-27.9 pg/ml in 6HU, 931.3+/-22.3 pg/ml in 8HU, 1825.2+/-18.8 pg/ml in 10HU and 23.6+/-5.1 pg/ml in physiologic saline. IL-10 levels were 80.2+/-21.5 pg/ml in 2HU, 244.4+/-35.4 pg/ml in 4HU, 382.2+/-22.6 pg/ml in 6HU, 740.1+/-33.0 pg/ml in 8HU, 997.3+/-16.8 pg/ml in 10HU and 35.8+/-15.0 pg/ml in physiologic saline. After administration of 1,000U recombinant mouse IL-10, comparing to control group(931.3+/-22.3 pg/ml), TNF-alpha level was reduced to 307.2+/-23.9 pg/ml(P=0.003). CONCLUSION: IL-10 has an inhibitory effect on the production of TNF-alpha although it is released together with TNF-alpha in toxemic mice. IL-10 blood levels are directly related to the severity of toxemia. We conclude that IL-10 is a prognostic factor for the development of sepsis and might be used for the treatment of sepsis.

Angiographic Findings of Choroidal Lesions in Serous Retinal Detachment

PURPOSE: To study the relationship between the damage of retinal pigment epithelum and the lesion of choroidal vessels in various types of the serous retinal detachment(SRD) on fluorescein angiography(FAG) and indocyanine green angiography(ICGA). METHODS: FAG and ICGA were performed 81 eyes with various types of serous retinal detachment. The series comprised central serous chorioretinopathy(CSC, 63 eyes), toxemia of pregnancy(8 eyes), and Harada's disease(10 eyes). RESULTS: All the eyes showed dye leakage through the retinal pigment epithelium(RPE) by FAG. Of sixty-three eyes with CSC, sixty eyes showed choroidal tissue staining in late phase on ICGA. Delayed filling of ICG dye in early phase was present around the site of leakage on FAG in 48 eyes with CSC. In toxemia of pregnancy and Harada's disease, all the cases showed delayed choroidal circulation and leakage from choroidal vessels on ICGA. As a common feature, ICGA showed choroidal hypoperfusion or delayed choroidal circulation and choroidal vascular hyperpermeability in the three types of SRD. CONCLUSIONS: The authors presume that they might contribute to the damage of RPE. The pathogenesis of SRD may be related to the hypothesis fact that choroidal vascular hyperpermeability probably moves fluid into the subretinal space from the choroid.

A Case of Pheochromocytoma Manifested by Generalized Seizure / 대한내분비학회지

Pheochromocytoma is originated from chromaffin cells of sympathetic nervous system and clinical symptoms are caused by catecholamine released from tumor. In typical cases, periodic attacks of hypertension, palpitation, headache, and sweating are main symptoms. But, the diagnosis of pheochromocytoma is sometimes difficult since its clinical presentation is quite variable. We evaluated a 25-year-old woman who was admitted because of left flank pain and seizure. She had a history of hemoptysis and toxemia. During the hospitalization, she experienced generalized seizure once more. The clinical diagnosis of pheochromocytoma was proven by highly elevated urinary catecholamines and confirmed histologically after operation. We think it is the first case report of pheochromocytoma manifested by seizure in korea, so we report this case with literature review.

Changes of Whole Blood Glucose Level in Toxemic Mice Induced by Vibrio vulnificus Cytolysin / 대한피부과학회지

BACKGROUND: Vibrio(V.) vulnificus is a pathogenic, marine, halophilic, gram-negative bacillus which causes fulminant septic shock. Shock can be complicated by occurrence of hypoglycemia, which is caused by an unbalance between glucose production and consumption. Metabolic changes, especially glucose metabolism, in septic shock caused by V. vulnificus are not well clarified yet. OBJECTIVE: Our purpose was to investigate the changes of blood sugar level after intravenous administration of V. vulnificus cytolysin which is known to be a major virulent factor for elucidating pathogenesis of septic shock. METHODS: After administration of the lethal dose(8 hemolytic units)of V. vulnificus cytolysin through mouse tail vein in non-fasting and fasting group, we obtained blood samples from heart according to time courses of every thirty minutes. We measured whole blood glucose level using commercially available blood glucose meter. RESULTS: The level of blood glucose increased until 90 minutes, began to decrease at 120 minutes, and fell to baseline at 360 minutes in non-fasting mouse group. In fasting group, although elevation of blood glucose level was not observed in early stage of toxemia, hypoglycemia was nearly concordant with non-fasting group in late stage of toxemia. CONCLUSION: Hypoglycemia should be checked in patients with V. vulnificus sepsis. Failure to recognize and treat the hypoglycemia may contribute to the prognosis of these patients.