[Prolonged neonatal cholestasis: prospective study]. / Colestase neonatal prolongada: estudo prospectivo.

Due to the urgency in choosing either clinical treatment or immediate surgical intervention, the study of the prolonged neonatal cholestasis involves two basic aims: the differential diagnosis between biliary atresia and neonatal hepatitis and the research into the associated etiological agents. So, in a prospective trial carried out in the 70's, 77 children with prolonged neonatal cholestasis were studied in order to establish the differential diagnosis between biliary atresia and neonatal hepatitis, followed by the evaluation of 108 children towards a pathogenesis of the prolonged neonatal cholestasis. The results of the differential diagnosis showed that within 18 items examined only 8 proved to be good biliary atresia indicators. They are as follows (in decreasing order): ductular proliferation (portal tracts), fibrosis (portal tracts), cholestasis (portal tracts), stools colour--acholia, hepatomegaly, canalicular cholestasis (lobule), infiltrate (portal tracts), giant cells (lobule). These eight items were then gathered in a sole indicator of great discriminative power, with a confidence level of 99%. The figures regarding the pathogenesis are: rubella virus 0%, herpes simplex virus 0%, listeriosis 0%, cytomegalovirus 2.2%, hepatitis B virus 2.4%, toxoplasmosis 2.8%, alpha-1-antitrypsin deficiency 13.1%, syphilis 21.1%, autoantibodies against the liver 58.4%. Such work thus revealed that those eight most important factors when differentiating biliary atresia from neonatal hepatitis remain as fundamental indicators and, when employed alongside other diagnostic methods, can help in the assembling of a multifactorial strategy less and less invasive and more precise. The pathogenic study, with its heavy dependency on time and place, has become more complete with the introduction of new diagnostic methods, evolving to the ideal progressive reduction of idiopathic processes.

Enhancement of sodium intestinal secretion in relation to absorption in malnourished rats. Hyperosmolar challenge.

Two experimental models were tried in young malnourished rats in order to study effect of an hyperosmolar challenge in the small intestine on the bi-directional fluxes of sodium. Weanling rats were fed with energy restricted diets. In model I 1 mL of NaCl 900 mOsm/kg was introduced in the small intestine of the rats and left from 5 up to 70 min, in order to determine the moment of higher net Na+ secretion, which occurred at 10 min. In model II, the bi-directional fluxes of Na+ and Cl- were studied using NaCl or mannitol 900 mOsm/kg under the effect of mecholil, atropine or 2-4 dinitrophenol, for 10 min. Mecholil decreased the Na+ absorption enhancing the net secretion. Control rats were used as reference. In the restricted diets animals occurred an increase of the net secretion stimulated by NaCl 900 mOsm/kg, and this effect was enhanced by mecholil. It is suggested that in malnutrition there is an impairment in Na- intestinal absorption.

[Follow-up of left ventricular systolic function in the first year following previous infarction]. / Seguimiento de la función sistólica ventricular izquierda en el primer año tras infarto anterior.

OBJECTIVES: To follow the left ventricular systolic function changes as assessed by global and regional ejection fraction during the first year of evolution after anterior myocardial infarction, as well as to analyse how the most relevant clinical and angio-graphic parameters influence them. MATERIALS AND METHODS: Sixty-six consecutive patients with a first infarction of anterior location, completed 1 year of follow-up with radionuclide ventriculography, T1-SPECT after exercise or dypiridamole and cardiac catheterization before discharge; radionuclide ventriculography was repeated 6 and 12 months later. Twenty-five patients underwent revascularization procedures at the time of predischarge, 16 using successful percutaneous angioplasty of the left anterior descending artery and 9 using aorto-coronary graft surgery. Dilated patients were controlled, from an angiographic point, of view 6 months after PTCA. RESULTS: Predischarge global EF (42.9 +/- 12.6) increased significantly between the 6-month (46.9 +/- 12.8; p < 0.001) and 12-month (47.6 +/- 12; p < 0.001) studies. Differences in these two last studies were minor and had no statistical significance. A significant increase was present in revascularized or medically treated patients; i.e. those who underwent thrombolytic therapy or conventional treatment at admittance as well as mono or multivessel disease patients. No significant differences were detected in the mean ejection fraction in patients without residual stenosis in the infarct-related artery (48.1 +/- 13.3 vs 50 +/- 12.6; NS) or those presenting a pre-discharge ejection fraction > or = 45% (53.5 +/- 7.5 vs 55.1 +/- 3.3; NS). Among different variables tested, predischarge global ejection fraction (negative coefficient) and, to a lesser extent, percutaneous angioplasty were independent predictors of a significant increase of ejection fraction during follow-up. Changes from predischarge to 12 month study were significant in the regional ejection fraction in the anteroseptal (33.1 +/- 14.7 vs 40.1 +/- 13.3; p < 0.001), inferoseptal (34.6 +/- 15.8 vs 42 +/- 16.9; p < 0.001), apical (46.3 +/- 19.1 vs 50.8 +/- 19.7; p < 0.01), antero-medial (50.6 +/- 22.4 vs 56.6 +/- 24.3; p < 0.01) and anteroapical (51.6 +/- 23.5 vs 58 +/- 27.5; p < 0.01) segments. In the anterobasal segment, regional ejection fraction only showed a statistical tendency to increase during follow-up and changes in inferior and lateral segments, distal to the infarcted area, were minor and without statistical significance. The most distinct infarct-related segments, antero- and inferoseptal, showed significant increases in the main group of patients, revascularized or nonrevascularized, undergoing thrombolitic or conventional therapy, with single or multivessel disease. Only patients without residual stenosis of the infarct-related artery (the left descending anterior) disclosed negligible or negative changes without statistical significance. Percutaneously dilated patients showed the highest increase of the infarct-related segments regional ejection fraction. In multivessel disease, the infarct-related segments regional ejection fraction did not increase significantly in surgically treated patients, conversely to those who underwent medical therapy. CONCLUSIONS: Global and regional ejection fraction of the infarcted area increased significantly during the first year after anterior myocardial infarction, mainly prior to six months patients with significant residual stenosis of the artery related to the infarct. Recovery is present both in patients who underwent thrombolysis or conventional treatment at admittance and revascularization or medical treatment before discharge and is inversely correlated to the predischarge global ejection fraction value. This evolution suggests that a significant amount of stunned myocardium is still present before discharge.

[Detection of residual ischemia after acute anterior myocardial infarction using Thallium-201 SPECT]. / Detección de isquemia residual tras infarto agudo de miocardio de localización anterior mediante SPECT con talio-201.

OBJECTIVES: To assess the utility of single photon emission computed tomography (SPECT) with Thallium-201 after anterior myocardial infarction at predischarge time in the detection of; a) the prevalence of isotopic redistribution in the infarct area or at a distance; b) the correlation between peri-infarction ischemia and the angiographic state of the infarct-related artery, and c) the correlation between ischemia at a distance and the presence of multivessel disease. MATERIAL AND METHOD: Seventy-three survivors of an uncomplicated anterior myocardial infarction, 67 men and 7 women, with a mean age of 56 +/- 9 years (34-70 range), underwent T1-SPECT after stress test (62 exercise test and 11 pharmacological Dipyridamole test) as well as coronarographic studies before discharge. Peri-infarction ischemia was defined as redistribution presence in the distribution territory of the left anterior descending artery (LAD) and was assessed in a semi-quantitative way scoring both stress and rest images that allowed the calculation of a redistribution index R (Stress Score-Rest Score/Stress Score). Ischemia at a distance was defined as redistribution presence in the territories of circumflex and right coronary arteries as assessed both by visual analysis (VA) and bull's eye polar maps (BE) or by washout imaging (WO). RESULTS: Peri-infarction ischemia (R > 0) was found in 48 (65.7%) patients; 43 with and 5 without significant residual lesions in the LAD and the absence of peri-infarction ischemia (R = 0) was found in 25 (34.3%) patients, 19 with and 6 without significant residual lesions in the LAD. Sensitivity and specificity for multivessel disease detection by ischemia at a distance was 64% and 85% respectively, for VA; 60% and 77% for BE; and 95% and 65% for WO. Combinations of different analytical methods (multiparametric approach) showed a decrease in sensitivity but improved specificity and positive predictive value: 60%, 90% and 75%, respectively, for BE & WO; 44%, 90% and 69% for VA & BE and 60%, 92% and 79% for VA & WO. CONCLUSIONS: TI-SPECT imaging is a useful diagnostic method to detect both peri-infarction ischemia and ischemia at a distance at predischarge time following anterior myocardial infarction. Redistribution presence in the non infarct-area shows a fair sensitivity and a high positive predictive value to detect residual multivessel disease.

[Lipomatous hypertrophy of the interauricular septum: diagnosis with transesophageal echocardiography and computerized tomography]. / Hipertrofia lipomatosa del tabique interauricular: diagnóstico mediante ecocardiografía transesofágica y tomografía computadorizada.

Transesophageal echocardiographic and computed tomographic imaging in a patient with lipomatous hypertrophy of the interatrial septum and advanced left bundle branch block are presented. Transesophageal echocardiography demonstrated a thickening of the atrial septum sparing the fossa ovalis region. Computed tomographic scan at the level of the interatrial septum showed a mass of fat density, and the HIS bundle electrogram showed an advanced infra-his block after intravenous ajmaline. We stress the utility of transesophageal echocardiography in this disorder, and the possible relationship between lipomatous hypertrophy of the interatrial septum and conduction disturbances.

[Acute myocardial infarction secondary to non-penetrating thoracic trauma]. / Infarto de miocardio agudo secundario a traumatismo torácico no penetrante.

We present a case of acute myocardial infarction located anteriorly in a healthy young man who suffered a blunt chest trauma following a motor vehicle accident, with coronarographic evidence of intimal dissection of the left anterior descending artery and evolution to ventricular aneurysm. We comment on the rare incidence of this entity and the mechanism involved in this case, a coronary contusion with subsequent intimal dissection.

Histamine release following the administration of iodinated contrast media during cardiac catheterization.

This study was motivated by the discrepancy in the results of published studies on the amount of histamine released following the intravascular administration of iodinated contrast media (ICM) in humans. From a group of patients due to undergo cardiac catheterization, we selected 45 subjects with no history of atopy. A central blood sample (left ventricle) was taken from each subject before and at various times following the administration of the ICM. We determined total and basal histamine levels in every sample. We did not find any significant difference in the total histamine concentration between the samples taken before and after the administration of the ICM; but the basal histamine concentration rose from 5.32 ng/ml to 11.26 ng/ml (p less than 10(-9)). This increase was inversely proportional to the time that had elapsed between the administration of the ICM and the taking of the sample (p less than 0.01). We believe that the inconclusiveness of the results from studies on histamine release following the administration of ICM may be explained by the dilution and inactivation of histamine in the systemic circulation.

Bio-utilization of protein, calcium and zinc from diets based on rice and beans, in human beings.

Nine male healthy adults volunteers of average body weight 69.51 +/- 11.59 kg were submitted to 3 experimental diets: I complete diet, containing rice and beans (RB): II--low protein, low calcium: III--vegetable diet containing RB. The diets were consumed "ad libitum". The total energy intake in each dietary period were: 46.04 +/- 9.18; 37.57 +/- 9.04; 55.27 +/- 7.18 respectively. The average free choice for the proportion of rice/beans was 1.22 and 1.35 in the periods I and III. The protein balance was positive only for the diet I and the balance of calcium was positive in diets I and II. Zinc didn't attained positive balance neither in diet I. It is suggested that the presence of beans in diets I and III plays an important role in decreasing the bio-utilization of the studied nutrients.

[Effect of lactose ingestion on body development. Study in rats]. / Efeito da ingestão de lactose no desenvolvimento corporal. Estudo em ratos.

Dams (rats) and their offsprings were fed on diets containing casein (Cas) or rice and beans (RB) as protein source. The presence of lactose improved the whole animal as well as the intestinal development in Cas diet but not from RB ones. It is suggested that lactose must be maintained permanently in diet but in low concentration. In this investigation it was also observed that the small intestinal development occurs initially by enhancement of length and weight, while after weaning only weight continues to increase independently of the presence or not of lactose in diet.

[Emergencies in peptic gastroduodenal ulcers]. / Urgências na ulcera péptica gástrica e duodenal.

The authors present an objective review of the main emergencies regarding peptic ulcer disease, gastric and duodenal. The complications, perforation, bleeding and pyloric stenosis, are dealt with in detail, regarding diagnosis and best therapeutic orientation, either clinical or surgical.

Non specific immunological response in moderate malnutrition.

The phagocytic and chemotactic activity of mononuclear leucocytes was assessed "in vitro", as were the total complement and component C3 and C4 serum levels, in twenty children suffering from moderate primary protein-calorie malnutrition in the 6-month to 5-year age group. The results were compared to those from well-nourished children of the same age and showed a reduction of the non-specific immunological response in the malnourished children, due to the intrinsic problem of the mononuclear leucocytes.