[Surgical treatment of terminal heart failure]. / Tratamiento quirúrgico de la insuficiencia cardiaca terminal.

Terminal heart failure with no response to pharmacological treatment has been a challenge in medical practice: besides its deleterious effects on quality of life for all patients, it has a very high mortality rate. At present, surgical treatment of terminal heart failure consist basically in cardiac transplantation, which demands precise surgical indications, donor and receptor selection and adequate immunosuppression. Cardiac transplantation has contributed lower mortality rate and quality of life. Other surgical procedures that have been tried include cardiomyoplasty, partial left ventriculostomy (Batista's surgical procedure) and the use of several left ventricular mechanical devices.

Cyfra 21-1 marker in carcinoma of the cervix.

Cyfra 21-1 has been reported to be an effective tumor marker for epithelial carcinomas. The purpose of this investigation was to determine its value in evaluating response to treatment in patients with carcinoma of the cervix. Cyfra 21-1 levels were measured by immunoassay in the serum of 55 untreated patients with cervical cancer; a second sample was obtained in all of them after conventional treatment for association with clinical response. Pre-therapy levels were elevated in only 45% (25 of 55) of the patients, with a slight tendency to increase according to clinical stage: 33% (5/15) in stage I, 36% (8/22) in stage II and 67% (12/18) in stage III. In regards to association with response to therapy, and including patients with either normal or elevated pretreatment values, 46% (19/41) of women with a complete clinical response either persisted with or developed elevated levels after treatment completion. All 14 patients with persistent disease after therapy continued to have or developed elevated values. No patient with persistent disease had normal values after therapy, and all patients with negative values after treatment were truly complete clinical responders. The results of our study suggest that the test has a low sensitivity therefore and, despite our findings, a negative level after treatment may not be a safe indicator of disease-free status. On the other hand, an elevated post-treatment level is not a reliable indicator of persistence, proven by the fact that 46% of clinical responders fell in this category. Therefore, Cyfra 21-1 has a very limited role in correlating with response to treatment in carcinoma of the cervix.

[Partial pericardial tamponade immediately after cardiac surgery]. / Taponamiento pericárdio parcial en el postoperatorio inmediato de cirugía cardíaca.

Partial pericardial tamponade is a critical situation frequently misdiagnosed. We describe five patients with this entity during an urgent surgical reintervention performed few hours after the initial one. We found clots compressing cardiac cavities in all, usually in the right atrium. In one of them we found also a clot compressing the left atrium. None of the patients studied had the classical clinical features of cardiac tamponade (Kussmaul's sign: pulsus paradoxus) and we found no difference in blood pressure, quantity of bleeding or pulmonary capillary pressure, considering the reinterventional moment in comparison to the values taken immediately after the initial surgery and the ones registered during the surgical reintervention. There was significative increase in the central venous pressure value, decreased urine output and drop in the cardiac index. Based on this observation, we believe it is possible to have a presumptive diagnosis of partial pericardial tamponade by bidimensional echocardiographic studies just before the surgical reintervention.

[Is there an etiopathogenic relationship between diabetes mellitus and chronic diffuse hepatopathy?]. / Existen relaciones etiopatogénicas entre la diabetes mellitus y la hepatopatía crónica difusa?

Standard biochemical studies to rule out Diffuse Hepatopathy are performed in 60 diabetic patients in different grades of compensation, having no previous hepatic disease. In order to determine the degree of glucemic compensation, Glicosilated Haemoglobin A1C was analyzed. None of the studied parameters showed statistical difference between the four studied groups (DID, NIDD, compensated versus non compensated), indicating that the specific diabetic heatopathy does not exist. We conclude that the hepatotrophic effect of insulin could be related to previous hepatic lesiones, having no influence when the liver architecture is preserved.

Gold staining in cellulose acetate membranes.

A novel method for revealing proteins after electrophoresis on cellulose acetate is described, based on adsorption of mixed gold-Tween 20 micelles onto TCA-fixed protein bands. The sensitivity is 2-300 times higher than conventional Coomassie Blue staining and ca. 10 fold higher than silver coloring, detecting barely 1 ng protein/mm2 gel. Acidic and ammoniacal silver dyeing, based on ionic silver, perform very poorly on cellulose matrices, while a new variant, colloidal silver, stains protein bands on a clear background, but with a sensitivity ca. 10 times lower than micellar gold. Urines, cerebrospinal fluid and other biological liquids can be revealed without resorting to a concentration step prior to electrophoresis. The method is simple to perform and does not require any destaining step.

Clinical studies with d-Trp 6-luteinizing hormone-releasing hormone in anovulatory women.

Nine anovulatory patients with hypothalamic-pituitary dysfunction were treated with d-Trp6-luteinizing hormone-releasing hormone, an analog with far greater gonadotropin-releasing activity than luteinizing hormone-releasing hormone. Four of eight patients, who were formerly unsuccessfully treated with clomiphene, human chorionic gonadotropin, and human menopausal gonadotropin, ovulated after treatment with the peptide alone or with peptide preceded by clomiphene, and three became pregnant. The ninth patient, who had amenorrhea and anovulation due to excessive loss of weight caused by anorexia nervosa, also ovulated after treatment with the analog. These results demonstrate the effectiveness of this potent analog for induction of ovulation and pregnancy and point favorably toward clinical applications.

Hydrolysis of synthetic pyrophosphoric esters by an isoenzyme of apyrase from Solanum tuberosum.

A highly purified isoenzyme of apyrase obtained from potatoes (Solanum tuberosum var. Pimpernel) exhibits a low specificity for the organic moiety of synthetic pyro- and triphosphates. Methyl di- and tri-phosphates were hydrolysed at higher rates than ADP and ATP, but their Km values were also higher. Steric hindrance at the carbon atom linked to the pyrophosphate chain decreases both binding and maximum rate, whereas length or polarity of the organic chain do not have systematic effects. t-Butyl diphosphate, inorganic pyrophosphate, adenosine 5'-[alpha,beta-methylene]triphosphate and adenosine 5'-[beta,gamma-methylene]triphosphate are competitive inhibitors of the hydrolysis of ATP and ADP.

Pituitary and ovarian response patterns to stimulation in the postpartum and in galactorrhea-amenorrhea. The role of prolactin.

In order to assess the action of prolactin on the puerperal pituitary-ovarian resistance to physiologic stimulation, a study was conducted in 27 women divided into three groups. Group I: 9 postpartum women who did not wish to breastfeed their infants and received 2.5 mg bromocriptin (CB 154) twice daily for 14 days starting immediately after delivery; Group II: 9 normally lactating mothers; and Group III: 9 women with hyperprolactinemia associated with amenorrhea. The three groups underwent stimulation with LHRH and Pergonal 500. Results indicate lack of prolactin dependence in the pituitary-ovarian resistance of the puerperium. The possible mechanisms involved in the anovulatory period of lactation are discussed.

Effects of protein-modifying reagents on an isoenzyme of potato apyrase.

Treatment of an isoenzyme of potato apyrase of high adenosine triphosphatase/adenosine diphosphatase (ATPase/ADPase) ratio with iodine, N-acetylimidazole or tetranitromethane inactivates the ATPase activity of this enzyme faster than its ADPase activity. There was protection by substrates with the two last-named substances. This and the appearance of nitrotyrosine suggests the participation of tyrosyl residues in both enzymic activities of potato apyrase. The participation of thiol groups is excluded by the insensitivity of apyrase to p-chloromercuribenzoate. Also, 2-hydroxy-5-nitrobenzyl bromide or carboxymethylation produce the same rate of inactivation of ATPase and ADPase activities. Substrates protect both activities from inactivation. Hydrogen peroxide and photo-oxidation inactivate ATPase activity faster than ADPase activity. There is no protection by substrates. Analysis of pH effects on V(max.) and K(m) suggest different pK values for the amino acid residues at the ATP and ADP sites.