[Extreme increase in the blood erythroblast count in a patient with iron-deficiency anemia and asplenia]. / Eritroblastemia intensa en un paciente con anemia ferropénica y asplenia.

Bone marrow stress can provoke the presence of high erythroblast count in peripheral blood of patients with splenectomy, but is very rare in patients with normal spleen. Hypoxia occurring in patients with severe ferropenic anaemia could originate the occasional presence of erythroblasts in peripheral blood. An associated pathology should be excluded if there is a high normoblast count. We present the case of a 40 years old woman with ferropenic anaemia and a very high normoblast count. Hyperplastic polips were found in the gastric tissue as the cause for her anaemia. The absence of spleen explained the presence of erytroblasts. Further studies excluded the possibility of hemoglobinopathy and bone marrow studies were normal. Treatment with iron was successfully in correcting the hemoglobin levels and the normoblasts disappeared from peripheral blood also. A careful examination of the peripheral blood film and, specially the presence of Howell-Jolly bodies is the cornerstone of the possible diagnosis confirmed with the appropriate radiological studies.

[Detection campaign for hemoglobinopathies and thalassemias among school children in northern Extremadura]. / Campaña de detección de hemoglobinopatías y talasemias en la población escolar del norte de Extremadura.

PURPOSE: To detect carriers of thalassaemia and haemoglobin variants among the northern Extremadura school population. MATERIAL AND METHODS: The study was carried out in the Plasencia health service area, comprising about 120,000 people. All children between 4 and 15 years of age were offered to take part in the programme. The first-stage screen was mean corpuscular volule (MCV) measured in a Coulter STKS automatic counter. When low VCM was detected, ferritin estimation was carried out; if ferritin was normal, hemoglobin A2 was quantified. Haemoglobin electrophoresis at pH 8.4 was performed in all samples whatever the MCV, and patients were classified into the following groups: iron deficiency, beta-thalassaemia, Hb Lepore, structural haemoglobin variant, or atypical microcytosis. RESULTS: Out of 22 schools from 20 towns, 2,818 children were studied, the participation reaching 75.48%. Lower than normal MCV was found in 162 children (5.74%), who were grouped as follows: thalassaemia, 15 cases (0.53%), Hb Lepore, 8 cases (0.28%), iron deficiency, 77 cases (2.73%), atypical microcytosis, 55 cases (1.95%), and structural variants 7 cases (0.24%). These variants were further identified as HbS (3), Hb Hofu (1), in natives, and HbC (3) in children from Morocco. Higher prevalence of anomalies was seen in some places: Riolobos, 1.5%, Galisteo, 2.5%, Jaraiz de la Vera, 3.02%; a significant group of Hb Lepore carriers was detected in this last town. CONCLUSIONS: The prevalence of abnormalities seen in some small towns or villages grants this type of programmes as such places, which could be considered as isolated communities, might provide a number of high-risk couples.

Inversion of the normal interatrial septum convexity in acute myocardial infarction: incidence, clinical relevance and prognostic significance.

Inversion of the normal interatrial septum convexity has been described in patients with right atrial pressure or volume overload, but there is no reference to this abnormality in acute myocardial infarction. A group of 576 consecutive patients with acute infarction and serial echocardiographic studies were prospectively evaluated during a mean follow-up period of 406 days. Inverted interatrial septum convexity was found in 30 patients (5.2%); 29 of the 30 presented with inferior infarction with right ventricular involvement (29 [24.4%] of 119) and the remaining presented with cardiac tamponade secondary to heart rupture. The incidence of inverted interatrial septum convexity rapidly decreased, and after 3 months it was present in only five patients. All patients with inverted interatrial septum convexity had a right atrial pressure greater than or equal to pulmonary capillary pressure, a relation found in only 2 of 43 patients with right ventricular involvement and normal septal convexity. In patients with right ventricular infarction, right atrial pressure was higher in the presence of inverted septal convexity (15.9 +/- 4.1 versus 10.5 +/- 4.1 mm Hg, p less than 0.0001) and the incidence of hypotension (10 [34.4%] of 29 versus 15 [17.4%] of 90, p = 0.04) and third degree atrioventricular block (10 [34.4%] of 29 versus 11 [12.2%] of 90, p = 0.006) as well as the mortality rate after 3 months (9 [31%] of 29 versus 11 [12.2%] of 90, p = 0.04) were higher in the presence of inverted convexity than in patients with normal septal convexity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Distal hemoperfusion during coronary angioplasty with prolonged balloon inflation]. / Hemoperfusión distal durante la angioplastia coronaria con inflado prolongado de balón.

We present the results of 6 coronary angioplasties associated with coronary distal hemoperfusion by an injection pump. The inflation mean time was 5 min 10 sec and the quantity of perfused blood was 43 +/- 14 ml. The procedure was successful in all cases. No biochemical alterations were detected in the perfused blood. A significant clinical and electrocardiographic improvement was observed in all but 2 cases. The cause was the occlusion of a collateral branch and a high flow pattern, respectively. Technical aspects and usefulness of this and other perfusion systems are analysed.

[Trans-sigmoid urinary diversion and dediversion and cancer: experimental study]. / Derivación y desderivación urinaria transigmoidea y cáncer: estudio experimental.

The present experimental study was carried out in 75 female Wistar rats. End-to-side vesicosigmoidostomy was performed in 65; the remaining 10 rats comprised the control group. Thirty-three rats were de-diverted at 1 and 2 months later. The site of the vesicosigmoid anastomosis was assessed histologically at 1, 2, and 3 months postoperatively in diverted rats, and at 1 and 2 months in de-diverted rats. Squamous metaplastic changes and variable degrees of transitional cell line neoplasm were observed in the diverted rats. Bladder changes did not regress significantly after de-diversion. No structural changes were observed at the level of the sigmoid. This experimental animal model confirms the oncogenic potential of mixing feces and urine, and shows that de-diversion does not achieve significant regression of bladder tumor lesions.