HLA class I and II alleles and response to treatment with interferon-beta in relapsing-remitting multiple sclerosis.

In the present study, we investigated the influence of HLA class I and class II genes in the response to interferon-beta (IFNbeta) in multiple sclerosis (MS) patients. HLA-A, -B, -C, -DRB1, -DQA1, and -DQB1 DNA typing was performed by polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) in a cohort of 149 relapsing-remitting MS patients classified into IFNbeta responders (n=74) and non-responders (n=75) based on stringent clinical criteria. Distribution of HLA class I and class II alleles individually and the HLA-DR2 haplotype was similar between responders and non-responders to treatment. These findings do not support a role of the HLA class I and class II genes as modifiers of the response to IFNbeta.

[Pleural effusion in children with pneumonia: a study of 63 cases]. / Derrame pleural en niños con neumonía. Estudio de 63 casos.

INTRODUCTION: An increase in the number and severity of pleural effusions has been observed in the last few years. The aim of the study is to describe the epidemiological characteristics, clinical findings and the treatment of this disease. MATERIAL AND METHODS: This is a retrospective study of patients admitted into the PICU in Hospital Niño Jesús with parapneumonic pleural effusion from January 2005 to May 2006. RESULTS: Sixty-three patients were included in the study. An increase of 29 % was observed in the number of patients admitted with parapneumonia effusion from 2005 to 2006. The most common aetiology was Streptococcus pneumoniae. In 65 % of patients pleural effusion was an empyema and in 33 % it was an exudate. In all patients with C-reactive protein below 100 mg/L the effusion was an exudate, whereas 81 % of patients with C-reactive protein above 170 mg/L had an empyema, p < 0.05. The patients who had an exudate needed lower doses of fibrinolytics than those who had an empyema (1.6 vs. 4.5, p < 0.05). The number of days having a chest tube or admitted in PICU was lower in patients with exudate (3 days each) than those with empyema (7 and 9 days respectively) (p < 0.05). CONCLUSIONS: An increase in the number of complicated pneumonias is observed amongst children in our country, S. pneumoniae being the main aetiology. Using laboratory techniques such as C-reactive protein can help to distinguish between complicated and uncomplicated pneumonia. Pleural effusion characteristics seem to have an influence on the need for fibrinolytic and the length of chest tube treatment.

Derrame pleural en niños con neumonía. Estudio de 63 casos / Pleural effusion in children with pneumonia: a study of 63 cases

Introducción. En los últimos años se ha venido observando en España un incremento en el número de casos de neumonía con derrame y en su gravedad. El objetivo de este estudio es describir la epidemiología, las características clínicas y el tratamiento de los pacientes ingresados con esta enfermedad en la unidad de cuidados intensivos pediátricos (UCIP) de un hospital pediátrico. Material y métodos. Estudio retrospectivo de los pacientes que, entre enero de 2005 y mayo de 2006, ingresaron en la UCIP del Hospital Infantil Universitario Niño Jesús de Madrid con el diagnóstico de neumonía con derrame. Resultados. Se incluyó en el estudio a 63 niños. La etiología más frecuente fue Streptococcus pneumoniae. En el 65 % de los casos el derrame cumplía las características de empiema, y en el 33 % se trataba de un exudado. En todos los pacientes con proteína C reactiva (PCR) < 100 mg/l el derrame era un exudado, mientras que el 81 % de los casos con PCR > 170 mg/l cumplían los criterios de empiema (p < 0,05). Los pacientes que cumplían criterios de exudado necesitaron significativamente un menor número de dosis de fibrinolíticos que aquellos que presentaban empiema (1,6 frente a 4,5; p < 0,05). El número de días de mantenimiento del tubo de drenaje y de estancia en la UCIP fue también menor en los casos de exudado (3 días en ambos casos) frente a los pacientes con empiema (7 y 9 días, respectivamente) (p < 0,05). Conclusiones. Existe un incremento en el número de neumonías complicadas que requieren ingreso en la UCIP, con S. pneumoniae como principal agente etiológico. El empleo de técnicas rutinarias como la PCR puede ayudar a diferenciar las características del derrame paraneumónico. Las características del líquido pleural parecen influir en la necesidad de fibrinolíticos y el tiempo de mantenimiento del tubo de drenaje

Introduction. An increase in the number and severity of pleural effusions has been observed in the last few years. The aim of the study is to describe the epidemiological characteristics, clinical findings and the treatment of this disease. Material and Methods. This is a retrospective study of patients admitted into the PICU in Hospital Niño Jesús with parapneumonic pleural effusion from January 2005 to May 2006. Results. Sixty-three patients were included in the study. An increase of 29 % was observed in the number of patients admitted with parapneumonia effusion from 2005 to 2006. The most common aetiology was Streptococcus pneumoniae. In 65 % of patients pleural effusion was an empyema and in 33 % it was an exudate. In all patients with C-reactive protein below 100 mg/L the effusion was an exudate, whereas 81 % of patients with C-reactive protein above 170 mg/L had an empyema, p < 0.05. The patients who had an exudate needed lower doses of fibrinolytics than those who had an empyema (1.6 vs. 4.5, p < 0.05). The number of days having a chest tube or admitted in PICU was lower in patients with exudate (3 days each) than those with empyema (7 and 9 days respectively) (p < 0.05). Conclusions. An increase in the number of complicated pneumonias is observed amongst children in our country, S. pneumoniae being the main aetiology. Using laboratory techniques such as C-reactive protein can help to distinguish between complicated and uncomplicated pneumonia. Pleural effusion characteristics seem to have an influence on the need for fibrinolytic and the length of chest tube treatment

An investigation of the fine structure, cell surface carbohydrates, and appeal of the diatom Extubocellulus sp. as prey for small flagellates.

The fine structure and surface exopolymers of a coastal planktonic nanodiatom of the sparsely reported genus Extubocellulus were studied respectively by scanning electron microscopy and confocal microscopy in conjunction with fluorescent lectins. Monitoring the suitability of the species as prey food for other protists was also investigated by video microscopy coupled with digital film. Cells are rectangular in girdle view, with a pervalvar axis longer than the apical axis. Valves are almost circular with a diameter of 2.8 to 3.6 microm. The valve face bears randomly distributed areolae (ca. 50 in 10 microm), which may be either open or occluded. Two small raised ocelluli occur at the apices, with a rim devoid of perforations and about 6-7 porelli. Glucose and N-acetyl-glucosamine moieties present on the surface of the live diatom were labelled with fluorescent lectins, and a differential pattern of distribution for both carbohydrates was observed. The potential role of fluorescent lectins as cellular probes of taxonomic value in small diatoms is compared with that of nucleotide and antibody probes. We provide the first illustrative evidence of the presence of Extubocellulus sp. in the cytoplasm of the nanoflagellate Goniomonas amphinema and of the egestion of diatom frustules. Results obtained are discussed in the light of the present knowledge of the role of carbohydrate-protein interactions in phagocytosis of prey by free-living protozoa.

Trasplante hepático en tumores malignos en el niño / Liver transplantation for malignant tumors in children

Objetivo. Analizar nuestros resultados con el trasplante hepático (TxH) en tumores primitivos hepáticos malignos irresecables. Discutirlas indicaciones controvertidas en base a nuestra experiencia. Pacientes. Doce niños (edad 6 meses-14 años) con hepatoblastoma (11)y hepatocarcinoma (1) sin cirrosis. El TxH se planteó como tratamiento primario en 10 casos (catalogados como PRETEXT IV o con cualquier grado si tenían extensión a cava retrohepática, a 3 venas hepáticaso a tronco de la porta o sus 2 ramas principales) y como tratamiento de rescate tras recidiva (1) o constancia de persistencia de restos (..) (AU)

Objective. To analyse our results on liver transplantation(LTX) in primitive malignant unresectable liver tumours in children and discussing its controversial indications in order to our experience. Methods/Patients. We report 12 patients with ages ranging from 6 months to 14 years old. They had hepatoblastoma (11) and fibrolamellar hepatocellular carcinoma (1) without cirrhosis. LTX was considered as primary treatment in 10 patients (PRETEXT IV or any grade if extension to retrohepaticcava vein, 3 hepatic veins or porta vein were assessed) and as rescuetherapy after recurrence (1) or persistence of unresectable macroscopicrests (2). One of the patients who underwent a LTX as primary therapy had lung metastases previously resolved with chemotherapy. We usedentire liver (5), left lateral segment from cadaveric donor (3), live related donor (3, 2 segments II-III and 1 right liver) and left lateral segment (..) (AU)

[Severe bronchiolitis. Epidemiology and clinical course of 284 patients]. / Bronquiolitis grave. Epidemiología y evolución de 284 pacientes.

INTRODUCTION: Bronchiolitis is the leading cause of hospital admission and a frequent cause of pediatric intensive care unit (PICU) admission among infants during the winter months. The objective of this study was to analyze the characteristics and clinical course of patients admitted to the PICU for bronchiolitis. PATIENTS AND METHOD: We performed a descriptive, observational study by clinical chart review of all patients admitted to the PICU for severe bronchiolitis from November 1994 to March 2006. RESULTS: A total of 284 patients were included. Most were admitted during December and January and 74% had respiratory syncytial virus (RSV) infection. At least one risk factor for severe disease was present in 68% of the patients: the most frequent risk factor was age < 6 weeks (45%), followed by prematurity (30%). Mechanical ventilation was required in 64 of the 284 patients (24%). Mortality was 1.8% and was associated with chronic pre-existing illness (p < 0.001). The factors associated with a greater risk of mechanical ventilation and a longer PICU stay were the association of two or more risk factors (42/284; 15%), the presence of apnea (73/284; 25.7%), and images of pulmonary consolidation or atelectasis on admission chest X-ray (157/284; 55%). CONCLUSIONS: Most patients admitted for severe bronchiolitis to the PICU are healthy infants whose principal risk factor is young age. The main predictors of severe clinical course during PICU stay are the association of two or more risk factors, the presence of apnea, and pulmonary consolidation on admission chest X-ray. Bronchiolitis-associated mortality is low and is associated with pre-existing chronic illness.

Bronquiolitis grave. Epidemiología y evolución de 284 pacientes / Severe bronchiolitis. Epidemiology and clinical course of 284 patients

Introducción La bronquiolitis es la causa más frecuente de hospitalización y un motivo frecuente de ingreso en la unidad de cuidados intensivos pediátricos (UCIP) en menores de un año durante los meses de invierno. El objetivo del estudio fue analizar las características y la evolución de los pacientes que precisan ingreso en la UCIP por bronquiolitis. Pacientes y método Estudio descriptivo, observacional, por revisión de historias clínicas entre noviembre de 1994 y marzo de 2006 de todos los pacientes ingresados en la UCIP por bronquiolitis. Resultados Se estudiaron 284 pacientes. La mayoría ingresaron durante los meses de diciembre y enero; el 74 % presentaban infección por el virus respiratorio sincitial. Un 68 % presentó algún factor de riesgo de evolución grave: el más frecuente fue la edad menor de 6 semanas (45 %) seguido del antecedente de prematuridad (30 %). En total 64/284 pacientes (24 %) precisaron ventilación mecánica. La mortalidad fue de 1,8 % y se asoció a la existencia de enfermedad previa (p < 0,001). Condicionaron un mayor riesgo de ventilación mecánica y una estancia en la UCIP más prolongada, la asociación de dos o más factores de riesgo (42/284; 15 %), las pausas de apnea (73/284; 25,7 %) y la imagen de consolidación o atelectasia en la radiografía de tórax al ingreso (157/284; 55 %). Conclusiones La mayoría de los pacientes que ingresan en la UCIP por bronquiolitis grave son lactantes sanos cuyo principal factor de riesgo es la corta edad. La asociación de dos o más factores de riesgo, la presencia de consolidación radiológica y las pausas de apnea al ingreso son los principales determinantes de evolución grave en la UCIP. La mortalidad por bronquiolitis es baja y se asocia a la existencia de enfermedades crónicas previas

Introduction Bronchiolitis is the leading cause of hospital admission and a frequent cause of pediatric intensive care unit (PICU) admission among infants during the winter months. The objective of this study was to analyze the characteristics and clinical course of patients admitted to the PICU for bronchiolitis. Patients and method We performed a descriptive, observational study by clinical chart review of all patients admitted to the PICU for severe bronchiolitis from November 1994 to March 2006. Results A total of 284 patients were included. Most were admitted during December and January and 74 % had respiratory syncytial virus (RSV) infection. At least one risk factor for severe disease was present in 68 % of the patients: the most frequent risk factor was age < 6 weeks (45 %), followed by prematurity (30 %). Mechanical ventilation was required in 64 of the 284 patients (24 %). Mortality was 1.8 % and was associated with chronic pre-existing illness (p < 0.001). The factors associated with a greater risk of mechanical ventilation and a longer PICU stay were the association of two or more risk factors (42/284; 15 %), the presence of apnea (73/284; 25.7 %), and images of pulmonary consolidation or atelectasis on admission chest X-ray (157/284; 55 %). Conclusions Most patients admitted for severe bronchiolitis to the PICU are healthy infants whose principal risk factor is young age. The main predictors of severe clinical course during PICU stay are the association of two or more risk factors, the presence of apnea, and pulmonary consolidation on admission chest X-ray. Bronchiolitis-associated mortality is low and is associated with pre-existing chronic illness

Miastenia gravis juvenil. Una enfermedad olvidada por los pediatras / Juvenile myasthenia gravis. An overlooked disease by pediatricians

No disponible

[Liver transplatation for malignant tumors in children]. / Trasplante hepático en tumores malignos en el niño.

OBJECTIVE: To analyse our results on liver transplantation (LTX) in primitive malignant unresectable liver tumours in children and discussing its controversial indications in order to our experience. METHODS/PATIENTS: We report 12 patients with ages ranging from 6 months to 14 years old. They had hepatoblastoma (11) and fibrolamellar hepatocelullar carcinoma (1) without cirrhosis. LTX was considered as primary treatment in 10 patients (PRETEXT IV or any grade if extension to retrohepatic cava vein, 3 hepatic veins or porta vein were assessed) and as rescue therapy after recurrence (1) or persistence of unresectable macroscopic rests (2). One of the patients who underwent a LTX as primary therapy had lung metastases previously resolved with chemotherapy. We used entire liver (5), left lateral segment from cadaveric donor (3), live related donor (3, 2 segments II-III and 1 right liver) and left lateral segment from split (1). All children received chemotherapy prior and post-transplantation following SIOPEL protocol. OUTCOMES ANALYSED: Procedure tolerance, survival, recurrence rate, disease-free period and risk factors for adverse evolution. RESULTS: All patients overcame the LTX and no early loss of the graft was assessed. 2 patients died because of tumoral relapse, 1 after primary LTX and 1 after rescue LTX (survival rate of both groups 90% vs 50%). Graft and patients 1-year, 3-year, 5-year and 14-year survival were 91%, 91%, 82% and 82% respectively. The boy who presented lung metastases developed new ones one year after LTX that were removed and he actually is free of disease. The disease-free period has a probability for 1, 3 and 5 years of 91%, 75% and 75%. Tumoral tissue persistence is the only risk factor for an adverse evolution in our series. CONCLUSIONS: LTX is possible therapeutic approach for unresectable malignant liver tumours. It provides better results as a primary treatment than as a rescue one, being these outcomes comparable to those from resectable tumours. A right staging and referring patients to an expertise centre contribute to optimize results. LTX for patients presenting with lung metastases could be a controversial option. Live-related donor transplantation is an excellent alternative to avoid disease progression during cadaveric waiting list.

Trauma craneal grave en la infancia. Variables precoces asociadas a mala evolución / Several cranial trauma in infancy. Early variables associated to a poor evolution

Objetivos: Conocer las variables prehospitalarias y al ingreso en la Unidad de Cuidados Intensivos Pediátricos (UCIP) que ayudan a predecir la evolución de pacientes con traumatismo craneoencefálico (TCE) grave. Métodos: Estudio retrospectivo de pacientes que ingresaron en la Unidad de Politrauma Pediátrico de un hospital terciario con TCE grave (puntuación en la escala de coma de Glasgow ≤ 8) desde enero de 1999 a junio de 2005. Se recogieron datos sobre tipo de traumatismo, situación prehospitalaria, al ingreso en UCIP y variables pronósticas. Resultados: Fueron estudiados 49 pacientes, con una edad media de 7,2 años, DS 4,9; el 57% eran varones. Las causas más frecuentes fueron atropellos 41% y caídas 27%; 2 de cada 3 fueron traumatismos cerrados. Presentaron hipoxemia e hipotensión inicial el 29% y 21% respectivamente, y el 6% y 9% al ingreso en UCIP, las pupilas fueron normales en 2 de cada 3. Se intubó fuera del hospital al 79%. La media en la puntuación de Glasgow inicial fue de 5,4±1,9 y la mediana del índice de trauma pediátrico (ITP) en UCIP de 4. El 60% presentaba fracturas craneales y el 57% hemorragias intracraneales. La mortalidad global fue del 23% y la mediana de la puntuación en la escala pronóstica de Glasgow (Glasgow Outcome Scale) de 4. Un 53% de los supervivientes presentaron algún tipo de secuela neurológica al alta, las más frecuentes fueron hemiparesia (12%) y afectación de pares craneales (10%). Los que presentaron prehospitalariamente buena saturación de oxígeno (>90%) y tensión arterial normal, sobrevivieron 9 de cada 10. Fallecieron 2 de cada 3 de los que presentaron hipoxemia al ingreso en UCIP y la mitad de los que tuvieron hipotensión. Se observaron diferencias en la media de GOS en los pacientes con pupilas normales 4±1,3; anisocoria 3,5±1,4 y midriasis arreactiva 1,4±1,13 (p5 fue de 0,043 (0,005-0,39) (p<0,05). Conclusiones: El traumatismo craneoencefálico grave en niños tiene una elevada morbi-mortalidad. La valoración de la reactividad pupilar, la puntuación de coma de Glasgow y la presencia de hipoxemia e hipotensión ayudan a predecir el pronóstico vital y neurológico (AU)

Objective: To determine variables in the place of accident and when admission to hospital that help to predict the outcome of patients with severe craneal trauma. Methods: Retrospective study of patients who were admitted to the Pediatric Politrauma Unit of a tertiary hospital with severe craneal trauma (Glasgow Coma Scale ≤8) from January 1999 until June 2005. Data about kind of trauma, clinical signs at the place of accident, at admission to Pediatric Intensive Care Unit (PICU) and about functional outcome were collected. Results: 49 patients were studied, mean age 7.2 years old, SD 4.9; 57% were males. The etiology was: 41% were running over, 27% falls. Two out of three were closed traumas. Twenty-nine percent and twenty-one percent had hypoxemia and hypotension respectively at the accident place, and 6% and 9% when admitted to hospital. Pupils were normal in 2 out of every 3 patients. Seventy-nine percent of patiens required traqueal intubation. The mean in Glasgow Coma Scale was 5,4±1,9 and the median Pediatric Trauma Index (PTI) was 4. Sixty percent had skull fractures and 57% intracraneal haemorrhages. Mortality was 23% and median in Glasgow Outcome Scale (GOS) was 4. Fiftythree percent of survivors had some kind of neurological disabilities, the most common were hemiparesis (12%) and cranial nerves paresis (10%). Nine out of 10 who had good oxigen saturation (>90%) and blood pressure before arriving to hospital, they survived. Two out of 3 who had hypoxemia and half of those who had hypotension when admitted to PICU died. Differences in GOS were found between patients who had normal pupils 4±1.3, anisocoria 3,5±1.4 and mydriasis 1.4±1.13 (p5 was 0.043 (0.005-0.39) (p<0.05). Conclusions: Morbidity and mortality of severe craneal trauma in children are high. Assessment of pupils status, Glasgow Coma Scale, hypoxemia and hypotension can help to predict life and neurological outcome. Correct management from first stages and afterwards in a Pediatric Politrauma Unit should improve the future of these patients (AU)

Ciliate communities of rotating biological contactor biofilms: a multivariate approach.

Physical-chemical monitoring and characterization of ciliate communities from a full-scale rotating biological system (RBC) have been carried out for a year. RBC system operated efficiently in removing the organic matter, as the decrease of the BOD5 loading along the successive RBC units revealed. 55 species of ciliated protozoa were identified in the RBC biofilms. Differences in abundance, occurrence and type of species were found along the different units of the RBC system; the last RBC held a more stable and diverse ciliate community. The complexity of interspecific relationships among the ciliates has been outlined using multivariate methods (Cluster and Correspondence analysis). Correlation between ciliate species and physical-chemical conditions were obtained by regression analysis. Results show that 12 species of ciliates were related to an optimal efficiency in organic matter removal, Litonotus crystallinus being the most sensitive species. The presence and abundance of Litonotus crystallinus and Acineria uncinata was associated with a decrease in the organic factor. Metopus es was the only species related to a decrease in process efficiency due to its association with an increase in organic factor. The results provide statistical evidence of the use of certain ciliate species as reliable bioindicators in full-scale RBC wastewater treatment plants.

An integrated approach to analyse biofilms of a full scale wastewater treatment plant.

A rotating biological contactor (RBC) system operating in a full-scale wastewater treatment plant has been described by several approaches accounting for performance, composition and structure of biofilms in three stages through biological wastewater treatment (RBC1, RBC 2, RBC 3). RBC biofilms were effective in removing the BOD loading from 13 g BOD5 d(-1) m(-2) in RBC 1 to 6 g BOD5 d(-1) m(-2) in RBC 3. Analysis of biofilm composition showed: i) the volatile solids were similar in the three RBCs (0.6 g m(-2) VS per g m(-2) of TS); ii) the protozoan and metazoan biocenosis was mainly made up of ciliated protozoa, which were most abundant in RBC 2 (1.84 x 10(6) ciliates g(-1) VS). Relationship between ciliate species and physical-chemical profile of the system by cluster analysis indicated that the species Acineria uncinata, Amphileptus punctatus, Cinetochilum margaritaceum and Holosticha mancoidea were associated with the best RBC performance; iii) the exopolymeric matrix of the three RBC biofilms was mainly constituted by proteins, although humic substances, polysaccharides, uronic acids and DNA were also found. Analysis of biofilm structure by confocal microscopy indicated changes in biofilm organisation with depth. Results have been brought together and a graphic representation of the composition and architecture of RBC biofilms is presented.

Dynamics of protozoan and metazoan communities in a full scale wastewater treatment plant by rotating biological contactors.

Performance of a full-scale wastewater treatment plant by rotating biological contactors (RBC) system was monitored during a year by physico-chemical and microbial characterisation. Six points along wastewater treatment were selected in the plant: three points along the water line (influent, sedimentation tank and effluent) and three points along RBC system (RBC1, RBC2 and RBC3). Although a large seasonal change in the values of physico-chemical parameters was observed, operation of the plant was optimal during all year (90% of removal in BOD5 and SS influent content). Microbial characterisation was approached by determining the structure and dynamics of protozoan and metazoan communities. Protozoa were the most abundant in all stages in the plant, heterotrophic flagellates being the most representative group in the water line and ciliates in the RBC system. The same seasonal preference was only observed for heterotrophic flagellates in the water line and green flagellates in the RBC system, both groups having highest abundances in summer and spring, respectively. Identification of ciliated protozoa populations rendered 58 species of ciliates in the plant. Most of these species are typical of aerobic wastewater treatment systems except three of them, which are cited for the first time in this type of ecosystems: Chaenea stricta, Holosticha mancoidea and Oxytricha lanceolata. Along the water line 34 species were identified, and half of them only appeared occasionally (once in all the study), while along the RBC system biofilms 55 species were observed, and the majority appeared permanently in this system. Our results indicate that the type of habitat, rather than the physico-chemical water parameters, was the primary factor in determining the different distribution of protozoan and metazoan communities in the plant. In RBC biofilms, the structure of ciliate protozoa community was found to be quite sensitive to changes in physico-chemical parameters, mainly to organic loading (BOD5) variations.

Characterization of extracellular polymeric substances in rotating biological contractors and activated sludge flocs.

Extracellular polymeric substances (EPS) from biofilms of a rotating biological contactor (RBC) system and from activated sludge flocs were extracted using ultrasound and a cation exchange resin. In both wastewater treatment systems, the EPS matrix was mainly constituted of proteins, humic-like substances and polysaccharides, although other components--DNA and uronic-like substances--were also present. The composition of the biofilm EPS was different in the succesive RBC wastewater treatment stages: protein had its highest concentration in the first RBC unit, while humic substances and polysaccharides in the third RBC. Significant differences between biofilm and sludge floc EPS were also reported. The amount of proteins was 3.5 times higher for RBC biofilms than for sludge flocs, and quantities of humic substances and polysaccharides extracted from biofilms were twice as high than in sludges. Moreover, biofilm exopolymers were two times more hydrophobic than those of sludge flocs. Implications of wastewater chemistry and microbial growth strategies into EPS composition and properties are suggested.

Morphology and infraciliature of a marine scuticociliate with a polymorphic life cycle: Urocryptum tortum n. gen., n. comb.

A new genus and species combination are proposed for Urocryptum tortum n. gen., n. comb., a scuticociliate with a polymorphic life cycle. This marine ciliate was isolated from a sample taken at Gokasho Bay in Mie Prefecture (Japan). Specimens from different phases of the growth cycle were examined in vivo and with two silver staining techniques. Three life-history stages were observed: an exponential growth phase stage (trophont), a stationary phase stage (tomite), and finally a resting stage (cyst). The exponential growth form is laterally flattened and ovoid; it has 20-24 somatic kineties (SK) and a typical complement of scuticociliate oral structures. Polykinetid 1 (Pk1) has two longitudinal files of 6 kinetosomes (Ks); sometimes one or two additional kinetosomes are located anteriorly. Polykinetid 2 (Pk2) has two files of 6 or 7 Ks; a third file of three widely spaced kinetosomes is located on its right side, as well as a small curved row of 5 Ks positioned on the right hand side of the posterior end of Pk2. Polykinetid 3 (Pk3) has 3 rows of 4, 5, and 7 Ks's perpendicular to the haplokinety (Hk) or paroral membrane. The stationary growth phase cell is spindle-shaped and has a similar number of SK that are much more closely spaced than in exponentially growing specimens. Oral infraciliary structures are reduced in size, having fewer kinetosomes and being positioned more anteriorly in the cell. Pk1 is composed of two files of 5-Ks, Pk2 has only two files of 6-7 Ks, and Pk3 has two to three rows of 3-4 Ks. The Hk is displaced anteriorly and becomes straight, losing the shape typical of exponential growth phase cells. Cysts are pyriform with a wide cyst wall; no infraciliary structures were visible.

Blood chemistry profile of a South Pacific Island population.

AIMS: To determine basic blood chemistry parameters in the population of the island of Mauke in the South Pacific. METHODS: As a part of a health survey carried out in 1992, 24 laboratory parameters were measured in serum samples of 502 subjects representing 80.8% of the total population. RESULTS: Blood glucose, uric acid and globulin values were above the respective reference intervals in 9%, 5% and 4% of the subjects. Blood urea nitrogen and serum creatinine values were elevated in 1.8% and 1.2% of the subjects. Hypoalbuminaemia was found in 1.2% to 4% of the subjects, more frequently in the older age groups. Gamma glutamyltransferase levels were elevated in 6.2% of the subjects. Iron values were below the reference interval in 8.0% of the subjects. Serum cholesterol levels were elevated in 4.4% of the subjects. CONCLUSIONS: The blood chemistry data reflect the disease profile of this Pacific Island population including the presence of diabetes and iron deficiency as well as renal, hepatic and infectious diseases. The data can be used in comparative inter-island studies as well as in those between Pacific Island and other populations.

Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice.

HYPOTHESIS: That changing practices in a single institution toward performing total thyroidectomy as the preferred option for the treatment of bilateral benign multinodular goiter (BMNG) can alter attitudes and practice within an entire region (Australia and New Zealand). DESIGN: (1) Single-institution study of patients with bilateral BMNG treated by thyroidectomy over a 40-year period, examining the changing pattern of use of bilateral subtotal thyroidectomy and total thyroidectomy in the initial surgical treatment of nodular goiter. (2) Mail survey of all endocrine surgeons (n = 75) in Australia and New Zealand, seeking information on their changing practice in the surgical treatment of BMNG. SETTING: Tertiary academic referral center. PATIENTS: A group of 3468 patients who underwent thyroidectomy for bilateral BMNG during the study period. Of these, 1838 had a subtotal thyroidectomy performed and 1251 had a total thyroidectomy as the primary surgical treatment. MAIN OUTCOME MEASURES: The changing incidence of each type of thyroid procedure each year over the study period. RESULTS: Within our unit, bilateral subtotal thyroidectomy was the principal procedure performed until 1984, when total thyroidectomy became the preferred procedure. Our unit now treats 94% of these patients with total thyroidectomy. Secondary thyroidectomy for recurrent goiter initially increased over the years (with a lag period of 13 years), reflecting the numbers of subtotal procedures previously performed, and is now declining. This pattern has been reflected throughout Australia and New Zealand; 60% of practicing endocrine surgeons now perform total thyroidectomy as the preferred treatment for bilateral BMNG. CONCLUSIONS: Total thyroidectomy is a safe and effective treatment for bilateral BMNG, and it is now the routine procedure throughout Australia and New Zealand. Its use has corresponded to a reduction in the need for secondary thyroidectomy for recurrent goiter.

The spectrum of emergency admissions for thyroidectomy.

Emergency physicians frequently encounter patients with thyroid disease. However, it is unusual for these thyroid disorders to create acute, life-threatening situations. Critical airway compression attributable to benign or malignant thyroid enlargement may occur suddenly. Similarly, venous obstruction from thyroid tumors or severe physiological compromise from thyrotoxicosis may require urgent treatment. We reviewed a group of patients who were evaluated by emergency physicians for acute thyroid pathology and subsequently admitted for urgent thyroidectomy. Over a 7-year period, 13 patients had acute airway compressive symptoms, and 1 had acute venous compressive symptoms. Six patients had thyrotoxicosis with physiological compromise. Common airway management techniques were successfully used. Nineteen patients underwent thyroidectomy. One patient suffered a cardiopulmonary arrest before thyroidectomy could be performed. Surgical morbidity may be increased for patients undergoing thyroidectomy for urgent indications.

Age is no contraindication to thyroid surgery.

BACKGROUND: There is increased risk of surgical treatment in elderly patients, but little has been written on the safety and efficacy of thyroid surgery in this group. OBJECTIVE: To determine if there is an increased risk of morbidity and mortality of thyroid surgery in patients over 75 years old. PATIENTS AND METHODS: During the period 1986-96, 1631 patients aged 50 and over underwent 1673 procedures by two surgeons in our unit. We retrospectively compared indications for surgery, procedures, pathology complications and mortality in three groups: 50-60-year-olds (725 patients), 61-74-year-olds (685 patients) and those aged 75 years and over (221 patients) RESULTS: The main indication for surgery in all three groups was compression or risk of malignancy. Total thyroidectomy was the main procedure performed. Although benign multinodular goitre was the commonest diagnosis, the over-75-year-olds had fewer benign multinodular goitres than the 61-74 group and more malignancy than the other two groups. There was no significant difference in mortality between the three groups. CONCLUSIONS: Surgery in patients over 75 is as safe as in younger patients with no increase in morbidity and mortality. Benign multinodular goitre is the most common indication for surgery.