Retroceso bilateral de rectos laterales comparado con retroceso/resección unilateral para el tratamiento de la exotropia intermitente básica / Bilateral lateral rectus recession versus unilateral recession/resection for basic intermittent exotropia

Resumen INTRODUCCIÓN: En determinadas circunstancias clínicas, la exotropia intermitente básica requiere resolución quirúrgica. Existen dos técnicas para ello: el retroceso bilateral de rectos laterales y el retroceso/resección unilateral. Aunque el retroceso bilateral es la técnica más utilizada, no está claro cuál de estas técnicas tiene mejores resultados. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron siete estudios primarios, de los cuales tres son ensayos aleatorizados. Concluimos que el retroceso/resección unilateral podría tener un mayor éxito quirúrgico y probablemente disminuiría la tasa de subcorrección/recurrencia, cuando se le compara al retroceso bilateral de rectos laterales.

Abstract INTRODUCTION: Intermittent exotropia requires surgical resolution under some clinical circumstances. The main techniques are bilateral lateral rectus recession and unilateral recess/resection. Although bilateral recession is the most widely used, it is not clear whether it leads to better results. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including seven studies overall, of which three were randomized trials. We concluded unilateral recess/resection might achieve greater surgical success and probably decrease the rate of undercorrection/recurrence when compared to bilateral lateral rectus recession.

Epidemic of jungle yellow fever in Brazil, 2000: implications of climatic alterations in disease spread.

Seventy-seven human cases of sylvatic yellow fever were reported in Brazil during the period January-June 2000. The first cases were reported 1 week after New Year's day and originated at Chapada dos Veadeiros, a tourist canyon site in Goiás state, near Brasília, the Brazilian capital. The laboratory procedures used for diagnoses included serology with an IgM capture assay and plaque reduction neutralization test, virus isolation in suckling mice and C6/36 cells, and immunohistochemistry. All cases were diagnosed by at least two different laboratory procedures, with the exception of the first three fatal cases, which were diagnosed on the basis of clinical and epidemiological information. The cases were reported in eight Brazilian states as follows: Goiás with 64.9% (50 cases); Amazonas (1); Bahia (10); Distrito Federal (1); Mato Grosso (4); Minas Gerais (2); Pará (1); São Paulo (2); and Tocantins (6). Patient ages were within the following ranges: 13-74 years old (mean 34.3), 64 (84.4%) were male, especially agricultural workers (n = 30), but tourists (n = 11), carpenters (n = 4), fishermen (n = 4), students (n = 3), truck drivers (n = 3), and other people (n = 22) were also sickened. The case fatality rate was 50.6% (39/77). In Bahia state, a serologic survey that was carried out has suggested a symptomatic/asymptomatic coefficient of 1:4. Field studies developed in Distrito Federal, Goiás, and São Paulo states showed that Haemagogus janthinomys was the mosquito species associated with the transmission. A single strain was also obtained from Aedes scapularis in Bahia. Epizootic occurrence (monkey mortality) was observed in 49 municipalities mainly in Goiás state, where 40 municipalities made reports, 21 of which also diagnosed human cases. Data obtained by the National Institute of Meteorology in Brazil showed an increase in temperature and rain in December 1999 and the first 3 months of 2000 in Goiás and surrounding states, which perhaps has contributed to the intense and widespread transmission of the yellow fever virus. The relatively small number of cases probably reflects the extensive use of yellow fever 17D-vaccine during the last 3 years, in which about 45 million doses were used. During the last months of 1999, 16 and 11 yellow fever cases were reported in Tocantins and Goiás states, respectively. It is noteworthy that the last reported autochthonous cases of sylvatic yellow fever in São Paulo and Bahia, both states outside the endemic/enzootic area, had occurred in 1953 and 1948, respectively.

Serious adverse events associated with yellow fever 17DD vaccine in Brazil: a report of two cases.

BACKGROUND: The yellow fever vaccine is regarded as one of the safest attenuated virus vaccines, with few side-effects or adverse events. We report the occurrence of two fatal cases of haemorrhagic fever associated with yellow fever 17DD substrain vaccine in Brazil. METHODS: We obtained epidemiological, serological, virological, pathological, immunocytochemical, and molecular biological data on the two cases to determine the cause of the illnesses. FINDINGS: The first case, in a 5-year-old white girl, was characterised by sudden onset of fever accompanied by headache, malaise, and vomiting 3 days after receiving yellow fever and measles-mumps-rubella vaccines. Afterwards she decompensated with icterus and haemorrhagic signs and died after a 5-day illness. The second patient-a 22-year-old black woman-developed a sore throat and fever accompanied by headache, myalgia, nausea, and vomiting 4 days after yellow fever vaccination. She then developed icterus, renal failure, and haemorrhagic diathesis, and died after 6 days of illness. Yellow fever virus was recovered in suckling mice and C6/36 cells from blood in both cases, as well as from fragments of liver, spleen, skin, and heart from the first case and from these and other viscera fragments in case 2. RNA of yellow fever virus was identical to that previously described for 17D genomic sequences. IgM ELISA tests for yellow fever virus were negative in case 1 and positive in case 2; similar tests for dengue, hantaviruses, arenaviruses, Leptospira, and hepatitis viruses A-D were negative. Tissue injuries from both patients were typical of wild-type yellow fever. INTERPRETATION: These serious and hitherto unknown complications of yellow fever vaccination are extremely rare, but the safety of yellow fever 17DD vaccine needs to be reviewed. Host factors, probably idiosyncratic reactions, might have had a substantial contributed to the unexpected outcome.

Apoptosis in sea urchin embryos.

It is demonstrated by DNA electrophoresis analysis, morphological observations and TdT in situ reaction, that Paracentrotus embryos if treated with TPA plus heat undergo an apoptotic reaction. Indication is also obtained that non treated embryos undergo spontaneous apoptosis at the early pluteus stage, especially in the districts of arms and intestine. The possible meaning of this latter observation is discussed.

Time course of vinblastine-induced autophagocytosis and changes in the endoplasmic reticulum in murine pancreatic acinar cells: a morphometric and biochemical study.

The time course of the vinblastine(-sulfate; 10 mg/kg body weight, single injection)-induced enlargement and subsequent regression of the autolysosomal compartment was studied by electron microscopic morphometrical and cell biochemical methods in order to gain information concerning some key problems of this major route of intralysosomal degradation of the cell's endogenous macromolecules and structures. Detailed analysis of the dynamics of the total autophagic vacuole (AV) compartment and its different subcompartments (early, advanced, late, and fused AVs), as well as of changes of rough-surfaced endoplasmic reticulum (RER) showed: 1. Pancreatic acinar cells react to vinblastine biphasically, i.e. two expansion phases of the AV compartment, the first in the 0 to 90 min and the second in the 2 to 8 h post-injectional periods, were detected. 2. Fusions of AVs are not inhibited by vinblastine, at least during the second expansion phase when cytoplasmic volume fraction (CVF) of fused AVs steadily increased until the 12th h. Fusion of early, advanced and late AVs or composition of fused complex vacuoles (AVc) are somehow regulated, as the proportion of the three AV stages from the CVF of AVc, was maintained constant throughout the second expansion phase. 3. Stimulation of autophagosome formation and resulting substrate overload seems to be the primary mode of action by which vinblastine causes the enormous expansion of the autolysosomal compartment. 4. Degranulation of the rough-surfaced endoplasmic reticulum (RER) membranes occurs in a biphasic fashion, similarly to the volume and surface changes of the AV compartment, thus supporting our previous hypothesis, that labilization or change of RER may have a role in the formation of autophagosomes. 5. Vinblastine-induced autophagocytosis is a selective process, as mitochondria, Golgi elements and zymogen granules are very much underrepresented, whereas RER is more than twice overrepresented in the volume of early AVs, when compared to their volume fraction in the whole cytoplasm. 6. Immunogold electron microscopy revealed the presence of ubiquitinylated proteins in advanced and late, but not in early AVs.

L-arginine is unlikely to exert neuroendocrine effects in humans via the generation of nitric oxide.

There is now considerable evidence that nitric oxide is an important neuroregulatory agent, but there has been very little investigation of its possible role in neuroendocrine mechanisms in humans. We have investigated the effects of two nitric oxide precursors, L-arginine and molsidomine, under basal conditions on the pituitary hormones growth hormone (GH), prolactin, luteinizing hormone, follicle-stimulating hormone, thyrotrophin, adrenocorticotrophin (ACTH) and vasopressin, and also on serum cortisol; we have also studied the effect of L-arginine on circulating prolactin, ACTH and cortisol in normal human subjects under hypoglycaemic stress. L-Arginine stimulated both GH and prolactin release under basal conditions but had no effect on the other hormones studied, while the nitric oxide donor molsidomine showed no effect on any hormone studied. L-Arginine potentiated the hypoglycaemia-stimulated release of ACTH but did not influence the rise in GH. The current studies suggest that the effects of L-arginine on the stimulation of GH and prolactin release are unlikely to be mediated via the generation of nitric oxide.

Somatostatin infusion suppresses GH secretory burst frequency and mass in normal men.

In attempting to elucidate the neuroendocrine mechanisms that regulate pulsatile growth hormone (GH) secretion, we measured serum GH concentrations by an ultrasensitive immunofluorometric method in blood collected every 10 min for 8 h in 11 young healthy male volunteers (age range 21-31 yr) before and during somatostatin (SS) administration (an iv bolus dose of 350 micrograms followed by a continuous infusion at the rate of 6 micrograms.kg-1.h-1, which increases the circulating SS levels to approximately 570 pg/ml). Pulsatile GH secretion was analyzed using the computer-assisted pulse detection program cluster method and deconvolution analysis. The area and frequency of GH peaks were significantly reduced during SS infusion compared with basal values, but detectable pulsatile episodes were still present. These data suggest that, in adult males, SS controls pulsatile GH secretion and can decrease the mass and frequency of GH secretory bursts.

Effect of exogenous growth hormone administration on endogenous growth hormone secretion induced by a met-enkephalin analog.

Exogenous growth hormone (hGH) administration in humans attenuates the endogenous growth hormone (GH) response to some pharmacological stimuli; in particular, pretreatment with hGH completely blocks the serum GH response to growth hormone-releasing hormone. In order to evaluate the mechanism(s) whereby opiods induce GH secretion in man, we gave the following treatments to six healthy male volunteers: (a) IV saline; (b) a met-enkephalin analog G-DAMME 250 micrograms IV as a bolus at time 0'; (c) hGH 2 IU as an IV bolus at time -180'; (d) G-DAMME as above, preceded by hGH as above. In our study, G-DAMME stimulated GH secretion both basally (peak 17.9 +/- 6.0 ng/ml) and, to a lesser extent, after hGH pretreatment (6.0 +/- 2.7 ng/ml). Since in our study G-DAMME was able to partially overcome the inhibitory effect of hGH administration, it is suggested that opioids act through an inhibition of somatostatin release and not through a GHRH-dependent pathway. However, an additional direct effect of hGH on pituitary somatotrophes cannot be excluded.

[Hospital day-surgery: comparative evaluation of 3 general anesthesia techniques]. / Day hospital chirurgico: valutazione comparativa di tre tecniche di anestesia generale.

For the voluntary interruption of pregnancy, three anaesthetic techniques have been compared being a random assigned to three groups of 40 patients. Induction of anaesthesia was based on fentanyl 0.005 mg/kg+midazolam 0.2 mg/kg or fentanyl 0.005 mg/kg = propofol 2.5 mg/kg or ketamina 0.5 mg/kg+propofol 2.0 mg/kg. Anaesthesia was maintained delivering in spontaneous-assisted ventilation N2O 70% in O2. In addition to the intraoperative conditions, quality and rapidity of some neurofunctional aspects of the recovery have been evaluated using the Steward Score and the Coin Counting Test respectively. Our data suggest fentanyl-propofol association as the safest one as regards the needs of one-day surgery.

Opioid peptide and alpha-adrenoceptor pathways in the regulation of the pituitary-adrenal axis in man.

Opioid peptides are well established as potent inhibitors of the pituitary-adrenal axis, while alpha 1-adrenoceptor drugs have recently been shown to stimulate this axis: both classes of agents appear to work principally above the level of the pituitary, most probable directly on the hypothalamus. There is also evidence that these drugs interact in their control of pituitary-adrenal function, although the specific hypothalamic releasing hormone involved has remained unclear. We have therefore carried out a study into the interaction of methoxamine, an alpha 1-adrenoceptor agonist and naloxone, an opioid antagonist, together with human corticotrophin-releasing hormone (CRH), in a group of healthy volunteers in order to establish the mode of action of these drugs. The following drugs were administered to a group of seven healthy male subjects in a randomized double-blind manner: methoxamine (6 micrograms/kg per min over 3 h); naloxone (10 mg bolus); human CRH (100 micrograms bolus); methoxamine plus CRH; naloxone plus CRH; methoxamine plus naloxone; saline (control). Plasma ACTH and serum cortisol were measured at intervals in each subject, and blood pressure and pulse rate recorded with each sample. Both CRH and naloxone produce a marked rise in ACTH and cortisol, peaking at approximately 45 min after infusion. In combination, the drugs produced a peak response in plasma ACTH at the same time, but its magnitude was greater than that after either drug alone. Methoxamine produced a rise in plasma ACTH which was maximal at approximately 75 min, as well as a peak rise in serum cortisol at 120 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of captopril, an inhibitor of the converting enzyme on naloxone induced secretion of ACTH and LH in man.

It has been previously shown that endogenous opioid peptides suppress human ACTH and gonadotropins secretion via hypothalamic mechanism. Since the angiotensin converting enzyme can participate in the metabolism of opioid peptides, this study examined the action of Captopril, an angiotensin converting enzyme inhibitor, on corticotropin and gonadotropin (LH and FSH) release induced by the opiate antagonist naloxone in man. Seven male hypertensive volunteers (aged 30-52) were treated with A) saline; B) naloxone 8 mg iv as a bolus followed by an iv infusion of 4 mg/h; C) naloxone as above after pretreatment with captopril 150 mg/day for 15 days; D) captopril alone. Naloxone significantly stimulated ACTH and LH secretion when compared with the saline infusion. This stimulating effect was taken as an indirect evidence for a tonic opioid inhibition on pituitary hormones release. The pre-medication with captopril significantly enhanced the ACTH and LH response to the opiate antagonist naloxone, but captopril alone did not modify ACTH and LH values when compared to saline. The results would suggest that captopril interferes with the opioid regulation of human ACTH and LH secretion probably by blocking the proteolytic degradation of opioid peptides.

Effect of medium-199 and fetal calf serum on in vitro maturation of domestic cat oocytes.

In vitro maturation (IVM) and fertilization are potentially useful for propagating threatened or endangered species. The domestic cat is currently used in this field as an experimental model for studies aimed at non-domestic Felidae. At present optimal conditions for obtaining IVM of cat oocytes have not yet been completely defined. The aim of this study was to evaluate two parameters derived from the procedures that currently ensure high maturation rates in domestic ruminants: (1) the suitability of a complex medium (M-199) for IVM of cat oocytes; (2) the effect of different concentrations of fetal calf serum in the culture medium with or without the addition of gonadotrophins. The maturation rate at two different intervals from the onset of culture (24 and 48 h) was also evaluated. The use of M-199 allowed resumption of meiosis in 4.3-18.7% of cat oocytes, according to the supplements and culture periods used. No significant differences were recorded among the treatment groups (P > 0.05). Meiosis was completed in 90.9% of cases within 24 h with no significant differences between the three treatment groups (P > 0.05). A 3.2% rate of parthenogenesis was observed at the end of the maturation period with no significant differences between the culture systems (P > 0.05). However, the percentage cleavage of oocytes was much higher (29%) when correlated with the percentage that had matured. In this case significant differences among treatments were also observed (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Dynamics of vinblastine-induced autophagocytosis in murine pancreatic acinar cells: influence of cycloheximide post-treatments.

Accumulation of autophagic vacuoles (AVs) was monitored by electron microscopic morphometry in murine pancreatic acinar cells during the 5-hr period after a single injection of vinblastine (VBL). The expansion of the autophagic compartment (AC) occurred in two waves. AVs accumulated in the first 90 min and regressed in the next hour, but thereafter AC expanded again, and 5 hr following the VBL injection, as much as 5.3% of the cytoplasmic volume was found sequestered into the AC. The high rates of accumulation of AVs indicated that VBL stimulated AV formation (segregation) during both expansion phases. To have a deeper insight into the dynamics of the process segregational inhibitor cycloheximide (CHI) was given 1 and 3 hr after VBL and the subsequent regression of the AC and its subcompartments (i.e., early, advanced, and late AVs) were measured during the next 90 min. We found that regression of AVs was fast in the first expansion and slowed down in the second expansion phase during which only early AVs regressed. CHI proved to be a fast and effective inhibitor of autophagic segregation, whether it was given before, simultaneously, or after the VBL injection. The aforementioned results argue for a dual mode of action of VBL (i.e., a prompt stimulation of segregation and a delayed retardation of AV maturation). The two effects of the alkaloid prevail differently along the time course. A further analysis of the behavior of the AC subcompartments showed that CHI perhaps inhibits segregational step(s) occurring prior to the actual formation of the autolysosomes.

The dynamics of structural modifications of mitochondria at the early stages of sea urchin embryonic development.

The organization of the chondriome and the ultrastructure of mitochondria have been studied in eggs and embryos of the sea urchin Paracentrotus lividus. The egg chondriome is characterized by an arrangement in well-delimited clusters. Analysis of mitochondrial clusters on electron micrographs of ultrathin serial sections shows two kinds of mitochondria of different shapes, the rod-shaped and the spherical. The egg mitochondria have a dense matrix and a well-ordered arrangement of cristae which, in rod-shaped variety, are perpendicular to the major axis. Cell division is accompanied by significant changes in intracellular distribution of mitochondria and in their structure. At the stage of 2-4 blastomeres, the clusters break up and numerous mitochondrial rods show signs of fragmentation; most of the observable mitochondria are of spherical shape. At the same time, the matrix becomes less dense, and the orderly arrangement of the cristae disappears. From the blastula to the gastrula stage, the observed modifications are reversed: the number of spherical-shaped mitochondria decreases, while that of the rod-shaped increases; the diameter of the latter is almost equal to the initial diameter of the spherical forms, the matrix becomes dense again and the cristae resume their orderly arrangement.

Translational inhibitors cycloheximide, emetine, and puromycin inhibit cellular autophagy in mouse liver parenchymal and pancreatic acinar cells in vivo.

The protein synthesis inhibitor cycloheximide is widely used (in vitro or in vivo) to inhibit the autophagic degradation of endogenous cellular proteins. Circumstantial evidence has been obtained largely from in vitro experiments for a similar effect of other translational inhibitors. In the present study, the in vivo effects of cycloheximide, emetine and puromycin on autophagy in murine exocrine pancreatic and liver cells were tested using electron microscopic morphometry. The experiments were based on the assumption that the autophagic compartment will regress if the formation of the vacuoles is blocked while degradation in the pre-existing vacuoles goes on. To make the measurements easier, autophagic compartment of the cells was greatly enlarged in both cell types by administering vinblastine (10 mg/kg b. wt.) for 2 h when the inhibitors were set on for an additional 30 min. During this half-an-hour, cycloheximide (0.2 mg/g b. wt.), emetine (0.12 mg/g b. wt.) and puromycin (0.2 mg/g b. wt.), respectively caused 58.5, 35.6, and 69.5% regression of the pancreatic and 46.7, 64.2, and 54.2% of the hepatocytic autophagic vacuole compartment. Thus, similarly to cycloheximide, both emetine and puromycin have proved to be inhibitors of autophagy in vivo. The results argue for a possible relationship between the synthesis and degradation of endogenous cellular proteins.

Time course of vinblastine-induced cellular autophagy in the murine pancreatic acinar cells in vivo. Different regression rates of the autophagic compartment caused by cycloheximide given different times after the vinca alkaloid. A morphometric study.

Autophagy is a three-step process in which parts of cytoplasm are segregated by membranes to form autophagosomes gaining acid hydrolases later, being converted this way into autolysosomes in which lysosomal degradation takes place. The actual size of the autophagic vacuole compartment (AVC) is obviously dependent on the velocity of these main steps. According to our morphometric measurements, a single dose (10 mg/kg b.wt.) of vinblastine (VBL) caused a conspicuous expansion of the AVC in pancreatic acinar cells, occurring in two waves: it expanded in the first 90 min but regressed in the next hour. This was followed by a second expansion monitored until the 5th post-injectional hour. The expansion rates indicate the existence of stimulation of autophagic segregation in both expansion phases. To take a further look, into the dynamics of the process, we blocked segregation by giving cycloheximide (CHI 0.2 mg/g b.wt.) 1 and 3 h after VBL and the subsequent regression of the AVC was followed by morphometry in the next 90 min. At the height of the first wave (1-2 h after VBL) the regression of AVC was not retarded, but rather, degradation rate seemed elevated. When CHI was given 1 h after VBL, 92% of the cytoplasmic volume fraction (CVF) of AVC regressed within the next 30 min. The main factor causing the expansion of AVC might be enhanced segregation in the first wave. Contrarily, at the beginning of the second wave, the turnover of AVs is dramatically slowed down. When CHI was given 3 h after VBL, only 27% of CVF of AVC regressed in the next 90 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of different protein synthesis inhibitors on the exocrine pancreatocytic autophagocytosis in vivo.

The translational inhibitor cycloheximide is also used as an inhibitor of cellular autophagy and intracellular degradation of endogenous cellular proteins. Some evidence for a similar effect of other inhibitors of protein biosynthesis is also available (largely from in vitro systems). In the present study, the in vivo effects of cycloheximide, emetine and puromycin on autophagy in murine exocrine pancreatic and liver cells were tested using electron microscopic morphometry. The experiments were based on the fact that when the formation of autophagosomes is inhibited, a regression of the autophagolysosomal compartment can be measured, provided intralysosomal degradation in the pre-existing autophagic vacuoles continues at an unchanged rate. To make the measurements easier, autophagolysosomal compartment of the cells was enlarged by administering vinblastine (10 mg/kg b.wt.) for 2 h when the inhibitors were given for an additional 30 min. During this time cycloheximide (0.2 mg/g b.wt.), emetine (0.12 mg/g b.wt.) and puromycin (0.2 mg/g b.wt.), respectively caused 35, 25 and 52% regression of the pancreatocytic autophagolysosomal compartment. Since all the above translational inhibitors inhibited autophagocytosis as well, the possibility of a coupling between the regulation of synthesis and inhibition of proteins arises.

Mechanism and dynamics of macroautophagy in murine exocrine pancreatic cells. A review of vinblastine-induced changes.

Autophagy is a major pathway of lysosomal degradation of cellular macromolecules. The paper summarizes the results obtained in the studies on macroautophagy using the exocrine pancreatic acinar cell as model system and vinblastine as inducer. Current knowledge about the origin and properties of the limiting membranes of autophagic vacuoles, and the results of quantitative morphological studies into the dynamics and kinetics of vinblastine-induced autophagocytosis, as well as recent achievements in isolation and characterization of subclasses of autophagic vacuoles (autophagosomes and autolysosomes) are reviewed.