Estudio de las gestantes de edad avanzada en el Hospital Universitario de Caracas / Advanced maternal age studies in the Hospital Universitario de Caracas

Se realizó un estudio retrospectivo, descriptivo, comparativo en 436 pacientes embarazadas atendidas en el Servicio de Obstetricia del Hospital Universitario de Caracas, durante el período comprendido entre enero de 2000 y diciembre de 2003. Fueron distribuidas en dos grupos, el grupo "A" constituido por 212 embarazadas de 35 años o más, atendidas en la consulta de alto riesgo obstétrico y el grupo "B" conformado por 224 embarazadas menores de 35 años atendidas en la consulta prenatal de bajo riesgo. Los objetivos del estudio fueron determinar si es cierto que la edad materna avanzada es un factor de alto riesgo y determinar si el control prenatal, el control del parto y el puerperio hecho en la gestante de edad avanzada disminuye el grado de riesgo materno - fetal haciendo que su pronóstico sea similar al de las gestantes de menor edad con menos riesgo. En el grupo estudio hubo mayor porcentaje de complicaciones prenatales, destacándose la hipertensión. La cesárea tuvo una proporción del 45,29 por ciento, siendo más frecuentes las de emergencia. Las cifras de amenaza de parto pretérmino fueron semejantes en ambos grupos. El puerperio fue de evolución satisfactoria con un número menor de casos para el grupo estudio. No hubo muertes maternas en ambos grupos. El peso de los recién nacidos fue adecuado muestra en ambos grupos con un porcentaje mayor de recién nacidos macrosómicos en el grupo estudio. La evolución neonatal tuvo un porcentaje mayor de casos no satisfactorios en las gestantes de edad avanzada. Se concluye que a pesar de ser las gestantes de edad avanzada un grupo de alto riesgo, el control adecuado y frecuente para la detección oportuna de las complicaciones y una conducta más intervencionista en la resolución de los casos y a una mayor atención de las madres en el posparto, así como de sus hijos en forma inmediata, hacen que los índices de morbimortalidad perinatal no muestren diferencias significativas con respecto al grupo control catalogado.

A retrospective, comparative study control case was performed in 436 pregnant women assisted on the Hospital Universitario de Caracas, between January 2000 and December 2003. They were distributed in two groups, group "A" with 212 pregnant women 35 or more old years, assisted on Obstetrical High Risk Consultation and group "B" conformed by 224 pregnant women minor 35 year old. The objective was to determine if true than advanced age in pregnant women is a high risk factor; and the prenatal control, intrapartum and puerperal care in the pregnant women 35 or more years old minimizes the risk, making it similar to control group. In study group there were a larger percentage of prenatal complications, principally hypertension. Cesarean section was done a in 45.29 percent, often as emergencies. The premature delivery threat numbers were similar in both groups. Puerperal evolution was satisfactory with fewer cases for the study group. There were not maternal deaths in both groups. Weight of newborns showed in both groups a large percentage with standard weight, with a double incidence for macrosomics in the study group. Neonatal evolution had more unsatisfactory cases for the patients with advanced maternal age. We conclude that advanced age in pregnant patients is a high risk factor. Pregnant women with good health and an adequate prenatal care can reduce risks, resulting in a good maternal-fetal prognostic similar to the low risk group.

Substances with estrogenic activity in effluents of sewage treatment plants in southwestern Germany. 2. Biological analysis.

The proliferation test with human estrogen receptor-positive MCF-7 breast cancer cells (E-Screen assay) was applied for quantitative determination of total estrogenic activity in 24-h composite effluent samples from 16 municipal and two industrial sewage treatment plants (STPs) in the state of Baden-Württemberg, southwestern Germany. The estrogenic efficacy relative to the positive control, 17beta-estradiol, was between 26 and 74% (median, 48%) for the 16 municipal STPs. Estradiol equivalent concentrations (EEQs) were between 0.2 and 7.8 ng/L (median, 1.6 ng/L) and, thereby, were lower than those found in a pilot study, which revealed EEQs of greater than 10 ng/L in the effluents of two other STPs. The EEQs in 14 of the 16 effluent samples were very similar (0.9-3.3 ng/L), indicating a rather constant input of estrogenic substances via STPs into rivers. Additional activated charcoal filtration turned out to be very efficient in further eliminating estrogenic activity from effluents. The EEQs of the E-Screen assay and those calculated from the results of extensive chemical analysis using the estradiol equivalency factors determined for 13 natural and synthetic estrogenic substances were comparable for most of the effluent samples. 17beta-Estradiol, 17alpha-ethinylestradiol, and, to a lesser extent, estrone contributed to 90% or more of the EEQ value.

Input/output balance of estrogenic active compounds in a major municipal sewage plant in Germany.

24 h samples of untreated and treated wastewater were taken in parallel from a modern municipal sewage plant in southern Germany in March and June 1998. After solid phase extraction, total estrogenic activity was quantitatively measured with a miniaturized E-screen assay and the levels of nine estrogenic phenolic chemicals analyzed by HRGC/LRMS. 17Beta-estradiol equivalent concentrations (EEQ) were 58 and 70 ng/l in the influent and 6 ng/l in the effluent, indicating that the load of estrogenic activity of the wastewater was reduced by about 90% in the sewage plant. Less than 3% of the estrogenic activity was found in the sludge. 4-t-octylphenol, 4-nonylphenol, bisphenol A, 2-hydroxybiphenyl, and 4-chloro-3-methylphenol were detected in the untreated wastewater at levels from 0.13 to 3.6 microg/l. 4-t-octylphenol, 4-nonylphenol, and bisphenol A were present in the effluent at concentrations from 0.16 to 0.36 microg/l, 2-hydroxybiphenyl and 4-chloro-3-methylphenol were not detectable. The contribution of the quantified levels of phenolic xenoestrogens to total estrogenic activity in the sewage was 0.7-4.3%.

Pitfalls in the application of enzyme-linked immunoassays for the detection of circulating trypanosomal antigens in serum samples.

The experimental infection of two goats with Trypanosoma vivax trypanosomes provided samples for analysis using parasitology techniques and antigen-detection enzyme-linked immunosorbent assays (ELISAs) for T. vivax, T. congolense and T. brucei. Clinical, parasitological and serological findings were monitored during the course of infection to identify problems in the application of these ELISAs. The data clearly showed that the ELISAs examined were entirely unsuitable for the reliable detection of trypanosomal antigen. Consequently, research strategies pertinent to the development of a new generation of both antigen and antibody ELISAs are outlined considering the problems encountered. These were (1) the reactivity of the reagents; (2) the specificity of the reagents; (3) the nature of the test sample, e.g. the compartmentalisation of trypanosomes between plasma, serum and red blood cells; (4) possible interference with the ELISA through immune complexing; and (5) the biology of the host/trypanosome relationship to gain an understanding of fluctuations in trypanosomes in the systemic circulation.

Development of a sensitive E-screen assay for quantitative analysis of estrogenic activity in municipal sewage plant effluents.

A simplified proliferation test with human estrogen receptor-positive MCF-7 breast cancer cells (E-screen assay) was optimized and validated for the sensitive quantitative determination of total estrogenic activity in effluent samples from municipal sewage plants. After solid phase extraction of 1 l sewage on either 0.2 g polystyrene copolymer (ENV+) or 1 g RP-C18 material and removal of the solvent, analysis of the extracts in the E-screen assay could be performed without any clean-up step. This was even possible with untreated sewage. Parallel extraction of four sewage samples on both different solid phase materials gave comparable quantitative results in the E-screen. A blank sample did not induce cell proliferation. As additive behaviour of the estrogenic response of single compounds was proven for two different mixtures each containing three xenoestrogens, total estrogenic activity in the sewage samples, expressed as 17 beta-estradiol equivalent concentration (EEQ), could be calculated comparing the EC50 values of the samples with those of the positive control 17 beta-estradiol. The detection limit of the E-screen method was 0.05 pmol EEQ/l (0.014 ng EEQ/l), the limit of quantification 0.25-0.5 pmol EEQ/l (0.07-0.14 ng EEQ/l). In total, extracts of nine effluent and one influent sample from five different municipal sewage plants in South Germany were analyzed in the E-screen. All samples strongly induced cell proliferation in a dose-dependent manner which was completely inhibited by coincubation with 5 nM of the estrogen receptor-antagonist ICI 182,780. The proliferative effect relative to the positive control 17 beta-estradiol (RPE) was between 30 and 101%. 17 beta-Estradiol equivalent concentrations were between 2.5 and 25 ng/l indicating a significant input of estrogenic substances via sewage treatment plants into rivers.

Validation and application of a rapid in vitro assay for assessing the estrogenic potency of halogenated phenolic chemicals.

The E-Screen assay serves as an in vitro tool for the detection of estrogenic activity of chemicals and extracts of environmental samples. Based on the induction of proliferation in human estrogen receptor-positive MCF-7 breast cancer cells we could substantially simplify the assay. As one important step of validation we applied the modified assay for testing nine known xenoestrogens. We could confirm the results of other groups assuring the reproducibility of the E-Screen assay. The results provide evidence that the E-Screen assay is suitable for determination of estradiol equivalency factors (EEFs) for environmental estrogens to rank their estrogenic potency relative to the natural estrogen 17 beta-estradiol. Further, we used the optimized proliferation test to screen nine halogenated phenolic compounds for their possible estrogenic potency. Three widely applied chemicals expressed a weak receptor-mediated estrogenic activity: the flame retardant Tetrabromo-Bisphenol-A, the disinfectant 4-chloro-3-methylphenol, and the herbicide educt 4-chloro-2-methylphenol. Their estrogenic potencies were five to six orders of magnitude lower than that of 17 beta-estradiol.

[Continuation of the observation and serological investigation of a Maedi-Visna virus infected sheep flock from January 1990 to June 1996]. / Fortsetzung der Beobachtung und der serologischen Untersuchung einer Maedi-Visna-Virus-infizierten Schafherde von Jänner 1990 bis Juni 1996.

This paper describes the second part of a longtime-study, started in 1987. Serologic investigations for detecting antibodies against Maedi Visna-virus (MVV) were performed, involving an institute own sheep flock. The method used was the immunodiffusiontest. The flock consisted of different breeds and their offsprings. So far, the virus seems to persist in the herd. This work also shows the importance of the central role of the does for spreading the virus. Seroconversion was detected in a sheep at the age of 32 months. The mother of this sheep was a thoroughbred and MVV-negative mountain sheep. After removal of the animals with high antibody (ab)-titers, until the end of 1991, the percentage of seronegative sheep increased. Then seropositive sheep didn't show high ab-titers anymore. Since 1990 only offsprings increased the size of the herd. The health status of the flock was clinically inconspicuous. It can be concluded that in spite of good food quality, good hygiene, without culling positive animals and just giving away accidentally some sheep, no elimination of MVV was registered in the flock over a period of more than six years. There was only seen a reduction of seropositive animals. Single results of serological tests, without knowing the sheep and the serological status of the herd, could pretend a false negative status.

The adhesion molecule E-cadherin and a surface antigen recognized by the antibody 9C4 are selectively expressed on erythroid cells of defined maturational stages.

The antigen expression of immature erythroid bone marrow cells was studied using two recently generated monoclonal antibodies (mAb), mAb 67A4 and 9C4, with specificities for the epithelial cell adhesion molecule E-cadherin (E-cad; mAb 67A4), and a novel 110 kDa differentiation antigen (mAb 9C4) with unknown molecular structure. Pappenheim staining of FACS-purified cells labeled with mAb 9C4 and anti-glycophorin A (GA) revealed that the majority of the 9C4+GA- and 9C4+GA+ cells consisted of erythroblasts. In contrast, the E-cad-positive population comprised normoblasts and erythroblasts. While the E-cad+GA- fraction contained mainly erythroblasts and basophilic normoblasts, the E-Cad+GA+ population was enriched in orthochromatic and polychromatophilic normoblasts. By colony assays of affinity column-purified cells it could be shown that erythroid colony forming units (CFU-E) were enriched and erythroid burst forming units (BFU-E) were depleted in the 9C4- and E-cad-positive fractions. Flow cytometric analysis of bone marrow cells double-labeled with mAb 67A4 and anti-CD71, anti-CD117, anti-CD34, or anti-GA revealed that about 90% of the E-cad-positive cells coexpressed CD71, about 70% were positive for CD117, about 50% for GA, and only about 5% coexpressed CD34. The expression pattern of 9C4 antigen was similar to that of E-Cad with the exception that only a minority of the 9C4-positive cells coexpressed GA. Lymphoid and myeloid markers were negative on both the E-Cad- and 9C4-positive populations. In these studies we describe the identification of a new mAb-defined antigen which is specifically expressed on erythroblasts and CFU-E(9C4) and demonstrate that E-Cad is not only expressed on epithelial cells but also on erythropoietic cells of defined maturational stages.

[Isolation of the agent of European swine plague from imported frozen wild boar meat]. / Isolierung des Erregers der Europäischen Schweinepest (ESP) aus importiertem gefrorenen Wildschweinfleisch.

Since July 1993 imported frozen meat of wild boars has to be screened for the presence of HCV. The number of taken samples is given by the Ministry of health, sport and consumer protection. Until August 1994 the total number of 688 samples from different countries, have been examined. Three of them were found positive for HCV. The first one (November 1993) was from China, the other two positive samples were sent in one delivery from Romania in May 1994.

Effect of increased wall thickness on indices of left ventricular pump function in children.

OBJECTIVE: To investigate whether augmented chamber performance in children with a concentric hypertrophied left ventricle is due to increased myocardial shortening or a geometric effect of the thickened ventricular wall. DESIGN: Chamber performance in terms of fractional area change and myocardial shortening--that is, circumferential midwall shortening--were measured by cross sectional echocardiography in young people with normal left ventricles and those with concentric hypertrophy of the left ventricle. PATIENTS: 52 healthy infants, children, and young people (age range 3 1/2 weeks to 26 years; body weight 1.8-89 kg (mean 23.6 kg)) and 29 infants, children, and adolescents with ventricular hypertrophy (mean body weight 31.4 kg, age range 4 weeks to 18.7 years). MAIN OUTCOME MEASURES: Chamber areas, fractional area change, midwall circumferential shortening normalised to body weight. RESULTS: In the controls normalised reference values were: end diastolic cavity area, 1.47 (0.25) cm2/kg0.65; fractional area change, 0.56 (0.03); end diastolic myocardial area, 1.62 (0.25) cm2/kg0.55; midwall circumferential shortening, 0.21 (0.03). By comparison, the patients had normal chamber areas (end diastolic myocardial area, 1.57 (0.42) cm2/kg0.65), increased fractional area change, 0.68 (0.05) (P < 0.001), and normal midwall circumferential shortening, 0.21 (0.03). There was a significant relation between the degree of hypertrophy (in terms of end diastolic myocardial area) and pump function while midwall shortening remained constant: 0.08 x end diastolic myocardial area + 0.44 (r = 0.74, P < 0.001). CONCLUSIONS: The relation between myocardial shortening, wall thickness, and fractional area change emphasises that the augmentation of pump function variables in left ventricular hypertrophy in young people is an effect of the thickened wall and not necessarily due to increased myocardial shortening. This relation offers the possibility of assessing the adequacy of chamber performance with respect to the degree of hypertrophy.

Septic focus localized by determination of arterio-venous difference in neopterin blood levels.

We describe a case of a 38-year-old female accident victim who was admitted to the trauma hospital with an ISS of 66. Successful emergency treatment (including amputation of the left leg) and 4 weeks of intensive care led to an overall improvement so that the patient was extubated on day 29. Throughout this period neopterin was measured routinely 3 times a week and correlated well with the clinical course. At the end of the fifth week massive lung impairment and all clinical signs of sepsis appeared. Neopterin values increased dramatically up to 200 nmol/L. However, no abnormal findings were revealed by X-ray, contrast fluoroscopy, or sonographic imaging. To examine the amputation site more closely, simultaneous determination of neopterin in samples from the vena and arteria femoralis was performed. We found a 50% higher level in the venous blood (300 vs. 200 nmol/L). This was regarded as evidence for a hidden focus. Immediate surgical intervention revealed an abscess, which proved to be Pseudomonas aeruginosa positive. After adequate treatment the patient recovered quickly. In this case neopterin was not only helpful in monitoring the septic episodes of the patient, but proved essential for the detection of a septic focus and the risk of explorative relaparotomy could be omitted.

Seroprevalence survey for Anaplasma marginale-infection of Austrian cattle.

A serologic survey study of 5,076 Austrian cattle farming herds was carried out in the period of December 1988 till March 1990. One animal was randomly selected from each herd and the antibody titer against Anaplasma marginale in blood serum samples was evaluated by means of the complement fixation test. The number of these tested blood samples was 3.6% of 140,081 cattle herd farms of Austria. 109 (2.1%) of the tested animals showed positive titers (1:10) against Anaplasma marginale, in relation to the 140,081 cattle herds 0.08%, 4,786 (94.3%) blood serum samples were sero-negative, 188 (3.8%) reacted anticomplementary. The highest number of antibody-positive animals of 8 tested Austrian districts could be found in Carinthia (46 = 5.7%). In Burgenland all tested sera turned out to be negative. Concerning the distribution of sero-positive animals in Austria it can be stated that a decrease of positive reactors from southern to northern region is evident. A connection between the occurrence of anaplasmosis in Italy, Yugoslavia, Switzerland and Hungary, is postulated as a result of the different systems of keeping cattle in the provinces and the regional increase of tick invasion. Possibly an intensive animal transportation is of importance due to the introduction of the disease mentioned before. The results obtained show that anaplasmosis does occur in different areas of Austria. For control of this disease in Austria it is proposed that all imported cattle should be tested serologically for antibodies against Anaplasma marginale. Other diseases in connection with anemia should be excluded by clinical, serological, blood-, as well as pathological examinations.

[Serological studies of the recent infections of Austrian horses with the equine arteritis virus]. / Serologische Untersuchungen zur aktuellen Verseuchung österreichischer Pferde mit dem Virus der Equinen Arteritis.

944 serum samples of horses, collected in 1988 and 1989, were examined for the occurrence of antibodies against equine arteritis virus by a microneutralizations test. In 10.9% of all sera reactors could be found. The distribution of seropositive horses varied from 4.6% (Salzburg) to 15.7% (Lower Austria). From Tyrol and Vorarlberg no samples could be obtained. It was not possible, to correlate clinical symptoms (infertility, respiratory symptoms, fever and edema) with the infection. It is assumed, that the disease appears in Austria only in a clinical inapparent form.

[The detection of antibodies to the agent of malignant catarrhal fever in sheep and goat sera]. / Zum Nachweis von Antikörpern gegen den Erreger des bösartigen Katarrhalfiebers in Schaf- und Ziegenseren.

An epidemiologic study was undertaken by means of the SNT on three sets of sheep sera and one set of goat sera to evaluate for the occurrence of antibodies against strain WC11. Out of 791 sera of a sheep breeding organisation 57 samples (7.2%) showed positive titers. The positive samples originated from 24 farms (36.4%) out of 66 farms under test. Out of 118 sheep sera sent in from different parts of Austria 35 (29.7%) showed positive titers. 73 sheep sera out of a farm where MCF had clinically occurred were also tested. 20 samples (27.4%) scored positive. Also 40 goat sera (20.3%) out of 197 samples showed positive titers. The results are in accordance with publications from other countries. Special reference is made to goats as possible carriers and transmitters of MCF.

Evidence that the sheep associated form of malignant catarrhal fever is caused by a herpes virus.

Out of a cow, which was infected with the sheep form of malignant catarrhal fever (MCF), blood and spleen samples were inoculated into rabbits. From the spleen cells of an infected rabbit, which were cocultivated with bovine embryonic gingiva cells, a herpesvirus could be isolated. The isolate showed crossreactions with reference sera against the strain WC 11 (wildebeest form) in the SNT. An immunosuppressed heifer, which was infected with the isolate, contracted typical clinical symptoms of MCF. The isolate was named No. 732.

[Serological studies of antibodies against maedi-visna virus in sheep in Austria]. / Serologische Untersuchung auf Antikörper gegen das Maedi/Visna-Virus bei Schafen in Osterreich.

883 sheep from 68 flocks were tested for the prevalence of antibodies against Maedi/Visna-(M/V)virus. As serological method the Agar Gel Immunodiffusion Test (AGID) was performed, 9.5% of the blood samples were positive against M/V, 1.7% showed questionable results. The highest incidence of serum-antibodies showed the Texel (47.7%) and Milk sheep (26.1%). No antibody titers were found in Mountain and Suffolk sheep. Merino sheep had antibody titers against M/V in 2.6% and Mountain sheep crossbreeds in 1.7%.

[Serologic progression studies using CF and ELISA for the detection of antibodies against Eperythrozoon suis infection of swine]. / Serologische Verlaufsuntersuchungen mittels KBR und ELISA zum Nachweis von Antikörpern gegen die Eperythrozoon-suis-Infektion des Schweines.

Serological studies by means of a CF-Test and Elisa were undertaken for evaluation of antibody titers against Eperythrozoon suis infection in swine. The animals were partly splenectomized and underwent artificial infection. It could be shown that the splenectomized animals showed higher and longer lasting antibody titers than the non splenectomized swine. It is stated, that the above mentioned tests can be used in diagnosis on a herd basis but not on a single animal basis.

[Results of a serological study of the natural spread of maedi-visna virus infection in a sheep herd during an observation period of 30 months]. / Ergebnisse einer serologischen Studie über die natürliche Ausbreitung der Maedi-Visna-Virusinfektion in einer Schafherde während eines Beobachtungszeitraumes von 30 Monaten.

In a sheep population consisting of animals of different breeds the epidemiologic development of the Maedi-Visna-infection was evaluated by means of monthly Immune Diffusion Test (ID) for a period of 30 months. At the beginning the herd consisted of eight animals, where four of them showed clinical symptoms indicative for a MV-infection with positive serological results. The other 4 animals were negative. The herd increased in number by including the offspring and buying in other animals. During the time of 30 months only in one animal a seroconversion could be observed. In nine of 13 lambs borne of seropositive mothers colostral antibodies could be observed. By testing the colostrum of MV-seropositive mothers 6 of 7 animals showed precipitating antibodies. Positive sera showed average titers of 1:2 till 1:64, the highest titer was 1:512. On the postmortal examination of five serological positive animals which were killed because of dominant clinical symptoms, three of them showed MV-lesions partly superinfected with bacteria. In one sheep the diagnosis was pasteurellosis. On a further animal the clinical picture and the histologic results were indicative for the Visna-form of the disease.