Dimensions of suicidal behavior according to patient reports.

Five factor analyses with limitations explored the Suicidal Intent Scale (SIS) subscales reflecting suicidal behavior dimensions. This larger sample study conducts an exploratory factor analysis of the SIS. Two large samples of suicide attempters (N= 435 and N= 252) from a general hospital were studied. The validity of SIS subscales obtained from the factor analysis was investigated by examining the association between the subscales and clinical variables. There were two factors: expected lethality and planning. In both samples, male gender and depression tended to be associated with higher scores in both subscales (small to medium effect sizes). Hospitalization was associated with higher scores in both SIS subscales (medium to large effects) suggesting that these subscales were reasonably good predictors of suicide attempt severity. Clinicians assessing patient reports to establish the severity of suicide attempts need to ask questions regarding both dimensions: expected lethality and planning.

Potential contraceptive use of epididymal proteins: immunization of male rats with epididymal protein DE inhibits sperm fusion ability.

Rat epididymal protein DE associates with the sperm surface during maturation and participates in sperm-egg fusion. Immunization of male rats with DE raised specific antibodies and produced a significant reduction in the animals' fertility. The present study focused on determining the in vivo mechanism involved in fertility inhibition. Wistar males were injected with DE, and antibody levels and animal fertility were evaluated. Results revealed an association between the two parameters, since animals with absorbance values lower than 0.5 in ELISA presented high fertility rates (66%, 100%) while those with absorbance values higher than 0.5 exhibited the lowest fertility rates (0%, 33%). Histological studies showed no evidence of orchitis, epididymitis, or vasitis in DE-immunized animals. ELISA results revealed the presence of anti-DE antibodies in epididymal and vas deferential fluids. Indirect immunofluorescence and ELISA experiments indicated that these antibodies would not interfere with the synthesis or secretion of DE or with its association with the sperm surface. Finally, while epididymal sperm recovered from DE-immunized animals presented no changes in motility, viability, or ability to undergo capacitation and acrosome reaction, they exhibited a significant decrease in their ability to fuse with zona-free eggs, with no effect on their ability to bind to the oolemma. Together these results indicate that immunization of male rats with epididymal protein DE specifically interferes with the sperm fertilizing ability, supporting the use of epididymal proteins for contraceptive vaccine development.

Potential contraceptive use of epididymal proteins: evidence for the participation of specific antibodies against rat epididymal protein DE in male and female fertility inhibition.

Previous studies in our laboratory indicated that immunization of male and female Wistar and Lewis rats with epididymal protein DE, resulted in the development of anti-DE antibodies in over 90% of the animals, with a significant and reversible reduction of fertility. In the present study, ELISA assays performed to analyze the evolution of the immune response indicated that antibody levels in the sera of immunized animals reached a maximum at 8 weeks after the initial injection and then gradually decreased, returning to control values by the end of the sixth month. Western blot experiments demonstrated that the immune sera specifically recognized DE in epididymal sperm extracts and epididymal cytosol, while no reaction was observed with different reproductive and essential organs. The immune sera were also capable of recognizing DE on the surface of both fresh and capacitated sperm as indicated by indirect immunofluorescence experiments. Finally, the exposure of sperm to immune sera prior to uterine insemination resulted in a significant (P < 0.05) reduction in the percentage of fertilized eggs compared to controls, with no effect on sperm motility and viability, nor on their ability to undergo capacitation. Together, these results support the participation of the raised antibodies as mediators of the antifertility effect and suggest a specific interference at the sperm-egg interaction level.

[Mitral valve insufficiency in acute myocardial infarction. Assessment with pulsed and coded Doppler color]. / Insuficiencia mitral en el infarto agudo del miocardio. Valoración con Doppler pulsado y codificado en color.

We studied 108 patients who sustained an acute myocardial infarction (AMI) by means of echocardiography, pulsed doppler (PD) and Doppler color flow imaging (CD). We evaluate the presence of mitral regurgitation (MR) and it relationship to the site of the AMI and also to the ventricular function. The incidence of MR was 50.92%, (55/108), it was detected in higher percentage when the AMI was inferior (61.8%) than when anterior (39.6%). The correlation with the ejection fraction (EF) was only significative when the AMI was anterior. The incidence of MR was 57.1% when the EF was below 25%. CD had better diagnostic capabilities independently of the site of the AMI, (48% vs 32.1% when the AMI was anterior and 76.1% vs 52.6% when it was inferior).

[Clinico-pathologic manifestations of ruptured aneurysm of the sinus of Valsalva]. / Manifestaciones clínico-patológicas de los aneurismas rotos del seno de Valsalva.

The clinical files from the National Institute of Cardiology "Ignacio Chávez" were reviewed, we found 26 corroborated cases of ruptured aneurysms Valsalva's sinus. There is predominance of the male sex in proportion 3:1 and the median age when the diagnosis was made was 22 years. 77% of these cases were in N.Y.H.A. clinical class I or II and the main symptom was dyspnoea on exertion. On the physical examination a continuous murmur or sistolo-diastolic murmur was heard over precordium in 92% of the cases and a hyperkinetic circulatory regimen. Only in 23% of these patients the diagnosis was suspected and the more common confusion was with the V.S.D. associated with aortic incompetence. On the E.K.G. we found data with volumetric overload of the right heart in 15 cases. The hemodynamic study confirmed the diagnosis only in 60%. The aortic valve was substituted for associated incompetence in 12 cases and the pathological study revealed fibromixoid degeneration in 9 cases and only fibrosis in the remaining 3. The sinus of Valsalva more affected was the right coronary and the chamber where the rupture was more frequent was the right ventricle in 73% of the cases. We conclude that the ruptured aneurysms of the Valsalva's sinus is rather frequent among the congenital heart diseases and has particular clinical data and special features in making a precise diagnosis.

[Left aortic arch without a circumflex segment and a right descending aorta: a hypothetical case and a real example]. / Arco aórtico izquierdo sin segmento circunflejo y aorta descendente derecha: de un caso hipotético a un ejemplo real.

We studied a case of a patent left ductus arteriosus, with a left aortic arch connected to a right descending aorta without an aortic circumflex (retroesophageal) segment. We believe this is the first world-published example of this--so far--hypothetical anomaly, included in Kirkling and Edwards classification of vascular rings. The case was a 27-year-old deaf-mute female patient with a patent left ductus arteriosus, with important left to right shunt and moderate pulmonary arterial hypertension who underwent a successful closing surgical procedure. In the aortographic study a left (normal) aortic arch was seen, which after giving off a large left ductus arteriosus, crossed to the right and connected to a right descending aorta. In the upper part of the thorax the esophagus and trachea were displaced to the right by the left aortic arch. The esophagus in the middle and the upper inferior parts of the thorax was also displaced to the right by the descending right aortic segment. Complete vascular ring was not evident. The case--although without clinical importance--reinforces the pathogenic concept of the Rathke diagram of a complete double aortic primitive arch originating the pulmonary and supraaortic vascular structures which are formed by the obliteration or disappearance of particular segments of the structure. This knowledge explains the embryogenesis of these complex anomalies. Our case is believed to be formed by the very early disappearance of a frontal portion of the primitive left dorsal aorta.

[Value of the DI and AVL leads in the diagnosis of infarction of the right ventricle]. / Utilidad de las derivaciones DI y AVL en el diagnóstico del infarto del ventrículo derecho.

The present study attempts to analyze the sensitivity and specificity of the S-T segment depression in I and a VL leads in the diagnosis of postero-inferior myocardial infarction with right ventricular extension. Thirty four specimens from autopsies performed in the Instituto Nacional de Cardiología Ignacio Chávez with histopathological evidence of postero-inferior myocardial infarction, with an adequate clinical, enzymatic and electrocardiographic documentation were studied. In 23 the postero-inferior myocardial infarction had extended to the right ventricle (group I) and in ll only left ventricle was involved (group II). There were not significative differences in severity and extension of coronary obstructions between the two groups studied. Sensitivity of S-T segment depression in DI lead ad diagnosis of right ventricular extension had 82.6%, specificity 90.9%, positive predictive value 95%, negative predictive value 71.4% and diagnostic efficiency 85.2%. Sensitivity of S-T segment depression in a VL lead as diagnostic of right ventricular extension was 91.3%, specificity 81.8%, positive predictive value 91.3%, negative predictive value 81.8% and diagnostic efficiency 88.2%.