A comparative study on the occurrence, genetic characteristics, and factors associated with the distribution of Listeria species on cattle farms and beef abattoirs in Gauteng Province, South Africa.

These cross-sectional studies reported the occurrence, genetic characteristics, and factors associated with the distribution of Listeria species on cattle farms and beef abattoirs in Gauteng Province, South Africa. A total of 328 samples (faeces, feeds, silage, and drinking water) were collected from 23 cattle farms (communal, cow-calf, and feedlot), and 262 samples (faeces, carcass swabs, and effluents) from 8 beef abattoirs (low throughput and high throughput) were processed using standard bacteriological and molecular methods to detect Listeria species. The factors associated with the prevalence of Listeria species were investigated, and multiplex polymerase chain reaction (mPCR) was used to determine Listeria species, the pathogenic serogroups, and the carriage of eight virulence-associated genes by Listeria monocytogenes. The overall prevalence of Listeria species in cattle farms was 14.6%, comprising Listeria innocua (11.3%), Listeria monocytogenes (3.4%), Listeria welshimeri (0.0%) compared with 11.1%, comprising Listeria innocua (5.7%), Listeria monocytogenes (4.6%), Listeria welshimeri (0.8%) for beef abattoirs. Of the three variables (area, type of farm/abattoir, and sample type) investigated, only the sample types at abattoirs had a significant (P < 0.001) effect on the prevalence of L. innocua and L. welshimeri. The frequency of distribution of the serogroups based on 11 L. monocytogenes isolated from farms was 72.7% and 27.3% for the serogroup 1/2a-3a and 4b-4d-4e, respectively, while for the 12 L. monocytogenes isolates recovered from abattoirs, it was 25%, 8.3%, 50% and 16.7% for the serogroup 1/2a-3a, 1/2b-3b, 1/2c-3c, and 4b-4d-4e respectively (P < 0.05). All (100%) isolates of L. monocytogenes from the farms and abattoirs were positive for seven virulence genes (hlyA, inlB, plcA, iap, inlA, inlC, and inlJ). The clinical and food safety significance of the findings cannot be ignored.

Genetic identification of Anisakis spp. (Nematoda: Anisakidae) from cetaceans of the Southwestern Atlantic Ocean: ecological and zoogeographical implications.

Adult Anisakis Dujardin, 1845 were found in two specimens of killer whale Orcinus orca and one specimen of franciscana Pontoporia blainvillei stranded from off the coast of Buenos Aires Province, Argentina. Genetic identification of the nematodes (N = 144) was performed by sequence analysis of the mitochondrial (mtDNA cox2) and the nuclear (nas 10 nDNA) gene loci. Anisakis pegreffii and Anisakis berlandi were detected in the two individuals of O. orca, while Anisakis typica and A. pegreffii were identified in P. blainvillei. Morphological and morphometric analysis also carried out on adult specimens of A. pegreffii and A. berlandi has allowed to underlining the usefulness of genetic/molecular markers in their recognition. This represents the first record of A. pegreffii in O. orca and P. blainvillei and of A. berlandi in O. orca. This is also the first sympatric and syntopic occurrence, as adults, of A. pegreffii and A. berlandi from the Austral Region of the Atlantic Ocean waters. These results provide insights into the knowledge of the host ranges and geographical distribution of these parasites in the basin waters of the region. Pontoporia blainvillei showed low abundance values of infection with Anisakis spp., which is the general pattern for coastal dolphins in the area, whereas O. orca harboured higher abundance of Anisakis spp. than those previously recorded among cetacean species in the Argentine Sea. Differences in the Anisakis spp. distribution and their parasitic loads, observed among the three host specimens, are discussed in relation to the oceanographic parameters, as well as to the host ecology. The usefulness of genetic/molecular markers in the recognition of adults of the sibling species A. pegreffii and A. berlandi with considerable overlapping in morphometric and morphological characters was underlined. The distribution of Anisakis species from Southwestern Atlantic waters is discussed in relation to their value as indicators for studies on the zoogeography of their hosts at a regional-scale level.

Corticosteroids for Eosinophilic Esophagitis in Children: A Meta-analysis.

CONTEXT: Treatment of eosinophilic esophagitis (EoE) is focused on dietary, pharmacologic, and endoscopic therapy options. Within the pharmacologic alternatives, topical corticosteroids are the most used, and a large number of studies evaluating their effectiveness have been published, requiring a new summary of evidence. OBJECTIVE: To evaluate the histologic and clinical effectiveness of the use of corticosteroids in pediatric patients with a diagnosis of EoE. DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Embase, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, Latin American and Caribbean Health Sciences Literature, and ClinicalTrials.gov (June 2019). STUDY SELECTION: We selected randomized controlled trials assessing corticosteroids versus a placebo or dietary treatment of EoE in children. DATA EXTRACTION: Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system. The primary outcomes were clinical and histologic improvement. RESULTS: A total of 1655 studies were identified. Five studies were included (206 patients). Histologic response was 49.25% in the corticosteroids group and 4.16% in the placebo group (risk ratio 11.05 [confidence interval 3.8-32.15]; P < .0001). Symptomatic response was 33.6% in the corticosteroids group and 21.8% in the control group (risk ratio 1.62 [confidence interval 0.94-2.79]; P = .08). There were no major adverse effects. LIMITATIONS: Heterogeneity of the diagnosis of EoE. CONCLUSIONS: Our review revealed favorable results of corticosteroids versus placebo, mainly in histologic response. More studies are needed, by using validated clinical scores, to obtain more reliable results.

Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. / Prevalencia de esofagitis eosinofílica: estudio multicéntrico en población pediátrica evaluada en 36 centros de gastroenterología de América Latina.

INTRODUCTION AND OBJECTIVE: Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. MATERIALS AND METHODS: A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. RESULTS: Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4). CONCLUSIONS: The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.

Resolución intra-quirúrgica de osteotomía sagital bilateral de rama mandibular desfavorable en paciente con látero-desviación: estado del arte de casos reportados / Intra-operative resolution of unfavorable bilateral mandibular sagittal ramus osteotomy in a patient with lateral deviation

Objetivos: 1) presentar un caso clínico de fractura de rama ascendente mandibular luego de realizar laosteotomía sagital bilateral y su correspondiente resolución 2) Determinar a través de una Revisión Bibliográfica si la presencia de terceros molares incrementa o no el índice de fracturas desfavorables al momentode la osteotomía sagital de rama.Materiales y método: 1) Se presenta un caso clínico de fractura de rama ascendente mandibular luego deosteotomía sagital de rama en una mujer de 24 años, quien presenta un tercer molar normalmente erupcio-nado, la resolución de dicha complicación y controles a distancia. 2) En una búsqueda realizada en Pubmedy Medline, limitada para artículos clínicos de los últimos 20 años y con un numero mayor a 100 osteotomías, se dividió a los pacientes en 2 grupos: Grupo 1 (con tercer molar presente) n= 898 osteotomías y Grupo 2 (tercer molar ausente) n=1217 osteotomías.Se analizaron Índices de fractura durante la osteotomía con presencia o no del tercer molar, ubicación dela fractura según sea el segmento proximal o distal, según el sexo y según sean mandíbulas prognáticas oretrognáticas. Conclusiones: 1) La presencia del tercer molar al momento de la osteotomía no incrementa el índice de fracturas p: 0,98. 2) A mayor experiencia del cirujano, menor índice de fracturas. 3) En ausencia del tercermolar, la fractura del segmento proximal es más frecuente que la del distal p: 0,0089. 4) En presencia del tercermolar son más frecuentes las fracturas distales p: 0,012. 5) Son más frecuentes las fracturas en mandíbulasretrognáticas que las prognáticas.Caso clínico: 1) Se lograron los objetivos planteados en el VTQ. 2) El cóndilo izquierdo se encuentra remo-delado, en función. No se observan alteraciónes en los movimientos de apertura y cierre mandibular, ni tam-poco desviación de las líneas medias dentarias superior e inferior en apertura y cierre

Estudio sobre la calidad de vida en pacientes con accidente vascular cerebral isquémico / Study on the quality of life in patients with ischaemic stroke

Estudiar la calidad de vida (CV) y el estado neurológico funcional de pacientes a los tres años de sufrirun primer accidente vascular cerebral (AVC) isquémico. Pacientes y métodos. Se escogieron pacientes que cursaron con AVC isquémico, clasificados en las categorías I 63 a I 69. La CV y el estado neurológico funcional se midieron mediante la escalade Rankin modificada (mRS) y el cuestionario de salud SF-36, respectivamente. Resultados. De 59 pacientes encuestados (media de edad: 62 años; sexo: 51% mujeres), cerca de la mitad (29 pacientes; 49,1%) presentaron algún grado de discapacidad (mRS igual o superior a 2). Treinta pacientes (50,9%) eran independientes o presentaban secuelas mínimas (mRS igual o superiora 1) al final del período de seguimiento. La CV medida con el cuestionario SF-36 disminuyó progresivamente con el aumento de la puntuación en la mRS, especialmente en el grupo con mRS igual o superior a 3. Si bien el grupo etario más joven (rango: 20-36 años) obtuvo el mejor promedio (84 puntos) en el SF-36, no se encontró una diferencia significativa con los restantesgrupos de edad, aunque el grupo de 75 años o más fue el que obtuvo una puntuación media más baja (63 puntos). LosAVC extensos (infartos totales de la circulación anterior) de origen cardioembólico (fibrilación auricular) presentaron los más bajos índices de CV (p < 0,05). Conclusión. En la población analizada, la CV varió inversamente con el incremento de la edady la gravedad del déficit funcional de pacientes que sobrevivieron a un infarto cerebral, especialmente en el subgrupo de origen cardioembólico, debido a su asociación con infartos cerebrales más extensos

To study the quality of life (QoL) and functional neurological status of patients three years after suffering their first ischaemic cerebrovascular accident (CVA). Patients and methods. For the study we chose patients who presented ischaemic CVA, classified in categories I 63 to I 69. QoL and functional neurological status were measured using the modifiedRankin Scale (mRS) and the SF-36 health questionnaire, respectively. Results. Of a total of 59 patients who answered the surveys (mean age: 62 years; sex: 51% females), nearly half of them (29 patients; 49.1%) presented some kind of disability(mRS = 2). Thirty patients (50.9%) were independent or presented minimum sequelae (mRS = 1) at the end of the follow-up period. The mean QoL with the SF-36 questionnaire progressively diminished as the mRS score increased, especially in the group with mRS = 3. Although the youngest age group (range: 20-36 years) got the best average score (84 points) on the SF-36,no significant differences were found with the remaining age groups; the group made up of 75-year-olds and above was the one that obtained the lowest average score (63 points). Extensive strokes (total anterior circulation infarctions) of a cardioembolic origin (atrial fibrillation) had the lowest QoL indexes (p < 0.05). Conclusions. In the population that wasanalysed, the QoL was inversely proportional to the age and the severity of the functional deficit of patients who survived a completed stroke, especially in the cardioembolic-origin subgroup, due to its being associated with more extensive cerebral infarcts

[Study on the quality of life in patients with ischaemic stroke]. / Estudio sobre la calidad de vida en pacientes con accidente vascular cerebral isquémico.

AIM: To study the quality of life (QoL) and functional neurological status of patients three years after suffering their first ischaemic cerebrovascular accident (CVA). PATIENTS AND METHODS: For the study we chose patients who presented ischaemic CVA, classified in categories I 63 to I 69. QoL and functional neurological status were measured using the modified Rankin Scale (mRS) and the SF-36 health questionnaire, respectively. RESULTS: Of a total of 59 patients who answered the surveys (mean age: 62 years; sex: 51% females), nearly half of them (29 patients; 49.1%) presented some kind of disability (mRS = 2). Thirty patients (50.9%) were independent or presented minimum sequelae (mRS = 1) at the end of the follow-up period. The mean QoL with the SF-36 questionnaire progressively diminished as the mRS score increased, especially in the group with mRS = 3. Although the youngest age group (range: 20-36 years) got the best average score (84 points) on the SF-36, no significant differences were found with the remaining age groups; the group made up of 75-year-olds and above was the one that obtained the lowest average score (63 points). Extensive strokes (total anterior circulation infarctions) of a cardioembolic origin (atrial fibrillation) had the lowest QoL indexes (p < 0.05). CONCLUSIONS: In the population that was analysed, the QoL was inversely proportional to the age and the severity of the functional deficit of patients who survived a completed stroke, especially in the cardioembolic-origin subgroup, due to its being associated with more extensive cerebral infarcts.

[Practicability of the vaginal prolapse surgery in the elderly woman]. / Faisabilité de la chirurgie vaginale du prolapsus chez la patiente très âgée.

OBJECTIVE: To evaluate the vaginal prolapse cure in the elderly woman. PATIENTS AND METHODS: A retrospective study is carried out on 38 patients of more than 80 years, operated for a vaginal genital prolapse cure between November 1997 and October 2004. The patients' general state of health, the type of analgesia, the operative type and time, the per- and postoperative complications and the evolution of the patients one month after the intervention, had been assessed. RESULTS: The average age of the patients was 84.2 (80-95). The patients' general state of health, according to the ASA classification was about 55.3% ASA II, and about 44.7% ASA III. The anaesthesia was general in 92.1% and spinal in 7.9%. The operating type was vaginal hysterectomy associated to a Marion-Kelly and a posterior perineorrhaphy in 68.4%; and a simple vaginal hysterectomy, associated more or less to the installation of a TVT in 13.1%; an intervention of Lefort, a case of Richter and a case of simple colpectomy in 10.5%. The average operative time is about 43 minutes. The peroperative complications can be summed up in a conversion in laparotomy due to haemorrhage, and a case of ligation of the right urethra. The transfer in an intensive care unit during 24 hours is necessary only for one case in 38. The postoperative complications are in one case death at eleventh day as a result of a pulmonary embolism, and a case of temporospatial disorientation and a prolapse relapse at 6 months. The duration of stay in hospital is about 7 days (2-18). The surgery did not affect the autonomy of the patients at one month. DISCUSSION AND CONCLUSION: Vaginal prolapse concerning the elderly woman is workable in quite common practice; it involves a good cooperation between anaesthetist and surgeon. The vital risk is really present but relative. This functional surgery must not be delayed by the installation of a pessary which must be used only for the inoperable patients.

Detection of the sentinel lymph node under local anaesthesia in early-stage breast cancer: feasibility study in a series of 78 unselected patients.

AIMS: To evaluate the feasibility of excision of the sentinel lymph node under local anaesthesia in early-stage breast cancer. METHODS: Sentinel lymph node detection under local anaesthesia was carried out on all patients presenting with breast cancer at Stage T0, T1 or T2 < 3 cm and N0, M0. The lymph node was mapped using a radioisotope and patent blue dye and lymphoscintigraphy was routinely performed. No premedication was given, and local anaesthesia was carried out with xylocaine. The patients underwent tumorectomy one week later under general anaesthesia, with or without complete axillary dissection, depending on the results of the definitive histopathological examination of the sentinel lymph node. RESULTS: 78 patients underwent this procedure over a period of 20 months. The procedure was successful in 76 out of the 78 patients, with one failure in mapping and one failure in detection (detection rate = 97.4%). The mean time to detection was 21 min (range: 6-45). It was unnecessary to interrupt the procedure due to patient discomfort in any of the cases. One allergic reaction to patent blue dye was noted and required corticosteroid therapy without interruption of the procedure. The time to detection was correlated with the experience of the surgeon carrying of the procedure, the patient's body mass index and the number of labelled lymph nodes found at lymphoscintigraphy. CONCLUSION: We have shown that it is feasible to detect the sentinel lymph node under local anaesthesia in an unselected population. Using this procedure, patients can undergo surgery with the knowledge of their axillary lymph node status while at the same time avoiding the uncertainties of an intraoperative examination of the sentinel lymph node--a source of many false negatives, particularly in the event of micrometastases.

Major limb amputation in Ibadan.

A prospective study of patients who had major limb amputation at the University College Hospital Ibadan over a 5-year period is presented. One hundred and one major limb amputations were performed within this period (71 Males, 30 Females, M:F = 2.3:1). Trauma accounted for 48% of the cases followed by diabetes in 26%, soft tissue infection in 13% and tumours also in 13%. The major post-op complication was wound infection. In accordance with the findings in other centers, a higher proportion of the amputations (69%) were carried out in the lower limbs. Patient's refusal to accept amputation resulted in a delay in amputation in 49 patients. This delay (before surgery) ranged from 1 day to 150 days, with a mean of 15.49 (SD 9.V). From this study, we found that a reduction in vehicular accidents and increasing emphasis on efficient foot care (and glycaemic control) in the diabetic may significantly reduce the rate of amputations in our environment.

Pattern of mechanical intestinal obstruction in Ibadan: a ten year review.

A retrospective review of 232 patients with (mechanical) instestinal obstruction managed at the University College Hospital, Ibadan over a ten-year period: 1978 to 1987. The leading aetiological factor was obstructed inguinal hernia (45.7%), although its incidence seems to be on the decline. Ileo-colic type instussusception was the most prevalent variety (62.8%) with preponderance of the paediatric age group. There is an observed increase in the proportion of obstruction due to tumours. Ascaris infestation is no longer a prominent aetiological factor. One third of the 8.2% mortality rate observed was in neonates.

Total paracentesis in cirrhotic patients with tense ascites and dilutional hyponatremia.

OBJECTIVE: The safety of large-volume paracentesis with plasma expander infusion in ascitic cirrhotic patients with advanced liver disease, hyponatremia, or renal failure has not been elucidated. Our aim was to investigate the safety of total paracentesis in cirrhotic patients with ascites and severe hyponatremia. METHODS: Forty-five cirrhotic patients with tense ascites were treated with total paracentesis and infusion of plasma expanders. At inclusion, 20 patients showed severe hyponatremia (serum sodium <130 mEq/L). In the remaining 25 patients, serum sodium was >130 mEq/L (range, 133-146 mEq/L). RESULTS: Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were significantly higher in patients with hyponatremia (PRA: 19.7 +/- 5.8 ng/mL/h; PAC: 217 +/- 35 ng/dL) than in those patients without hyponatremia (PRA: 4.9 +/- 1.1 ng/mL/h; PAC: 95 +/- 31 ng/dL), indicating a more severe systemic hemodynamic deterioration. After paracentesis, PRA and PAC increased similarly in both groups of patients. Serum sodium levels remained unchanged after paracentesis in patients with hyponatremia (127 +/- 0.5 to 128 +/- 1.5 mEq/L) and decreased slightly in patients without hyponatremia (137 +/- 1 to 135 +/- 1 mEq/L; p < 0.005). The incidence of complications during the first hospitalization, the probability of readmission for complications of cirrhosis, and the probability of survival at 1 yr were similar in both groups of patients. CONCLUSIONS: These results indicate that therapeutic paracentesis is a safe treatment for tense ascites in cirrhotic patients with severe hyponatremia.

Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients.

Selective intestinal decontamination with norfloxacin is useful to prevent bacterial infections in several groups of cirrhotic patients at high risk of infection. However, the emergence of infections caused by Escherichia coli resistant to quinolones has recently been observed in cirrhotic patients undergoing prophylactic norfloxacin. Our aim is to determine the characteristics of the infections caused by E. coli resistant to norfloxacin in hospitalized cirrhotic patients. One hundred and six infections caused by E. coli in 99 hospitalized cirrhotic patients were analyzed and distributed into two groups: group I (n = 67), infections caused by E. coli sensitive to norfloxacin, and group II (n = 39), infections caused by E. coli resistant to norfloxacin. The clinical and analytical characteristics at diagnosis of the infection were similar in both groups. Previous prophylaxis with norfloxacin was more frequent in group II (15/67, 22.4% vs. 32/39, 82%, P <.0001), as a result of a higher number of patients submitted to continuous long-term prophylaxis in this group, whereas previous short-term prophylaxis was similar in both groups. Infections were more frequently nosocomial-acquired in group II than in group I (17/67, 25.3% vs. 20/39, 51.2%, P =.01). The type of infections was similar in both groups: urinary tract infections 38 in group I and 24 in group II, spontaneous bacterial peritonitis 8 and 2, spontaneous bacteremia 4 and 4, and bacterascites 1 and 0, respectively (pNS). Mortality during hospitalization was similar in the two groups (4/67, 5.9% vs. 5/39, 12.8%, pNS). None of the E. coli resistant to norfloxacin were also resistant to cefotaxime and only one of them was resistant to amoxicillin-clavulanic acid. Prophylaxis with norfloxacin, usually continuous long-term prophylaxis, favors the development of infections caused by norfloxacin-resistant E. coli. Long-term antibiotic prophylaxis should therefore be restricted to highly selected groups of cirrhotic patients at high-risk of infection. Infections caused by E. coli resistant to norfloxacin show a severity similar to those caused by sensitive E. coli. No significant associated resistance between norfloxacin and the antibiotics most frequently used in the treatment of bacterial infections in cirrhotic patients has been observed.

Expression of beta-amylase from alfalfa taproots.

Alfalfa (Medicago sativa L.) roots contain large quantities of beta-amylase, but little is known about its role in vivo. We studied this by isolating a beta-amylase cDNA and by examining signals that affect its expression. The beta-amylase cDNA encoded a 55.95-kD polypeptide with a deduced amino acid sequence showing high similarity to other plant beta-amylases. Starch concentrations, beta-amylase activities, and beta-amylase mRNA levels were measured in roots of alfalfa after defoliation, in suspension-cultured cells incubated in sucrose-rich or -deprived media, and in roots of cold-acclimated germ plasms. Starch levels, beta-amylase activities, and beta-amylase transcripts were reduced significantly in roots of defoliated plants and in sucrose-deprived cell cultures. beta-Amylase transcript was high in roots of intact plants but could not be detected 2 to 8 d after defoliation. beta-Amylase transcript levels increased in roots between September and October and then declined 10-fold in November and December after shoots were killed by frost. Alfalfa roots contain greater beta-amylase transcript levels compared with roots of sweetclover (Melilotus officinalis L.), red clover (Trifolium pratense L.), and birdsfoot trefoil (Lotus corniculatus L.). Southern analysis indicated that beta-amylase is present as a multigene family in alfalfa. Our results show no clear association between beta-amylase activity or transcript abundance and starch hydrolysis in alfalfa roots. The great abundance of beta-amylase and its unexpected patterns of gene expression and protein accumulation support our current belief that this protein serves a storage function in roots of this perennial species.

Hemodynamic changes in patients developing effective hypovolemia after total paracentesis.

BACKGROUND/AIMS: In many centers paracentesis is considered the treatment of choice for tense ascites. However, the mechanism of effective hypovolemia after paracentesis, the main complication associated with this procedure, remains unknown. In the current study, systemic hemodynamics was sequentially studied before and after total paracentesis in 46 patients with cirrhosis and tense ascites. The aim of the study was to assess the mechanism of effective hypovolemia after paracentesis. METHODS: Plasma renin activity and aldosterone, mean arterial pressure, cardiac output (ECO-Doppler) and systemic vascular resistance were measured before, and 3 h, 6 h and 6 days after total paracentesis associated with plasma volume expansion. RESULTS: Effective hypovolemia after paracentesis (defined as 50% increase in plasma renin activity up to a level over 4 ng x m(-1) x h(-1) at the 6th day after paracentesis) occurred in 20 cases [plasma renin activity increased from 8+/-17 to 19+/-2.7 ng x m(-1) x h(-1)]. In the remaining 26 cases no changes in plasma renin activity [8.5+/-2.4 vs. 8.7+/-2.2 ng x m(-1) x h(-1)] were observed. The amounts of ascitic fluid volume removed were similar. Effective hypovolemia after paracentesis was associated with a significant decrease in mean arterial pressure (89+/-2 vs. 81+/-3 mmHg) and systemic vascular resistance [1263+/-67 vs. 1014+/-80 dyn x s(-1) x cm(-5)] 6 days after treatment. In contrast, no significant changes in these parameters were observed in patients not developing this complication. In the whole group of patients a significant inverse relation was observed between changes in plasma renin activity and in systemic vascular resistance (r=0.74;p< 0.001). CONCLUSIONS: These results indicate that effective hypovolemia after paracentesis in cirrhosis is predominantly due to an accentuation of the arteriolar vasodilation already present in these patients.

[The cervix uteri in pregnancy]. / Le col de l'utérus en cours de grossesse.

It is during labor that the most dramatic changes to the cervix are apparent, yet the cervix begins its process of adapting early on in pregnancy. From an anatomic perspective, the gravid cervix is changed little in the beginning of pregnancy. It is strikingly less muscular than the rest of the uterus and its connective tissue is comprised essentially of collagen fibers and a matrix rich in proteoglycans. Cervical maturation begins imperceptibly during pregnancy but does not become noticeable until shortly before labor. These changes result from biochemical modifications of the cervical constituents with dissolving of collagen fibers and changes in the respective levels of different proteoglycans. The regulation of this maturation is still poorly understood; steroid hormones, prostaglandins, and collagenases have all been implicated. The effacement and dilatation of the cervix occur with labor. Effacement corresponds with thinning and opening of the internal os and dilatation corresponds with opening of the external os. These phenomena are passive, resulting from physical pressure from fetal engagement under the effects of uterine contractions. Our material understanding of cervical maturation and dilatation are still insufficient, for although we are better and better able to guide the induction and course of labor, it still is impossible for us to arrest premature cervical maturation in the setting of a threatened abortion or premature delivery.

cDNA structure and expression patterns of a low-temperature-specific wheat gene tacr7.

The low-temperature (2 degrees C)-specific wheat cDNA, pTACR7, represents a gene designated tacr7 from hard red winter wheat (HRWW; Triticum aestivum L. cv. Winoka). The term low-temperature-specific (LTS) is used because tacr7 is not induced by ABA or stresses such as salt, dehydration, and heat. pTACR7 was isolated by RT-PCR with mRNA from wheat crown tissue, the oligonucleotide primers derived from the barley cognate pHVCR8 (GenBank accession number L28091). Based on the deduced amino acid sequence, TACR7 is highly hydrophobic, with a single transmembrane domain and an amino acid bias for leucine (19%). Thus, the encoded protein TACR7 is unique among low-temperature-regulated wheat proteins described in the literature. Analysis of steady-state levels of tacr7 transcripts (630 nt) showed accumulation in wheat seedlings, crown tissue, and callus cultures after transfer from control (25 degrees C) to low temperature (2 degrees C). No detectable transcripts were observed by northern blot hybridization with pTACR7 probe from seedling or callus treated with ABA, salt, dehydration, or heat stress. tacr7 transcripts accumulated during 2 degrees C exposure to a greater amount in a freeze-resistant HRWW (FR; SDmut 16029) than in a freeze-susceptible HRWW (FS; SDmut 16169) crown tissue, with the largest difference between genotypes being 30% +/- 3% at 3 weeks.

Continuous versus inpatient prophylaxis of the first episode of spontaneous bacterial peritonitis with norfloxacin.

Cirrhotic patients with ascites and low ascitic fluid total protein and/or high serum bilirubin levels are at high risk to develop the first episode of spontaneous bacterial peritonitis during long-term follow-up. The aim of the present study was to determine the efficacy of continuous long-term selective intestinal decontamination with norfloxacin in the prevention of this complication. One hundred nine cirrhotic patients with ascites and ascitic fluid total protein levels of < or = 1 g/dL or serum bilirubin levels of > 2.5 mg/dL without previous spontaneous bacterial peritonitis were prospectively randomized into two groups: group 1 (n = 56) received norfloxacin, 400 mg daily administered orally, and group 2 (n = 53) was the long-term control group, receiving norfloxacin only during hospitalization. During a mean follow-up of 43 +/- 3 weeks, there was one spontaneous bacterial peritonitis (1.8%) in group 1 and 9 (16.9%) in group 2 (P < .01). The incidence of community-acquired spontaneous bacterial peritonitis was lower in group 1 (1.8% vs. 13.2%, P < .05), whereas the incidence of nosocomial spontaneous bacterial peritonitis (0% vs. 3.7%) and the incidence of extraperitoneal infections (25% vs. 24.5%) were similar in both groups (P = NS). The actuarial probability of survival at 18 months was 75% in group 1 and 62% in group 2 (P = NS). Resistance to norfloxacin was observed in 9 of 10 (90%) Escherichia coli isolated in infections from group 1 and in 4 of 11 (36.3%) from group 2 (P < .05). The overall incidence of infections caused by norfloxacin-resistant bacteria was higher in group 1 (19.6% vs. 15%), but it did not reach statistical significance. Continuous long-term selective intestinal decontamination with norfloxacin is effective in preventing the first spontaneous bacterial peritonitis in cirrhotic patients at high risk. However, the emergence of infections caused by norfloxacin-resistant bacteria must be weighed carefully against the benefits of continuous long-term prophylaxis.

Total paracentesis with dextran 40 vs diuretics in the treatment of ascites in cirrhosis: a randomized controlled study.

The aim of the current study was to compare total paracentesis associated with dextran-40 infusion with diuretics in the treatment of tense ascites in patients with cirrhosis. Eighty patients were randomly allocated to two groups: 40 patients were treated with paracentesis plus dextran-40 infusion (8 g per liter of ascitic fluid removed), and 40 patients with diuretics. After treatment patients were discharged with diuretics, and patients developing tense ascites during follow up (54 +/- 4 weeks) were treated according to their initial schedule. Paracentesis was more effective than diuretics in mobilizing the ascitic fluid. The incidence of complications was significantly higher (p < 0.05) in the diuretic group (38%) than in the paracentesis group (15%). This difference was mainly due to a higher incidence of hepatic encephalopathy in the former group (30% vs. 2.5%). A significantly higher incidence of hepatic encephalopathy was also observed in the diuretic group during the follow-up readmissions for ascites recurrence. There were no significant differences between the two treatment groups in the probability of survival after inclusion. Plasma renin activity and plasma aldosterone concentration measured before and 2 and 6 days after paracentesis in 20 randomly selected patients increased significantly (p < 0.05) (baseline values: 5.3 +/- 1.4 ng.ml-1.h-1 and 63 +/- 21 ng/dl; 48 h after paracentesis: 11.7 +/- 3.9 ng.ml-1.h-1 and 99 +/- 31 ng/dl; 6 days after paracentesis: 10.9 +/- 3 ng.ml-1.h-1 and 110 +/- 27 ng/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

[Transvaginal color Doppler in ovarian neoplasms]. / Doppler color transvaginal en tumores ováricos.

Thirty one patients with clinical and sonographic diagnosis of ovarian tumor were studied prospectively, with Transvaginal Color Doppler. There were 24 benign and 7 malignant tumors (4 stage I borderline, I stage IA cistoadenocarcinoma and 2 adenocarcinoma stage III). Six malignant tumors had resistance indexes (IR) from 0.17 to 0.55. In one borderline no vascular signal was obtained. The probability of malignancy increased inversely with the IR from 60%, with RI below 0.60 to 100% with IR below 0.4.