Epidemiología de los defectos estructurales cardíacos en una población infantil / Epidemiology of heart structural defects in a child population

Introducción. La auscultación de un soplo constituye con frecuencia el principal motivo de consulta en Cardiología Pediátrica. Un pequeño porcentaje de pacientes (0.8-1%) presentan cardiopatía estructural; entre los defectos más graves, la morbimortalidad continúa siendo elevada, recomendándose la evaluación ecocardiográfica ante la sospecha de patología. Material y métodos. Estudio retrospectivo descriptivo de 1.529 niños entre 0 y 16 años atendidos en la consulta de Cardiología del Hospital Clínico Universitario Lozano Blesa, de Zaragoza, entre enero de 2010 y diciembre de 2012. Se analizaron los hallazgos más frecuentes de la muestra y cada grupo de edad. Resultados. El principal motivo de consulta fue la auscultación de un soplo, el 43,4% (649) de los pacientes procedían de Atención Primaria. Los hallazgos más frecuentes fueron los defectos del tabique intraventricular en un 6,5% (99), interauricular 5,8% (89%) y las valvulopatías 5,2% (80). Entre los neonatos se evidenció patología en el 5.2% (80). Entre los neonatos se evidenció patología en el 65,4% (208) frente al 16,7% (112) de los escolares. Conclusiones. La mayoría de los pacientes son remitidos desde Atención Primaria, siendo el principal motivo de consulta la auscultación de un soplo. En un porcentaje elevado de casos la ecocardiografía es normal, siendo frecuente el diagnóstico de soplo inocente, especialmente entre los pacientes de mayor edad (AU)

Introduction. The finding of an innocent murmur in the child frequently represents the first cause to consult in Cardiology. A small percentage of patients (0.8-1%) presents a congenital heart disease; between the severest defects, the morbimortality continues being high, which leads to tecommend the ecochardiografic evaluation due to suspicion of disease. Material and methods. A descriptive research of 1529 patients between 0 to 16 years old assessed at the Paediatric Cardiology consult at the Hospital Clínico Universitario Lozano Blesa in Zaragoza between January 2010 to December 2012. The most frequent findings were analized from the whole and each age group. Outcomes. The first cause to consult was the finding of a murmur with the stethoscope; 42,4% (649) of the patients came from Primary Attention. The principal findings were the ventricular septal defects in 6,5% (99), atrial septal defects 5,8% (89)and the valvulopathies 5,2% (80). There was pathology in the 65.4% (208) between neonates, but in the 16,7 (112) between the schoolchildren. Conclusions. Most of the patients came from Primary Attention, due to the finding of a murmur. In a high percentage the echocardiography is normal, the diagnostic of an innocent murmur is frequent specially in the oldest age range (AU)

Absceso retroorbitario por «Streptococcus constellatus» en un paciente con neurocisticercosis / Retro orbital abscess by "Streptococcus constellatus" in a patient with neurocysticercosis

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Dietary intake of polyphenols and major food sources in an institutionalised elderly population.

BACKGROUND: Polyphenols are bioactive compounds widely found in fruit, vegetables and beverages of plant origin. Epidemiological studies have suggested an association between polyphenol intake and health; antioxidant, anti-inflammatory, anti-carcinogenic and other bioactivities may contribute to these beneficially protective effects. To date, most epidemiological studies describing polyphenol intake have been limited by the information available in nutrient databases. The present study aimed to determine the total and individual polyphenol intake among institutionalised elderly people living in Asturias (North of Spain) and to identify the major dietary sources of polyphenol classes and subclasses. METHODS: The study sample comprised 304 subjects with a mean age of 73.2 years for men and 76.8 years for women. Dietary intake was assessed by means of a food frequency questionnaire. Phenol content was estimated from the Phenol-Explorer database, as developed at the French National Institute for Agricultural Research. The contribution of each food to the total and subgroup intake of polyphenols was calculated as a percentage. RESULTS: Except for flavonones, total polyphenol intake, groups and subgroups, was higher in men than women. The main polyphenol groups contributing to total polyphenol intake were flavonoids (62%) and phenolic acids (35.5%). We identified red wine, coffee, apples, oranges and green beans as the major food sources providing total polyphenol intake. Flavonoid and lignan intake was lower for those aged >80 years. Smoking habit, red wine consumption, physical activity and a Mediterranean diet score were associated with a greater polyphenol intake. CONCLUSIONS: The present study provides information on polyphenol intake in an elderly Mediterranean population with a level of detail that has not been achieved previously. The identification of age and lifestyle factors associated with the intake of polyphenols may be useful in future studies regarding polyphenols.

Epidemiología de los trastornos del ritmo cardíaco en una población infantil / Epidemiology of cardiac rhythm disorders in a child population

Introducción y objetivos. Los trastornos del ritmo cardíaco en la población pediátrica son poco frecuentes. El objetivo del estudio fue analizar la epidemiología de las arritmias cardíacas. Material y métodos. Es un trabajo descriptivo, revisando las historias clínicas de pacientes atendidos por sospecha de alteración del ritmo cardiaco, en la consulta de Cardiología Infantil del Hospital clínico Universitario Lozano Blesa de Zaragoza entre los años 1981 y 2011. Resultados. Consultaron 286 pacientes por posible arritmia; en 133 (46,5%9 se detectaron alteraciones. La edad media fue de 8,3 años. El 75,2% fueron derivados del Centro de Salud, a mayoría por palpitaciones (68,2%). Únicamente 1% debutó con insuficiencia cardiaca. Se registraron extrasístoles en 57,8% y taquicardia paroxística supraventricular (TPSV) en 21,8%. En menores de un año (10,2%) se constató TPSV en el 50%. Del total, 22 pacientes precisaron tratamiento médico y 13 requirieron intervención. Conclusiones. La mayor parte de los pacientes derivados a la consulta de Cardiología por alteración del ritmo proceden de Centros de Salud. En la mayor parte de estos niños no se detectan alteraciones o éstas son leves y no precisan tratamiento. No obstante, hay arritmias cuyas consecuencias son graves por lo que es preciso el diagnóstico y tratamiento correcto (AU)

Introduction and objectives. Heart rhythm disorders in pediatric population are not common. This study aims at investigating the epidemiology of the cardiac arrhythmias in a sample of children. Material and methods. We looked into the medical history of patients with clinical suspicion of cardiac rhythm disturbances recorded by staff at Hospital Clinico Universitario Lozano Blesa in Zaragoza between 1981 and 2011. Results. The medical history record listed 286 with possible arrhythmia. Cardiac abnormalities were detected in 133 (46,5%) patients. The mean age amounted to 8.3 years. 75,2% of the casescame from their Health Center. The majority of the patients (68,2%) showed heart palpitations. 1% of the cases were afflicted with heart failure. Extrasystoles were detected in 57,8% and supra-ventricular tachycardia in 21,8% of the patients. Among children under one year (10.2%) half of the cases showed supra-ventricular tachycardia. 22 patients required medication, and 15 of them needed interventionist treatment. Conclusion. Most of the patients whose cardiac rhythm disturbance was diagnosed by the paediatric cardiologist came from the health centers. Almost all the cases show minor disturbances and do not require treatment. However some cases of cardiac arrhythmias may have serious consequences. Therefore, accurate diagnosis and proper treatment are necessary (AU)

Complete failure of insulin-transmitted signaling, but not obesity-induced insulin resistance, impairs respiratory chain function in muscle.

The role of mitochondrial dysfunction in the development of insulin resistance and type 2 diabetes remains controversial. In order to specifically define the relationship between insulin receptor (InsR) signaling, insulin resistance, hyperglycemia, hyperlipidemia and mitochondrial function, we analyzed mitochondrial performance of insulin-sensitive, slow-oxidative muscle in four different mouse models. In obese but normoglycemic ob/ob mice as well as in obese but diabetic mice under high-fat diet, mitochondrial performance remained unchanged even though intramyocellular diacylglycerols (DAGs), triacylglycerols (TAGs), and ceramides accumulated. In contrast, in muscle-specific InsR knockout (MIRKO) and streptozotocin (STZ)-treated hypoinsulinemic, hyperglycemic mice, levels of mitochondrial respiratory chain complexes and mitochondrial function were markedly reduced. In STZ, but not in MIRKO mice, this was caused by reduced transcription of mitochondrial genes mediated via decreased PGC-1α expression. We conclude that mitochondrial dysfunction is not causally involved in the pathogenesis of obesity-associated insulin resistance under normoglycemic conditions. However, obesity-associated type 2 diabetes and accumulation of DAGs or TAGs is not associated with impaired mitochondrial function. In contrast, chronic hypoinsulinemia and hyperglycemia as seen in STZ-treated mice as well as InsR deficiency in muscle of MIRKO mice lead to mitochondrial dysfunction. We postulate that decreased mitochondrial mass and/or performance in skeletal muscle of non-diabetic, obese or type 2 diabetic, obese patients observed in clinical studies must be explained by genetic predisposition, physical inactivity, or other still unknown factors.

Enhanced tyrosine hydroxylase phosphorylation in the nucleus accumbens and nucleus tractus solitarius-A2 cell group after morphine-conditioned place preference.

Although dopamine (DA) has been extensively implicated in the morphine-induced conditioned place preference (CPP; a measure of reward), noradrenaline (NA) and other systems may play a larger role than previously suspected. The mesolimbic DA system, comprised of projections from the ventral tegmental area (VTA) to the nucleus accumbens (NAc), receives noradrenergic innervations from the nucleus tractus solitaries (NTS)-A2 cell group and is modulated by NA. The purpose of the present study was to evaluate the turnover of DA and NA in the NAc and the site-specific phosphorylation of TH in the NAc, VTA, and NTS on the CPP mice conditioned by morphine. A dose-effect curve for morphine-induced CPP (0.5-8 mg/kg, s.c.) was obtained using 6-day conditioning sessions followed by a CPP test. TH phosphorylation was determined by quantitative blot immunolabeling and immunohistochemistry using phosphorylation state-specific antibodies; NA and DA turnover was evaluated by high-performance liquid chromatography. Morphine-induced CPP phosphorylates TH at serine (Ser)40 but not Ser31 in NAc, which is associated with an enhanced of DA and NA turnover. We also found that morphine-induced CPP increased levels of TH phosphorylated at Ser31 and Ser40 in the NTS. The present study demonstrates that morphine-induced CPP might stimulate TH activity and accelerate DA and NA turnover in the NAc via a mechanism involving phosphorylation of TH.

Diet score is associated with plasma homocysteine in a healthy institutionalised elderly population.

BACKGROUND AND AIM: Total plasma homocysteine (tHcy) is an independent risk factor for cardiovascular diseases. Among other dietary and non-dietary factors, B vitamins, such as folate, riboflavin and cobalamin, are primary determinants of tHcy in the general population. However, research has concentrated on the relationship of these nutrients with tHcy, and little is known about overall eating patterns and tHcy. METHODS AND RESULTS: In this study, we analysed whether a diet score based on the consumption of folate-, riboflavin- and cobalamin-rich food groups was associated with tHcy in a sample of 140 institutionalised elderly subjects (59 men and 81 women aged 60-80 years) from Northern Spain. The food groups identified as the major contributors to the intake of the three vitamins were vegetables, fruit, fish, meat and milk and dairy products. The mean tHcy level was 13.3+/-5.1 micromol/L (range: 3.9-30.7 micromol/L). None of the food groups predicted tHcy levels individually, but the overall diet score was inversely associated with tHcy in a multiple linear regression analysis. High tHcy levels (>16 micromol/L) were almost twice as prevalent in the groups scoring less than 7 than in those scoring 7 or more (37.5 vs 19.6%, p=0.021). CONCLUSIONS: These data suggest that a dietary pattern characterised by high intakes of B vitamin-rich foods is associated with a lower tHcy concentration and a reduced percentage of high tHcy levels in elderly subjects. They also support the use of dietary pattern approaches to evaluate the relationships between diet and health outcomes that go beyond single nutrient analyses.

Variability of fish consumption within the 10 European countries participating in the European Investigation into Cancer and Nutrition (EPIC) study.

OBJECTIVE: To describe and compare the consumption of total fish (marine foods) and the fish sub-groups - white fish, fatty fish, very fatty fish, fish products and crustacea, in participants from the European Investigation into Cancer and Nutrition (EPIC) study. DESIGN: Cross-sectional analysis of dietary intake using a computerised standardised 24-hour recall interview. Crude means, means and standard errors adjusted by age, season and day of the week were calculated, stratified by centre and gender. SETTING: Twenty-seven redefined centres in the 10 European countries participating in the EPIC study. SUBJECTS: In total, 35 955 subjects (13 031 men and 22 924 women), aged 35-74 years, selected from the main EPIC cohort. RESULTS: A six- to sevenfold variation in total fish consumption exists in women and men, between the lowest consumption in Germany and the highest in Spain. Overall, white fish represented 49% and 45% of the intake of total fish in women and men, respectively, with the greatest consumption in centres in Spain and Greece and the least in the German and Dutch centres. Consumption of fatty fish reflected that of total fish. However, the greatest intake of very fatty fish was in the coastal areas of northern Europe (Denmark, Sweden and Norway) and in Germany. Consumption of fish products was greater in northern than in southern Europe, with white fish products predominating in centres in France, Italy, Spain, The Netherlands and Norway. Intake of roe and roe products was low. The highest consumption of crustacea was found in the French, Spanish and Italian centres. The number of fish types consumed was greater in southern than in northern Europe. The greatest variability in consumption by day of the week was found in the countries with the lowest fish intake. CONCLUSIONS: Throughout Europe, substantial geographic variation exists in total fish intake, fish sub-groups and the number of types consumed. Day-to-day variability in consumption is also high.

Effects of education on the quality of life, diet, and cardiovascular risk factors in an elderly Spanish community population.

An inverse relation between education and health has been reported, suggesting the importance of examining the underlying mechanism of this association. We examined whether cardiovascular risk factors, diet, and indicators of quality of life (mood, self-perceived health, social relationships, self-rated sensory, and dental adequacy) vary according to educational level among 352 old people (65-95 years old) in the city of Oviedo (Northern Spain). Lower educational level (LE) was associated with unhappiness, poor social relationships, poor self-assessed health, and sensory, and masticatory problems. LE elderly consumed less vegetables and meat products and more carbohydrates. LE women had a lower contribution of proteins and lipids to their total energy intake as well as a lower vitamin A intake. Except for hypercholesterolemia, no differences were found for the cardiovascular risk factors studied. The educational level of old people has a strong influence on their quality of life, nutrient intake and food consumption. These findings may provide part of the explanation for the social gradient in mortality.

Types of fat intake and body mass index in a Mediterranean country.

BACKGROUND: Although the fatty acid fractions provide similar metabolizable energy, the type of dietary fat consumed could be relevant to the development of obesity. OBJECTIVE: To investigate the relationship between body mass index (BMI), obesity and the consumption of different types of fat and olive oil in a Mediterranean country with high prevalence of obesity, and high intake of monounsaturated fatty acids (MUFA) and olive oil. SUBJECTS: The study was carried out in Spain among 23 289 women and 14 374 men, aged 29-69 years, who were participants of a large European prospective cohort. METHODS: : Information on usual food intake was collected by interviewers by means of a dietary history questionnaire. The association between obesity (BMI >/= 30 kg m2), dietary fat, other dietary patterns and other non-dietary factors were tested using multilinear regression analysis. The ratio of reported energy intake to energy requirement was used as an estimation of dietary underreporting. RESULTS: The association between fatty acid fractions intake (saturated fatty acids (SFA) in women, and MUFA and polyunsaturated fatty acids (PUFA) in both sexes) and BMI was very weak, accounting for less than 1% of variance. All dietary and non-dietary variables accounted for 21% of variance in the measurement of BMI in women and only 6.7% of variance in men. Estimated underreporting of energy intake was 17.5% in obese women and 5.5% in obese men. CONCLUSIONS: The association between consumption of specific types of dietary fat, olive oil and obesity in Spain is not very important. However, because of the cross-sectional design and some level of underreporting of energy intake observed in overweight subjects and overreporting in underweight subjects, systematic bias cannot be completely discarded.

Mediterranean diet and age with respect to overall survival in institutionalized, nonsmoking elderly people.

BACKGROUND: In studies from Italy and Greece, a Mediterranean dietary pattern was shown to favorably affect life expectancy in the elderly population. This pattern is thought to reduce the risk of cancer in addition to being cardioprotective. OBJECTIVE: The objective of this study was to evaluate the interactive effects of the Mediterranean diet and age with respect to survival after controlling for several other variables that could be considered as confounders: age, sex, body mass index, albumin concentration, physical activity, self-assessment of health, and dieting in response to chronic conditions. DESIGN: This was a cohort study involving 161 nonsmoking elderly subjects (74 subjects aged <80 y and 87 subjects aged > or =80 y) living in Spain. The subjects were followed up for > or =9 y. Diet was assessed with a semiquantitative food-frequency questionnaire. RESULTS: A diet score based on 8 characteristics of the traditional diet in the Mediterranean region was associated with a significant reduction in overall mortality in elderly subjects aged <80 y but not in subjects aged > or =80 y. A unit increase in the diet score predicted a 31% reduction in mortality in subjects aged <80 y (95% CI: 7%, 57%). CONCLUSION: Efforts to promote adherence to the Mediterranean dietary pattern appear to be worthwhile in persons aged <80 y, in whom the diet predicts survival, but we do not have any available evidence that such a diet benefits subjects aged > or =80 y.

Alcohol and stroke: a community case-control study in Asturias, Spain.

The relationship between alcohol consumption and stroke is uncertain. Heavy alcohol consumption has been associated with an increased risk of stroke, while light drinking appears to be protective. However, the evidence is not uniform. We sought to examine the relationship between alcohol consumption and stroke, according to stroke type. We performed a population-based case-control study from September 1990 to December 1991. The study comprised 467 incident cases of stroke and 477 controls aged between 40 and 85. Case was defined following WHO criteria and control was randomly selected from the study base population. Alcohol exposure was obtained by medical interview. We found that consumption of less than 30 g/day of alcohol was protective against all stroke types combined, the multivariated adjusted odds ratio (OR) was 0.58 (95% confidence interval [CI], 0.41-0.83). Moderate alcohol drinking is also protective against all cerebral infarction combined (OR = 0.53; 95% CI, 0.35-0.80) and cortical infarction (OR = 0.40; 95% CI, 0.18-0.86). Drinking up to 30 g/day of alcohol has a borderline protective effect on deep cerebral infarction (OR = 0.40; 95% CI, 0.16-1.02) and has no effect on intracerebral hemorrhage (OR = 0.88; 95% CI, 0.44-1.74). Heavy alcohol drinking, over 140 g/day, is a risk factor for all stroke types combined (OR = 3.2; 95% CI, 1.1-9.7), all cerebral infarction combined (OR = 5.0; 95% CI, 1.5-16.3), small deep cerebral infarction (OR = 9.7; 95% CI, 2.6-36.7), intracerebral hemorrhage (OR = 6.2; 95% CI, 1.3-24.0), and is marginally associated with superficial cerebral infarction (OR = 4.6; 95% CI, 1.0-20.6). The relationship between alcohol and stroke depends on the alcohol dose and the pathology of the disease. Atherosclerosis of the large and medium cerebral arteries is found mainly in superficial cerebral infarction, and this type of stroke shows a J-shaped relationship with alcohol similar to that found in coronary heart disease, suggesting that they are similar diseases. On the other hand, arteriosclerosis of the penetrating arteries has been found in deep cerebral infarction and intracerebral hemorrhage, while atherosclerosis is not prominent. This may explain why alcohol does not have a protective effect on cerebral hemorrhage whereas heavy drinking is a strong risk factor in these two types of stroke.

Dietary intake of vegetables and fruits among adults in five regions of Spain. EPIC Group of Spain. European Prospective Investigation into Cancer and Nutrition.

OBJECTIVE: To assess the consumption of vegetables and fruits (V&F) in adults from five regions in Spain according to sex, age and educational level. DESIGN: Cross-sectional study within the members of the EPIC cohort in Spain. SETTING: Three regions of the north of Spain (Asturias, Guipúzcoa and Navarra) and two regions of the south of Spain (Granada and Murcia). SUBJECTS: 41448 healthy volunteers (15365 men, 25813 women), aged 29-69 y. INTERVENTIONS: Information on habitual diet during the previous year was collected by means of a computerised version of a diet history questionnaire. RESULTS: Among men, the mean daily consumption of vegetables and of fruits was 273.7 g (3.4 servings) and 348.3 g (4.4 servings) respectively. Among women, the corresponding vegetables and fruit intakes per day were 244.4g (3.1 servings) and 349.4g (4.4 servings). The total V&F intake tended to increase with age and educational level. Overall, 74% of subjects consumed 400 g/d (5 servings) of vegetables and fruit. CONCLUSIONS: Consumption of vegetables and fruits in healthy adults in Spain is considerably higher than in most European countries and the United States; this complies with what is considered to be the Mediterranean diet. Despite some regional differences, there were no clearly differentiated patterns of V&F intake between southern and northern regions within Spain.

Food habits and anthropometric measurements in a group of independent and institutionalized elderly people in Spain.

Because of an increase in the number of elderly and the problems of nutrition associated with them, we considered it of interest to study the eating habits of 352 elderly persons (134 males and 218 females) 65 to 95 years of age in an urban area in the north of Spain (Oviedo). The purpose of this study was specifically to describe the differences in the eating habits of elderly institutionalized persons and those resident at home and to detect the nutritional status of 161 subjects living in institutions and 191 living at home. The weight, height, body mass index (BMI), and triceps skinfold (PTP) of each were recorded. To determine the eating habits, a questionnaire measuring the frequency of food consumption was distributed to the subjects. The mean age of the institutionalized elderly was greater than those living independently. The mean values of BMI indicated overweight in all cases, with values around those of obesity in independent females (BMI = 29.97). The value of PTP was found to be within normal limits, but a greater percentage of institutionalized subjects showed PTP values of less than P10 (males, 10.2%; females, 11%). Food habits showed that the consumption of fish and margarine/oil was greater in institutionalized subjects of both sexes. Independent males consumed more vegetables; females consumed more milk and greens. Milk, vegetables, fruit, and fish were the food groups with consumption frequencies less than those recommended. A greater percentage of noncompliance was seen among the institutionalized elderly.

[Stroke incidence in Asturias, 1990-1991]. / Incidencia del accidente cerebrovascular en Asturias: 1990-1991.

BACKGROUND: Stroke, with a rate of 121/100,000 was the second cause of death in Asturias, Spain. Here we communicate the results of a population based stroke register in the oriental health districts of Asturias. METHOD: The study took place between October 1, 1990 and May 30, 1991, covering a population of 652,549. Surveillance was both active and passive and included the public and private hospitals, and the primary health care. Death certificates could not be checked due to legal reasons. We defined case following the WHO criteria. RESULTS: During the eight months of study 708 case occurred. The crude incidence rate of first stroke was 132.4/100,000 and that of any stroke, 162.7/100,000. The age adjusted incidence to the world population was, respectively, 61.3/100,000 and 73.6/100,000. There were no differences in the incidence across sexes. Age showed a strong effect in cerebral infarctation and less marked in intracerebral hemorrhage Infarcts are very rare in women before 50. Distribution of stroke type was: infarct: 77%; intracerebral hemorrhages: 14%: subarachnoid hemorrhage: 4% and unspecified stroke: 4%. Almost 50% of the strokes occurred in the morning hours, from 6:00 am to 12:00 am also during the cold season, winter and fall, the proportion of stroke was higher than during the warm season. CONCLUSION: Stroke is an important cause of morbi-mortality in Asturias. The magnitude of mortality is larger than the expected from the incidence. It maybe explained by a high case/fatality ratio in Asturias due to proportion of hemorrhagic stroke, the ageing of the population and the distribution of competing causes of death. However, we cannot rule out a small incomplete registration of cases, mostly in patients over 85. We estimated the incidence of any stroke, given underegistration, to be 176/100,000 for any stroke.

Na+-sugar cotransport system as a polarization marker during organization of epithelial membrane.

The present study analyzed the changes in Na+-dependent sugar transport and transepithelial electrical resistance as LLC-PK1 cells reorganize into epithelial membranes. Sugar influx increased to reach a maximum 9 h after plating. The increase in the transepithelial electrical resistance, however, showed a significant delay, reaching steady state 15 h after plating. No changes in the electrochemical Na+ gradient were observed during the reorganization of the epithelial membranes. Kinetic analysis and [3H]phlorizin-binding studies showed that the increase in sugar influx resulted from an increase in the number of carriers. Unidirectional sugar influx measurements indicated that the sugar transporters were primarily located at the apical surface of the epithelial cells. These observations are consistent with the hypothesis that the sorting of native proteins occurs intracellularly before their insertion in the apical membrane, or as an alternative that they are randomly inserted, but then immediately sorted such as any carrier could be detected in the basolateral side during the reorganization process. In addition, the results suggest that the functional development of the apical membrane may occur before the complete sealing of the intercellular space during the development of the occluding junctions. Furthermore, development of the sugar transport system and occluding junctions was inhibited by cycloheximide and puromycin but not by actinomycin D, suggesting that the expression of epithelial cell polarization is probably a posttranslational event in the protein synthesis.