Implementing rules to improve the quality of concept post-coordination with SNOMED CT.

The use of SNOMED CT as a standard reference terminology enables interoperability between clinical systems. This reference tool provides a method for creating post-coordinated terms by users according to local needs. While the creation of these terms is free, there are a number of rules, as defined in the user manual of SNOMED CT that must be followed.The Hospital Italiano of Buenos Aires has a Terminology Server that encodes medical terms, using SNOMED CT as the reference vocabulary. An interoperability analysis performed with the Nebraska Medical Center in 2006 found a high error rate (26%) in post-coordinated terms. Therefore, we implemented an automatic system of rules within the Terminology Server as defined in the user manual. Following rules implementation, the error rate decreased from 26% to 2%.

Cysticercosis in epileptic patients of Mulungu do Morro Northeastern Brazil.

With the aim to study the magnitude of infection by the metacestode of Taenia solium in a population of epileptic patients in the arid region of Bahia, Northeastern Brazil, we examined 200 consecutive cases who attended an ambulatory clinic in the disctrict of Mulungu do Morro. Sixty-six of the patients had a diagnosis of epilepsy. From them 10 (15.2%) presented antibodies against a specific fraction of antigens in Western blot, and 4 (6.0%) had circulating parasite products, as tested by capture ELISA. Only 1 case was positive for antibodies and antigens. We found that the frequency of seropositivity was related to the time without epileptic seizure. We conclude that cysticercosis is endemic in the region of Mulungu do Morro and that it is related to a benign form of epilepsy.

Anxiolytic-like actions of melatonin, 5-metoxytryptophol, 5-hydroxytryptophol and benzodiazepines on a conflict procedure.

Male Wistar rats (120-230 g) were used in these experiments. Some rats were deprived of water for 48 h before testing in a conflict procedure. Then, after 20 licks from a water bottle with a metal drinking tube, the animal received an electric shock (0.5 mA/500 msec). The effects of two classical anxiolytic drugs, DIAZ (1.0, 2.0 and 4.0 mg/Kg b.wt), and CDP (5.0 and 10.0 mg/Kg b.wt) were compared to those produced by MEL (0.1, 0.2, 0.5, 1.0 and 2.0 mg/Kg b.wt), 5-MTOPHOL (1.0 and 2.0 mg/Kg b.wt), 5-HTOPHOL (1.0 and 2.0 mg/Kg b.wt) and vehicle solution. Anxiolytic drugs as well as MEL produced a dose-dependent increase in the number of shocks received. The results suggest that the three pineal indoles are involved in the modulation of the stress responses. MEL showed a higher potency than the other indoles.

Constitutional translocation (8;13) in a patient with non-Hodgkin's lymphoma.

We report a case of non-Hodgkin's lymphoma in a 16-year-old male, whose peripheral white blood cells have a t(8;13)(q24;q14). There are no previous reports that describe this association. Although the tumor cells were not studied, we discuss the possible link between this finding and the development of the malignant lymphoma.

Protective behavior of captopril on Hg(++)-induced toxicity on kidney mitochondria. In vivo and in vitro experiments.

Mercurials are known to induce morphological and functional modifications in kidney mitochondria. In this work we studied in vitro and in vivo the protective effect of captopril on the deleterious effect of Hg(++)-induced nonspecific membrane permeability changes to Ca++ and membrane de-energization. In vivo the administration of captopril prevented the toxic effects of mercury poisoning on membrane permeability, oxidative phosphorylation and Ca++ homeostasis. Moreover, captopril preserves kidney tissue morphology from Hg(++)-induced damage. The protective effect of captopril is most likely related to the existence of a sulfhydryl group in the drug.

[Congenital ventricular diverticula. Presentation of 6 cases]. / Divertículos ventriculares congénitos. Presentación de seis casos.

Congenital diverticulum of the heart is an unusual malformation. It is frequently associated with thoracic or abdominal midline alterations and also with various types of congenital heart disease. Complications of this anomaly are rupture, peripheral embolism and heart failure. Surgical management consists of resection of the diverticulum either as an isolated operation or at the time of correction of accompanying malformations. We present six cases of congenital diverticulum of the heart, four on the right ventricle and two on the left. In one patient with Fallot's tetralogy a diverticulum was found at necropsy; in two cases the underlying malformation was double outlet ventricle; one case had pulmonary artery stenosis and two did not have associated malformations.

Temperature dependence of the atractyloside-induced mitochondrial Ca2+ release.

1. Mitochondrial Ca2+, accumulated by succinate oxidation was released by addition of 50 microM atractyloside. Beside this Ca2+ efflux, a large oxidation of pyridine nucleotides and sustained membrane depolarization occurs. An absolute requirement for acetate to support Ca2+ release is demonstrated. 2. Membrane de-energization, NAD(P)H oxidation, and Ca2+ efflux as induced by atractyloside were temperature-dependent, since it occurs when mitochondria are incubated at 22 degrees C and was abolished at 4 degrees C. 3. Taking into account this latter, the effects of atractyloside on mitochondrial Ca2+ release appears not to be a simple result of the binding of the inhibitor to adenine nucleotide translocase. 4. It is proposed that the mechanism involved in atractyloside-driven membrane permeability to Ca2+ must be related with the transference of the conformational change of the carrier, to another membrane structure responsible for the maintenance permeability to ions.

Interatrial conduction and STa in experimental atrial damage.

Right (RA) and left atrial (LA) damage was produced with a subepicardial infiltration of 96 degrees alcohol in two groups of dogs. In six other dogs the left or right portion of the interatrial band was also injured. Conventional ECG and supplementary unipolar leads were recorded using photographic and direct inscription polygraphs at paper speeds of 50 and 100 mm/sec. Control, immediate postinjury and late tracings were obtained. A-V block was provoked to determine QTac. Slowing of heart rate and slight widening of the P wave and P-R interval were observed with both types of atrial damage. In four cases low right atrial rhythm was detected: two showed anatomo-histological sinus node involvement in right atrial injury. Qp waves were registered over the left precordium with necrosis of both sides, but were more frequent with RA damage. Damage of the left portion of the interatrial band delayed left atrial activation and split P waves in the precordial leads. Damage of the RA distorts the initial vectors, magnifying the left ones and simulating LA enlargement. The Qp registered on the RA is also detected by surface leads. Contrary distorted LA depolarization increases the RA vector and delays the left, ones, giving rise to greater asynchronsim and bimodal P waves.

[Rheumatic activity and clinico-pathologic dissociation. Clinical and pathologic parameters in rheumatic heart disease]. / Actividad reumática y disociación clínico-patológica. Parámetros clinicos y patólogicos en la cardiopatía reumática.

We studied atrial appendages and valvular apparatus from patients undergoing cardiac surgery for rheumatic heart disease, looking for active histologic lesions. After reviewing 673 specimens (1980-1985) we studied two groups: 31 cases with Aschoff nodules or ill-differentiated histopathological lesions, and 31 cases, without tissular inflammatory abnormalities. In the former we found 8 cases with suspected clinical activity in a 3 months period before surgery, in the latter only 2 cases had similar findings. The Jones criteria are not useful for recognizing rheumatic activity among patients with chronic rheumatic heart disease, there is no clinical-histopathological correlations and it is possible that chronic inflammation occurs at the heart as an organ-limited condition.

[Impact of experimental infarction of the right ventricle on P, Ta and QTa readings]. / Repercusiones del infarto experimental de la aurícula derecha sobre P, Ta y QTa.

Right atrial (RA) damage was produced by subepicardial infiltration with 96 percent alcohol in 18 dogs' hearts. Anterolateral, right appendage and right side of interauricular band were injected. 19 surface readings, including right thoracic, abdominal (MD, ME, MI), and five direct atrial unipolar records were obtained using VR6 photographic paper and a direct-writing machine (Sanborn 150) with 4 channels at 50 and 100 mm/sec speed. Records were made in control conditions and immediately after infiltration as well as 120 minutes later. Premature atrial contractions and A-V block were provoked in order to measure, precisely, the QTa duration and its termination in the ventricular ST. Rate slowing, slight broadening of P and P-R as well and in 4 cases low right atrial rhythm were observed. Significant changes in the right thoracic leads and even in the V4-V5 leads, as well as in RA unipolars, were also demonstrated, that is: P-R segment elevation (injury vector pointing toward the RA), Qr or Wp waves (necrosis vector away from RA). Nevertheless, leads II, III and a VF showed q o w p waves with less significant Ta changes. Ischemic vector went away RA pointing toward the left one, magnifying the protuberance or irregularities on ventricular ST. The QTac was prolonged beyond VM + 0.04, with the greater one in RA leads. This behaviour was evidenced on premature blocked atrial contractions as well as in A-V block. Similar alterations of P wave can be observed in RA infarction as well in myocarditis.

[Comparison of the postmortem anatomical study and bidimensional echocardiography in myocardial infarction]. / Comparación del estudio anatómico postmortem y la ecocardiografía bidimensional en el infarto del miocardio.

We studied 10 patients between the ages of 30 and 69 years, all of whom had suffered myocardial infarction (MI) at least 6 months before they died. Two-dimensional echocardiography (2-D E) and catheterism were done no more than 15 days before death. The location and extension of MI were compared to the segmentary mobility (SM), end diastolic wall thickness (EDWT) and percentage of systolic wall thickening (PSWT) determined by 2-D E, in the 15 segments of the left ventricular wall. We also compared 2-D E and coronariographic findings. There was a good correlation between the location (P less than 0.01) and extension (P less than 0.05) of the necrotic area dyssynergy, specially when the MI was transmural. The postmortem measurement of the wall thickness in each one of the segments had also good correlation with the EDWT as measured with 2-D E (r = 0.926). The EDWT was less in the necrotic segments (8.8 +/- 1.8 mm) than in non affected segments (14.1 +/- 1.9 mm) and this difference was significant (P less than 0.05). The wall was thinnest in segment affected by transmural necrosis. The PSWT was significantly less (P less than 0.01) in necrotic segments (12.1 +/- 3%) than in segments without necrosis (24.1 +/- 4.3%). The alteration of SM correlated with coronary obstructions greater than 75%, specially when it was associated with necrosis. The EDWT was less in necrotic segments with important coronary artery obstruction than in those without necrosis even though vascular narrowing was marked (P less than 0.01). The PSWT was also less in the areas with necrosis when coronary obstruction was severe as well as moderate (11.3 +/- 2.3%) than in segments with coronary obstruction but without necrosis (22.3 +/- 4.2%) and even less than that obtained in cases with neither coronary artery obstruction nor necrotic area (30.1 +/- 2.2%) and the difference is statistically significant (P less than 0.01). The segmentary measurement by 2-D E of the EDWT and the PSWT are useful for recognizing areas with necrosis and differentiating it from ischemic areas of left ventricle in coronary artery disease.

The role of calcium in cell injury. A review.

The role of calcium in cell injury is currently under investigation in many laboratories. It appears that movement of calcium between extra- to intracellular compartments and between various intracellular compartments plays a key role in determining many important reactions of cells both to lethal and sublethal injuries of diverse types as well as in adaptive new steady states. Prevention and/or modification of calcium movements has implication for the control of cell population growth, the prevention of cancer, and the retrieval of victims of shock, myocardial infarction and stroke. Regardless of what type of initial injury occurs, for example ischemia or direct cell membrane damage, the cell undergoes calcium accumulation either by impaired energy metabolism and/or plasmalemmal alterations. This elevated intracellular calcium concentration is responsible for cytoskeletal modifications which alter cell shape, the activation of phospholipases which results in perpetuation of membrane damage and finally, mitochondrial calcification. Although such changes have been partially characterized biochemically and morphologically, some obscure points continue to need clarification. The importance of determing the event(s) responsible for cell death is directly related to the potential capability of their manipulation. Therefore, this could result in the development and/or modification of pharmacologic interventions for the control and prevention of many human diseases. It is the purpose of this paper to review the present state of the art regarding the role of calcium in cell injury, to put it into perspective concerning organelle changes from the standpoint of morphology, and to indicate the present and future role of analytical microscopy in furthering the understanding of these processes.