[Primary leiomyosarcoma of the gallbladder].
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Biomedical subjects
Publications and source records attributed to A Navarro.
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373 (59%) out of 636 faecal specimens obtained during the first 2 years of life of 72 Mexican children yielded adherent Escherichia coli (HEp-2 cells). Strains with localised adherence were significantly associated with acute non-bloody diarrhoea, whereas strains with aggregative adherence were significantly associated with persistent diarrhoea. Half the strains with localised adherence were not enteropathogenic E coli serotypes nor did they hybridise with an enteropathogenic E coli adherence factor DNA probe. All strains with localised adherence gave a positive fluorescent actin staining (FAS) assay, irrespective of serotype. One-third of children colonised by aggregative strains had bloody diarrhoea. Isolation of strains with diffuse adherence was not related to type or duration of diarrhoea but was generally associated with isolation of another pathogenic organism.
A patient who first presented with episodic cluster headache later developed narcolepsy. In spite of REM sleep alterations associated with narcolepsy, the frequency and distribution of pain attacks did not change when narcolepsy occurred and were similar to those seen in cases of episodic cluster without narcolepsy. The lack of influence of narcolepsy on the pattern of cluster pains questions the role of REM sleep states in triggering pain in episodic cluster.
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All implants initiate a foreign-body response that leads to their encapsulation by scar tissue. In order to better understand this encapsulation process and the differences between soft (comfortable) and firm (contracted) breasts, we studied 22 patients who had come in for reaugmentation during a 2-year period. The capsules removed were prepared and measured using a new method. The capsules were (1) removed and stored in physiologic solution until the time of measurement (30 minutes to 2 hours) and (2) measured using a Mitutoyo dial-thickness gauge (MDTG) that employs a uniform pressure of 85 gm. The measurements revealed that soft breasts (Baker 1) have the thinnest scar-tissue capsules, which ranged in thickness from 0.002 to 0.010 inches. Firm breasts yielded the thickest capsules. Baker 3 measured between 0.010 and 0.078 inches thick, and Baker 4 measured between 0.018 and 0.162 inches thick. We also compared the precision of measurement between the MDTG and a standard (screw-type) micrometer by taking a series of readings on a soft, pliable substance (textured silicone rubber).
Two genes, xynD and gluB, encoding a xylanase and an endo-beta-(1,3)-(1,4)-glucanase (lichenase) from Bacillus polymyxa have been cloned and expressed in Escherichia coli and Bacillus subtilis. A sequenced DNA fragment of 4,466 bp contains both genes, which are separated by 155 bp. The xynD and gluB genes encode proteins of 67.8 kDa (XYND) and 27 kDa (GLUB). Two peptides with molecular masses of 62 and 53 kDa appear in cell extracts of E. coli and culture supernatants of B. subtilis clones containing the xynD gene. Both peptides show xylanase activity in zymogram analysis. The XYND enzyme also shows alpha-L-arabinofuranosidase activity. The XYND peptide and the xylanase XYNZ from Clostridium thermocellum (O. Grépinet, M. C. Chebrou, and P. Béguin, J. Bacteriol. 170:4582-4588, 1988) show 64% homology in a stretch of about 280 amino acids.
The household acceptance of oral rehydration solution salts was studied in a cohort of 75 rural mothers over a two year period. The study was carried out in a rural Mexican village between August 1985 and February 1988. There were 636 episodes of diarrhea, with an average of four episodes per child per year. There were no deaths due to diarrhea or its complications and only 2% of these episodes required the use of parenteral solutions. Acceptance of oral rehydration remained around 50% during subsequent bouts of diarrhea. Variables such as a medium high socioeconomic level of the family, and the reading of journals and newspapers by the mother and the presence of water supply in the home were significantly associated with the acceptance of oral rehydration treatment. On the other hand, families classified as traditional rejected the procedure with significantly higher frequency. The data presented indicates the need for redesigning oral rehydration, treatment programs to increase their impact at the community level.
A comparative study between tube agglutination using Spicer-Edwards antisera and a coagglutination method using Staphylococcus aureus Cowan 1 (NCTC 8530) protein A to detect Salmonella flagellar antigens was carried out. A total of 39 Salmonella strains belonging to eight serogroups of the Kauffmann-White scheme were typed by both methods. Each serogroup include monophasic and biphasic strains. Statistical analysis of the results showed that the coagglutination method was more sensitive and specific that the classic tube agglutination method normally used in different laboratories. The use of less antiserum in the coagglutination method to detect Salmonella antigens without loss of specificity or sensitivity represents an important saving for clinical laboratories and for epidemiologic research that require the identification of these antigens.
The etiology of bloody diarrhea was investigated in a cohort of 75 children followed longitudinally from birth during the first two years of life in a rural Village of Central Mexico. Of a total of 636 episodes of diarrhea, 71 (11%) showed presence of blood. A single associated pathogen was isolated in 59 (83%) of 71 children; 35% showed the presence of enteroaggregative E. coli (EAEC), 11% of E. coli producing Shiga-like toxins (SLT) I and/or II; 13% of Shigella, 7% of Campylobacterjejuni or enterotoxigenic E. coli (ETEC) and 4% enteropathogenic E. coli (EPEC), enteroinvasive E. coli (EIEC), Salmonella, Giardia lamblia or Hymenolepis nana. Mixed cultures were found in 16% of cases during the first year and in 18% during the second. These were mainly combinations of C. jejuni, with ETEC or EAEC. In 78% of children with bloody diarrhea the episode was single event during the first two years of life, lasting on average seven days. Epidemiologically, the incidence of bloody diarrhea rose steadily during the first two years of life, with a significant decrease after the tenth month. Prevalence was affected by seasonality in all pathogens, except for EAEC that had an endemic frequency. In the case of Shigella and SLT-producing E. coli clustering of cases and isolation of serologically identical strains indicated that infections were the result of common source outbreaks.
The efficacy and tolerability of lovostatin (L) and bezafibrate (B) were compared in a total of 39 patients, 24 males and 15 females, 59 +/- 9 years old. Showing a total serum cholesterol superior to 250 mg/dl and total serum triglycerides inferior to 350 mg/dl, after 1 month on a low cholesterol diet and another on placebo, were eligible for participation. After randomization 19 treated with L started with 20 or 40 mg at night according to baseline cholesterol under or above 300 respectively and 20 with B received 200 mg tid. If after 6 weeks of therapy cholesterol remained above 200, the doses of L or matching placebo in those with B was double while dose of B or matching placebo remained constant. Cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol were determined using an enzymatic analytical method. Apolipoproteins were obtained by radial immunodiffusion. Routine hematological analysis and blood chemistry safety tests were performed at baseline and every 6 weeks during active treatment. The average most important results, after 12 weeks of treatment, comparing L vs B were: 1) cholesterol was reduced 26 vs 10% (p less than 0.001); 2) LDL-cholesterol decreased 35 vs 15% (p less than 0.001); 3) HDL-cholesterol increased 5 vs 19% (p = NS); 4) triglycerides diminished 15 vs 18% (p = NS). Three patients in L and 1 in B showed adverse events and two of them, one each group, were drop-out. In summary: a) L was more effective lowering total cholesterol and LDL-cholesterol; b) B was more potent decreasing triglycerides and increasing HDL-cholesterol; c) both drugs showed good tolerability.
The incidence of colonization by enteropathogenic, enterotoxigenic, enteroinvasive, and enterohemorrhagic Escherichia coli (detected by DNA hybridization with specific radiolabeled probes), Salmonella sp., Shigella sp., Campylobacter jejuni, and rotavirus was related to the presence of diarrhea in a cohort of 75 rural infants followed longitudinally during the first year of life. The study was carried out between August 1985 and February 1987 in the village of Lugar Sobre la Tierra Blanca, in the state of Morelos, 180 km southwest of Mexico City. Intestinal colonization by specific enteropathogens was followed with fecal cultures taken every fortnight and every time a child had diarrhea. Pathogens isolated from cultures taken in the 48 hours prior to the initiation of the diarrheal episode were considered to be associated with the disease. Diarrhea was detected in 82% of the children with initial isolation of enterohemorrhagic E. coli and in 64% of the children with enteropathogenic E. coli or Shigella sp. The risk of diarrhea associated with the initial isolation of other pathogens was lower, at 41% for rotavirus and approximately 25% for enterotoxigenic E. coli, Salmonella sp., and C. jejuni. Initial colonization by the enteropathogens studied, whether or not they were associated with diarrhea, prevented disease, but not colonization by the same organism, when the children were reinfected during the first year of life. Enteropathogenic E. coli adherence factor, human or porcine heat-stable enterotoxins, fimbrial colonization factor antigens, and Shiga-like toxins I and II were important pathogenic characteristics related to the presence of diarrhea and to protection against subsequent infection by the same organisms.
A total of 43 surgically removed staghorn urinary calculi were examined under a scanning electron microscope; the findings, together with microanalytical data, were used to determine morphostructural patterns corresponding to different mineral compositions. The stones were classified into 3 groups: phosphatic, urate and cystine.
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Maternal mortality (MM) continues to be a problem that plagues many developed and underdeveloped countries around the world. It has been estimated that the minimum amount of underreporting in the U.S. to be 20%, resulting in MM rates that may be substantially higher than reported. The national goal for the MM for the year 1990 has been set at 5/100,000, and at the present trend it is expected that this may be achieved among the white population, but not among minorities. P.R. reported a maternal mortality rate of 5/100,000 in 1975. It was suspected that such a low rate was due to underreporting, a study was undertaken to investigate that possibility. The results indicated that there was severe underreporting of maternal deaths during 1978 = 79. Recently, there has been a growing concern that the level of underreporting in PR continues to be high. Since there has been no evidence that the surveillance has improved, the Dept. of Health requested from the Dept. of Ob-Gyn of the University of Puerto Rico Medical School and the Dept. of Maternal and Child Health to conduct a study to find out if the previous findings held true for recent years. The study was based on the review of selected medical records corresponding to deaths of women of childbearing age whose causes of death, as coded in the death certificate, were considered as having a high probability of masking a misreported maternal death. It was decided to investigate those deaths occurring in 1982, to see if the results of the previous study had caused any impact on the surveillance of maternal deaths in Puerto Rico.
A differential staining method of myelinated fibers and nerve cell bodies applicable to whole blocks of mammalian central nervous tissue is described. Experimental material fixed by perfusion or necropsy material fixed in block can be used. Blocks of 2 mm in thickness were obtained with a vibratome, immersed in 50% ethanol for 7 h and stained for 1 week in the following solution: 0.3% thionine, 5% formaldehyde and 5% acetic acid. After the staining period the blocks were washed in distilled water, dehydrated through graded alcohols, cleared in butyl acetate and infiltrated in paraffin. Sections of 10 microns in thickness were obtained, attached to slides, dewaxed in xylene and coverslipped with mounting media in the usual manner.
A prospective study has been made of the incidence of changes in transaminase levels, hyperkalaemia and thrombocytopenia in three groups of patients: 89 consecutive patients with venous thrombosis receiving therapeutic heparinization, 49 patients admitted because of hip fracture and receiving prophylactic low-dose conventional heparin, and 43 patients admitted because of hip fracture and randomly allocated to receive low molecular weight heparin. Laboratory measurements were made on admission and 8 days after commencing heparin. Only two patients on high-dose heparin developed thrombocytopenia. Increased transaminases were frequent with conventional heparin (18% and 32% of patients on high-dose heparin developed abnormal AsT and AlT values, respectively compared with 14% and 17% patients on low dose therapy). In contrast, only one patient on low molecular weight heparin developed abnormal AlT activity. Hyperkalaemia was uncommon in patients on any form of heparin therapy, and severe hyperkalaemia occurred in only one patient.
Desferrioxamine was tested in vitro for activity against promastigotes of Leishmania donovani. In addition, the effects of liposome-encapsulated desferrioxamine and free desferrioxamine on macrophages infected with amastigotes of L. donovani were compared. The drug was added to the culture medium for three days, and the results were compared with several controls; the drug solvent, empty liposomes, and desferrioxamine which had been re-ferrated with an equimolar concentration of ferric ammonium sulphate. Desferrioxamine was found to be inactive against growing promastigotes at the highest concentration used, 50 micrograms ml-1. On the other hand, 44% and 60% of amastigotes were eliminated when macrophages infected with L. donovani were exposed to 50 micrograms ml-1 of free or liposome-encapsulated desferrioxamine respectively.
In a randomized, prospective, double-blind trial, the effect of conventional low-dose heparin (5,000 units every 8 hours) was compared with that of a low molecular weight fragment (2165 LMWH, Kabi Vitrum AB, starting 2,500 units 2 hr before surgery, and then 5,000 units subcutaneously every morning for 9 days). A total of 90 patients admitted because of hip fracture fulfilled the inclusion criteria and were analyzed for development of pulmonary embolism and deep vein thrombosis: 46 patients were included in the low molecular weight heparin (LMWH) group, and 44 in the conventional heparin group. Two and three, respectively, died before diagnostic tests were performed. In the remaining patients a ventilation-perfusion lung scan was performed 8 days after intervention. In the first 57 patients studied a bilateral ascending venography was performed on the ninth day only if clinical symptoms suggested a deep venous thrombosis. Because of the rate of venous thrombosis detected in those patients was unexpectedly low, venography was requested in the remaining 33 patients, even if the screening tests were negative. Pulmonary embolism occurred in six patients, all in the LMWH group. Deep vein thrombosis occurred in 14 patients in the LMWH group and in six patients in the conventional heparin group. Both differences are statistically significant. Mortality did not differ between the groups, nor did haemorrhagic complications. Our findings suggest that, in patients with hip fracture, LMWH is not useful at the dosage used.