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Biomedical subjects

F Guerra

Publications and source records attributed to F Guerra.

At least 19 recordsLinked to original sources

Application of new sepsis definitions to evaluate outcome of pediatric patients with severe systemic infections.

No published reports have stratified pediatric patients with systemic infections according to the new sepsis terminology guidelines. In addition little is known about the outcome of sepsis in developing countries. This large 12-year retrospective study evaluated the outcome of 815 infants and children with sepsis managed in a Latin American pediatric intensive care unit. Of these children 171 (21%) had sepsis, 497 (61%) had severe sepsis and 147 (18%) had septic shock. Multiorgan dysfunction was present in 120 (24%) and 77 (52%) patients with severe sepsis and septic shock, respectively. Infection was bacteriologically proved in 212 (26%) cases, with Staphylococcus aureus and Neisseria meningitidis being the most frequent responsible organisms. Three hundred nineteen (39%) patients died. Case-fatality rates were higher in patients with septic shock, multiorgan dysfunction, sepsis caused by Pseudomonas aeruginosa and meningococcemia than in those without these conditions. Although no difference in mortality was detected between culture-proved and culture-negative sepsis, more patients receiving an inappropriate antimicrobial agent died than those treated with an appropriate drug (53% vs. 34%, P = 0.012). We believe that with the use of the new terminology system a more reliable comparison of data from pediatric sepsis studies and of emerging immunomodulating therapeutic modalities can be achieved.

Adolescent

Effect of sialoadenectomy on medroxyprogesterone-acetate-induced mammary carcinogenesis in BALB/c mice. Correlation between histology and epidermal-growth-factor receptor content.

To evaluate the possible involvement of the salivary glands in the modulation of medroxyprogesterone (MPA)-induced mammary tumorigenesis, 48 sialoadenectomized virgin BALB/c female mice and 47 controls were treated with 40mg MPA depot s.c. every 3 months for 1 year. Mammary tumors developed in 11 sialoadenectomized and in 34 control mice with similar latencies. In both groups, 75% of the tumors were ductal and progestin-dependent (PD) while the remainder were lobular and progestin-independent (PI). Epidermal growth factor (EGF) levels were measured in salivary glands (SG-EGF) and serum (S-EGF) in both groups. MPA induced a significant increase in SG-EGF and in S-EGF that became evident only after 1 month of MPA treatment. No increase in S-EGF was detected in MPA-treated sialoadenectomized mice, indicating that salivary glands are the major source of S-EGF. The presence of EGF receptors (EGF-R) was investigated in ductal PD and PI tumor lines and compared with 8 PI tumor lines of lobular origin. A significant difference in EGF-R content was found between lobular and ductal tumors. No increase in EGF-R was noted when ductal tumors became autonomous. EGF-R did not correlate with tumor growth rate and there was an inverse correlation between EGF-R and steroid receptors. When the effect of sialoadenectomy on tumor growth was tested in vivo in syngeneic transplants of 2 ductal PD, 1 ductal PI and 2 lobular PI mammary adenocarcinomas, it was not found to be significant when compared with the controls. It may be concluded that SG-EGF plays an important role in the induction of mammary adenocarcinomas by MPA, while it has no significant effect on the growth of established tumors.

Animals

Sensitization to sunflower pollen: only an occupational allergy?

Sunflower (Helianthus annuus) pollen sensitization has been reported as an occupational allergy. In this report, the sensitization of the general population living in sunflower-growing areas to Helianthus pollen was studied. Both RAST results in 32 adults with summer symptoms previously diagnosed as allergic to Artemisia pollen, and cross-reactivity studies between H. annuus and other Compositae suggested that H. annuus pollen was the main allergen involved in the hypersensitivity reaction of those patients. Good correlation was found between RAST and SPT to Helianthus and between RAST and conjunctival provocation test to Helianthus. Bronchial challenge tests performed on 8 of the 32 patients confirmed the clinical implication of Helianthus pollen in suspected subjects. Five workers, handling sunflower pollen, who suffered from related symptoms were subjected to the same study, showing lesser wheal areas and lesser specific IgE levels than a non-worker group. Thirteen patients with RAST values > or = class 2 showed 2 IgE-binding fractions at 34.0 and 42.8 kD in 65% of sera and 3 IgE-binding fractions at pI 4.9, 9.6 and 10.2 in 54% of sera. By means of micropreparative high-resolution chromatography, it was possible to purify a 34-kD major allergen. Analysis performed by RAST inhibition with sera from atopic patients and ELISA inhibition with experimental anti-Helianthus rabbit sera demonstrated a cross-reactivity between Helianthus and other Compositae, but low affinity of specific anti-Helianthus antibodies for heterologous antigens. Taking into account the above-mentioned data, and the high prevalence of Helianthus pollen in the atmosphere during harvesting (in spite of its entomophilous character), Helianthus pollen should be considered as an allergenic source to be investigated in the general population living in sunflower-growing regions suffering from seasonal summer allergy.

Agricultural Workers' Diseases

Oral metastasis of renal cell carcinoma. Report of case and critical evaluation of morphologic features for differential diagnosis.

Two clear cell neoplastic lesions of the oral cavity, the first on the cheek and the second on the mucosa of the upper lip, were identified, in a 44 year old otherwise healthy man, 46 and 51 months after left nephrectomy for renal clear cell carcinoma. Basing on this case, unique for the double and limited metastasis of clear cell carcinoma of the kidney in the oral cavity, we discuss about the morphologic criteria usefull in the differential diagnosis of oral cavity clear cell tumors.

Adult

[Sulindac and indomethacin effects on lamb fetuses chronically monitored].

Sulindac and indometacin, both prostaglandins inhibitors, have a similar tocolytic effectiveness, in contrast their fetal effects seem to be different. For specify these differences we compared the effects of the infusion of sulindac with known effects of indometacin. We operated 6 fetal lambs, in which polyvinyl catheters were inserted chronically for continuous measure of heart rate, blood pressure, incidence of fetal breathing movements and arterial pH and gas tension. The fetuses were infused in a 2 hour control period with vehicle, and then with 150 mg of either sulindac or indometacin (in alternate days) for a 6 hour period. There was no change in any variable when sulindac was given, but there was a significant increase in fetal breathing movements with indometacin. The reason for this difference is not clear, and requires further studies. These results added to previous reports supports the hypothesis that sulindac could be a first choice tocolytic drug for treatment of premature labor when no fetal effect is desired.

Animals

[Evaluation of maternal and fetal blood flow indices in intrahepatic cholestasis of pregnancy].

To determine the existence of any change in the blood flow velocity indexes in patients with cholestasis of pregnancy, we studied a total of 51 pregnant women, (normal n = 15; anicteric cholestasis n = 21 and icteric cholestasis n = 15). There was no significant change in the parity, maternal age, gestational age, birth weight and in the apgar score among the groups. There was also no significant change in any of the blood flow indexes determined in the uterine artery, umbilical artery and fetal cerebral artery. We conclude that there are no significant changes in blood flow velocity indexes determined by doppler blood flow analysis in patients with cholestasis of pregnancy.

Adult

[Behavior of flow waves of the uterine and external iliac arteries during labor contractions].

To evaluate the changes of blood flow velocities of the uterine and external iliac arteries, we studied a total of 15 normal full term pregnant, which were in the active phase of labor. The mean maternal age was 21.6 +/- 5.2 years (X +/- SD), the mean parity was 0.6 +/- 0.5, and the mean gestational age was 39.2 +/- 1.1 weeks. All patients had normal deliveries, the newborn weight was 3440 +/- 621 g, and the apgar score was 8.6 +/- 1.6 and 9.0 +/- 0.7 at 1 and 5 min, respectively. In the uterine artery, the systolic/diastolic ratio and the resistance index increased significantly from 1.83 +/- 0.25 to 4.24 +/- 1.55 (p < 0.05) and from 0.46 +/- 0.05 to 0.74 +/- 0.08 (p < 0.01), respectively from the relaxation phase to the contraction phase. In all 15 patients the external iliac artery showed a reverse diastolic flow during uterine relaxation, whereas only 2 of the 14 patients showed this reverse flow during uterine contraction (p < 0.01). Furthermore, the flow velocity was modified with maternal hyperventilation. Finally, we conclude that uterine contraction induced profound changes in the blood flow velocities in the uterine and external iliac arteries. We proposed that these changes could be explained by uterine muscular contractions causing the blood flow to be shunted to areas of less resistance.

Adult

The European-American exchange.

The European-American exchange of infectious diseases was responsible for the demographic havoc of the native population in the New World after 1492. Prior to this date medical writers describe the presence in Spain of viral diseases like influenza, parotitis, smallpox, measles, poliomyelitis, and rabies; there were also rickettsiasis, diphtheria, salmonellosis, plague, tubercolosis, leprosy, malaria, scabies and tinea. In America, before European arrivals, there were no records of human viral diseases, though there were records of rickettsiasis, treponematosis--pinta, yaws and syphilis--leihsmaniasis, amibiasis and perhaps leprosy. With the discovery of America in 1492, Columbus's sailors were contaminated by yaws and spread this disease into Europe. In 1493 influenza, as a zoonosis, was introduced into Santo Domingo and was responsible for the annihilation of the natives of the Antilles in less than a quarter of a century; in 1518 smallpox was also introduced in Santo Domingo and then to the American continent by negro slaves: by the same means measles were introduced in 1531. The previous existence or introduction of other infectious diseases in America is also discussed.

Americas

Failure of Hancock pericardial xenografts: is prophylactic bioprosthetic replacement justified?

The incidence of major valve-related complications was evaluated in a series of patients in whom the Hancock pericardial xenograft was used for aortic (AVR; n = 84), mitral (MVR; n = 17) and mitral-aortic (MAVR; n = 13) valve replacement. At 7 years actuarial survival is 66% +/- 8% after AVR, 64% +/- 13% after MVR, and 41% +/- 15% after MAVR, whereas actuarial freedom from valve-related death is 79% +/- 7% after AVR, 78% +/- 13% after MVR, and 81% +/- 12% after MAVR. Actuarial freedom from thromboemboli and anticoagulant-related hemorrhage at 7 years is 93% +/- 4% and 98% +/- 2% after AVR and 83% +/- 10% and 88% +/- 11% after MVR; no such complications occurred after MAVR. Structural valve deterioration determined at reoperation, at autopsy, or by clinical investigation was observed in 34 patients with AVR (10.0 +/- 0.2%/patient-year), in 10 with MVR (10.6 +/- 3.3%/patient-year), and in 9 with MAVR (16.6 +/- 5.5%/patient-year). After AVR, 19 patients underwent reoperation and 2 died before reoperation; 4 patients with MVR underwent reoperation, and 7 patients with MAVR underwent reoperation and 1 died before reoperation. Seventy-eight percent of the current survivors (13 patients with AVR, 7 with MVR, and 1 with MAVR) have clinical evidence of valve failure. At 7 years actuarial freedom from structural deterioration of the Hancock pericardial xenograft is 25% +/- 7% after AVR, 29% +/- 14% after MVR, and 0% after MAVR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Extended follow-up of the standard Hancock porcine bioprosthesis.

We have reviewed 665 patients in whom the standard Hancock porcine bioprosthesis (HPB) was used for aortic (AVR = 173), mitral (MVR = 437), and mitral and aortic (MAVR = 55) valve replacement in the time interval from 1970 to 1983. After AVR, HPB-related deaths occurred in 24 patients (1.7% +/- 0.4% per patient-year); 11 had thromboembolic episodes (0.8% +/- 0.2% per patient-year), 6 hemorrhages related to anticoagulants (0.4% +/- 0.2% per patient-year), 9 endocarditis (0.7% +/- 0.2% per patient-year), 7 prosthetic leak (0.5% +/- 0.1% per patient-year), and 59 structural deterioration (4.3% +/- 0.6% per patient-year). At 16 years, actuarial survival is 40% +/- 6%, freedom from thromboembolic episodes 89% +/- 4%, from hemorrhages 90% +/- 5%, from endocarditis 94% +/- 2%, from prosthetic leak 95% +/- 2%, and from structural deterioration 36% +/- 6%. After MVR, HPB-related deaths occurred in 64 patients (1.6% +/- 0.2% per patient-year); 68 had thromboembolic episodes (1.7% +/- 0.2% per patient-year), 28 hemorrhages (0.7% +/- 0.1% per patient-year), 12 endocarditis (0.3% +/- 0.1% per patient-year), 9 prosthetic leak (0.2% +/- 0.1% per patient-year), and 158 structural deterioration (4.0% +/- 0.3% per patient-year). At 18 years, actuarial survival is 33% +/- 4%, freedom from thromboembolic episodes 57% +/- 13%, from hemorrhages 81% +/- 6%, from endocarditis 91% +/- 4%, from prosthetic leak 98% +/- 1%, and from structural deterioration 18% +/- 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis

The risk of reoperation in patients with bioprosthetic valves.

The risk of operative mortality in patients undergoing a first reoperation for bioprosthetic failure was assessed in a series of patients reoperated upon during the last two decades (1970-1990). A total of 330 such patients underwent replacement of 351 bioprostheses: 88 had aortic; 221 mitral; and 21 mitral and aortic bioprosthetic replacement. Indication for reoperation was in most cases structural valve deterioration (87%), followed by periprosthetic leak (7%) and endocarditis (6%). The operative mortality was significantly higher in patients who preoperatively were in New York Heart Association Functional Class IV or had a lower left ventricular function, in those reoperated because of prosthetic infection, and in those reoperated on an emergency basis. Structural valve deterioration was associated to a substantially low risk; operative mortality has improved in recent years, regardless of the indication for reoperation, partly due to the increasing experience and improved surgical techniques. Our results indicate that in recipients of bioprosthetic valves, careful follow-up with closer surveillance of valve and cardiac function and earlier prosthetic replacement might contribute to reducing the risk of reoperation.

Adolescent

Humoral immunity in different phases of contact dermatitis.

Although cell-mediated hypersensitivity seems to be the main immunological response of man in contact dermatitis, recent studies suggest the potential involvement of antibody-mediated and basophilic cutaneous hypersensitivity in the physiopathology of this affection. The aim of this work was to contribute data intended to clarify the possible involvement of factors traditionally assigned to humoral hypersensitivity in the pathology of contact dermatitis. For this purpose blood levels of the different immunoglobulins were determined in patients with contact dermatitis. Three phases were considered, namely, one in which the patients showed typical clinical signs (acute phase), another in which the lesions had subsided (intercrisis phase) and a third in which the signs had recurred (acute outbreak). All those patients who concomitantly suffered from or had any personal or family antecedents of type I hypersensitivity were excluded from the study. The results found were compared with those obtained for a control gorup consisting of healthy individuals with no atopic antecedents. No significant differences were found between the results obtained in the three phases. However, the IgE levels of the patients were significantly higher than those of the control group, whereas the differences in the IgE, IgA and IgM levels were insignificant.

Acute Disease

Influence of prosthetic design on durability of the Liotta porcine valve in the mitral position.

From March 1979 to December 1984, the Liotta low-profile porcine bioprosthesis was employed for mitral valve replacement in 71 patients to avoid potential left ventricle-prosthesis mismatch occasionally observed with the standard, high-profile, Hancock porcine xenograft. Follow-up of 61 operative survivors showed at 10 years an actuarial survival of 67% +/- 7%, freedom from thromboemboli of 96% +/- 2%, freedom from structural deterioration of 63% +/- 11% and freedom from all Liotta bioprosthesis-related complications of 53% +/- 10%. Complications related to excessive protrusion of the stent into the left ventricular cavity were eliminated with the Liotta bioprosthesis; the peculiar stent configuration, however, was responsible for an increased rate of structural deterioration requiring reoperation in 10 patients (2.8% +/- 0.9%/patient-year) at a mean interval of 76 +/- 18 months after mitral valve replacement (range, 45 to 106 months). Common findings in all explants were cusp prolapse, cusp tears, and commissural rupture related to various degrees of tissue calcification, constantly leading to severe prosthetic incompetence. As also shown experimentally, such structural changes have been attributed to increased systolic stresses on the closed cusps, favored by excessive reduction of the stent height. Our experience shows that the Liotta bioprosthesis used for mitral valve replacement does not provide any clear-cut advantage over standard porcine bioprostheses and that its long-term durability appears affected by the unique prosthetic design.

Adult

Long-term performance of the Hancock porcine bioprosthesis in the tricuspid position. A review of forty-five patients with fourteen-year follow-up.

Because little information is available regarding the clinical performance of the Hancock porcine bioprosthesis (Johnson & Johnson Cardiovascular, King of Prussia, Pa.) implanted in the tricuspid position, we reviewed the long-term follow-up of patients who had tricuspid valve replacement with this device. From March 1970 to December 1983, 45 patients had tricuspid valve replacement, either isolated (seven patients) or combined with replacement of other valves (38 patients) by means of a standard, glutaraldehyde-preserved Hancock porcine bioprosthesis. Follow-up ranged from 0.2 to 14.7 years (mean, 7.6 +/- 3.6 years) and was complete. The late mortality rate was 6.6% +/- 1.6%/pt-yr and the actuarial survival rate at 14 years was 23% +/- 9%. Reoperation because of structural deterioration of the tricuspid, the mitral, or both bioprostheses was performed in nine patients (3.7% +/- 1.2%/pt-yr) from 40 to 177 months (mean, 112 +/- 43 months) and resulted in no deaths. Actuarial freedom from structural deterioration of a Hancock tricuspid porcine bioprosthesis at 14 years is 68% +/- 13%. Morphologic examination of explanted porcine bioprostheses showed that those implanted in the tricuspid position had lower degrees of calcification and less severe structural changes than those simultaneously explanted from the mitral position. We conclude that the Hancock porcine bioprosthesis has an acceptable long-term durability and satisfactory performance after tricuspid valve replacement, and we continue to favor its use in the tricuspid position even in association with mechanical prostheses in the left side of the heart.

Adolescent

Mitral valve replacement with the Hancock, Björk-Shiley and Lillehei-Kaster prostheses. A comparison based on a 15-year follow-up.

The performance of the standard Hancock porcine bioprosthesis (HPB), the Björk-Shiley spherical disc prosthesis (BSP) and the Lillehei-Kaster tilting disc prosthesis (LKP) was compared over a 15-year follow-up in patients who underwent isolated mitral valve replacement (502 HPB, 183 LKP and 119 BSP). The cumulative duration of follow-up is 3,488 patient-years (mean, 8.0 +/- 3.7 years) for patients with a HPB, 1,302 patient-years (mean, 8.4 +/- 4.9 years) for patients with a LKP and 718 patient-years (mean, 7.1 +/- 5.6 years) for those with a BSP. At 15 years a significant difference was found among the 3 groups in freedom from (1) anticoagulant-related haemorrhages, between HPB (83% +/- 7%) and BSP (65% +/- 8%) recipients (P less than 0.05); (2) prosthetic dysfunction, BSP (96% +/- 3%) and LKP (83% +/- 6%) versus HPB (42% +/- 5%) recipients (P less than 0.001); (3) overall reoperations, BSP (94% +/- 3%) and LKP (89% +/- 3%) versus HPB (40% +/- 5%) recipients (P less than 0.001) and (4) prosthetic failure, BSP (88% +/- 4%) and LKP (71% +/- 6%) versus HPB (38% +/- 5%) recipients (P less than 0.001). No difference was found in actuarial survival, freedom from thromboembolic episodes, treatment failure and overall prosthesis-related complications. Our results confirm that the long-term performance of the HPB in the mitral position is adversely affected by the high incidence of tissue degeneration while haemorrhagic complications may limit the advantage of the longer durability of mechanical prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Valve replacement in children: early and late results.

In order to analyze the problems associated with prosthetic valve replacement (PVR) in the pediatric population, we have reviewed 29 children, 3.5 to 15 years of age, who were operated upon from 1970 to 1986. The indications were congenital valve malformations in 16 patients, rheumatic valve disease in 7, degenerative disease in 2 and bacterial endocarditis in 4. Ten children underwent aortic valve replacement (AVR), 14 mitral valve replacement (MVR), 1 tricuspid valve replacement and 4 double valve replacement (mitral-aortic in 3 and mitral-tricuspid in 1). Twenty-one mechanical (11 aortic and 10 mitral) and 12 biological prostheses (8 mitral, 2 aortic, and 2 tricuspid) were implanted. There was 1 hospital death (3.4%). Follow-up data were available for all survivors from 3 to 184 months. There were 8 late deaths (5.9% patient-year), 4 among children with mechanical and 4 among those with biological prostheses. Overall actuarial survival at 14 years is 62.5 +/- 10.2% with no significant difference in survival between AVR (77.8 +/- 14%) and MVR (44.4 +/- 16%) (p = 0.31) at 10 years and between recipients of mechanical (65.7 +/- 13%) or biological prostheses (60.0 +/- 15%) (p = 0.62) at 6 years. No documented embolic or anticoagulant-related complications occurred in the entire series.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis

Aortic valve replacement with the Hancock standard, Björk-Shiley, and Lillehei-Kaster prostheses. A comparison based on follow-up from 1 to 15 years.

Three series of patients undergoing isolated aortic valve replacement with the standard glutaraldehyde-preserved Hancock porcine bioprosthesis, the standard Björk-Shiley spherical disc prosthesis, and the Lillehei-Kaster tilting disc prosthesis were compared during a 15-year follow-up. From March 1970 to December 1985, aortic valve replacement was performed in 506 patients, 379 men and 109 women, whose ages ranged from 17 to 71 years (mean, 47 +/- 12 years); 196 had a Hancock bioprosthesis, 147 a Björk-Shiley prosthesis, and 163 a Lillehei-Kaster prosthesis. There were no significant differences among the three groups in terms of mean age, preoperative New York Heart Association class, valve lesion, associated intracardiac procedures, and operative mortality (11.7% for the Hancock bioprosthesis group, 8.8% for the Björk-Shiley prosthesis group, and 9.2% for the Lillehei-Kaster prosthesis group). Cumulative duration of follow-up is 1140 patient-years (mean, 6.6 +/- 1.5 years, 100% complete) for Hancock bioprosthesis patients, 878 patient-years (mean, 5.9 +/- 0.4 years, 98% complete) for Björk-Shiley prosthesis patients, and 1184 patient-years (mean, 7.3 +/- 0.3 years, 97% complete) for Lillehei-Kaster prosthesis patients. Actuarial survival rates at 15 years are 30% +/- 15% for Hancock bioprosthesis, 49% +/- 6% for Björk-Shiley prosthesis, and 44% +/- 7% for Lillehei-Kaster prosthesis patients. There were eight embolic episodes in Hancock valve recipients (0.7% +/- 0.1%/pt-yr), nine in Björk-Shiley prosthesis recipients (1.0% +/- 0.3%/pt-yr), and nine (0.7% +/- 0.1%/pt-yr) in Lillehei-Kaster prosthesis recipients (p = no significant difference). Actuarial freedom from emboli at 15 years is 89% +/- 4% for Hancock, 92% +/- 3% for Björk-Shiley, and 93% +/- 2% for Lillehei-Kaster prosthesis recipients (p = no significant difference). A significant difference was found in the incidence of the following complications. (1) Anticoagulant-related hemorrhage: 0.1% +/- 0.1%/pt-yr for Hancock bioprosthesis, 1.3% +/- 0.3%/pt-yr for Björk-Shiley prosthesis, and 1.9% +/- 0.4%/pt-yr for Lillehei-Kaster prosthesis patients (p less than 0.001), with an actuarial freedom at 15 years of 97.6% +/- 1% for Hancock, 85% +/- 5% for Björk-Shiley, and 68.8% +/- 10% for Lillehei-Kaster recipients (p less than 0.001). (2) Structural deterioration: 3.7% +/- 0.6%/pt-yr for Hancock and none for Björk-Shiley and Lillehei-Kaster patients (p less than 0.001), with an actuarial freedom of 100% for Björk-Shiley prosthesis and Lillehei-Kaster prosthesis patients and 38.4% +/- 12% for Hancock bioprosthesis patients at 15 years.

Adolescent

Allergy to pollen grains from Amaranthaceae and Chenopodiaceae in Cordoba, Spain. Annual and daily variation of pollen concentration.

We have studied the annual and daily variation of pollen grains from Amaranthaceae and Chenopodiaceae for 3 consecutive years. Samples of pollen grains from both families, which make a stenopalynologic group, were collected by the volumetric method with the aid of a Burkard spore-trap. These pollen grains were found to occur in the atmosphere of the city of Córdoba virtually throughout the year, although their presence was continual only between April and October with maximum concentrations detected in the summer months. We have also studied the daily variation of pollen concentration, which peaked between 10 AM and 3 PM. In order to determine the incidence of pollinotic patients sensitive to pollen grains from Chenopodium, we reviewed 1000 clinical records available in the Allergy Unit and found 8.42% to be allergic. On evaluation of the time evolution of the symptoms we found that most patients continued to show them until September each year.

Air Pollution