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Dextran is widely used in order to prevent intraperitoneal adhesions during pelvic surgery. Of 25 women who underwent laparotomy and in whom dextran was instilled intraperitoneally, almost half developed pleural effusions. These were generally mild and required no treatment. None of a control group of 20 women developed a pleural effusion. The mechanism of this type of effusion is discussed.
A new two-dimensional heteronuclear multiple-quantum magic-angle spinning (MQ MAS) experiment is presented which combines high resolution for the half-integer quadrupolar nucleus with information about the dipolar coupling between the quadrupolar nucleus and a spin I=1/2 nucleus. Homonuclear MQ coherence is initially created for the half-integer quadrupolar nucleus by a single pulse as in a standard MQ MAS experiment. REDOR recoupling of the heteronuclear dipolar coupling then allows the creation of a heteronuclear multiple-quantum coherence comprising multiple- and single-quantum coherence of the quadrupolar and spin I=1/2 nucleus, respectively, which evolves during t1. Provided that the t1 increment is not rotor synchronized, rotor-encoded spinning-sideband patterns are observed in the indirect dimension. Simulated spectra for an isolated IS spin pair show that these patterns depend on the recoupling time, the magnitude of the dipolar coupling, the quadrupolar parameters, as well as the relative orientation of the quadrupolar and dipolar principal axes systems. Spectra are presented for Na2HPO4, with the heteronuclear 23Na-1HMQ MAS experiments beginning with the excitation of 23Na (spin I=3/2) three-quantum coherence. Coherence counting experiments demonstrate that four- and two-quantum coherences evolve during t1. The heteronuclear spinning-sideband patterns observed for the three-spin H-Na-H system associated with the Na(2) site are analyzed. For an IS2 system, simulated spectra show that, considering the free parameters, the spinning-sideband patterns are particularly sensitive to only, first, the angle between the two IS internuclear vectors and, second, the two heteronuclear dipolar couplings. It is demonstrated that the proton localization around the Na(2) site according to the literature crystal structure of Na2HPO4 is erroneous. Instead, the experimental data is consistent with two alternative different structural arrangements, whereby either there is a deviation of 10 degrees from linearity for the case of two identical Na-H distances, or there is a linear arrangement, but the two Na-H distances are different. Furthermore, the question of the origin of spinning-sidebands in the (homonuclear) MQ MAS experiment is revisited. It is shown that the asymmetric experimental MQ sideband pattern observed for the low-C(Q) Na(2) site in Na(2)HPO4 can only be explained by considering the 23Na chemical shift anisotropy.
BACKGROUND: The prevalence of hypertrophic pachymeningitis (HP) remains poorly defined worldwide. In Japan, the estimated prevalence is 0.949 cases per 100,000 inhabitants, with most cases related to ANCA-associated vasculitis or IgG4-related disease. In contrast, epidemiological data from other regions, including Latin America, are scarce. METHODS: This study was conducted at a tertiary referral center in the city of São Paulo, Brazil. The prevalence of HP was estimated by comparison with the known prevalence of multiple sclerosis (MS), based on the number of patients with each condition followed at our institution. The etiological distribution of HP was also analyzed. In addition, HP prevalence was compared with that of tuberculous meningoencephalitis, a compulsory notifiable disease and a well-established cause of chronic meningitis in Brazil, using data from the national surveillance system (SINAN). RESULTS: We identified 55 patients with HP: 36 (65%) idiopathic, 10 (18%) IgG4-related disease, 4 (7%) ANCA-associated pachymeningitis, 4 (7%) probable or definite neurosarcoidosis, and 1 (2%) secondary to rheumatoid arthritis. Among 968 registered MS patients and assuming an MS prevalence of 15 per 100,000 inhabitants in São Paulo, the estimated HP prevalence was 0.85 per 100,000 inhabitants. This estimate was comparable to the prevalence of tuberculous meningoencephalitis in the same region. CONCLUSION: The estimated prevalence of HP in São Paulo (0.85 per 100,000) is consistent with reports from other regions and is comparable to that of tuberculous meningeal disease, although with a distinct etiological profile. IgG4-related disease was the most frequent systemic association, differing from previous reports. ANCA-associated HP appears to be less frequent than in other geographic regions, possibly reflecting differences in disease phenotype. Key Points • The estimated prevalence of HP in São Paulo was 0.85 per 100,000 inhabitants. • IgG4-related disease was the most common systemic disease identified among patients with HP. • ANCA-associated HP was less common than reported in Asian and European cohorts. • The prevalence of HP was comparable to that of tuberculous meningoencephalitis in São Paulo.
INTRODUCTION: The coronary sinus (CS) can provide access to targets across and within the atrioventricular (AV) junction. METHODS: In 12 dogs (32 +/- 3 Kg), cryo balloons (10-19 mm) were applied to regions of the AV junction for 3 minutes at a temperature of -75.9( composite function) +/- 9(composite function)C (ranging -57 to -83). Electrical activity and pacing within the CS were assessed pre and post ablation and at least 3 months later in 9 dogs. In the 3 other dogs, hearts were examined immediately after cryo ablation. CS and circumflex angiography was performed pre and post ablation. The hearts, CS, and Cx were then examined for structural injury. The AV junction was sectioned and the hearts were immersed in Tetrazolium, and the lesions were inspected for transmurality across the AV groove. RESULTS: In 3/12 dogs the distal CS cryo lesions resulted in inferior ST segment depression that resolved within 5 minutes. There was no arrhythmia or hemodynamic changes. No CS electrical activity was noted post ablation. The pacing threshold increased from 2 +/- 2.3 mA to 7.4 +/- 3.6 mA (p < 0.001). Pathological examination of 3 acute hearts revealed hematomas. There was no pericardial effusion. No evidence of stenosis or thrombosis was seen within the CS and the circumflex artery. After 3 months of recovery, transmural lesions across the AV groove were present in all of the targeted AV regions. CONCLUSION: Intra-CS cryo balloon ablation is safe and can potentially replace endocardial RF ablation targeting the AV junction and the CS muscular sleeve.
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The generally accepted indications for removal of an intra-abdominal intrauterine device (IUD) are: a) a closed variety of IUD, b) medicated IUDs with copper or hormone release, and c) a medico-legal or psychological problem. A perforated IUD can be left in the peritoneal cavity if it is made of non-irritating plastic. The copper IUD causes adhesions, but these lead to few cases of serious complications. The reason for removal of the IUD stems only from the fear of adhesion formation. Our experience, supported by the literature, leads us to believe that this indication should no longer be accepted.
The management of preterm rupture of membranes (ROM) is controversial. Some advise immediate delivery and others advocate conservative approach in the hope of decreasing morbidity and mortality rates associated with prematurity. A retrospective review of 75 pregnancies with preterm ROM treated conservatively was performed to delineate the relative risk factors. All patients with preterm ROM were placed at bed rest until either labor or chorioamnionitis prompted delivery. Chorioamnionitis developed in 25% of the cases. The percentage of women developing chorioamnionitis increased with duration of ROM. Fetal morbidity and mortality was not increased in the group with chorioamnionitis. Hyaline membrane disease (HMD) and intra ventricular hemorrhage (IVH) were the major causes of neonatal death in the entire group of preterm ROM. There was a significant relationship between neonatal mortality and birth weight. The smaller the birth weight, the greater the risk of neonatal death. Our data support the conservative approach to preterm ROM especially in the very low birth weight group where extreme caution must be taken before a decision is made to terminate pregnancy.
Fifty three women with PROM between 26 and 34 weeks of gestation were examined. Twenty five women (group A) underwent one digital examination for cervical assessment while in 28 women (group B) the cervix was evaluated by speculum. No pelvic examinations were performed throughout the latent period. The latent period increased from 3.1 days in group A to 9.5 days in group B (P less than 0.005). Chorioamnionitis developed in 24% in group A and in 18% in group B (N.S.).
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The Ames test has been used to detect the mutagenic activity of organic extracts from Santiago (Chile) airborne particles collected in 1990 and 1991 in one of the monitoring net system stations (MACAM). The samples were assayed with the strains TA98, TA98-NR, and TA98/1,8-DNP6 of Salmonella typhimurium, in the presence and in the absence of liver S9 fraction obtained from rats treated with Aroclor 1254. With the strain TA98 all the samples showed a very high mutagenic response either in the presence or in the absence of S9 fraction, suggesting that Santiago airborne particles contain both indirect-acting (polycyclic aromatic hydrocarbons) and direct-acting mutagenic agents. The mutagenicity of Santiago airborne particles was much higher than that reported in studies performed in other countries. Results obtained with the strains TA98-NR and TA98/1,8-DNP6 suggest that the extracts also contain mononitro and dinitroarenes. These nitroarenes have been described as very potent mutagenic agents, that can be generated by photochemical reactions under certain atmospheric conditions, or in the combustion of fuel, especially of diesel motors. The presence of polycyclic aromatic hydrocarbons and nitroarenes in Santiago airborne particles, as well as the high levels of mutagenicity detected, suggest that the inhabitants permanent exposure to these kinds of compounds represents a high risk for human health.
BACKGROUND: The relationship and behavior of serum immunoglobulin E (IgE) level, peripheral blood mononuclear cell (PBMC) human leukocyte antigen DR (HLA-DR) expression and erythrocyte glutathione antioxidant pathway in asthma patients treated with systemic ozone therapy have not been studied before. METHODS: Asthma patients were treated about 1 year with three cycles (5 or 6 months each) with three different ozone therapy protocols. Ozone major autohemotherapy (MAHT) was applied at doses of 4 and 8 mg, 15 sessions each cycle; and ozone rectal insufflations (RI) at a dose of 10 mg, 20 sessions each cycle. Serum IgE, HLA-DR expression in PBMC and biomarkers for antioxidant pathway were measured before and at the end of each cycle. Lung function and symptoms test were recorded at the beginning and after the third cycle. RESULTS: IgE and HLA-DR decreased with the three types of treatments, while increments in reduced glutathione, glutathione peroxidase, glutation reductase and glutathione S-transferase were achieved with all treatments. Lung function and symptoms test were markedly improved. However, in all parameters the best response was obtained in the order: MAHT at 8 mg better than MAHT at 4 mg better than RI at 10 mg. Before ozone treatment, glutathione antioxidant parameters were under the normal reference values, suggesting the occurrence of oxidative stress associated with atopic asthma. CONCLUSIONS: This study demonstrates the effectiveness of ozone therapy in reducing IgE and inflammatory mediators along with the induction of antioxidant elements. The study raises the role of systemic ozone therapy in atopic asthma by means of its immunomodulatory and oxidative stress regulation properties.
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