[Prevalence and incidence of electrocardiographic abnormalities in healthy population older than 49]. / Prevalencia e incidencia de las alteraciones electrocardiográficas en población general sana mayor de 49 años.

PURPOSE: To determine the prevalence and incidence of electrocardiographic abnormalities (EKG-abn). MATERIAL AND METHODS: Design. 2 stage study: 1st: descriptive cross-sectional, 2nd: prospective cohort. LOCATION: 28 urban primary health centers in Barcelona city area. PARTICIPANTS: The study population was composed by patients who had participated in the population based ARTPER multicentric study. This study has two phases where each patient had one EKG, physical examination and blood test to obtain the secondary variables. The available EKG from both phases were reviewed, achieving a total of 2,727 patients with EKG. 601 (22%) individuals with CV disease were excluded. A total of 2.126 patients were studied of whom 392 (18%) had 2 EKG, one at each phase. Mean measurements. The association between the presence of EKG-abn and explanatory variables was performed using multivariate logistic regression, obtaining odds ratios (OR) and their 95% confidence intervals (95%CI). RESULTS: 58% women and average age 66years. 32% (95%CI: 30%-34%) (n=671) presented EKG-abn of whom 60% (n=402) were minor and 40% (n=269) major disorders. The most common EKG-abn were the conduction disturbances. EKG-abn were associated with males (OR: 1.7; 95%CI: 1.4-2.1) and patients older than 65 (OR: 1.6; 95%CI: 1.4-2.0). Among the 345 people without EKG-abn at baseline and with 2 available EKG, 71 showed an EKG-abn at the second EKG (incidence in 4.7years of 21% (95%CI: 16%-25%). CONCLUSION: EKG abnormalities are common in healthy general population. EKG-abn are more common in male and elderly patients.

[Underdiagnosis of peripheral arterial disease in the Spanish population. ARTPER study]. / Infradiagnóstico de la arteriopatía periférica en la población española. Estudio ARTPER.

BACKGROUND AND OBJECTIVES: Although peripheral arterial disease (PA) is an important clinical marker of cardiovascular morbimortality, the rate of under-diagnosis is unknown. Our aimed to know the proportion of patients underdiagnosed of PA and the associated factors. PATIENTS AND METHODS: 3786 patients >49 years old, randomly selected, were studied. PA was diagnosed by means of the ankle-brachial index (ABI<0, 9). Underdiagnosed was considered when ABI<0, 9 and when they were not diagnosed of PA in the clinical record. We also determined the presence of intermittent claudication (IC) defined by Edinburgh's questionnaire. RESULTS: 7,6% had an ABI <0, 9 (IC95% 6.7-8.4). Of these patients 80.7%, were underdiagnosed, although the 29.3% had IC. PA underdiagnosis was low in current smokers or former smokers (OR 0.20; IC95% 0.07-0.59), if IC (OR 0.40; IC95% 0.18-0.89), if ABI between <0.7 and 0.5 (OR 0.36; IC95% 0.16-0.81) or <0,5 (OR 0.04; IC95 % 0.01-0.20), being higher in >70 years (OR 3.12; IC95% 1.12-8.67). CONCLUSIONS: PA underdiagnosis is high, especially in old patients. It is necessary to reach consensus criteria for the practice of the ABI in the general population.

Molecular discrimination of Hyalomma tick species serving as reservoirs and vectors for Crimean-Congo hemorrhagic fever virus in sub-Saharan Africa.

The species identification of tick vectors of Crimean-Congo hemorrhagic fever virus (CCHFV), especially Hyalomma (H.) species, is a prerequisite to understand the eco-epidemiology of this disease and to reveal vector and virus reservoir species. However, the morphologic species discrimination can be difficult for damaged or blood-fed ticks and in case of species intercrosses. Therefore, we used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and restriction fragment length polymorphism (RFLP) analysis to distinguish the most common Hyalomma species from sub-Saharan Africa (H. truncatum, H. rufipes and H. dromedarii). Within the last years, MALDI-TOF MS analysis based on tick leg proteins has been shown to be a reliable method to distinguish several tick species. For this purpose, a reference spectral library of several European, American and African tick species was established. In this study, six different Hyalomma species were tested, all of which were all clearly distinguishable by mass spectrometric analyses. Moreover, MALDI TOF- MS was able to confirm morphologic findings where sequencing provided ambiguous results. In addition, a polymerase chain reaction (PCR) based on the CO1 gene amplification of ticks has been developed for the unequivocal species identification by amplicon sequencing and specific restriction endonuclease cleavage pattern analysis. RFLP proved to be a feasible auxiliary discrimination tool for selected Hyalomma species when access to sequencing methods is not available, as for instance during field studies.

Junctions between lens fiber cells are labeled with a monoclonal antibody shown to be specific for MP26.

A monoclonal antibody (mcAb) that recognizes an intracellular domain of the major lens membrane protein in both chicken and bovine lenses is described. Mice were immunized with chicken lens fiber cell membranes that had been washed with 7 M urea. Hybridomas were screened by means of enzyme-linked immunosorbent assays and the molecular specificities of the mcAbs were determined using electrophoretic transfer procedures, "Westerns." One of these mcAbs, an IgG designated B2, reacted with a single band of 28,000 Mr from the chicken embryo lens (MP28) and the analogous 26,000 Mr protein in the bovine lens (MP26). Monoclonal B2 was shown to be specific for these proteins, since (a) heating in SDS caused MP26 to aggregate and reduced B2 binding to the protein band at an Mr of 26,000 in Western transfer analysis; (b) apparent dimers were bound by B2 in Western transfers; (c) soluble protein fractions from the lens contained no detectable B2 antigens; and (d) a cyanogen bromide fragment of MP26 was bound by B2. Studies with several proteases indicated that the antigenic site for B2 resides on a 2-kd, protease-sensitive region at the C-terminal end of MP26 and MP28. Evidence for B2 binding on the cytoplasmic side of the membrane comes from labeling studies done at the ultrastructural level. These studies, utilizing indirect methods with peroxidase and colloidal gold markers, clearly demonstrated that B2 labels two types of junctional profiles. In our calf lens membrane preparations after tannic acid staining, the predominant type (80%) measured 16-18 nn thick, with the second type measuring only 12-14 nm. Chick embryo lens cells that had differentiated in vitro and formed groups of lens fiber-like cells (termed lentoids), fluoresced brightly only when they had been permeabilized before labeling with B2 and a fluorochrome-conjugated antibody. This binding was concentrated at the plasma membranes of cells within the lentoids, even outside areas of cell-cell contact. Surrounding epithelioid cells were not stained. Solubilized lens cultures, examined by Westerns, displayed a single immunoreactive band, which co-migrated with MP28.

Right bundle branch block: Prevalence, incidence, and cardiovascular morbidity and mortality in the general population.

Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.

[Recurrent parathyroid cyst: a clinical case]. / Quiste de paratiroides recurrente: A propósito de un caso.

The parathyroid cyst is a very infrequent entity, so much so that only round about 200 cases have been described up to now. It can be functional and non-functional. The studies of image don't clarify to us if procedence becomes of parathyroid or it has another origin, and the diagnosis is made with the analysis come from the liquid obtained in the puncture aspiration, where high PTH's concentrations are seen. Surgery is the treatment for functional cysts and the puncture aspiration for non- functional, the fact that they use to get solved with only one but sometimes is necessary to repeated it, even more than one time, keeping for the surgery when recurrent. We presented a clinical case of recurrent parathyroid cyst and his natural evolution, due to patient rejects surgery, being necessary repeated punctures. It hasn't become malignant after 10 years and his functional status wasn't changed, being necessary to accomplish repeated punctures aspirations each 2-3 months for local bothers.

Semi-automatic measuring of arteriovenous relation as a possible silent brain infarction risk index in hypertensive patients. / Medición semiautomática de la relación arteriovenosa retiniana como posible marcador de riesgo de infarto cerebral silente en pacientes hipertensos.

OBJECTIVE: To evaluate the usefulness of a semiautomatic measuring system of arteriovenous relation (RAV) from retinographic images of hypertensive patients in assessing their cardiovascular risk and silent brain ischemia (ICS) detection. METHODS: Semi-automatic measurement of arterial and venous width were performed with the aid of Imedos software and conventional fundus examination from the analysis of retinal images belonging to the 976 patients integrated in the cohort Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study (ISSYS), group of hypertensive patients. All patients have been subjected to a cranial magnetic resonance imaging (RMN) to assess the presence or absence of brain silent infarct. RESULTS: Retinal images of 768 patients were studied. Among the clinical findings observed, association with ICS was only detected in patients with microaneurysms (OR 2.50; 95% CI: 1.05-5.98) or altered RAV (<0.666) (OR: 4.22; 95% CI: 2.56-6.96). In multivariate logistic regression analysis adjusted by age and sex, only altered RAV continued demonstrating as a risk factor (OR: 3.70; 95% CI: 2.21-6.18). CONCLUSIONS: The results show that the semiautomatic analysis of the retinal vasculature from retinal images has the potential to be considered as an important vascular risk factor in hypertensive population.

Biological, microscopic and scanning electron microscopic investigations of the effects of postinor /d-norgestrel/ in rabbits.

The contraceptive effect of d-norgestrel given immediately after copulation in various quantities was investigated in rabbits. It was established that the effect is dose-dependent. A correlation was found between the amount of dose administered and the changes taking place on the surface of endometrium. It can be suggested that d-norgestrel alters the surface of the endometrium to such an extent that nidation is unable to take place; therefore, it can be used for postcoital contraception at any time.

An investigation on the influence of steroidal contraceptives on milk lipid and fatty acids in Hungary and Thailand. WHO Special Programme of Research, Development and Research Training in Human Reproduction. Task Force on oral contraceptives.

A double-blind clinical trial to examine the effects of oral and long-acting injectable contraceptive steroids on milk lipid and its fatty acid content has been done in Szeged, Hungary, and Khon-Kaen, Thailand. In Szeged, a combined and a progestin-only pill did not significantly alter total milk lipid. In Khon-Kaen, treatment with the combined pill was followed by a significant increase in the proportion of milk lipid. In the group treated with the long-acting injectable contraceptive, depot-medroxyprogesterone acetate (DMPA), the milk lipid decreased significantly in the first six weeks in comparison with the control group and the individual pretreatment values. A similar but weaker effect was noticed with the progestin-only pill in Khon-Kaen. Few consistently significant differences were found in the shorter chain fatty acids (myristic, lauric and palmitic acids) during treatment. The percentage proportions were increased during the combined pill treatment in Szeged and Khon-Kaen, and reduced in DMPA and progestin-only treatment in Khon-Kaen milks. The possibility that these reflected a response to a milk volume decrease in the combined pill treatment and a reduction in milk lipid synthesis in association with DMPA and the progestin-only pill is discussed. In Khon-Kaen, linoleic acid (which is not synthesized in the body) was increased by comparison with the controls, as a percentage proportion of the fatty acids in the progestin-only and DMPA groups. Calculation of the amounts of linoleic acid per litre of milk revealed that there had been a significant decrease of linoleic, eicosadienoic, dihommo-gamma-linolenic, arachidonic, docosatetraenoic acids in the w6 family and alpha-linolenic acid in the w3 family in the first two post-treatment visits (3 and 4). This reduction in essential fatty acid output follows the reduction in milk volume. In Khon-Kaen, the combined pill group showed a significant decrease compared with the controls, in the proportions of dihommo-gamma-linolenic acid. The difference in response of the mothers in Khon-Kaen and Szeged is discussed in relation to their different nutritional backgrounds.

Termination of very early pregnancy by RU 486--an antiprogestational compound.

RU 486, a new antiprogestational compound, was given to 37 women seeking termination of pregnancy and with amenorrhea of 42 days or less. One patient was found at the second follow-up visit to have an extrauterine pregnancy. The patients received either 25 mg, 50 mg or 100 mg RU 486 twice daily for four days. All patients attended three follow-up visits, one, two and five to six weeks after the start of therapy. The start, duration and amount of bleeding as well as plasma progesterone, beta-hCG and cortisol concentrations were determined for each treatment day and at the follow-up visits. All patients but three started to bleed during treatment. Frequency of complete abortion was 61% (22 out of 36 patients). In only three patients was the pregnancy unaffected by treatment. The clinical efficacy of the treatment was not dose-dependent. Most of the patients experienced only minor side effects in terms of mild uterine pain, nausea and vomiting. However, two patients suffered from heavy bleeding requiring blood transfusion and curettage. In the patients with complete abortion, beta-hCG values decreased significantly but not until the first follow-up visit. The plasma progesterone also decreased. The decrease appeared earlier with the higher daily dose of RU 486. Cortisol concentrations increased during treatment with all 3 dosage regimens but the levels remained within the normal range. It is concluded that treatment with RU 486 may provide a novel therapy for "menstrual regulation" but the efficacy of the treatment needs to be improved to compete with alternatives such as vacuum aspiration.

PIP: RU 486, a new antiprogestational compound, was given to 37 women seeking termination of pregnancy and with amenorrhea of 42 days or less. 1 patient was found at the 2nd follow-up visit to have an extrauterine pregnancy. The patients received either 25 mg, 50 mg, or 100 mg RU 486 twice daily for 4 days. All patients attended 3 follow-up visits, 1, 2, and 5-6 weeks after the start of therapy. The start, duration, and amount of bleeding as well as plasma progesterone, beta-human chorionic gonadotropin (hCG) and cortisol concentrations were determined for each treatment day and at follow-up visits. All but 3 patients started to bleed during treatment. Frequency of complete abortion was 61% (22 of 36 patients). In only 3 patients was the pregnancy unaffected by treatment. The clinical efficacy of the treatment was not dose-dependent. Most of the patients experienced only minor dise effects in terms of mild uterine pain, nausea, and vomiting. However, 2 patients suffered from heavy bleeding requiring blood transfusion and curettage. In patients with complete abortion, beta-hCG values decreased significantly but not until the 1ft follow-up visit. The plasma progesterone also decreased. This decrease appeared earlier with the higher daily dose of RU 486. Cortisol concentrations increased during treatment with all 3 dosage regimens but the levels remained within the normal range. It is concluded the treatment with RU 486 may provide a novel therapy for menstrual regulation but the efficacy of it needs to be improved to compete with such alternatives as vacuum aspiration.

Effects of hormonal contraceptives on milk volume and infant growth. WHO Special Programme of Research, Development and Research Training in Human Reproduction Task force on oral contraceptives.

WHO conducted a three-centre study in Hungary and Thailand to evaluate the effects of hormonal contraception on lactation and infant growth. Women choosing oral contraceptives were randomly assigned to a combined oral contraceptive containing 30 micrograms ethinyl estradiol and 150 micrograms levonorgestrel (N = 86) or a progestin-only preparation containing 75 micrograms dl-norgestrel (N = 85). Identical packaging and treatment schedules allowed double-blind observation. One-hundred-and-eleven women using no contraception or non-hormonal methods acted as controls. In the two Thai centres 59 women using depot-medroxyprogesterone acetate formed an additional comparison group. All subjects were healthy women with normal deliveries, whose infants had normal birth weights and satisfactory growth in the neonatal period. Breast milk volume was determined by pump expression using standardized procedures. Information was obtained on nursing frequency and supplementation, infant growth and morbidity. Pretreatment observations at 6 weeks post-partum were used as a baseline, and subjects were followed-up at 9, 12, 16, 20 and 24 weeks post-partum. Women using combined oral contraceptives had a decline in milk volume within 6 weeks of initiating treatment, whereas no significant decrease was observed in the other treatment groups. After 18 weeks of treatment, combined oral contraceptive users experienced a 41.9% decline in milk volume, compared to 12.0% with progestin-only minipills and 6.1% in the non-hormonal controls. The prevalence of complementary feeding and withdrawals due to inadequate milk supply were comparable in the four treatment groups. However, data were not available on the daily amounts of complementary feeds. There were no significant differences in growth of infants between treatment groups. Thus, women may have compensated for declines in milk volume by more supplementary feeding or by more prolonged and intense suckling episodes. We conclude that 30 micrograms estrogen-containing combined oral contraceptives impair milk secretion, but in the selected healthy group of mothers and children studied with the prevailing level of supplementary feeding, this did not adversely affect infant growth.

Lens junctional protein: analyzing MP26 with monoclonal antibodies.

Specific antibodies are versatile tools for analyzing cell surface proteins. This study involves the characterization of monoclonal antibodies which are specific for the junctional protein found in the lens fiber cell. This protein can be expected to include regions on the external membrane surface for junction formation, others on the cytoplasmic surface for regulation of junctional properties and, if cell-cell channels are indeed involved, transmembrane domains forming the hydrophilic connection between adjacent cytoplasms. Antibodies to these various regions would provide for an experimental analysis of the junctional protein, e.g., the identification of "active sites" for junction formation. Three monoclonal antibodies specific for the lens junctional protein in the chicken are described here. The first, termed B2, also recognizes the bovine junctional protein, MP26 (5). We have characterized the submolecular specificity of B2 and have found that it binds approximately ten amino acid residues from the C-terminus of MP26. In isolated lens junction preparations, B2 binds to the cytoplasmic surfaces of the lens junctions (both 12 nm and 16 nm thick forms). Thus, we consider MP26 a component of the lens junction. Monoclonal A4, the second antibody considered in detail here, was produced by immunization with lens membranes after treatment with low pH. We have found that lens junctional membranes are separated, or "split," by treatment at pH 2.5-3.0. It appears that A4 binds to the external surface of the junctional membrane; EM studies to confirm this are in progress. In order to map the A4 binding site within the chicken junctional protein and to explore the arrangement of this protein within the membrane, a number of procedures were used to generate fragments of MP26. These included reactions with N-chlorosuccinimide and proteases after acid treatment. Antibody binding to fragments was evaluated with immunotransfer ("Western") procedures. These studies mapped the A4 binding site to the center of the molecule and suggested that MP26 projected externally from the membrane at two different points. These results are consistent with a recent model, based on sequence data (6), for the arrangement of MP26 within the bovine lens membrane.

Relaxin in human decidua and term placenta.

Using both a homologous porcine RIA and 3 bioassays, we investigated the relaxin content of human decidua from first trimester and term gestations and of placentas at term. Aqueous extracts of these tissues yielded only between 211 and 1090 pg immunoreactive relaxin/g fresh tissue. Neither acetonehexane extraction, octadecylsilica cartridge elution nor molecular sieve chromatography increased these relaxin levels. Compared with term decidua, first trimester decidua contained significantly higher levels of immunoreactive relaxin. In vitro studies did not evidence significant relaxin production by either decidual or placental tissues, even in the presence of decidual prolactin production. These results are in direct contrast to earlier reports of high concentrations of relaxin in decidua and placenta.

[Study of the dissolution rate of ethinyl estradiol from tablets by radioimmunoassay (author's transl)]. / Untersuchung der Auflösungsgeschwindigkeit von Ethinylestradiol aus Tabletten durch Radioimmunoassay.

The authors investigated the dissolution rate of ethinyl estradiol, a constituent of Biscurin tablets, by radioimmunoassay. 60% of this compound dissolved in artificial intestinal juice within 2 min.

Citric acid contents in the ejaculate, significance of its determination in andrological diagnostics.

Critic acid was determined in the ejaculate in 100 cases. No significant correlations between citric acid values and other parameters of the spermiogram were found. In accordance with literary data we found low citric acid values in prostatitis and hypogonadism.

Gonadotrophin treatment of pathospermic patients.

The effectiveness of gonadotrophin treatment was studied in pathospermic patients. In the treatment of 10, 478 and 184 infertile men, Anthrogon, Choriogonin and Pergonal + HCG, respectively, were applied. Improvement of the spermiogram is anticipated especially when the pre-treatment plasma FSH level is low or normal. No success could be expected in hypergonadotrophic cases. Gonadotrophin treatment is not effective when infertility is due to genetic, mechanical, vascular or infectious diseases.

Significance of transaminase determination in seminal fluid.

GOT activity of the seminal fluid plasma was examined in 161 cases. High values were found in cases with astheno- and necrospermia, and in those with an increased spermatozoon count, low values were found in cases with oligospermia. The authors consider GOT determination in seminal fulid plasma a useful supplemental test in the diagnosis of male sterility.

Monitoring of artificial insemination.

Artificial insemination (ADI) has been carried out with donor semen since 1984. Following artificial insemination 14 women out of 27 became pregnant in 1984, 30 women out of 57 in 1985 and 33 women out of 56 until October 1, 1986. The cycles were monitored. Serum LH and oestradiol levels were determined every day from the 10th day of the cycle. Follicle size was monitored daily and cervical mucus was also examined every day. LH reaches the highest level at the time of ovulation. 17-Beta-oestradiol level increases parallel with the growth of follicle. Follicular growth can be best monitored by ultrasound folliculometry, providing 50-60% effectiveness.

Parlodel treatment of patients with pathospermia.

The response to bromoergocryptine (Parlodel, Sandoz) was examined in 42 pathospermic patients. The authors conclude that Parlodel did not influence the spermiogram considerably. Serum prolactin levels were lowered significantly, while the FSH, LH, testosterone, 17-alpha-hydroxyprogesterone and 17-beta-oestradiol concentrations did not change. Improvement was reported in potentia coeundi in one third of the patients.

Mesterolone treatment of patients with pathospermia.

The response to Mesterolone, in doses of 25 mg/day, was examined in 42 pathospermic patients. Treatment lasted for 100 days. The pronounced response to the Mesterolone treatment was observed in hypozoo- and oligozoospermia with low initial fructose content in the ejaculate. Fructose content attained its normal range after the treatment. During the therapeutic period 11 wives became pregnant. The authors conclude that Mesterolone does not influence plasma FSH, LH and testosterone levels, it has only peripheral effects.