[Transcatheter embolization device as a promising option in the treatment of pulmonary sequestration. Case reports]. / Embolización transcatéter con dispositivo, una promisoria opción en el tratamiento del secuestro pulmonary. Casos clínicos.

INTRODUCTION: Pulmonary sequestration (PS) has been treated for many years with conventional surgical removal of the ectopic lung tissue and ligation of aberrant vessels that arise from the aorta. There is evidence, especially in English-language literature that supports the use of transcatheter arterial embolization through a device for occlusion of the anomalous vessel, as a safe option and definitive treatment for intralobar PS. OBJECTIVE: To show our experience pioneering the technique of PS treatment through transcatheter embolization. CASE REPORT: The case reports of two teenagers aged 13 and 14 and a 26-day-old newborn that developed intralobar PS are described. The diagnosis was made through computerized axial tomography (CT scan) and successfully and without complication, during early and long term follow-up, treated by arterial embolization transcatheter. CONCLUSION: The use of transcatheter arterial embolization is a less invasive and definitive treatment for patients with PS.

Interferons and bacterial lipopolysaccharide protect macrophages from productive infection by human immunodeficiency virus in vitro.

To determine the effects of immunomodulatory agents upon HIV replication in macrophages, cultured monocyte-derived macrophages were treated with various substances and then infected with a macrophage-tropic strain of HIV-1. Pretreatment with rIFN-alpha, IFN-beta, and IFN-gamma, or bacterial LPS prevented viral replication in macrophages. In treated cultures, little or no infectious HIV or p24 core antigen was released into the supernatant, no virions were seen by electron microscopy, no viral RNA or DNA was detectable in the cell lysates, and no cytopathology (as determined by multinucleated giant cell formation) occurred. In contrast, pretreatment with a wide dose range of recombinant IL-1 beta, IL-2, IL-4, IL-6, M-CSF, TNF, or lymphotoxin failed to protect macrophages from productive infection by HIV. A consistent effect of granulocyte/macrophage-CSF on HIV replication in macrophages was not observed. In dose response studies, pretreatment with approximately 100 U/ml of IFN-alpha, approximately 10 U/ml of IFN-beta, or approximately 100 U/ml of IFN-gamma was sufficient to prevent virion release maximally and to prevent cytopathology completely. In kinetic studies, IFN-alpha, IFN-gamma, or LPS were added to the macrophage cultures either before or after infection with HIV. Even when added 3 d after infection with a multiplicity of 1 50% tissue-culture infectious dose per cell, all three treatments markedly reduced virion release, suggesting that these agents act at a point in the viral life cycle beyond the early events of virus binding, penetration, and uncoating. These data indicate that HIV replication in previously uninfected macrophages may be regulated by an inducible host cell mechanism. These findings may explain the restricted replication of HIV in macrophages in vivo and suggest an antiviral role for interferons in the therapy of HIV infection.

Isolation of RNA virus from papillary tumors of the human renal pelvis.

Virus particles were detected by electron microscopy in three papillary cancers of the human renal pelvis. Similar particles were seen in cells from all three tumors in primary culture. An RNA virus was isolated from these tumors. The serum of tumor patients contains neutralizing antibodies against virus isolated from two of the tumors. Initial studies suggest that this agent is not a known human RNA virus.

Immunogenicity of chemically induced murine colon cancers.

The antigenicity and immunogenicity of three colorectal carcinomas induced in BALB/c mice by 1,2-dimethylhydrazine or N-methyl-N-nitrosourethan were studied. All tumors were readily transplantable. Two of these tumors metastasized when transplants reached sufficient size. All tumors were found to be immunogenic in the strain of origin, and all tumors were shown to contain unique tumor-specific transplantation antigens in cross-protection experiments. The use of these tumors as an animal model for studies of adjuvant immunotherapy and chemoimmunotherapy is suggested.

Tenidap: a novel inhibitor of calcium influx in a mast cell line.

The anti-inflammatory agent tenidap has previously been shown to inhibit antigen-induced secretion in tumor mast cells. We have investigated the possibility that this effect is due to modulation of the Ca2+ response in mast cells and in particular that tenidap might be an inhibitor of the Ca2+ influx pathway or channel in these and other non-excitable cells. Tenidap inhibited the antigen-induced increase in intracellular Ca2+ measured both in cell suspensions and at the single cell level using digital imaging of Fura-2 fluorescence. Tenidap also inhibited both antigen- and thapsigargin-induced 45Ca influx across the plasma membrane at concentrations similar to those required for the inhibition of secretion. Somewhat unexpectedly, the compound itself caused some release of calcium from intracellular stores; however, this effect did not appear to be related to the inhibition of calcium influx or secretion. In mouse pituitary tumour (AtT-20) cells, tenidap inhibited depolarization-induced increases in intracellular Ca2+ suggesting that this compound also inhibits Ca2+ influx through voltage-sensitive calcium channels. We conclude that tenidap has a number of interesting effects on calcium handling which makes it a potentially valuable tool for the study of calcium movements particularly in non-excitable cells.

An enzyme immunofiltration assay useful for detecting human monoclonal antibody.

A microenzyme-linked immunoassay (EIA) utilizing an immunofiltration manifold has been developed which provides a rapid, simple, and sensitive method of detecting human monoclonal antibody class, concentration, and specificity. In this assay either whole cells or soluble antigens were immobilized on glass fiber filters followed by incubating with the test human hybridoma supernatant with subsequent analysis by EIA. A specially designed 96-chamber immunofiltration plate is employed which serves as both an incubation chamber and as a filtration manifold. The assay described is unique in that small volumes of human hybridoma supernatant are required, crude preparation of only a few target cells are needed, labile cell surface antigens are preserved and it can be completed in 3 h. This assay is well suited for the rapid screening of large numbers of human hybridoma supernatants.

Development of a rapid microELISA assay for screening hybridoma supernatants for murine monoclonal antibodies.

A micro enzyme-linked immunosorbent assay (ELISA) utilizing a filtration method has been developed which allows the rapid, simple, and sensitive detection of monoclonal antibodies that recognize either soluble or cell surface antigens. This assay involves the immobilization of target cells (or soluble antigen) onto glass fiber filter discs followed by an incubation with the test hybridoma supernatant and subsequent analysis by ELISA. A specially designed 96-well filtration device is employed which serves both as an incubation chamber and as a filtration manifold. This microELISA requires small volumes of antiserum, few target cells, and can be completed in less than 2 h. This assay is well suited for the rapid screening of murine hybridoma supernatants and can be adapted to detect monoclonal antibodies from other species.

Immobilization of viral antigens on filter paper for a [125I]staphylococcal protein A immunoassay: a rapid and sensitive technique for detection of herpes simplex virus antigens and antiviral antibodies.

A new technique is described for the rapid detection and quantitation of herpes simplex virus (HSV) antigens and antiviral antibodies. It involves immobilization of HSV antigens on filter paper discs and subsequent analysis by 125I-labeled staphylococcal protein A (SPA) radioimmunoassay. A specially designed 96-well filtration device is employed which serves both as an incubation chamber and as a filtration manifold. It is rapid, simple, sensitive and specific, and requires only small volumes of antiserum and few target cells. The results may be readily and objectively quantitated. This technique permits the simultaneous assay of a large number of specimens in less than 1 h. Its sensitivity is considerably greater than that of other currently used immunologic techniques, and it is amenable to automation. These characteristics suggest that this [125I]SPA immunofiltration technique may be applicable to the rapid diagnosis of viral infections.

Fibronectin production by cultured human trabecular meshwork cells.

Postmortem explants of human trabecular meshwork from 23 eyebank eyes had a growth rate of 32% (71/160) cultures, with 8% (12) showing abundant cellular spread. One hundred percent confluency was achieved with eyes from donors of 11 to 40 years of age. One of the cultures grew profusely and we were able to study it through eight passages in culture. This culture had the morphologic characteristics described by Polansky et al. for cultured human trabecular meshwork cells. A sensitive radioimmunoassay for fibronectin in tissue culture supernatant showed an increase in fibronectin secretion over a 96 hr period, with a characteristic shift-down response occurring between 24 and 48 hr postmedia change. Three of four cultures showed the presence of laminin, a basement membrane protein, establishing that the cells are not fibroblasts.

Fibronectin in human trabecular drainage channels.

Fibronectin, an extracellular glycoprotein, has been shown to be produced by human trabecular cells in culture by our group as well as Polansky and co-investigators. Studies of Rodrigues et al suggested that fibronectin may be one of several glycoproteins found in increased amounts in the corneoscleral trabecular meshwork of glaucomatous eyes. The authors have developed a sensitive immunoassay utilizing avidin-biotinylated enzyme complex (ABC) to detect low levels of fibronectin in frozen sections of human eyes. The authors have used this immunoassay together with a perfusion technique to demonstrate distribution patterns of fibronectin present in human aqueous drainage channels. The authors found that fibronectin is present in larger quantities in the aqueous drainage channels than in the surrounding tissues in 18 eyes from older patients.

Selective binding affinity of human plasma fibronectin for the collagens I-IV.

The binding of plasma fibronectin to the collagens I, II, and III was greater in a cohort of glaucoma patients. In contrast, binding of plasma fibronectin to collagen type IV was less in 39 glaucoma patients than in any of 3 other diagnostic categories, including 92 patients that were normal, cataract, and glaucoma suspect patients. This observation may have significance in further understanding the control of aqueous outflow resistance in glaucoma and nonglaucoma patients.

Immunoenzymatic staining of viral and chlamydial antigens in cell culture.

Methods are described for the conjugation of antibodies with biotin and for the use of these reagents in an immunoperoxidase staining procedure for infected cell cultures. This technique provides a simple, rapid, and specific approach to the identification and characterization of a number of viral and chlamydial isolates in the diagnostic laboratory.

Rural training tracks in four family practice residencies.

The use of rural training tracks (RTTs) in family practice residencies is a new strategy (beginning in the late 1980s) to increase the number of residents selecting rural careers. The authors describe the four residencies (in Washington, Nebraska, New York, and Kentucky) that have established RTTs. The first residency year is completed in an urban tertiary care center, and the second and third years are completed in a distant rural community wherein the primary faculty are the members of a rural family practice group. Inpatient experience for the residents is provided by community hospitals that offer obstetrics, emergency room care, and first-line critical care. The residents' training is supplemented by specialty faculty practicing in the rural communities. The curricula are highly structured and are evaluated to ensure training experiences of high quality. The RTTs' financial support comes from state initiatives, hospital reimbursement, recruitment budgets, and outpatient care revenues. The authors conclude that the RTT concept has the potential to lessen the shortage of rural physicians.

Humoral and cell-mediated immunity in peripheral blood following introduction of antigen into the middle ear.

Serum levels of specific IgG and the sensitization of peripheral blood T-lymphocytes were measured in guinea pigs after single-dose antigenic sensitization by two routes: intratympanic and intradermal injection. Keyhole limpet hemocyanin (KLH) served as the antigen. Intratympanic injection of antigen resulted in much lower levels of circulating anti-KLH IgG than intradermal injection. When KLH was conjugated with alum to produce nonspecific inflammation and serve as adjuvant, the intratympanic route was considerably enhanced, but remained much less effective than the intradermal route. Development of an IgG response was also somewhat less rapid following intratympanic than following intradermal administration. Marked sensitization of circulating T-lymphocytes was seen after intradermal injection of alum-precipitated KLH. A much weaker, though still positive, response was seen after intradermal injection of KLH alone and with the intratympanic injection of alum-precipitated KLH. No T-lymphocyte sensitization could be detected after intratympanic injection of KLH alone. It was concluded that the afferent limb of both humoral (IgG) and cell-mediated immunity was operative in the middle ear. Therefore, the middle ear does not represent an immunologically "privileged" site. On the other hand, the afferent limb from the middle ear appears to operate less effectively and rapidly than that from the dermis. This observation is consistent with observations in other mucosal systems.

Effective use of the learning laboratory.

We continue to utilize the learning laboratory as described. The learning labs are valuable in meeting the learning needs of students; they feel more secure when performing skills in the clinical area. We encourage other faculty to use their learning laboratory facility to its potential. Put the learning laboratory to work for you. It has been--and is--one of our greatest assets.

Content of the model teaching unit ambulatory care training and continuity of care in six family practice residency programs.

This article summarizes the practice content and continuity for 35 senior residents in six family medicine residency model teaching units utilizing a computerized information management system. Comparisons are drawn with the content of family practices in the National Ambulatory Medical Care Survey (NAMCS), showing that family medicine third-year residents provide a large proportion of pregnancy care and general medical examinations and treat a smaller number of chronic illness patients compared with family physicians in practice. Third-year residents performed few surgical procedures in the model teaching units. Continuity of care, though espoused by family medicine residencies in principle, was deficient in the model teaching units studied. Intensive training to compensate for these deficiencies is recommended.

Dislipidemia en niños y adolescentes con historia familiar de enfermedad cardiovascular precoz / Dyslipidemia in children and adolescents with a family history of early cardiovascular disease

INTRODUCTION: In Chile, cardiovascular diseases (CVD) represent the first cause of mortality. The risk of CVD is greater if other factors are associated, among which the family history of CVD acquires special relevance due it represents an independent risk factor of atherogenesis. Aim: To evaluate cardiovascular risk markers: lipid profile, hsCRP and nutritional status in children and adolescents with positive family history of early cardiovascular disease. SUBJECTS AND MATERIALS: Descriptive-transversal study. 138 children and adolescents with a mean age of 13,1 +/- 5,4 years were studied. Anthropometric measurements, blood pressure, lipid profile and hsCRP were evaluated. RESULTS: Dyslipidemia was found in 55,1 percent of the studied population, that was mainly characterized by hypertryglyceridemia and decreased levels of HDL-chol (39,1 percent). In the total of dyslipidemic subjects, 10,5 percent showed 3 altered lipid parameters (total chol, tryglicerides and HDL-chol), 22,4 percent presented 2 parameters that were out the reference range (tryglicerides and HDL-chol) and the 34,2 percent had only one lipid parameter altered (low levels of HDL-chol or hypertriglyceridemia). Dyslipidemia was observed in 69,1 percent, of the overweight and obese population and it was 40,6 percent in the normal weight subjects. hsCRP concentrations were higher in dyslipidemic and overweight and obese individuals. CONCLUSIONS: Dyslipidemia was highly frequent in children and adolescents with positive family history of early CVD and even higher in those overweight and obese subjects. These findings support the screening of dyslipidemia in children and adolescents with positive family history of early CVD.