Dyspnea and pulmonary function in the L-tryptophan-associated eosinophilia-myalgia syndrome.

We reviewed the pulmonary history, dyspnea ratings, and pulmonary function test results in 16 patients with L-tryptophan-induced eosinophilia myalgia syndrome to determine the correlation between reported pulmonary complaints and pulmonary function abnormalities. All patients reported pulmonary symptoms. Dyspnea, seen in 14 of 16 (87 percent) patients, was the most common symptom. The severity of dyspnea was graded by the baseline dyspnea index and the oxygen cost diagram. Pulmonary function testing including maximal static inspiratory and expiratory pressures were measured. The DCO was diminished in 12 of 16 (75 percent) patients. The MSIP was decreased in seven out of ten (70 percent) and the MSEP was decreased in nine out of ten (90 percent) of those patients tested. There was a statistically significant correlation between the severity of dyspnea as graded by the BDI and OCD, and the decrease in DCO. These results and a review of the literature of the pulmonary manifestations of EMS lead us to conclude that patients with EMS have a high prevalence of dyspnea, and it appears to be caused by both lung parenchymal involvement, as well as respiratory muscle weakness.

Alterations of erythrocyte morphology and lipid composition by hyperbilirubinemia.

Morphology and membrane lipid composition of erythrocytes from neonates (jaundiced and healthy) and adults (before and after incubation with bilirubin) were studied. The morphological index, expressing the relative proportions of the different stages of cell distortion, and the membrane cholesterol, phospholipids and cholesterol/phospholipids molar ratio, were determined. In jaundiced neonates a significant increase in the morphological index (P < 0.01) was found. After incubation with bilirubin, adult erythrocytes also showed an increase in the morphological index (P < 0.01). Hemolysis occurred under these conditions, and the red cell ghosts obtained (vesicles) showed a rounded morphology. Higher cholesterol/phospholipid ratio and lower phospholipid content were found in jaundiced neonates compared with healthy babies (P < 0.05) and adults (P < 0.01), as well as in the cells (P < 0.05) and vesicles (P < 0.01) obtained after bilirubin incubation. Bilirubin cytotoxicity may occur in a stepwise manner: deposition of bilirubin in membrane produces echinocytosis, which is followed by disintegration of the lipid bilayer with loss of phospholipids from the membrane.

Sciatic nerve conduction velocity of malnourished rats fed the human "basic regional diet" of the northeast of Brazil.

1. Rats were fed the "basic regional diet" (BRD) utilized by some human populations in northeastern Brazil, which contains only 7.8% protein (mainly from beans), to produce a form of malnutrition. The effects of chronic malnutrition on nerve impulse conduction velocity was studied in the sciatic nerve of young (121-143 days) and old (420-540 days) rats. 2. BRD rats presented a 50% reduction in sciatic nerve conduction velocity compared to controls fed a diet containing 22% casein. 3. Rats chronically fed a commercially available diet (CD group) containing an intermediate level of protein (14%) presented conduction velocities intermediate between values obtained from control and BRD rats (62% to 76% of the control values). 4. The conduction velocities of animals belonging to the same nutritional group were independent of sex, body weight or age. 5. Nutritional restriction imposed only in adult life by increasing the number of rats per cage in the casein group did not have any effect on the conduction velocity of nerve impulses. 6. The severity of the effects observed in the malnourished rats may be related to the quantity and quality of protein in the diet. In this respect, the present data agree with those reported in the literature on human and animal experiments. 7. The present results justify the use of the foods ingested by malnourished human populations for the development of experimental animal models of malnutrition.

Apomorphine does not mimic the effects of REM-sleep deprivation on cortical spreading depression.

The propagation of cortical spreading depression (SD) and the incidence of "spontaneous" SD were enhanced in rats after rapid-eye-movement sleep deprivation (REMD) as compared to control animals. Pseudo-deprived rats were similar to controls, suggesting that the facilitatory effect on SD is due to REMD rather than to the stress accompanying deprivation. In control rats, apomorphine (0.5 to 8 mg/kg) failed to reproduce the effects of REMD and also failed to enhance the REMD effects in deprived rats, suggesting that the dopaminergic system does not play an important role in propagation of cortical SD.

[Inadequacy of using size variations of esophageal varices to evaluate the permeability of distal splenorenal anastomoses]. / Inadequação do emprego das variações do tamanho das varizes do esôfago par avaliar a permeabilidade da anastomose espleno-renal distal.

After portal hypertension surgical treatment, the esophageal varices size reduction as endoscopically observed, has been pointed out as an indirect permeability sign and good function of portal systemic shunts. Three cases of distal splenorenal anastomosis thrombosis, studied angiographically, were followed by decrease of esophageal varices volume, are discussed.

[A comparison of 4 pregnancy assessment scales (CRIB, SNAP, SNAP-PE, NTISS) in premature newborns. Clinical Risk Index for Babies. Score for Neonatal Acute Physiology. Score for Neonatal Acute Physiology-Perinatal Extension. Neonatal Therapeutic Intervention Scoring System]. / Comparação de quatro escalas de avaliação da gravidade clínica (CRIB, SNAP, SNAP-PE, NTISS) em recém nascidos prematuros.

In recent years a number of neonatal risk scores have been developed in order to assure a more accurate evaluation of results obtained by different NICU's. It is noteworthy that throughout the years an effort has been made to adapt the scores to the specific neonatal problems and to make them easier to use. We felt that it would be important to compare various scores (CRIB, SNAP, SNAP-PE, NTISS) in a population of premature infants. This was the main objective in this study. Between January 1992 and February 1995 a total of 186 infants with birthweight under 1500 grams and/or gestational age under 32 weeks were admitted to our Unit. There were 40 deaths (21.5%). It was possible to use the four above mentioned scores retrospectively. The area under the ROC curve (for predicting in-hospital mortality) in each score was: CRIB 0.90; SNAP 0.88; SNAP-PE 0.88; NTISS 0.85. The CRIB score was easier to perform (only 5 minutes, in contrast to 20-30 minutes for the other scores). From this study CRIB score is apparently a suitable and accurate method easily performed in clinical practice.

[Perinatal morbidity and mortality related to gestational infection. The histological identification of chorioamnionitis and its incidence in the population studied]. / Morbilidade e mortalidade perinatal relacionadas com a infecção na gestação. Identificação histológica da corioamnionite e sua incidência na população estudada.

Infection of the embryo and foetus remains a major public health problem. It has been widely accepted as a major cause of spontaneous abortion, premature birth and morbidity and mortality of the newborn. Furthermore, many studies stress the role of chorioamnionitis in the onset of premature labor. We have found a significant incidence of chorioamnionitis in placentas examined in our laboratory, but we do not know the real prevalence of intra amniotic infection and the magnitude of its consequences. Furthermore, there is no data concerning the micro-organisms that can act as pathogens in our patients. The aim of this study was to better define the role of infection in pregnancy in our hospital. As a first approach we studied all the placentas that were sent to the Histopathology Department during 1993, trying to correlate histological findings with clinical data. We found that 38% of 280 placentas had histological criteria for chorioamnionitis, 33% of which were associated with fetal death. Only 13% of these cases had clinical signs of infection. These facts stress the need for a sensitive and selective method of identifying organisms that act as pathogens in intrauterine infection. It may be possible to prevent some of its complications if an earlier diagnosis and identification of the agent are done.

Cerebral blood flow in humans following resuscitation from cardiac arrest.

Cerebral blood flow was measured by xenon-133 washout in 13 patients 6-46 hours after being resuscitated from cardiac arrest. Patients regaining consciousness had relatively normal cerebral blood flow before regaining consciousness, but all patients who died without regaining consciousness had increased cerebral blood flow that appeared within 24 hours after resuscitation (except in one patient in whom the first measurement was delayed until 28 hours after resuscitation, by which time cerebral blood flow was increased). The cause of the delayed-onset increase in cerebral blood flow is not known, but the increase may have adverse effects on brain function and may indicate the onset of irreversible brain damage.

Learned and emotional behavior in chronically malnourished rats.

Weanling male and female Wistar rats, whose mothers received low protein diet (6.8%) during pregnancy and lactation, were fed on the same diet of their mothers and trained in an active avoidance situation at the ages of 60, 90 or 120 days. Control animals fed on a 20% protein diet of the same age groups were submitted to similar training. The consolidation and performance of the conditioned avoidance response and other behavioral reactions were studied. The malnourished animals showed delay of consolidation and lower frequency of conditioned avoidance responses, escape responses and holdings as well as higher frequency of anticipatory reactions, vocalization, riddance attempts and touching of surroundings. The results show that chronic malnutrition impairs the active avoidance response. They also show that chronic malnutrition affects the emotional behavior more markedly than early malnutrition. Chronic malnutrition also enhances the exploratory activity, in contrast to early malnutrition, and this is attributed to an alimentary drive-dependent mechanism.

A randomized trial for the study of the elective surgical treatment of portal hypertension in mansonic schistosomiasis.

From 1977 to 1983, 94 patients with esophageal varices and gastrointestinal bleeding secondary to mansonic schistosomiasis were entered into a prospective randomized trial comparing the three operations mainly used in Brazil: esophagogastric devascularization associated with splenectomy (EGDS, 32 patients), classical splenorenal shunt (SRS, 32 patients), and distal splenorenal shunt (DSRS, 30 patients). The randomization was interrupted because of a significant incidence of portosystemic encephalopathy (PSE) in the SRS group (26%), as compared to the DSRS (7%) and EGDS (0%) groups. The rate of rebleeding was the same in the three groups, but the rate of failure, as defined by the presence of technical problems, postoperative complications, or death, was significantly higher in the SRS group. This 2-year follow-up shows that SRS should be abandoned in hepatosplenic schistosomiasis and that a comparison between DSRS and EGDS with a longer follow-up is urgently needed.