Evaluation of the effects of chronic occupational exposure to metallic mercury on the thyroid parenchyma and hormonal function.

INTRODUCTION: Experiments in animals exposed to mercury (Hg) in different chemical states have shown thyroid parenchymal and hormone alterations. However, these experiments did not allow the establishment of dose-response curves or provide an understanding of whether these Hg effects on the thyroid parenchyma occur in humans. OBJECTIVE: To evaluate the association between chronic occupational exposure to metallic Hg and alterations in thyroid hormones and gland parenchyma 14 years after the last exposure. METHODS: A cross-sectional study including 55 males exposed in the past to metallic Hg and 55 non-exposed males, paired by age, was conducted in the Hospital das Clínicas (Brazil) from 2016 to 2017. Serum concentrations of total and free triiodothyronine (TT3 and FT3), free thyroxine (FT4), thyrotropin (TSH), reverse T3 (RT3), selenium and antithyroid antibody titers were obtained. The Hg and iodine concentrations were measured in urine. The thyroid parenchyma was evaluated by B-mode ultrasonography with Doppler. The nodules with aspects suspicious for malignancy were submitted to aspiration puncture with a thin needle, and the cytology assessment was classified by the Bethesda system. The t test or Mann-Whitney test, Chi-square test and Spearman correlation were used to compare the exposed and non-exposed groups and examine the relationships between the variables. Univariate and multivariate logistic regression models were used to trace determinants of the risk of thyroid hormone alteration. Statistical significance was defined by p < 0.05. RESULTS: The urinary Hg average was significantly higher in the exposed group than in the non-exposed group (p < 0.01). The mean TSH serum concentration in the exposed group was higher, with a statistically significant difference between the groups (p = 0.03). Serum concentrations of TSH exceeded the normality limit (4.20 µIU/ml) in 13 exposed individuals (27.3%) and 4 non-exposed individuals (7.3%), with a statistically significant association between the hormonal increase and exposure to Hg (p = 0.02). In the logistic regression model, exposure to Hg (yes or no) showed an odds ratio = 4.86 associated with an increase of TSH above the normal limit (p = 0.04). The serum concentrations of RT3 showed a statistically borderline difference between the groups (p = 0.06). There was no statistically significant difference between the mean TT3, FT3 and FT4 serum concentrations in the Hg-exposed group compared to the non-exposed group. The proportions of the echogenicity alterations were higher in the exposed group compared to the non-exposed group (27.3% versus 9.1%; p = 0.03). Papillary carcinomas were documented in three exposed individuals and one non-exposed individual. A follicular carcinoma was recorded in one non-exposed individual. CONCLUSIONS: Due to the higher serum TSH concentration and the prevalence of parenchymal alterations in the Hg-exposed group, even after cessation of exposure, it is recommended that the thyroid status of exposed workers be followed for a long period.

Rnx deficiency results in congenital central hypoventilation.

The genes Tlx1 (Hox11), Enx (Hox11L2, Tlx-2) and Rnx (Hox11L2, Tlx-3) constitute a family of orphan homeobox genes. In situ hybridization has revealed considerable overlap in their expression within the nervous system, but Rnx is singularly expressed in the developing dorsal and ventral region of the medulla oblongata. Tlx1-deficient and Enx-deficient mice display phenotypes in tissues where the mutated gene is singularly expressed, resulting in asplenogenesis and hyperganglionic megacolon, respectively. To determine the developmental role of Rnx, we disrupted the locus in mouse embryonic stem (ES) cells. Rnx deficient mice developed to term, but all died within 24 hours after birth from a central respiratory failure. The electromyographic activity of intercostal muscles coupled with the C4 ventral root activity assessed in a medulla-spinal cord preparation revealed a high respiratory rate with short inspiratory duration and frequent apnea. Furthermore, a coordinate pattern existed between the abnormal activity of inspiratory neurons in the ventrolateral medulla and C4 motorneuron output, indicating a central respiratory defect in Rnx mice. Thus, Rnx is critical for the development of the ventral medullary respiratory centre and its deficiency results in a syndrome resembling congenital central hypoventilation.

[Perforation of primary non-Hodgkin's lymphoma during chemotherapy. Clinical evaluation and therapeutic strategy]. / Perforazione di linfoma non-Hodgkin del cieco dopo chemioterapia. Valutazione clinica e strategia terapeutica.

Primary cecal lymphoma are very rare. The case is reported of an elderly woman having voluntary preliminary chemotherapy with consequent cecum perforation due to tumoral necrosis, some days after the first chemotherapy. The diagnostic, clinical and therapeutic protocol is analysed and stress is laid on the rare clinical cases described. Resection is advisable in the still delimited forms in order to avoid surgical complications due to preliminary chemotherapy and in order to classify precisely the neoplasm.

Validación del sistema APACHE II en cuatro Unidades Intensivas del área de Buenos Aires / Validation of APACHE II system in four intensive care units of the Buenos Aires area

Objetivos: Analizar la calibración y discriminación del Sistema APACHE II en cuatro UTIs Polivalentes de Hospitales de Alta Complejidad. Material y Métodos: Se recabó prospectivamente la información necesaria para el cálculo del score APACHE II a las 24 horas del ingreso, durante el período comprendido entre enero de 1994 a enero 1997, en cuatro UTI polivalentes de Centros de Alta Complejidad de Buenos Aires. Los criterios de exclusión fueron: edad menor de 16, cirugía cardiovascular y quemados. Se recabaron diariamente la edad, causa de ingreso a UTI según categorías de Knaus, ingreso por cirugía de urgencia o electiva, sumatoria de puntos de APACHE II y evolución. La evolución fue considerada como sobrevida (SV) o muerte (NS) durante la estancia hospitalaria. El cálculo de PM se efectuó utilizando los coeficientes de la ecuación original: PM =e Logit/ 1 + e Logit. Se analizaron los datos por medio de regresión logística múltiple. La calibración se efectuó por medio del estadístico Goodness of Fit de Hosmer y Lemeshow. La discriminación se analizó por medio de curvas ROC. Resultados: Se recolectó un total de 3137 registros para el análisis. La edad media fue 57 ñ 19 años, el APACHE II de 12,8 ñ 7,8 y la estdía en UTI de 7,6 ñ 6,4 días. La mortalidad renal fue de 33 por ciento. Existieron diferencias significativas entre APACHE II de SV 9,9 ñ 5,9 y de NS 18,6 ñ 8 (p<0.001). La mortalidad calculada fue de 20 ñ 18 por ciento. Se observó una correlación positiva entre outcome calculado y real (R² 0,74). Sin embargo el outcome calculado por APACHE II presentó una mala calibración con el real (Goodness of Fit 39,87 - p < 0,001). La discriminación arrojó un área bajo ROC de 0,78. Para un punto de corte de PM de 0,5 la Sensibilidad fue del 29,4 por ciento y la Especificidad del 97,5 por ciento. El valor predictivo positivo fue de 45,5 por ciento y el negativo de 91,6 por ciento. Conclusiones: el sistema APACHE II no valida correctamente los datos de mortalidad en la muestra estudiada. La mortalidad global real es mayor que la calculada según la ecuación PM. Esto hace caer en forma significativa el valor predictivo positivo y la sensibilidad del modelo comparados con la publicación original. Según las conclusiones del presente estudio, se propone la realización de un trabajo multicéntrico nacional para la validación del sistema en la población de pacientes de terapia intensiva y la confección de nuevos coeficientes que se ajusten...

Effects of cAMP on respiratory rhythm generation in brainstem-spinal cord preparation from newborn rat.

Involvement of cAMP in the generation of respiratory rhythm was studied in newborn rat brainstem-spinal cord preparations. The respiratory rhythm was monitored by C4 inspiratory activity and/or pre-inspiratory (Pre-I) activity of neurons in the rostral ventrolateral medulla; previously suggested to be primary rhythm generating neurons which have pacemaker properties. The effects of four cAMP-increasing agents (forskolin, IBMX, Db-cAMP, and 8-Br-cAMP) on this neuronal activity were examined. Perfusion with forskolin (3-10 microM) increased the burst rate of C4 inspiratory activity in 20 of 32 preparations, but in 8 of those the increase was preceded by transient depression. The facilitation of the respiratory rhythm was greater whenever the burst rate before forskolin treatment was lower. The Pre-I neuron burst rate, which was recorded together with C4 activity, predominantly increased with forskolin treatment. The effects of IBMX, Db-cAMP and 8-Br-cAMP were similar to those of forskolin, but they were slightly less potent. Long-lasting depression of the respiratory rhythm (C4 and Pre-I activity) by clonidine, which might decrease intracellular cAMP level via alpha 2-receptors, was reversed by forskolin. To investigate the direct effects of the cAMP-increasing agents on Pre-I neurons, Pre-I activity was isolated by blocking the chemical synaptic transmission by incubation in a low Ca solution (0.2 mM Ca2+, 5 mM Mg2+). Forskolin (5-10 microM), IBMX (5-10 microM), Db-cAMP (0.2-0.4 mM), and 8-Br-cAMP (0.4-0.75 mM) all enhanced the burst rate of isolated Pre-I neurons.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of primary retroperitoneal mucinous cystadenocarcinoma.

A rare case of primary retroperitoneal mucinous cystadenocarcinoma in a 44-year-old woman is reported. The cystic tumor was delineated by CT and echography. The tumor was removed intact in the presence of bilateral normal ovaries and demonstrated an infiltrating malignant process. This neoplasm may have arisen from a supernumerary ovary. The patient died of recurrence 4 months after surgery. A comparison of the known cases indicates that aggressive treatment by hysterectomy with bilateral salpingo-oophorectomy in addition to cyst extirpation may improve prognosis.

Errores en el manejo del traumatizado: informe preliminar / Errors in the handling of the traumatized: preliminary report

Se efectuó un estudio prospectivo desde marzo de 1991 hasta mayo de 1992 de los pacientes que presentaban un ISS = 9, tres o más días de internación, internación en UTI o fallecidos por trauma para detectar errores (E) y muertes (M) prevenibles. Los E fueron clasificados como: resucitativos (R), operatorios (O) y de cuidado crítico (C) y las M en: prevenibles (P), potencialmente prevenibles (PP) y no prevenibles (NP). Ingresaron 120 pacientes. El Trauma Score Revisado (TSR) fue de 7,0ñ1,31 y el ISS 19,5ñ11,1 con una Ps de 92,25 por ciento por el TRISS. Fallecieron 31 pacientes (25,8 por ciento). Tuvieron errores en 67 casos (55,8 por ciento) de los que fallecieron 28 (41,8 por ciento). Hubo tres óbitos sin errores en el tratamiento. Los errores hallados fueron: R en el 17,9 por ciento, O en el 49,3 por ciento y C en el 32,8 por ciento. Los fallecidos se asociaron a R el 25,8 por ciento; a O el 22,6 por ciento, a C el 41,9 por ciento y sin errores el 9,7 por ciento. Los errores R y C se encuentran relacionados con la mortalidad de manera muy signifivativa, no así los O. Los errores C constituyen el 32,8 por ciento del total de errores y tienen alto impacto en las MP, ya que un error en esta etapa aumenta el riesgo de muerte ocho veces. Los más frecuentes fueron las infecciones y en menor medida en la ventilación mecánica. Los errores en pacientes ó 54 años se presentaron en el 51,1 por ciento (9,1 por ciento R; 52,3 por ciento O y 38,6 por ciento C). En > 54 años se presentaron en el 69,8 por ciento (34,8 por ciento R; 43,5 por ciento O y 21,7 por ciento C). Se cometieron errores en 61,2 por ciento de los traumatismos contusos (TC) y en 31,8 por ciento de los penetrantes (TP), en éstos no hubo errores C. Dentro de los R el más común fue la reposición de volumen insuficiente o el retardo en el inicio de la misma y si bien se presentaron en un bajo porcentaje, contribuyeron mucho a la mortalidad (66,7 por ciento). Los errores O fueron en su mayoría de juicio (60,6 por ciento) y relacionados a retardo en la cirugía de las fracturas por política del servicio. Sin embargo, estos errores sólo contribuyeron al 21,2 por ciento del total de las M. El 41,9 por ciento de las M fueron P, el 38,7 por ciento PP y el 19,4 por ciento NP. Un grupo de trauma ha iniciado programas de capacitación, de vigilancia epidemiológica y protocolo interdisciplinario

Urethral obstruction owing to retroperitoneal cystic lymphangioma.

We report a case of cystic lymphangioma arising from retroperitoneal tissues of the pelvis, which caused urethral obstruction and eventual urinary retention. Sonography and computerized tomography demonstrated a retroperitoneal cystic mass in the pelvis. A preoperative diagnosis of retroperitoneal cystic lymphangioma was suggested by typical computerized and sonographic features.

Glucagon administration for the treatment of postoperative cholangitis after Kasai's operation--a preliminary report.

Clinical application of glucagon in postoperative ascending cholangitis after Kasai's operation for biliary atresia is reported. Therapeutic use of glucagon in two patients succeeded in treating ascending cholangitis, but failed to prevent progression to hepatic fibrosis. Prophylactic use in two patients prevented development of ascending cholangitis. Prophylactic glucagon administration appears to improve the prognosis of patients with biliary atresia who have undergone a Kasai's operation.