Gigantomastia juvenil. Hipertrofia virginal. Presentación de caso clínico / Juvenile macromastia. Virginal mammary hypertrophy. Case report

La gigantomastia juvenil es una afección médica benigna poco frecuente que causa el crecimiento excesivo y discapacitante de las mamas, provocando importantes trastornos físicos y psíquicos a pacientes púberes o adolescentes. Presentamos el caso en una paciente de 23 años, la cual se encontraba en la última etapa de su patología con una importante signosintomatología. Al no existir un tratamiento específico para ella, la mastoplastia reductiva es el procedimiento más efectivo con el que se cuenta. Se realizó una reducción de 9000 g de tejido mamario mediante la técnica de Torek, obteniendo mamas de volumen medio, simétricas, con cicatrices aceptables. La complejidad de esta patología hace que debamos manejarnos con un equipo multidisciplinario, tanto durante su estudio como en su tratamiento, y consideramos muy importante realizar un seguimiento estricto a largo plazo ya que es posible que, después del tratamiento quirúrgico, se presenten recurrencias.

Juvenile gigantomastia is a rare benign medical condition that causes excessive and disabling growth of the breasts and provokes considerable physical and psychological discomfort in patients in their puberty and adolescence. We introduce the case of a 23-year-old patient in the last stage of her condition with considerable signs and symptoms. There is no specific treatment for juvenile gigatomastia; hence breast reduction is the most effective procedure available. A reduction of 9,000 grams of breast tissue was performed using Torek's technique, resulting in medium volume, symmetrical breasts with acceptable scars. The complexity of this disorder requires a multidisciplinary team during the study and therapy stages. A strict long-term follow-up is recommended as relapses are possible after surgery.

Gigantomastia juvenil. Hipertrofia virginal. Presentación de caso clínico / Juvenile gigantomastia. Virginal hypertrophy. Clinical case presentation

La gigantomastia juvenil es una afección médica benigna poco frecuente que causa el crecimiento excesivo y discapacitante de las mamas provocando importantes trastornos físicos y psíquicos a pacientes púberes o adolescentes. Presentamos el caso en una paciente de 23 años de edad, la cual se encontraba en la última etapa de su patología con una importante signosintomatología. No existe un tratamiento especifi co para ella, por lo cual la mastoplastia reductiva es el procedimiento más efectivo con el que contamos. Se realizó una reducción de 9000 g de tejido mamario mediante la técnica de Torek, obteniendo mamas de volumen medio, simétricas, con cicatrices aceptables. La complejidad de esta patología hace que debamos manejarnos con un equipo multidisciplinario, tanto durante su estudio como en su tratamiento, y consideramos muy importante realizar un seguimiento estricto a largo plazo ya que es posible que, después del tratamiento quirúrgico, se presenten recurrencias

Juvenile Gigantomastia is a rare benign medical condition that causes excessive and disabling growth of the breasts and provokes considerable physical and psychological discomfort in patients in their puberty and adolescence. We introduce the case of a 23-year-old patient in the last stage of her condition with considerable signs and symptoms. There is no specifi c treatment for Juvenile Gigatomastia; hence breast reduction is the most eff ective procedure available. A reduction of 9,000 grams of breast tissue was performed using Torek's technique, resulting in medium volume, symmetrical breasts with acceptable scars. The complexity of this disorder requires a multidisciplinary team during the study and therapy stages. A strict long-term follow-up is recommended as relapses are possible after surgery

Prediction of acid lactic-bacteria growth in turkey ham processed by high hydrostatic pressure

High hydrostatic pressure (HHP) has been investigated and industrially applied to extend shelf life of meat-based products. Traditional ham packaged under microaerophilic conditions may sometimes present high lactic acid bacteria population during refrigerated storage, which limits shelf life due to development of unpleasant odor and greenish and sticky appearance. This study aimed at evaluating the shelf life of turkey ham pressurized at 400 MPa for 15 min and stored at 4, 8 and 12 ºC, in comparison to the non pressurized product. The lactic acid bacteria population up to 10(7) CFU/g of product was set as the criteria to determine the limiting shelf life According to such parameter the pressurized sample achieved a commercial viability within 75 days when stored at 4 ºC while the control lasted only 45 days. Predictive microbiology using Gompertz and Baranyi and Roberts models fitted well both for the pressurized and control samples. The results indicated that the high hydrostatic pressure treatment greatly increased the turkey ham commercial viability in comparison to the usual length, by slowing down the growth of microorganisms in the product.

Comparison of pre- versus post-incision administration of intraplantar indomethacin and MK886 in a rat model of postoperative pain

The amplification of pain long after the initial stimulus may be avoided if the treatment of pain is introduced before its initiation. However, conflicting evidence exists about the efficacy of such preemptive analgesia for the management of postoperative pain. This study compares the efficacy of intraplantar administration of indomethacin (a non-selective inhibitor of cyclooxygenase) and MK886 (an inhibitor of 5-lipoxygenase-activating protein), separately or in combination to produce preemptive analgesia in a model of surgical incisional pain in male Wistar rats. All incised rats (5 to 6 rats per group) had allodynia at 2, 6, and 24 h after surgery as evaluated using von Frey filaments. MK886, but not indomethacin (50 to 200 µg/paw), reduced the allodynia when injected either 1 h before or 1 h after surgery. The effect of preoperative MK886 (160 µg/paw) against incisional allodynia had a magnitude apparently similar to that produced by postoperative MK886. Pre-, but not postoperative MK886 (80 µg/paw) reduced the allodynia but the effect was seen only at 6 h after surgery. In contrast, MK886 (40 µg/paw) intensified the allodynia observed 2 h after the incision either injected before or after surgery. MK886 or indomethacin alone did not provide preemptive analgesia in the model of incisional pain. In contrast, the combination of MK886 with indomethacin reduced the allodynia more effectively when used before than after surgery, thus fulfilling the criteria for preemptive analgesia. In conclusion, preoperative inhibition of the local generation of both prostaglandins and leukotrienes by surgical incision may be an alternative to provide preemptive analgesia.

Co-circulation of genotypes IA and IB of hepatitis A virus in Northeast Brazil

The Northeast region is the location of most cases of acute hepatitis A virus (HAV) in Brazil. In the present study, the genotypes of HAV strains from Pernambuco State, one of most populous states in the Northeast region, were characterized. Blood samples positive for anti-HAV IgM from 145 individuals (mean age = 29.1 years), collected during 2002 and 2003, were submitted to nested RT-PCR for amplification of the 5'non-translated region (5'NTR) and VP1/2A regions of the HAV genome. The VP1/2A and 5'NTR regions were amplified in 39 and 21 percent of the samples, respectively. Nucleotide sequencing was carried out in 46 percent of VP1/2A and in 53 percent of 5'NTR isolates. The identity in nucleotide sequence of the VP1/2A region ranged from 93.6 to 100.0 percent. Phylogenetic analysis of the VP1/2A sequences showed that 65 percent belong to sub-genotype IA and 35 percent to sub-genotype IB. Co-circulation of both sub-genotypes was observed in the two years studied. Distinct clusters of highly related sequences were observed in both sub-genotypes, suggesting endemic circulation of HAV strains in this area. In the 5'NTR isolates, 92.7-99.2 percent identity was observed and two isolates presented one deletion at position 413. Phylogenetic analysis showed that genotype IA strains cluster in the tree in the same way as genotype IB strains, but one IIIA isolate from Spain clusters with genotype IB strains. These results do not allow us to state that 5'NTR could be used to genotype HAV sequences. This is the first report of co-circulation of sub-genotypes IA and IB in this region, providing additional information about the molecular epidemiology of HAV strains in Brazil.

Ciclo reproductivo de Lytchinus variegatus (Echinoidea: Toxopfneustidae) en el sur de Isla Margarita, Venezuela / Reproductive cycle of Lytechinus variegatus (Echinoidea: Toxopneustidae) in the south of Margarita Island, Venezuela

The sea urchin Lytechinus variegatus is of some commercial importance on the Southern coast of Margarita Island (Venezuela), where artisan women fishers process and sell the roe. The reproduction cycle of this species had not been fully studied. We collected these sea urchins in two stations from November 1997 through October 1998. The samples were transported fresh to the laboratory to determine weight, diameter and height. The sexual stage was established with a macroscopic scale and the gonadosomatic index (GI). Maturity is achieved when the animals reaches a diameter of 22 mm, although 50% of the population reaches sexual development at diameters of 43 mm (males) and 45 mm (females) at Station 1, and 35 mm for both sexes at Station 2. Mature individuals, in a sexual proportion of 1:1 were collected every month. According to the monthly GI variation and frequency (%) of the development stages, on the southern beaches the main reproductive period begins in April and continues through October, and it is most intensive from May to July, when gonads reach the greatest growth

Propuesta de diseño de sistema de información en Salud Mental. Aplicación y Evaluación de los Subsistemas de Farmacia, Consulta Externa y Hospitalización para el Ministerio de Salud / Information system design proposal in Mental Health. Application and Evaluation of the Subsistemas of Pharmacy, External Consultation and Hospitalization for the Ministerio de Salud

El Ministerio de Salud todavía no cuenta con un Sistema de Información en Salud Mental efectivo. Este sistema deberá ser implementado en fases sucesivas, en esta primera fase tres subsistemas: Consulta Externa, Hospitalización y Farmacia, diseñados con la participación de los usuarios externos, incluyendo los indicadores. Se utilizó el soporte informático existente en cada región. Se aplicó un instrumento diagnóstico a los usuarios del sistema actual y a los seis meses de la implementación de la propuesta. Es un estudio analítico, longitudinal y prospectivo. Se demostró en la fase de aplicación que existen las condiciones para la definición, implementación, sólo dos de las variables correspondientes a las características generales del sistema presentaron un cambio significativo relacionado con la mejora de la percepción del usuario, la oportunidad y la consolidación de la información. En las variables que median la utilidad en el proceso de administraciones presentó un cambio significativo en la efectividad. Esto se asocia a la motivación del usuario. Se debe continuar el uso del sistema propuesto y que los usuarios realicen las adaptaciones pertinentes, utilizando diferentes modelos de evaluación y dando entrenamiento y tutoría a todos los niveles.

Genetic variability of hepatitis A virus isolates in Rio de Janeiro: implications for the vaccination of school children

The epidemiology of hepatitis A virus (HAV) infection is shifting from high to intermediate endemicity in Brazil, resulting in increased numbers of susceptible individuals and a greater potential for the emergence of outbreaks. Universal vaccination against HAV has been recommended for children, but updated sero-epidemiological data are necessary to analyze the level of natural immunity and to identify candidates for preventive measures. In addition, more molecular studies are necessary to characterize the genotypes involved in HAV infections and outbreaks. Sera from 299 school children (5-15 years old) and 25 school staff members, collected during an outbreak of HAV at a rural public school in June 2000, were tested for IgM and total anti-HAV antibodies (ELISA). Viral RNA was amplified by RT-PCR from anti-HAV IgM-positive sera and from 19 fecal samples. Direct nucleotide sequencing of the VP1/2A region was carried out on 18 PCR-positive samples. Acute HAV infection was detected by anti-HAV IgM in 93/299 children and in 3/25 adult staff members. The prevalence of total anti-HAV antibodies in IgM-negative children under 5 years of age was only 10.5 percent. HAV-RNA was detected in 46 percent IgM-positive serum samples and in 16 percent stool samples. Sequence analysis showed that half the isolates belonged to subgenotype IA and the other half to IB. On the basis of these data, mass vaccination against HAV is recommended without prevaccination screening, especially for children before they enter school, since nearly 90 percent of the children under 5 years were susceptible. Molecular characterization indicated the endemic circulation of specific HAV strains belonging to subgenotypes IA and IB.

In situ enzyme immunoassay for titration of a Brazilian hepatitis A virus strain (HAF-203)

Hepatitis A virus (HAV) replicates relatively slowly in cell culture without a cytopathic effect, a fact that limits the use of tissue culture assays. The radioimmunofocus assay is the standard method for HAV titration, although it is labor intensive and requires the use of radioisotopes. A simple, rapid and objective infectivity assay based on an in situ enzyme immunoassay (EIA) is described here for a Brazilian cell culture-adapted HAV strain (HAF-203). The assay uses a peroxidase-labeled polyclonal antibody to fixed monolayers as an indicator of infection. EIA may be completed within 7 days using serial 5-fold dilutions of the virus, yielding a titer of 5.024 log 50 percent tissue culture infective dose (TCID50)/ml for HAF-203. This technique had a detection limit of 1.1 log TCID50/ml and the specificity was demonstrated by detecting no reaction on the columns of uninfected wells. The reproducibility (with intra- and inter-assay coefficients of variation ranging from 1.9 to 3.8 percent and from 3.5 to 9.9 percent, respectively) and quantitation of the assay were demonstrated by close agreement in virus infectivity titers among different assays of the same amount of virus and between assays of different amounts of virus. Furthermore, this assay does not require the use of radiolabeled antibodies. We describe here an efficient EIA that is highly reproducible and that could be used to monitor HAV growth in cell culture and to determine the quantity of HAV antigen needed for diagnostic assays. This is the first report of the infectious titer of the Brazilian cell culture-adapted HAV strain (HAF-203).

Marcadores sorológicos da hepatite B em usuários de um Centro de Testagem para o HIV / Serological markers of hepatitis B in users of services at an HIV Testing Center

The objective of this investigation was to study the prevalence of serological markers of hepatitis B and possible risk factors for this disease in a sample of 404 people who attended a Testing and Couseling Center for HIV in the city of Ribeirão Preto, São Paulo State, Brazil. The overall prevalence of serologic hepatitis B markers was 14.6%, equal to that obtained for anti-HBc. HBsAg and anti-HBc IgM showed prevalences of 1%. After adjustment using logistic regression, hepatitis B markers showed association with the following variables: age, place of residence, use of injectable drugs and positivity to anti-HIV. The overall prevalence of human immunodeficiency virus infection was 6.9%. Hepatitis B markers were detected in 55.6% among intravenous drug users and in 42.9% among those who tested positive for HIV, confirming literature findings which indicates high levels of infection in these specific population groups.

Esta investigação objetivou estudar a prevalência de marcadores sorológicos de infecção pelo vírus da hepatite B e analisar possíveis fatores de risco em 404 usuários submetidos à sorologia anti-HIV no Centro de Testagem e Aconselhamento de Ribeirão Preto, SP, Brasil. A prevalência global dos marcadores para o vírus da hepatite B foi de 14,6%, idêntica à encontrada para o anti-HBc, com valores de 1% para o HBsAg e anti-HBc IgM. Após ajuste por regressão logística, os marcadores de infecção do vírus B mostraram associação com as variáveis: idade, local de residência, uso de drogas endovenosas e positividade para o HIV. A prevalência de infecção pelo vírus da imunodeficiência humana foi de 6,9%. Marcadores do vírus B foram detectados em 55,6% dos usuários de drogas endovenosas e em 42,9% dos positivos ao vírus da imunodeficiência humana, confirmando altos índices de infecção nestes grupos específicos.

Abundancia de Lytechinus variegatus (Echinoidea: Toxopneustidae) en la isla de Cubagua, Venezuela / Abundance of Lytechinus variegatus (Echinoidea: Toxopneustidae) in the Cubagua island, Venezuela

The sea urchin roe is among the highest valued seafood items in the world. Increasing demand has extended this fishery worldwide and cases of overfishing have been detected in some countries. On the eastern coast of Venezuela some species of sea urchin, such as Lytechinus variegatus, are consumed as food but studies to determine the abundance and size do no exist. Between February 1998 and April 1999 six sampling stations (depth under 5 m) in Cubagua island (perimeter 25 km) were visited in 11 occasions to study the population density of L. variegatus, with a 0.25 m2 quadrat thrown eight times over seagrass (Thalassia testudinum) beds. Temperature was determined on site, and water samples for salinity and dissolved oxygen concentration were collected. Each specimen was measured and returned to the sea. Diameter range was 8.6 to 74.2 mm (n=3 404) and mean size 26.56-55.34 mm. On the northern coast density varied from 2 to 23 urchins/m2; on the eastern coast from 15 to 82/m2 and from 21 to 58/m2 on the southern coast. On the north coast the seagrass beds are scarce.

The use of non-human primates as animal models for the study of hepatitis viruses

Hepatitis viruses belong to different families and have in common a striking hepatotropsin and restrictions for propagation in cell culture. The transmissibility of hepatitis is in great part limited to non-human primates. Enterically transmitted hepatitis viruses (hepatitis A virus and hepatitis E virus) can induce hepatitis in a number of OLD World and New Worls monkey species, while the host range of non-human primates susceptible to hepatitis viruses transmitted by the parenteral route (hepatitis B virus, hepatitis C virus and hepatitis delta virus) is restricted to few species of Old World monkeys, especially the chimpanzee. Experimental studies on non-human primates have provided an invaluable source of information regarding the biology and pathogenesis of these viruses, and represent a still indispensable tool for vaccine and drug testing.

El arte curativo de los mayas y los primeros médicos de la península de Yucatán / The curative art of the Mayans and the first doctores in the Yucatan Peninsula, Mexico

Las enfermedades y los males provenían según los mayas, de los malos vientos, de los hechizos y brujerías, de la conjunción de los astros, o por el enojo de alguno de los dioses de la teogonia maya, Por este motivo, las enfermedades eran cuaradas bajo un signo y oración religiosa de los sacerdotes. El Ah-men era un profeta y adivino, que curaba los males espirituales de sus pacientes por medio de la inspiración divina que recibía en sus largos trances con los espíritus y dioses que invocaba. Utilizaba el "zaztún" o piedra taumaturga y conocían el secreto de muchas yerbas curativas. El Pul-yahob (Brujo hechicero) curaba las enfermedades practicando ritos con plantas y animales o utilizando figurillas de barro para ahuyentar los malos vientos y espíritus. Los Dzac yahes son curanderos que dominan el conocimiento químico y medicinal de la herbolaria. Su sistema curativo es reconocido como un método eficaz. Los primeros médicos en la península de Yucatán fueron extranjeros, a principios del siglo XVIII. Uno de ellos fue un portugués llamado Juan de Pereira, que tuvo un fin misterioso. Acusado de judeizante, ante el comisario del Santo Oficio, éste le hizo aprehender el 12 de febrero de 1713 y nadie volvió a tener noticia de su paradero. El segundo médico de la época que acabamos de citar, fue Giobani Francesco Mayoli. El vivió en Valladolid, donde ejerció su profesión con éxito hasta el 27 de mayo de 1770, en que falleció a una edad muy avanzada. La tradición atribuye al médico romano varios estudios botánicos sobre las plantas de la península, que han sido recopilados en un libro manuscrito "Descripción de los nombres y virtudes de las yerbas indígenas de Yucatán". También se cree que escribió un libro titulado "El Judío", siempre sobre el tratado de las plantas medicinales. Tenemos noticia de que se escribieron en Mérida dos obras del mismo género en el segundo siglo de la dominación española. Titulase la primera "Diccionario Hispano Maya y Maya Hispano Médico y Botánica Regional" y la segunda "Diccionario Botánico y Médico de Yucatán". La primera fue escrita por el franciscano Gabriel de San Buenaventura y la segunda por el fraile de la misma orden llamado Andrés Avendaño

Intragastric infection induced in marmosets (Callithrix jacchus) by a Brazilian hepatitis A virus (HAF-203)

Several specied of non-human primates have been used in studies on experimental infection with hepatitis A virus (HAV). Attempts to infect a South-American marmoset (Callithrix jacchus) with a Brazilian HAV isolate (HAF-203) are described here. Four seronegative animals were inoculated intragastrically and one was sacrificed on day 11,20,47 and 62 after infection. One uninfected animal was included as control. Liver, small intestine, lymph node, spleen and kidney samples were collected for histological diagnosis and immunocytochemistry studies. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) serum enzymes and anti-HAV antibodies were monitored by a colorimetric procedure (Abbott) and an enzyme immunoassay (ELISA), respectively. Feces were collected daily for HAV antigen (HAVAg) detection by ELISA. Increased levels of HAVAg were detected in hepatocytes 11 days after infection, with a gradual decrease during the course of infection. Shedding of HAVAg in feces was observed from the late incubation to the early acute phase (20th day to 47th day after infection). The end of the incubation period was indicated by the initial increases in serum ALT and AST. Severe hepatic lesions such as piecemeal necrosis and bridging necrosis were detected during the acute phase, coinciding with the maximum transaminase levels and the appearance of anti-HAV antibodies. On the 62nd day (convalescent phase), the hepatic tissue showed evidence of regeneration and the transaminase values had returned to baselines. The serological, biochemical, antigenic and histological evidence of hepatitis A was similar to that observed in several primate models inoculated with other HAV isolates. The data suggest that C. jacchus can be a valuable model for the study of hepatitis A and for the evaluation of HAV vaccines

Fast growth of a Brazilian hepatitis A virus (HAF-203) in a primate cell line

A hepatitis A virus (HAV, HAF-203) isolated in Brazil was submitted to 8 serial passages through fetal Rhesus kidney cells (FRhK-4). The kinetics of replication were monitored by enzyme immunoassay (EIA-HAVAg) and cDNA-RNA dot blot hybridization. The maximum level of RNA, which was observed 21 days post-infection (p.i.) during the 3rd passage, when HAVAg was still undetectable by EIA, served as a basis to establish subsequent passages every 21 days p.i. This schedule of passage resulted in a progressive reduction of time between culture infection and HAVAg and RNA production, together with an enhancement in antigen titer content of cell lysates. During the 7th passage, maximum HAVAg and RNA levels were detected at 7 days. Fourteen days after the 8th passage, clear morphological modifications appeared, suggesting a good adaptation of HAF-203 to FRhK-4 cells. Obtaining a fast-growing Brazilian HAV is very important for the development of vaccines

Primary isolation of a brazilian strai9n of hepatitis A virus (HAF-203) and growth in a primate cell line (FRhK-4)

Although hepatitis A is endemic in Brazil, this is the first report describing the isolation of a Brazilian strain of hepatitis A virus (HAV). Fecal specimens obtained from patients in the acute phase of hepatitis A were iunoculated into fetal Rhesus kidney cell cultures (FRhK-4). Only one inoculum, denoted HAF-203, could be propagated serially. Both cell lysates and tissue culture fluids of infected cells were used as inocula and evaluated for viral antigen and RNA content by enzyme immunoassay and cDNA-RNA hybridization, respectively. Cell lysates gave better yields when used as viral inocula. After three passages, viral RNA and antigen were detected in cell lysates 4 and 14 days post-infection, respectively. Using tissue culture fluid as inoculum, the incubation period was decreased from 49 to 7 days after 4 serial passages, reflecting the adaptation of HAF-203 to growth in FRhK-4 cells. FRhK-4 cells can now be used for HAV antigen production for diagnostic assays and molecular characterization

Resposta imune à vacina da hepatite B (Hevac B, França) em unidade de diálise / Immuneresponse to B hepatitis vaccine (Hevac B, France) in a dialysis service

Foi feita uma avaliaçäo da resposta imunológica a vacina da hepatite B (Hevac B, Instituto Pasteur, França) nos pacientes e pessoal de uma unidade de hemodiálise (HD). 88,4% (23/26) desenvolveram anticorpos contra o antígeno de superfície da hepatite B (anti-HBs) entre os elementos do pessoal da HD; 75% /12) dos pacientes adultos e 87,5% (7/8) dos pacientes infantis também desenvolveram o anticorpo, todos após seis meses da primeira dose de vacina. Nenhum dos recipientes da vacina apresentou o antígeno de superficie da hepatite B (AgABs) no sangue em qualquer momento. Ficou demonstrado alto índice de resposta a vacinaçäo contra a hepatite B no pessoal e nos pacientes da HD, particularmente nas crianças, com bons títulos de anti-HBs após quatro injeçöes da vacina Hevac B