Soymilk fermentation by Enterococcus faecalis VB43 leads to reduction in the immunoreactivity of allergenic proteins ß-conglycinin (7S) and glycinin (11S).

Food allergies represent a serious problem affecting human health and soy proteins rank among the most allergenic proteins from food origin. The proteolytic enzymes produced by lactic acid bacteria (LAB) can hydrolyse the major allergens present in soybean, reducing their immunoreactivity. Many studies have reported the ability of LAB to ferment soy-based products; while the majority of them focus on the improvement of the sensory characteristics and functionality of soy proteins, a lack of information about the role of lactic fermentation in the reduction of immunoreactivity of these proteins exists. The aim of the present study was to evaluate the capability of the proteolytic strain Enterococcus faecalis VB43 to hydrolyse the main allergenic proteins present in soymilk and to determine the immunoreactivity of the obtained hydrolysates. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) results of fermented soymilk demonstrated complete hydrolysis of the ß-subunit from ß-conglycinin and the acidic polypeptide from glycinin. Reversed phase high performance liquid chromatography (RP-HPLC) analysis of the peptides released after hydrolysis revealed the appearance of new peptides and the disappearance of non-hydrolysed proteins, indicating extensive hydrolysis of the substrate. Results from competitive enzyme-linked immunosorbent assay (ELISA) tests clearly indicated a reduction in the immunoreactivity (more than one logarithmic unit) in the fermented sample as compared to the non-fermented control. Our results suggest that the soymilk fermented by E. faecalis VB43 may induce lower allergic responses in sensitive individuals. The strain E. faecalis VB43 may be considered as an excellent candidate to efficiently reduce the immunoreactivity of soymilk proteins.

Optimization of fermentation parameters to study the behavior of selected lactic cultures on soy solid state fermentation.

The use of solid fermentation substrate (SSF) has been appreciated by the demand for natural and healthy products. Lactic acid bacteria and bifidobacteria play a leading role in the production of novel functional foods and their behavior is practically unknown in these systems. Soy is an excellent substrate for the production of functional foods for their low cost and nutritional value. The aim of this work was to optimize different parameters involved in solid state fermentation (SSF) using selected lactic cultures to improve soybean substrate as a possible strategy for the elaboration of new soy food with enhanced functional and nutritional properties. Soy flour and selected lactic cultures were used under different conditions to optimize the soy SSF. The measured responses were bacterial growth, free amino acids and ß-glucosidase activity, which were analyzed by applying response surface methodology. Based on the proposed statistical model, different fermentation conditions were raised by varying the moisture content (50-80%) of the soy substrate and temperature of incubation (31-43°C). The effect of inoculum amount was also investigated. These studies demonstrated the ability of selected strains (Lactobacillus paracasei subsp. paracasei and Bifidobacterium longum) to grow with strain-dependent behavior on the SSF system. ß-Glucosidase activity was evident in both strains and L. paracasei subsp. paracasei was able to increase the free amino acids at the end of fermentation under assayed conditions. The used statistical model has allowed the optimization of fermentation parameters on soy SSF by selected lactic strains. Besides, the possibility to work with lower initial bacterial amounts to obtain results with significant technological impact was demonstrated.

A collection of ticks (Ixodidae) from wild birds in Uruguay.

Thirty nine wild birds from seven families (Alcedinidae, Emberizidae, Furnariidae, Parulidae, Trochilidae, Turdidae and Tyrannidae) were caught from 4 to 7 of February, 2004 at Rincón da Vassoura (31 degrees 15' S 56 degrees 03' W) Department of Tacuarembó, Uruguay. Ninety one nymphs and forty one larvae of Ixodidae were recovered from them. The majority of ticks were conventionally identified but 16S mitochondrial rDNA sequences were obtained for larvae and nymphs of Amblyomma with uncertain specific status to be compared with sequences of species from this genus. The 16S rDNA of Haemaphysalis juxtakochi Cooley was also obtained. Most ticks, 1 nymph of Amblyomma longirostre (Koch), 5 larvae of Amblyomma aureolatum (Pallas) and 3 nymphs of Amblyomma spp., 10 nymphs and 71 larvae of H. juxtakochi, 23 nymphs and 12 larvae of Ixodes pararicinus Keirans and Clifford, were found on the 5 Turdus albicollis Vieillot and 6 Turdus rufiventris Vieillot (Turdidae) caught. One nymph of A. longirostre and 2 nymphs of I. pararicinus were collected from the only Syndactyla rufosuperciliata (Lafresnaye) (Furnariidae) captured; 1 larva of I. pararicinus was collected on one of two Basileuterus leucoblepharus (Vieillot) (Parulidae) trapped and 1 nymph of A. longirostre was found on one of nine Elaenia parvirostris Pelzeln (Tyrannidae) captured. All these findings constitute new host records with the exception of I. pararicinus on S. rufosuperciliata, and stress the importance of Turdus as hosts for I. pararicinus, H. juxtakochi and A. aureolatum. Nymphs of H. juxtakochi and Amblyomma spp. were also found on man and vegetation.

Contact angle studies on anodic porous alumina.

The preparation of nanostructures using porous anodic aluminum oxide (AAO) as templates involves the introduction of dissolved materials into the pores of the membranes; one way to determine which materials are preferred to fill the pores involves the measurement of the contact angles (theta) of different solvents or test liquids on the AAOs. Thus, we present measurements of contact angles of nine solvents on four different AAO sheets by tensiometric and goniometric methods. From the solvents tested, we found dimethyl sulfoxide (DMSO) and N,N(')-dimethylformamide (DMF) to interact with the AAOs, the polarity of the solvents and the surfaces being the driving force.

[Improvement in inspiratory muscle function in patients with mitral stenosis after percutaneous mitral valvuloplasty. Preliminary communication]. / Mejoría de la función muscular inspiratoria en pacientes con estenosis mitral cerrada después de valvuloplastia mitral percutánea; comunicación preliminar.

BACKGROUND: It has been proved that there is an inspiratory muscle dysfunction in mitral stenosis; Although its causes still remain unknown. AIM: To evaluate the effect of percutaneous balloon mitral valvuloplasty (PMV) on inspiratory muscle performance (IMP) in patients with mitral stenosis (mitral area < 1.5 cm2). PATIENTS AND METHODS: We studied IMP in 8 patients (35 +/- 10 years) before and 3 months after successful PMV. Inspiratory muscle strength was studied by measuring maximal statistical inspiratory mouth pressure (MIP). Endurance was evaluated using a two minute incremental threshold loading test in order to obtain the maximal sustainable inspiratory pressure (SIP), with the maximal sustainable load (MSL) the patients could sustain for 2 minutes. RESULTS: Mitral valvuloplasty increased mean cardiac index from 3.1 +/- 0.3 to 4.15 +/- 0.3 l/min/m2 (p < 0.01), and significantly decreased mean pulmonary and capillary pressures. The MIP value(118 +/- 6 cmH2O), similar to that of normal group, increased to 137 +/- 7 cmH2O (p < 0.01). SIP and maximal sustainable load were 52 +/- 3 cmH2O and 294 +/- 29 g respectively, lower than normal subjects (p < 0.05). They increased after PMV to 80 +/- 3 cmH2O and 463 +/- 26 g respectively (p < 0.001). CONCLUSIONS: PMV improved inspiratory muscle function in patients with severe mitral stenosis, probably secondary to a decrease work of breath and improvement of ventricular function.

[Lipoprotein particles LpA-I, LpA-I: A-II and LpB in coronary artery disease]. / Partículas lipoproteicas LpA-I, LpA-I: A-II y LpB en enfermedad coronaria.

BACKGROUND: High density lipoproteins are an heterogeneous population of particles. Two main subpopulations have been identified, one contains Apo A-I and Apo A-II and is denominated LpA-I:A-II and another one contains only Apo A-I and is denominated LpA-I. AIM: To measure the concentrations of these particles in patients with stable coronary artery disease. PATIENTS AND METHODS: Serum lipids, A-I and B apolipoproteins, LpA-I, LpA-I:A-II and LpB particles were measured in 73 men aged 33 to 82 years with angiographically documented coronary artery disease (CAD) and 33 control subjects aged 39 to 76 years. LpA-I, LpA-I:A-II and LpB were measured by a noncompetitive enzyme linked immunoassay using previously characterized monoclonal antibodies against ApoA-I, ApoA-II and apoB. RESULTS: Patients with CAD had significantly higher mean levels of LDL cholesterol than the control group (p = 0.038). The mean concentration of LpA-I particles in patients with CAD was significantly lower (p = 0.031) than in control subjects, while the concentration of LpA-I:A-II particles was significantly higher (p = 0.016). The percentage of coronary stenosis correlated negatively with LpA-I and positively with LpA-I:A-II. The best relative risk (RR) indicator in these patients was LDL-cholesterol. The relative risk increases 2.5 fold when LpA-I falls below the cut-off level. Likewise, the relative risk increases 3-fold when LpA-I:A-II raises over the cut-off level. CONCLUSIONS: Our findings indicate that the quantification of LpA-I and LpA-I:A-II particles might allow a more accurate evaluation of the CAD risk than HDL cholesterol. LpA-I might represent the antiatherogenic fraction of HDL.

[Otoneurologic abnormalities in insulin-dependent diabetes]. / Trastornos otoneurológicos en la diabetes insulinodependiente.

OBJECTIVE: To assess the auditory and vestibular function in patients with diabetes. MATERIAL AND METHODS: We studied and followed for three years, 10 patients (6 females) of 20.6 years of age (SD 5.5 years), with insulindependent diabetes mellitus of 9.5 years (SD 3.7 years). The patients were selected for having peripheral neuropathy without prolipherative retinopathy and otologic disease or individual factors which could cause neurootologic symptoms. Their glomerular filtration rate and renal plasma flow were 150 mL/min (SD 50) and 543 mL/min (SD 113). RESULTS: Initially all patients had normal audiologic responses, including auditory brainstem responses, but had abnormally and simetrically diminished horizontal vestibulo-ocular responses. A year later one patient had vertigo and asymmetric vestibulo-ocular responses. In the third year, another patient showed similar abnormalities and a third one showed sensorineural hearing loss. CONCLUSION: Our results suggest that patients with insulindependent diabetes mellitus may suffer neuro-otological deterioration.

[Percutaneous mitral valvuloplasty and open mitral commissurotomy: comparison of 2 techniques in immediate results]. / Valvuloplastía mitral percutánea y comisurotomía mitral abierta: comparación de las dos técnicas en los resultados inmediatos.

The aim of this study was to assess the real usefulness of percutaneous mitral balloon valvuloplasty (PMV). Eighty patients aged less than 56 years old, with symptomatic pure mitral stenosis, with an hemodynamic and echocardiographic area < 1.5 cm2, without associated valvular or coronary lesions and without surgical contraindications were studied. These were randomized in two groups of similar age, sex, symptomatology, cardiac rhythm, severity of stenosis and valve anatomy, that were subjected to PMV (n = 38) using a double balloon technique or to mitral commissurotomy (n = 42) with extracorporeal circulation (MC). Mitral areas (calculated using modified Gorlin's formula) increased in 1.15 +/- 0.28 and 1.72 +/- 0.34 cm2 in patients subjected to PMV and MC respectively. No patient died, there was one technical failure with PMV and two patients subjected to MC had a surgical wound infection. Mitral regurgitation increased in more than one degree in two patients treated with PMV (5%) and in 6 patients treated with MC (15%). It is concluded that PMV and MC are highly effective and safe procedures for the treatment of mitral stenosis. Mitral areas obtained with MC are higher than with PMV, however a significant improvement of the disease is achieved with both procedures and MC produces mitral regurgitation with a higher frequency.

[Percutaneous mitral valvuloplasty: immediate and late results in 300 patients]. / Valvuloplastía mitral percutánea: resultados inmediatos y tardíos en 300 pacientes.

Between December 1987 and July 1992, we performed a balloon mitral valvuloplasty to 300 patients aged 48 +/- 23 years, with pure or predominant, symptomatic mitral stenosis, with an hemodynamic area < 1.5 cm2 and a mean echocardiographic score of 8.8 +/- 1.3 (6-13). Young subjects with mobile and flexible valves as well as elders with highly damaged valves were included. A transeptal technique employing 2 balloons was used in 97% of cases. There were 3 failures and 9 deficient results. In 284 patients, the procedure was considered successful with a mean increase in mitral area (measured using modified Gorlin's formula) from 0.88 +/- 0.13 to 2.19 +/- 0.38 cm2. Four patients died two due to a left ventricular traumatism, one due to an irreversible low cardiac output and one due to a massive systemic embolism. In five, a cardiac tamponade was treated with pericardiocentesis or surgery. One hundred patients were followed for a mean of 40 +/- 3 months. Mitral areas remained over 1.5 cm2 in 87% and 14 had a significant reestenosis. The latter had an initial echocardiographic score over 8 or previous surgical commissurotomy. Multifactorial analysis identified valvular motility and global echocardiographic scores as predictors of immediate success. Likewise, the last parameter and subvalvular thickening were predictors of late reestenosis and of increase in mitral regurgitation post valvuloplasty. According to our experience, percutaneous balloon mitral valvuloplasty is a first choice therapeutic alternative in patients with mitral stenosis.

[Fatigue resistance of inspiratory muscles in patients with severe mitral valve stenosis]. / Resistencia a la fatiga de los músculos inspiratorios en pacientes con estenosis mitral severa.

The strength and endurance of the inspiratory muscles was assessed in 14 patients with severe mitral valve stenosis uncomplicated by other diseases. Strength was evaluated measuring the maximal static inspiratory pressure (MIP). Endurance was measured using a two minute weight incremental test, to obtain the maximal sustainable pressure (SIP), which is the highest pressure that a subject can generate to mobilize air with incremental weight during inspiration. MIP was similar to that of 8 normal subjects (110 +/- 21 and 128 +/- 27 cm H2O respectively p = NS). SIP, maximal sustainable weight and SIP as percentage of MIP were 47 +/- 10 cm H2O, 261 +/- 81 g and 43 +/- 6% respectively, all lower than in normal subjects (89 +/- 25 cm H2O, 525 +/- 167 g and 71 +/- 15% respectively) We conclude that patients with severe mitral valve stenosis have decreased inspiratory muscle endurance compared to normal subjects and this feature may be related to their decreased exercise tolerance.

[Percutaneous aortic valvuloplasty in the adult: immediate results and follow-up of 43 patients]. / Valvuloplastía aórtica percutánea en el adulto: resultados inmediatos y seguimiento en 43 pacientes.

From June 1986 to June 1991, percutaneous balloon valvuloplasty was performed in 43 patients with severe symptomatic aortic stenosis. Their age ranged from 52 to 81 years (mean 69). The retrograde approach was used in 34 and the transseptal technique in the remaining 9. One patient died from severe tamponade, another developed a large cerebral infarct and the procedure failed in a third. The procedure was considered successful in the remaining 36 patients. Cardiac output increased from 3.5 +/- 0.6 to 4.7 +/- 0.7 l/min, (p < 0.01) and aortic valve area from 0.53 +/- 0.21 to 0.97 +/- 0.2 cm2 (p < 0.01). After a follow up period of 24 +/- 9 months 3 patients, all with initially poor results, died. 10 of 19 patients with adequate initial results experimented a deterioration of functional class. The other 9 patients have preserved the initial improvement obtained with dilatation. Thus percutaneous aortic valve dilatation in adults with severe aortic stenosis is risky and of limited clinical value.

[Percutaneous mitral valvuloplasty during pregnancy]. / Valvuloplastia mitral percutánea durante el embarazo.

The mitral valve stenosis is the most frequently valvuloplasty in pregnant patients. When it carries a significant risk of mortality for both mother and fetus, it can be performed a surgical commissurotomy, with a high risk for the fetus. We report our experience in percutaneous mitral valvuloplasty (PMV) in 3 patients during the third trimester of pregnancy with severe mitral stenosis. In this cases, we performed PMV in NYHA (New York Heart Association) CF III patients refractory to medical treatment. We used the transseptal double balloon technique protecting the abdominal wall using a lead apron. The mitral areas increased from 1 to 2 cm2, without a significant development of mitral regurgitation. In all cases, the infants delivered at term without complications and with normal weight. The PMV arise like an ideal intervention for the treatment of mitral stenosis during pregnancy.

[Percutaneous mitral valvuloplasty as a treatment of choice for mitral stenosis. Immediate results and long-term follow-up]. / Valvuloplastía mitral percutánea como tratamiento de elección de la estenosis mitral. Resultados inmediatos y seguimiento alejado.

We evaluated 77 patients with symptomatic mitral stenosis for balloon valvuloplasty. Five patients were excluded from the procedure due to the presence of intra-atrial thrombi or mitral valve endocarditis as detected by 2D echocardiography. The mean age of the 72 treated patients was 38 +/- 11 years, 68 were NYHA functional class II or IV: only 6 patients had valvular calcification. Three patients had severe liver failure, 2 were chronic alcoholics, one had liver cirrhosis, 2 had severe weight loss and 13 had pulmonary hypertension at systemic levels. 69 patients had a technically adequate procedure, one patient died, 1 developed cardiac tamponade and 1 failed. Mitral valve area increased from 0.93 +/- 0.34 to 2.38 +/- 0.67 cm2. Mitral incompetence increased in only 16 patients. After a mean follow up period of 15 +/- 5 months (range 8 to 27), 56 patients remained in FC I or II. Mitral valve area remained satisfactory in 54 patients. Mitral valve anatomy evaluated by echocardiography is helpful to predict immediate and late outcome. We conclude that balloon mitral valvuloplasty is the first choice for patients with severe symptomatic mitral stenosis.

Evaluacion del compromiso del esfinter anal interno mediante la medicion de la intensidad u duracion del reflejo ano-rectal inhibitorio / Evaluation of the involvement of the anal internal sphincter by the measurement of the amplitude and duration of the ano-rectal inhibitory reflex

El propósito del presente trabajo fue el de evaluar una posible correlación entre el tono de reposo del canla anal (TR) y la amplitud y duración del reflejo ano rectal inhibitorio (RARI). Fueron estudiados 94 pacientes, 72 mujeres y 22 hombres (9-91 años X = 53). A todos se les realizó exámen manométrico con sistema de tres balones y se determinó la tensión de reposo del canal anal, así como la amplitud y duración del RARI. Los presentes fueron divididos en tres grupos de acuerdo a la tensión de reposo del canal anal. GRUPO I: TR: hasta 79 mmHg. GRUPO II: tr: 80 A 120 MMhG. GRUPO III: TR mayor de 121 mmHg. La amplitud del RARI fue: para el GRUPO I: X = 7,09 DS; 4,93 para el GRUPO II 10,5 DS; 7,3 para el GRUPO III X - 15,14 DS; 8.19. Entre GRUPOS I y III p < 0,001. La duración (d/s) del RARI fue para el GRUPO I: X : 180 DS: 70,1 GRUPO II: X : 175.6 DS: 68 GRUPO III X: 201;6 DS: 86,4. No fueron encontradas diferencias entre los GRUPOS I y II (p<13), I y III (p < 0,17), II y III (p < 0,33). Fue encontrada una positiva correlación de Sperman (p < 0,001) entre TR y la amplitud del RARI. La observación de una correlación positiva entre TR y la amplitud del RARI, sugiere que la integridad funcional del esfinter interno puede ser también evaluada considerando la amplitud pero no la duración del RARI

Evaluacion del compromiso del esfinter anal interno mediante la medicion de la intensidad u duracion del reflejo ano-rectal inhibitorio / Evaluation of the involvement of the anal internal sphincter by the measurement of the amplitude and duration of the ano-rectal inhibitory reflex

El propósito del presente trabajo fue el de evaluar una posible correlación entre el tono de reposo del canla anal (TR) y la amplitud y duración del reflejo ano rectal inhibitorio (RARI). Fueron estudiados 94 pacientes, 72 mujeres y 22 hombres (9-91 años X = 53). A todos se les realizó exámen manométrico con sistema de tres balones y se determinó la tensión de reposo del canal anal, así como la amplitud y duración del RARI. Los presentes fueron divididos en tres grupos de acuerdo a la tensión de reposo del canal anal. GRUPO I: TR: hasta 79 mmHg. GRUPO II: tr: 80 A 120 MMhG. GRUPO III: TR mayor de 121 mmHg. La amplitud del RARI fue: para el GRUPO I: X = 7,09 DS; 4,93 para el GRUPO II 10,5 DS; 7,3 para el GRUPO III X - 15,14 DS; 8.19. Entre GRUPOS I y III p < 0,001. La duración (d/s) del RARI fue para el GRUPO I: X : 180 DS: 70,1 GRUPO II: X : 175.6 DS: 68 GRUPO III X: 201;6 DS: 86,4. No fueron encontradas diferencias entre los GRUPOS I y II (p<13), I y III (p < 0,17), II y III (p < 0,33). Fue encontrada una positiva correlación de Sperman (p < 0,001) entre TR y la amplitud del RARI. La observación de una correlación positiva entre TR y la amplitud del RARI, sugiere que la integridad funcional del esfinter interno puede ser también evaluada considerando la amplitud pero no la duración del RARI (AU)

[Fate of women requesting fallopian tube recanalization]. / Destino de las mujeres que solicitan recanalizar sus trompas de Falopio.

A study of 115 patients, that requested reanastomosis of the Fallopian tubes is presented. Intrauterine pregnancy was achieved in 42 patients 4 ectopic pregnancies were detected.

[Evaluation of the involvement of the internal anal sphincter by the measurement of the amplitude and duration of the ano-rectal inhibitory reflex]. / Evaluación del compromiso del esfinter anal interno mediante la medición de la intensidad y duración del reflejo ano-rectal inhibitorio.

The aim of this study was the evaluation of a possible correlation between the resting tone of the anal canal (RT) and amplitude and duration of the recto anal inhibitory reflex (RAIR). 94 subjects, 72 women and 22 men, aged 9-91 years (mean 53 years) were studied. Manometric testing was performed on all subjects with a three balloon system. The maximal anal canal resting tone, the amplitude and duration of the RAIR, were measured. According with the RT, subjects were divided on three groups: GROUP I: RT up to 79 mmHg GROUP II: 80 to 120 mmHg and GROUP III: with RT more than 121 mmHg. The amplitude of RAIR was for GROUP I: mean = 7.09 SD:4.93, GROUP II: mean-10.5 SD:7.3, GROUP III: mean 15.14 DS: 8.19. p less than 0.001 between GROUPS I and III. The duration (d/s) of RAIR was for GROUP I: mean = 180 DS:70, GROUP II: 175.6 DS: 68, GROUP III mean: 201.6 DS 86.4. No differences were found between GROUPS I and II (p less than 0.13), I and III (p less than 0.17), and II and III (p less than 0,33). Positive Sperman correlation (p less than 0,001) was found between RT and amplitude of RAIR. The observation of a positive correlation between RT and RAIR amplitude suggest that the functional integrity of the internal sphincter could be also evaluated by the amplitude but not duration of the RAIR.

Evaluación del compromiso del esfinter anal interno mediante la medición de la intensidad y duración del reflejo ano-rectal inhibitorio. / [Evaluation of the involvement of the internal anal sphincter by the measurement of the amplitude and duration of the ano-rectal inhibitory reflex]

The aim of this study was the evaluation of a possible correlation between the resting tone of the anal canal (RT) and amplitude and duration of the recto anal inhibitory reflex (RAIR). 94 subjects, 72 women and 22 men, aged 9-91 years (mean 53 years) were studied. Manometric testing was performed on all subjects with a three balloon system. The maximal anal canal resting tone, the amplitude and duration of the RAIR, were measured. According with the RT, subjects were divided on three groups: GROUP I: RT up to 79 mmHg GROUP II: 80 to 120 mmHg and GROUP III: with RT more than 121 mmHg. The amplitude of RAIR was for GROUP I: mean = 7.09 SD:4.93, GROUP II: mean-10.5 SD:7.3, GROUP III: mean 15.14 DS: 8.19. p less than 0.001 between GROUPS I and III. The duration (d/s) of RAIR was for GROUP I: mean = 180 DS:70, GROUP II: 175.6 DS: 68, GROUP III mean: 201.6 DS 86.4. No differences were found between GROUPS I and II (p less than 0.13), I and III (p less than 0.17), and II and III (p less than 0,33). Positive Sperman correlation (p less than 0,001) was found between RT and amplitude of RAIR. The observation of a positive correlation between RT and RAIR amplitude suggest that the functional integrity of the internal sphincter could be also evaluated by the amplitude but not duration of the RAIR.

[Mitral commisurotomy in extracorporeal circulation: long term follow-up with clinical and hemodynamic control]. / Comisurotomía mitral bajo circulación extracorpórea. Seguimiento alejado con control clínico y hemodinámico.

We reviewed the clinical and hemodynamic findings in 52 patients undergoing open mitral commisurotomy. 85% were female and the mean age was 31 + 9 years. Before operation 21% were in functional class II, 73% in class III and 56% in class IV. Pure mitral stenosis was found in 61% and congestive heart failure in 42%. The mitral valve area was less than 1 cm2 in 61%, the wedge pressure over 25 mmHg in 59% and the pulmonary artery systolic pressure over 50 mmHg in 59%. There was no operative morbidity in 79% of cases. Operative mortality was 2% (1 patient). All survivors were followed for a mean of 40 + 26 months. At the final visit 79% were improved in their functional class and only 13% remained in heart failure. The mitral valve area increased from 0.98 + 0.26 to 1.5 + 0.48 cm2. Pulmonary wedge pressure was under 25 mmHg in 79% and pulmonary artery systolic pressure under 50 mmHg in 73%. We conclude that open mitral commisurotomy offers a low morbidity and mortality and good longterm results for the treatment of mitral stenosis.

[Volume, flow and respiratory muscle strength in mitral stenosis]. / Volumenes, flujos y fuerza muscular respiratoria en estenosis mitral cerrada.

Pulmonary function and respiratory muscle strength was assessed in 20 patients with mitral stenosis uncomplicated by other illness. Pulmonary function was evaluated by spirometry, flow-volume curves, functional residual capacity (FRC) and total lung capacity (TLC). Respiratory muscle strength was evaluated by measurement of maximal static inspiratory and expiratory mouth pressure (PIM, PEM cmH2O) at FRC and TLC respectively. Spirometric, FRC and TLC average values were normal. The maximal expiratory flow rate at 50 and 25% of vital capacity were decreased to 49.5 and 38.3% from predicted values. The values of PIM and PEM in patients (-93 +/- 17; 128 +/- 32 cmH2O, respectively) were similar to those of 12 normal subjects studied at comparable lung volume. Our results were similar to previous reports. There was no evidence of decreased respiratory muscle force, probably because the patients nutritional status and cardiac output were normal.