Genetic epidemiology of cholesterol cholelithiasis among Chilean Hispanics, Amerindians, and Maoris.

BACKGROUND & AIMS: The etiology of cholesterol gallstones is multifactorial, with interactions of genes and the environment. The hypothesis that aborigine cholesterol lithogenic genes are widely spread among Chileans, a population with a high prevalence of gallstones, was tested. METHODS: Medical history and anthropometric measurements were obtained and abdominal ultrasonography was performed in 182 Mapuche Indians, 225 Maoris of Easter Island, and 1584 Hispanics. Blood groups, DNA, lipids, and glucose were analyzed. The Amerindian Admixture Index and mitochondrial DNA (mtDNA) assessed the ethnicity and degree of racial admixture. RESULTS: Amerindian Admixture Index was 0.8 in Mapuches and 0.4 in Hispanics. All Mapuches, 88% of Hispanics, but none of Maoris had Amerindian mtDNA haplotypes. Age- and sex-adjusted global prevalence of gallstone disease was higher in Mapuches (35%) than in Hispanics (27%) and Maoris (21%). Compared with Hispanics, the youngest group of Mapuches had the greatest corrected risk of gallstones: odds ratios of 6.0 in women and 2.3 in men. In contrast, the gallstone risk in Maoris was lower compared with Hispanics: odds ratios of 0.6 for women and 0.5 for men. CONCLUSIONS: Cholesterol lithogenic genes appear widely spread among Chilean Indians and Hispanics. They could determine the early formation of gallstones and explain the high prevalence of gallbladder diseases among some South American populations.

[Epidemiology and natural history of biliary calculi. Implication for clinical management]. / Epidemiologia e historia natural de la litiasis biliar. Implicancias para el manejo clinico de la enfermedad.

The knowledge of the epidemiology of cholesterol gallstones is mainly descriptive in Chile. Prevalence data has been gathered from several autopsy studies. The prevalence in these studies is similar to the prevalence determined in a cholecystographic study in a sample of the population of Santiago: 51% of women and 17% of men harbor gallstones, or have been cholecystectomized. The risk factors of the disease are well known and include sex, age, obesity, pregnancy, female sex hormones and hypotriglyceridemic drugs, there is scarce data on the natural history of gallstone disease. In this article we review the present knowledge of both the epidemiology and natural history of gallstones. In addition, we present some specific questions related to the potential identification of environmental and genetic risk factors in epidemiological studies. It is stressed that the knowledge of the natural history of gallstone disease is critical for the appropriate rational management of silent gallstones.

Platelet 5-hydroxytryptamine increases with platelet age in dogs.

Thrombocytopenia was induced in mongrel dogs by two mechanisms: immunologically, by intravenous injection of heterologous antiplatelet antibody, and non-immunologically, by circulating the blood through glass beads in anesthetized animals. The platelet content of 5-HT was monitored before and during the recovery of the blood platelet counts. This period is associated with the normalization of the mean platelet survival time and with a progressive increase in the mean age of the circulating platelet population. A continuous increment in platelet 5-HT closely followed the increase in platelet counts in both models of thrombocytopenia, and a strong correlation was found between the platelet age and 5-HT content. These findings support the concept that platelets accumulate 5-HT during their physiological aging process, contradicting the notion that a negative balance in 5-HT content results at the end of their physiological lifespan in circulation. These results are not in conflict with the concept that circulating platelets release and re-uptake 5-HT.

[Gallbladder cancer mortality in Chile and its relation to cholecystectomy rates. An analysis of the last decade]. / Mortalidad por cáncer vesicular en Chile y su relación con las tasas de colecistectomía. Análisis de la última década.

Extrahepatic biliary tract cancer (mainly gallbladder cancer) mortality rates have increased from 7.84 x 100.000 to 9.6 x 100.000 in Chile during the last decade. The most significant risk factor for gallbladder cancer is gallstone disease. However, no apparent changes in the prevalence of gallstone disease has occurred during this period. In contrast, cholecystectomy rates have consistently decreased during the decade. The aim of this study was to correlate extrahepatic biliary tract cancer mortality and cholecystectomy rates of previous years during the last decade in our country. The best correlation coefficient between both variables was obtained when mortality was correlated with cholecystectomy rates two years prior to the mortality rate (r = -0.92). This finding is consistent with the hypothesis that changes in the number of cholecystectomies performed in a specific geographic area would reciprocally change gallbladder cancer mortality rate. It was estimated that increasing cholecystectomies by 12,500 per year would decrease at mortality rate from this cancer by approximately 1.0 x 100.000 two years in Chile.

Breastfeeding pattern and the duration of lactational amenorrhea in urban Chilean women.

The influence of the breastfeeding pattern and several clinical variables upon the duration of postpartum amenorrhea was assessed in a group of healthy women selected for having had a normal pregnancy and delivery and being highly motivated for prolonged breastfeeding on demand. 676 women who were fully nursing at the second month postpartum entered the study. Supplements were administered to 11% and 48% of the infants by the end of the 3rd and 6th month, respectively. The first bleeding was experienced before the end of the sixth month postpartum by 57% of the cases. Supplementation had a strong negative influence while nursing frequency had a significant positive influence upon the length of amenorrhea. Notwithstanding, a frequency of 8+ suckling episodes per 24 h could not maintain amenorrhea in around half of the subjects. Age and parity had a moderate negative influence upon the risk of experiencing the first postpartum bleeding. Maternal weight and ponderal index, infant sex, birth weight and growth rate showed no significant influence upon the length of amenorrhea. In this urban population selected for having the highest motivation and best breastfeeding performance, the association of breastfeeding with amenorrhea was weak in comparison with what has been described for other populations. The risk of experiencing the first bleeding was reduced while fully breastfeeding with a high number of nursing episodes per day and night, particularly in older women with higher parity. But even in such situation 25% and 50% of the women had started to cycle by the end of the fifth and eight postpartum month.

Frequency of gallbladder cancer in Chile, a high-risk area.

We report an autopsy study of gallbladder cancer prevalence in Chile, where the risk of this disease is among the highest reported world-wide. In 14,768 autopsy protocols obtained from 3 university hospitals, 45% of women and 20% of men older than 20 years had gallstone disease (the major known risk factor for gallbladder cancer). The prevalence of gallbladder cancer in Chileans was compared to that found in a Swedish-Czechoslovakian autopsy study previously published. These countries were chosen because of their high frequency of gallstone disease. The comparison was performed by using logistic regression models adjusting for possible differences in the age-sex structure or the true incidence of gallstones in both populations. We found that the most important single risk factor for gallbladder cancer in Chile was gallstone disease, with an estimated effect on the logistic scale meaning that the cancer risk for subjects with gallstones is seven times higher than for those without the disease. Second in importance was the risk for sex, women being 2.8 times higher than for men. The estimated difference in the sex composition and the incidence of gallstones resulted in 17.9% higher odds of cancer in Chile than in Sweden and Czechoslovakia. However, this difference was not significant. This study suggests that the major etiologic factors of gallbladder cancer in Chileans, Swedes and Czechoslovakians are primarily related to gallstone disease.

[Clinical and histological evaluation of 417 cases with the diagnosis of leprosy]. / Evaluación clínica e histológica de 417 casos con el diagnóstico de lepra.

A total of 417 suspected cases of hanseniasis reported in Rio Grande do Sul State, Brazil, between November 1, 1974 and December 31, 1977 are analyzed. New cases diagnosed only on clinical grounds by dermatologists and general practitioner are analyzed separately. All cases are submitted to anatomo-pathological test. Cases clinically diagnosed and cases confirmed by histological and clinical findings demonstrated that differences between the two classifications don't exert a significant influence in any of the granulomatous form cases count. A considerable amount of suspected cases of indeterminated form were eliminated during the study either because they reveal a granulomatous histological structure. These findings reduced the proportion between the indeterminated form and the others.

Leprosy classification for use in control programs.

Some classifications of Leprosy currently in use are reviewed and the difficulties of their application in field work are analysed. While it is recognized the scientific value of these classifications in order to identify precisely the clinical, bacteriological, histological and immunological aspects of the disease, an alternative simplified classification is suggested, to be used in control programmes. In this classification clinical forms that require the same public health action are put together. Thus, clinical forms are reduced to three basic groups. The clinical and laboratory criteria which define each group are presented, as well as the correlation between this simplified classification and the classic one.

Evidence of a specific nidation site in ruminants.

The site of umbilical cord attachment in ruminants indicates the limited segment of the uterus where the blastocyst attachment occurs and could have potential significance for locating presumptive nidation sites. Measurements of the site of cord attachment were made on impala (Aepyceros melampus) and common duiker (Sylvicapra grimmia) at several stages of gestation. Both implant only in the right uterine horn although they ovulate from either ovary. Relative to uterine length, cord attachment in impala is somewhat closer to the cervix than it is in common duiker. As pregnancy advances in common duiker, the relative position of cord attachment becomes closer to the tubal end. This relationship was not seen in impala and may perhaps to be attributed inadequate data. Upon extrapolation of the data from common duiker, a presumptive attachment area is suggested for this species. This region is located at about 41% of the distance from the internal cervical os to the uterotubal junction. Similar cord attachment data could be used in any ruminant species to indicate the existence and location of a specific nidation site.

Perfeccionamiento médico en la comunidad. Presentación de un plan destinado a los médicos de atención primaria de adultos / Improvement of medical services in the comunity. Presentation of a project for physician in primary adult care

Se exponen los propósitos de un plan de perfeccionamiento, destinado a los médicos de atención primaria responsabilizados con los sectores de adultos de los policlínicos que están adoptando progresivamente el modelo de Medicina en la Comunidad. Se identifican tres áreas de perfeccionamiento para el desarrollo del plan: interconsulta docente, cursos continuados y cursos de actualización. Se expone un programa de actividades para cada área de trabajo señalada (AU)