[Radiologic correlation between the lateral pillar classification stages and the presence of femoroacetabular impingement in patients with Legg-Calvé-Perthes disease]. / Correlación radiológica entre los estadios de la clasificación del pilar lateral y la presencia de pinzamiento femoroacetabular en pacientes con enfermedad de Legg-Calvé-Perthes.

BACKGROUND: Lateral pillar classification has proven to be useful for the prognosis and treatment of patients with Legg-Calvé-Perthes disease. Most patients progress to skeletal maturity with some kind of morphologic alteration. Femoroacetabular impingement is a condition that results in early osteoarthrosis. The objective of this study was to determine whether there is a correlation between the initial lateral pillar classification and the presence of final femoroacetabular impingement. MATERIAL AND METHODS: A retrospective review of 61 patients with Legg-Calvé-Perthes disease was conducted (68 hips); they were classified into three groups according to the lateral pillar classification. At the time of skeletal maturity the radiographic presence of femoroacetabular impingement was determined and the correlation between both variables was analyzed. RESULTS: The use of the lateral pillar classification resulted in seven hips considered as type A, 37 as type B, and 24 as type C. Three of the type A hips had radiographic findings of cam femoroacetabular impingement, three of pincer femoroacetabular impingement, and one of mixed femoroacetabular impingement. Among type B hips, radiographic data of cam femorocetabular impingement were found in17, of pincer femoroacetabular impingement in 12, and of mixed femoroacetabular impingement in 10. Twenty-three of the type C hips had radiographic data of cam femoroacetabular impingement, 15 of pincer femoroacetabular impingement, and 15 of mixed femoroacetabular impingement. CONCLUSION: Patients with Legg-Calvé-Perthes disease have a directly proportional relationship between the initial lateral pillar classification and subsequent femoroacetabular impingement.

La mente delirante: psicopatología del delirio / Delusional mind: psychopathology of delusion

Psychopathology studies mental issues in mental illnesses, being a fundamental tool in Psychiatry With the introduction of neuroimaging, neuropsychology and molecular genetics, a new understanding of mental disorders can be reached, provided we furnish them with precise psychopathological concepts; in turn, psychopathology needs to be renewed and re-calibrated to guide and understand the neurobiological investigation. In psychopathology and in psychiatric clinic, delusion has been considered as the "central subject" (Jaspers¹ 1913, Ey² 1958). In this paper we review: a) the conceptual history of delusion, b) predelusional states and delusion diacronism, c) new conceptions regarding language and delusion, and d) new cognitive models.

La Psicopatología estudia lo mental de las enfermedades mentales, y es una herramienta básica de la Psiquiatría. Con la introducción de avances y técnicas de neuroimagen, neuropsicológicas y de genética molecular podremos llegar a una mayor comprensión de los trastornos mentales, y para ello los resultados que arrojan dichas técnicas deben referirse a conceptos psicopatológicos precisos. A su vez la Psicopatología necesita ser actualizada y "recalibrada" periódicamente para así poder guiar e interpretar los estudios neurobiológicos. Si no es así, corre el peligro de ser simplemente un listado de términos usados para el entendimiento entre profesionales y para los manuales diagnósticos. En psicopatología y clínica psiquiátrica el delirio ha sido reiteradamente percibido como "el tema central" (Jaspers¹, Ey². En este trabajo revisamos: a) la historia conceptual del delirio, b) los estados predelirantes y la diacronía del delirio, c) nuevas concepciones sobre lenguaje y delirio, y d) nuevos modelos cognitivos.

Localization of Entamoeba histolytica amebopore in amebic liver abscesses in hamsters.

Amebopore was purified from axenically grown trophozoites of the Entamoeba histolytica strain HM1:IMSS. The purification procedure involved Mono Q anion-exchange chromatography and electroelution. Sequence analysis of the final product revealed that amebopore A was completely pure. Polyclonal antibodies against the purified amebopore were obtained from rabbits, and Western blot studies demonstrated their specificity. Sections of experimental, acute (1, 2, 3, and 4 days), amebic liver abscesses produced in hamsters were stained with the anti-amebopore antibody; in all the analyzed stages, amebopore appeared as a constitutively expressed cytoplasmic molecule in trophozoites. No extracellular or hepatocyte-membrane amebopore was found. This study is the first to trace amebopore in an in vivo model of amebic liver abscesses.

Entamoeba histolytica cysteine protease 2 (EhCP2) modulates leucocyte migration by proteolytic cleavage of chemokines.

Human amoebiasis is a disease produced by infection with the protozoan Entamoeba histolytica currently affecting many millions of people worldwide. Amoebic colitis is the most common clinical manifestation. Host protective immunity involves participation of both humoral and cellular responses. However, the mechanisms involved in immune evasion are not clear and remain under investigation. One of these mechanisms could be associated with the ability of parasite proteases to modulate or interfere with the inflammation process, which is initiated by expression of pro-inflammatory cytokines such as chemokines. To further clarify the potential role of cysteine proteases in modulating chemokine-mediated functions, we have analysed the ability of Entamoeba histolytica cysteine protease 2 (EhCP2) to have an effect on the chemotaxis of leucocytes by chemokine cleavage. We find that EhCP2 is capable of cleaving chemokines CCL2, CCL13 and CXCL8, and the resulting proteolysis products modulate the chemotaxis of leucocytes when compared to that induced by intact chemokine. Thus, the extracellular activity of the cysteine proteases affects chemokine-mediated responses and could be considered as part of the mechanisms used by Entamoeba histolytica to circumvent the host immune responses.

Purification and immunologic characterization of a 30-kDa cysteine proteinase of Entamoeba histolytica.

A 30-kDa cysteine proteinase was purified from extracts of axenically grown trophozoites of Entamoeba histolytica strain HM1:IMSS. The purification procedure involved two consecutive chromatographic steps. Sequence analysis revealed high similarity with histolysin and with other 27-kDa cysteine proteinase. Western-blot analysis using F(ab')2 fragments of a polyclonal antibody raised against the purified enzyme revealed that when the amebic extract was prepared in the absence of proteinase inhibitors there were many positive bands ranging in relative molecular weight from 115 to 12.5 kDa, but when the extract was prepared in the presence of proteinase inhibitors there was only a single 30-kDa positive band. Similar results were obtained with immunoprecipitates. This phenomenon would suggest the formation of multimer aggregates of the 30-kDa cysteine proteinase after partial proteolysis.

Embarazo en la adolescencia como factor de riesgo para la madre y el hijo / Pregnancy in adolescence as risk factor for mother and child

Según distintos trabajos (2,3,4) el embarazo en una mujer adolescente conlleva mayor riesgo tanto de patología propia del embarazo, parto y puerperio, como en el niño durante el primer año de vida. El objetivo de este trabajo es ver si en una comuna precordillerana como es Curacautín se observan estas diferencias en nuestras embarazadas adolescentes con respecto a las no adolescentes. En conclusión, nuestros resultados indican que las embarazadas adolescentes son más enflaquecidas, se enferman más durante el embarazo teniendo más anemia y síntomas de parto prematuro, los recién nacidos son de más bajo peso, presentan más ictericia fisiológicas, patologías dérmicas y retardo del desarrollo psicomotor el primer año de vida. Por lo tanto el embarazo en una adolescente es siempre un factor de riesgo tanto para la madre como para el hijo, ya sea en un área rural como es Curacautín o en áreas urbanas como lo describe la literatura

Role of cysteine proteinases of Entamoeba histolytica on the cytopathogenicity of axenic trophozoites on rat and hamster hepatocytes in vitro.

The role of amebic cysteine proteinase(s) on the in vitro cytotoxic and cytolytic effects of axenic trophozoites of a virulent strain (HM-1) of Entamoeba histolytica has been studied using freshly isolated rat and hamster hepatocytes as target cells. The cytotoxic effect was defined as cell killing without loss of cell structure and the cytolytic effect as cell disintegration. Incubation experiments of axenic trophozoites with rat or hamster liver cells in the presence and absence of bovine serum, of several proteinase inhibitors, and of galactose, galactosamine, and cysteine, at various ameba:liver cell ratios, different temperatures, and for several time periods, suggest that amebic cysteine proteinase is not involved in the cytotoxic effect but is essential for the cytolytic effect. This suggestion is supported by additional observations made with Transwell chambers, which effectively prevent contact between amebas and target cells, and by experiments with a fraction of an extract of lysed amebas that contained most of their cysteine proteinase activity.

Phagocytosis and proteinase activity are not related to pathogenicity of E. histolytica.

To examine the relationship between phagocytosis, proteinase activity and pathogenicity of axenically grown trophozoites of E. histolytica strain HM-1:IMSS four different cultures were used: (1) a culture preserved in our laboratory for over 4 years, which lost its pathogenicity 3 years ago; (2) a culture passaged several times through hamster liver, which lost its pathogenicity recently; (3) a highly virulent culture supplied by another laboratory; and (4) amebas recovered from hamster liver abscesses caused by culture 3. Phagocytosis was measured as erythrophagocytosis. Proteinase activity was determined on azocasein. Pathogenicity was defined as the capacity to cause liver abscesses in hamsters. A negative correlation was found between phagocytic activity and pathogenicity, since amebas unable to cause liver abscesses had the highest phagocytic activity, whereas those recovered from liver abscesses had the lowest phagocytic activity. The percent of phagocytic amebas showed wide variations through a 2-month observation period, with no change in amebic pathogenicity. No correlation was found between the level of proteinase activity and pathogenicity. It is concluded that neither phagocytosis nor proteinase activity is an adequate marker of amebic pathogenicity.

Hallazgos a la ultrasonografía transvaginal en 27 casos comprobados de embarazo ectópico / Findings of the transvaginal ultrasonography in 27 confirmed cases of ectopic pregnancy

Se realiza un estudio prospectivo del aspecto ultrasonográfico transvaginal en 27 pacientes con diagnóstico comprobado de embarazo ectópico. Diez pacientes se intervienen quirúrgicamente de entrada, 13 son tratadas con inyección de metrotexato MTX y 4 con manejo expectante. Durante la evolución es necesario añadir cirugía en 3 casos. Se estableció una importante correlación entre imágenes ultrasonográficas, la clínica, hallazgos quirúrgicos y anatomía patológica. Creemos que la imagen definida como anillo tubario en la ultrasonografía transvaginal USTV es altamente compatible con un embarazo ectópico temprano. Puesto que la detección precoz del embarazo ectópico se asocia a métodos de tratamiento conservador, tales como aspiración tubaria, manejo expectante, inyección local o sistémica de MTX, y todo lo anterior, a mejor pronóstico reproductivo, consideramos a la USTV un procedimiento valioso en el manejo del embarazo ectópico EE, y que debe agregarse a otros métodos ya tradicionales

Ischemia in experimental acute amebic liver abscess in hamsters.

In experimental acute amebic liver abscess, produced in hamsters by the intraportal inoculation of 1 x 10(6) axenic trophozoites of Entamoeba histolytica strain HM-1, we examined the blood perfusion of the lesions 5, 10, 24 and 72 h after injection of the parasites. India ink introduced into the portal circulation filled all liver vessels but was systematically excluded from even the earlier amebic lesions. The absence of serum proteinase inhibitors from the lesions may allow the participation of amebic proteinases in the causation of tissue necrosis.

Phagocytosis and proteinase activity are not related to pathogenicity of Entamoeba histolytica.

To examine the relationship between phagocytosis, proteinase activity and pathogenicity of axenically grown trophozoites of E. histolytica of strain HM-1:IMSS four different cultures were used: 1) a culture preserved in our laboratory for over 4 years, that lost its pathogenicity 3 years ago; 2) a culture passaged several times through hamster liver, that lost its pathogenicity recently; 3) a highly virulent culture supplied by another laboratory; and 4) amebas recovered from hamster liver abscesses caused by the latter culture. Phagocytosis was measured as erythrophagocytosis. Proteinase activity was determined on azocasein. Pathogenicity was defined as the capacity to cause liver abscesses in hamsters. A negative correlation was found between phagocytic activity and pathogenicity, since amebas unable to cause liver abscesses had the highest phagocytic activity whereas those recovered from liver abscesses had the lowest phagocytic activity. The percent of phagocytic amebas increased progressively in all cultures through a 2-month observation period. No correlation was found between the level of proteinase activity and pathogenicity. It is concluded that neither phagocytosis nor proteinase activity are adequate markers of amebic pathogenicity.

Significado del meconio en la colestasia intrahepática del embarazo / Meconium in pregnancy intrahepatic cholestasis

1. Se estudiaron 202 pacientes embarazadas portadoras de colestasia intrahepática del embarazo (CIE) que fueron atendidas en la Unidad de Feto de Alto Riesgo (FAR) de la Maternidad del Hospital del Salvador. Se compararon con un grupo control compuesto por 404 pacientes con embarazo de evolución normal. 2. Las pacientes portadoras de CIE presentaron tres veces más riesgo de tener un recién nacido (RN) de pretérmino con respecto a los controles (p < 0,01), descartando la cesárea como factor confundente. 3. Las pacientes con CIE sin patología asociada no presentaron mayor riesgo que los controles de tener un RN de bajo peso de nacimiento (< 2.500 g) o con Apgar al minuto < 7, a cualquier edad gestacional y vía del parto. 4. El riesgo de presentar meconio fue tres veces mayor en las pacientes portadoras de CIE, y éste aumentó aún más (Odds ratio = 4,87 con p < 0,01) al presentar una patología asociada. 5. Analizando separadamente el grupo de pacientes colestásicas con meconio y comparándolas con el 2.500 g), Apgar < 7 al minuto y extrañámente para parto de pretérmino. 6. Se postula que la presencia de meconio en portadores de CIE sin patología asociada, disponiéndose de monitorización adecuada de embarazo y parto, no se relaciona con mal pronóstico perinatal

[The mechanism of natural resistance in the rat to Entamoeba histolytica]. / Estudios sobre el mecanismo de la resistencia natural de la rata a Entamoeba histolytica.

The data presented in this paper may be summarized as follows: 1) intraportal injection of a virulent strain (HM-1) of Entamoeba histolytica in Wistar rats, of both sexes, gives way to non-progressive microscopic changes, characterized by a rapid leukocytic reaction surrounding the amebas, disappearance of the parasites within 5 hours, and total lack of hepatic damage; 2) leucopenia only modifies the previous description by the fact that there are no leucocytes around the amebas, although these disappear in the same time, showing, at this moment, an early and prominent vacuolar degeneration; 3) hypocomplementaemia shows the same results as leucopenia; 4) fragments and extracts from various tissues from the rat and hamster show variable degrees of interference with the viability of axenic amebas of Entamoeba histolytica conserved in culture; only a minimal part of the interference to be due to the activity of the complement which is present in the tissue extracts.