RESUMEN
PURPOSE: Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment. METHODS: Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12-24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D. RESULTS: Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism. CONCLUSIONS: Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.
Asunto(s)
Hipocalcemia/etiología , Hipoparatiroidismo/etiología , Complicaciones Posoperatorias/etiología , Tiroidectomía , Calcio/uso terapéutico , Femenino , Humanos , Hipocalcemia/sangre , Hipocalcemia/tratamiento farmacológico , Hipoparatiroidismo/sangre , Hipoparatiroidismo/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/tratamiento farmacológico , Estudios Prospectivos , Factores de Riesgo , Vitamina D/uso terapéuticoRESUMEN
The separation of mixed oligoribonucleotides obtained from enzymatic digestion of soluble RNA into fractions containing mixed oligonucleotides of identical chain length is improved by absence of terminal phosphate. Each fraction may be separated into individual components by ionexchange (Dowex) chromatography. Combination of these two chromatographic procedures yields maximum information on primary structure of the oligonucleotides.
RESUMEN
S-Adenosyl-L-methionine (AdoMet) is a safe and probably effective antidepressant agent in certain forms of clinical depression. This article presents a new hypothesis to account for the mechanism of action of S-adenosylmethionine in such illnesses, based upon the known biochemistry of this compound, and upon current knowledge of clinical and genetic aspects of affective disorders. Giulio Cantoni, S. Harvey Mudd and V. Andreoli postulate that at least some major mood disorders are due to abnormalities affecting the AdoMet-dependent methylation of a substance in the CNS. For convenience and without prejudging the chemical structure of this substance, they call it 'barinine'. The model requires that barinine be subject to AdoMet-dependent methylation and that methylbarinine be subject to metabolic demethylation to regenerate the original barinine. Methylbarinine should be mood elevating, whereas barinine itself should not be. Depression is a result of abnormalities lowering the normal steady-state concentration of methylbarinine, whereas mania results from an abnormal elevation of methylbarinine.
Asunto(s)
Trastornos del Humor/tratamiento farmacológico , S-Adenosilmetionina/uso terapéutico , Encéfalo/metabolismo , Humanos , Modelos Biológicos , Trastornos del Humor/genética , Trastornos del Humor/metabolismo , S-Adenosilmetionina/biosíntesisRESUMEN
The irreversible inactivation of S-adenosylhomocysteine hydrolase purified from hamster and bovine liver by adenosine analogs substituted in the 5' and 2 positions has been investigated in detail. 5'-Cyano-5'-deoxyadenosine inactivates as potently as 9-beta-D-arabinofuranosyladenine (Ara-A). Substitution of the Ara-A at the 2 position by halogens or deleting N at the 3 position decreases its potency. Although weak, 2',3'-dideoxyadenosine can also inactivate the enzyme. The irreversible inactivation of the hydrolase in rat hepatocytes incubated with 2-chloroadenosine or 3-deaza-Ara-A could be demonstrated, concomitant with increases in 35S-labeled S-adenosylhomocysteine and S-adenosylmethionine in the hepatocytes.
Asunto(s)
Hidrolasas/antagonistas & inhibidores , Nucleósidos/farmacología , Adenosina/análogos & derivados , Adenosina/farmacología , Adenosilhomocisteinasa , Animales , Bovinos , Cricetinae , Técnicas In Vitro , Cinética , Hígado/enzimología , Masculino , Ratas , Ratas Endogámicas , Vidarabina/análogos & derivados , Vidarabina/farmacologíaAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Enfermedades del Ano/inmunología , Condiloma Acuminado/inmunología , Terapia Antirretroviral Altamente Activa , Neoplasias del Ano/inmunología , Carcinoma in Situ/inmunología , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Cooperación del PacienteRESUMEN
The carbocyclic analogue of 3-deazaadenosine (3-deaza-C-Ado) has been synthesized and found to have antiviral activity in cell culture against herpes simplex virus type 1, vaccinia virus, and HL-23 C-type virus. It is relatively noncytotoxic at effective antiviral concentrations and is not subject to deamination or phosphorylation. It acts as a competitive inhibitor of S-adenosyl-L-homocysteine hydrolase, is at best a poor substrate, and does not inactivate the enzyme significantly. 3-Deaza-C-Ado may cause a selective inhibition of the methylation of the polynucleotide 5' cap of viral mRNA via higher cellular concentrations of S-adenosyl-L-homocysteine, resulting from the inhibition of S-adenosylhomocysteine hydrolase in infected cells, since increases in the intracellular level of S-adenosylhomocysteine, but no effects on DNA or RNA synthesis, were observed after incubation of these cells with it.
Asunto(s)
Antivirales/síntesis química , Hidrolasas/antagonistas & inhibidores , Ribonucleósidos/síntesis química , Tubercidina/síntesis química , Adenosilhomocisteinasa , Animales , Bovinos , Células Cultivadas , Cromatografía Líquida de Alta Presión/métodos , Cricetinae , Ratas , Tubercidina/farmacologíaRESUMEN
The effects of 3-deaza-adenosine on the cardiovascular system was investigated in normotensive (WKY) and spontaneously hypertensive rate (SHR). This compound (50 mg/kg i.p. 2X) significantly lowers blood pressure in both groups of animals, an effect which lasts for up to 2 h. The hypotensive effect is not affected by ganglion blockade, and appears to be due in part to a direct effect on blood vessels. While the response is similar to that seem with adenosine, it is more long-lasting. The results of this study suggest a potential role for this compound or analogues of its as possible antihypertensive agents.
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Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Ribonucleósidos/farmacología , Tubercidina/farmacología , Animales , Ganglios/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Compuestos de Hexametonio/farmacología , Hipertensión/fisiopatología , Masculino , Ratas , Factores de Tiempo , Vasodilatación/efectos de los fármacosRESUMEN
Epidemiological surveillance for hydatidosis is based on initial determination and follow-up of the infestation rate in man, sheep and dogs. The use of ultrasonography (US) as a screening method has demonstrated its usefulness in detecting asymptomatic human carriers of abdominal hydatidosis. To evaluate the contribution of US to epidemiological surveillance within the framework of disease control programs, we performed 719 US studies in school children from 7 to 13 years of age, in rural areas of Río Negro, Argentina, subjected to canine deparasitization during 1984/1986 and 1997/1998. In the first period, 15/268 (5.6%), while in the second, 5/451 (1.1%) carriers were detected (P < 0.0004). The average diameter of the cysts was 4.71 cm in 1984/1986 and 2.14 in 1997/1998. US as a mass screening method allows evaluation of early changes in human prevalence rates, closely related to infestation rates in sheeps and dogs, thus providing a sensitive indicator of the evaluation of control programs.
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Abdomen , Equinococosis/diagnóstico por imagen , Vigilancia de la Población , Abdomen/parasitología , Adolescente , Animales , Argentina/epidemiología , Niño , Equinococosis/epidemiología , Equinococosis/prevención & control , Echinococcus/aislamiento & purificación , Humanos , Control de Infecciones , Prevalencia , Población Rural , UltrasonografíaRESUMEN
A study was carried out to see if in patients with atherosclerotic lesions of the lower limbs the percentage of abdominal aneurysms is higher than in the general population. One hundred twenty five consecutive patients were studied in two different hospitals and compared with a control group. In the two groups with peripheral vascular diseases the patients had a prevalence of aneurysms of 12%, while in the control group the prevalence was of 3%. All patients were operated on successfully except two of them who are now in follow up with regular ultrasound assessment, one with an aortic aneurysm of 3.2 cm and the other with an aortic diameter of 4 cm and moderate liver failure.
Asunto(s)
Aneurisma de la Aorta Abdominal/complicaciones , Isquemia/complicaciones , Pierna/irrigación sanguínea , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
S-adenosyl-methionine (SAMe) is currently undergoing trials as a possible antidepressant. Because SAMe's mechanism of action is obscure and norepinephrine (NE) is often implicated in affective disorders, we studied the effects of SAMe on this neurotransmitter in volunteers. Plasma NE and 3-methoxy-4-hydroxyphenylglycol (MHPG) in the supine and standing position were studied before and after acute placebo or a single 400 mg dose of SAMe and following seven daily administrations; concomitant measures were heart rate (HR) and blood pressure. Subjects were unable to distinguish acute drug from placebo, and although chronic SAMe administration was open, they reported no behavioral effects. Standing HR and plasma NE were reduced following chronic SAMe. Qualitatively similar changes are obtained following chronic treatment with monoamine oxidase inhibitors (MAOIs). However, unlike MAOIs, chronic SAMe treatment was not associated with changes in plasma MHPG. Exaggerated standing NE is found in depressed patients; SAMe may reduce this abnormal response, providing a clue for its mechanism of action in depression.
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Presión Sanguínea/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Norepinefrina/sangre , S-Adenosilmetionina/farmacología , Adolescente , Adulto , Humanos , Masculino , Metoxihidroxifenilglicol/sangreRESUMEN
Hydatidosis (cystic echinococcosis) constitutes a serious public health problem in the Province of Rio Negro, Argentina. In the present work it was intended to evaluate the prevalence of the canine echinococcosis in rural areas of the Province of Rio Negro and studied the reinfection rate in dogs after treatment with Praziquantel during the period 1980-1997. A total of 496 dogs were studied in 18 canine concentrations in order to establish the initial prevalence rate which was 42.3%. From 1980 onward dogs should have been systematically treated with anthelmintic every 2 months in rural areas and every 6 months in urban areas. We estimated that approximately 65% of dogs were treated. To determine the reinfection rate, 476 dogs (1984) and 598 dogs (1996) were studied after anthelmintic treatment during two sequential time periods (0-45; 46-90 days). In both cases treated animals were compared with untreated dogs. Prevalences were 3.5%, 6.7% and 21.3% in 1984 and 0.8%, 4.0% and 10.0% in 1996. For the purpose of surveillance a total number of 21,444 dogs were studied during 18 years. Prevalence of Echinococcus granulosus decreased significantly in the first year from 42.3% to 6.1%.
Asunto(s)
Enfermedades de los Perros/epidemiología , Equinococosis/veterinaria , Animales , Argentina/epidemiología , Enfermedades de los Perros/parasitología , Perros , Equinococosis/epidemiología , Echinococcus/fisiología , Prevalencia , Recurrencia , Estudios Retrospectivos , Salud RuralRESUMEN
In this work, the impact of a hydatidosis control programme for dogs on the intermediate ovine host was specifically analysed to determine the levels of prevalence achieved and the dynamics of parasite transmission, as well as to evaluate the quality of diagnostic systems in slaughterhouses. A field study was conducted in four slaughterhouses (Valcheta, Los Menucos, Jacobacci, Bariloche) that process animals coming from all the departments within the work area. The control programme for dogs entailed treating dogs with 5 mg/kg praziquantel at 2-month intervals for 20 years. Sample size was determined with a 10% error margin and a 95% significance level. Harvested viscera (liver, lungs, kidneys) were preserved in 5% formaldehyde and sent to the laboratory for diagnostic confirmation of both positive and negative specimens. The 61% initial prevalence dropped to 18.3% at the end of the 10-year period, observed differences proving significant (Chi-square=15.454, P=0.00). There were statistically significant increases in infection prevalence with age (Pearson's Chi-square=133.61, P=0.00). Overall, 37.2% of hydatidosis cases diagnosed in slaughterhouses were considered non-hydatid by histological study. On the other hand, 1.1% of those diagnosed as healthy were found to be infected with hydatidosis. The number of hydatid cysts per animal increased with age: 0.04 in lambs and 1.22 in adults (linear regression equation, -0.0539+0.0127 x age), whereas the average for the whole period was 3.7% in lambs and 20.5% in adults. Viability studies indicated that 63.8% of parasitised animals had viable cysts, out of which 53.3% were fertile. Diagnosis of infection in sheep made by means of an adjusted statistical design and with histological confirmation of the presumptive diagnosis made in slaughterhouses demonstrated the flaws of the official systems for epidemic surveillance of hydatidosis. However, there was no overall significant difference in slaughterhouse and laboratory data.Ro was 0.53 and could imply a decrease in reproductive capacity of the parasite and steady state extinction.
Asunto(s)
Equinococosis/veterinaria , Enfermedades de las Ovejas/transmisión , Mataderos , Animales , Antihelmínticos/uso terapéutico , Argentina/epidemiología , Enfermedades de los Perros/prevención & control , Perros , Equinococosis/prevención & control , Equinococosis/transmisión , Echinococcus , Estudios Longitudinales , Praziquantel/uso terapéutico , Prevalencia , Distribución Aleatoria , Ovinos , Enfermedades de las Ovejas/parasitologíaRESUMEN
Two cases of aorto-bisiliac aneurysms in monocorial twins in their sixties were observed. We report experimental and clinical data from the literature about genetic involvement in the formation of aneurysms, especially when associated with other risk factors. In addition to the genetic factors in the twins we studied, we also found other risk factors, such as hypertension and smoking, which took a long time to affect the patients before the aneurysms were detected.
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Aneurisma/etiología , Aneurisma de la Aorta/etiología , Arteriosclerosis/complicaciones , Enfermedades en Gemelos , Arteria Ilíaca , Aorta Abdominal , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Factores de Riesgo , Fumar/efectos adversosRESUMEN
The basic strategy for development of hydatid struggle programs is in the actuality: Primary Attention of Health. In the present work and in this instance, it's arm a precocious detection system of hydatid disease, fixed in immunologic diagnostic by means of ELISA technical beginning with blood capillary samples, taken in filter paper by teachers and sanitary agents from official services of Rio Negro Province. 177 teachers and 45 sanitary agents were trained, correspondent to 25 schools, 3 lodging schools and 9 Hospitals all of them from rural area. 890 blood samples during the training were obtained. Lastly, the trained personal armed the system and they obtained 728 samples in the beginning of the Program. It hadn't statistical differences in the reactivity of both samples. The serological prevalence found was 1.32%. The activity displayed by teachers and sanitary agents permitted to detect 21 new cases it was the 20% of new cases diagnosed in this area in the period of work. The viability and the importance of the incorporation of non traditional effectors into the Hydatid Control Programs is discussed.
Asunto(s)
Participación de la Comunidad , Equinococosis/diagnóstico , Ensayo de Inmunoadsorción Enzimática , Humanos , Atención Primaria de SaludRESUMEN
Early in 1995 the first case of Hantavirus Pulmonary Syndrome was serologically confirmed in El Bolsón (Province of Río Negro, Argentina), corresponding to the third outbreak reported in Argentina. A total of 26 cases of HPS related to the Andean region of Rio Negro Province, were reported from 1993 to 1996, 17 in El Bolsón, 4 in San Carlos de Bariloche, and 5 in Buenos Aires. The incidence rate was 5.03 x 100,000 with a mortality rate of 51.85 x 100. The occurrence of cases was mainly seasonal, with a significantly greater number in the spring, and the persons affected mainly lived in urban or periurban areas. In four cases, the affected individuals were members of a couple, spouses or live-in contacts. Seven cases were Health workers (physicians, nurses or administrative staff). Twelve cases were related among them, due to an outbreak of 80 days. Two of them did not visit the Andean region. A total of 139 rodents were captured and seven of them, Olygoryzomys longicaudatus, were found to be serologically positive. The possibility of infection by contact with rodents or fecal matter is being analyzed and also hypothesis related with interhuman transmission.
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Brotes de Enfermedades , Síndrome Pulmonar por Hantavirus/epidemiología , Adolescente , Adulto , Anciano , Animales , Argentina/epidemiología , Niño , Reservorios de Enfermedades , Femenino , Síndrome Pulmonar por Hantavirus/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Roedores , Estaciones del AñoRESUMEN
The Authors tested a standard exercise suggested by Laing in 1980 for the screening and the follow-up of patients with atherosclerotic lesions of the arteries of the lower limbs. Were included in this study 44 patients with monolateral symptoms and was studied the asymptomatic limb. The results were compared with the ones obtained by the traditional exercise proposed by Strandness and with the ones of a control group studied with the two tests. The excellent correlation of the data gives us the opportunity to reaffirm the utility of the Laing's standard exercise in the clinical investigation of potentially arteriopathic patients.
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Prueba de Esfuerzo , Claudicación Intermitente/diagnóstico , Pierna/irrigación sanguínea , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The contamination of the operating field by a number of substances including the starch used to lubricate surgical gloves is one of the causes of foreign body granuloma formation. The role of starch is particularly clearly documented in the peritoneal cavity where it may provide the basis of a well defined nosological phenomenon, "starch peritonitis", but it has also been reported in most other anatomical districts. The most logical solution to this problem is to use starch-free surgical gloves prepared using another type of lubricant without the aforesaid drawbacks. This paper analyses international clinical and experimental literature focusing on the damaging effects resulting from the introduction of starch into the peritoneal cavity.
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Guantes Quirúrgicos , Granuloma de Cuerpo Extraño/etiología , Enfermedades Peritoneales/inducido químicamente , Almidón/efectos adversos , Humanos , Adherencias Tisulares/inducido químicamenteRESUMEN
The smooth muscle tumors of the small intestine are particularly interesting for the difficulty and the delay of their diagnosis. This usually happened for the poor and indefinite symptomatology and the problematic exploration of the organ. Starting up from the observation of 7 patients between 1986 and 1989 the Authors critically examined the literature about this problem to value the diagnostic opportunities of the principal clinical exams, suggesting as resolutive investigation, if indicated, the angiographic selective study of the visceral abdominal arteries.
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Neoplasias del Íleon/diagnóstico , Neoplasias del Yeyuno/diagnóstico , Leiomioma/diagnóstico , Leiomiosarcoma/diagnóstico , Músculo Liso , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias del Íleon/patología , Neoplasias del Yeyuno/patología , Leiomioma/patología , Leiomiosarcoma/patología , Masculino , Persona de Mediana EdadRESUMEN
On the basis of a recent case of fundic gastric heterotopia in the gallbladder, the principal, possible embryogenetic hypotheses of the malformation are described and discussed. The possibility that acid secretion of the gastric glands contained in the ectopic fundic mucosa determined part of the symptomatological and clinical picture accompanying signs of lithiasic cholecystopathy is also evaluated.