Low dose of lidocaine: comparison of 15 with 20 mg/ml with dextrose for spinal anesthesia in lithotomy position and ambulatory surgery.

BACKGROUND: Spinal anesthesia with the local anesthetic lidocaine has come under scrutiny because it is associated with transient neurologic symptoms (TNS). Although TNS is not associated with either lidocaine concentration or dose, its incidence has never been examined with very small doses of hyperbaric spinal lidocaine in patients in the lithotomy position. We designed this study prospectively to compare the efficacy of low-dose 15 mg/ml with low-dose 20 mg/ml hyperbaric lidocaine in patients undergoing elective outpatient surgery in the lithotomy position. METHODS: A total of 100 patients were randomized to receive either 30 mg of 15 mg/ml or the same dose of 20 mg/ml hyperbaric lidocaine. Lidocaine density at 37 degrees C is 1.0241 g/ml for the 15 mg/ml and 1.0260 g/ml for the 20 mg/ml solution. Patients were examined for motor block, sensory block, and block duration. Patients were contacted at 24, 48 and 72 h and questioned about their perceptions of pain after the spinal anesthesia with specific questions designed to diagnose TNS. RESULTS: The spread of analgesia was the same with both solutions of lidocaine. Motor block was incomplete in all patients in both groups. TNS were not observed when low doses of both solutions of lidocaine with dextrose were used in these ambulatory patients in the lithotomy position. CONCLUSION: Hyperbaric lidocaine results in rapid recovery from sensory block and motor blockade. It may have advantages for patients in a day-case setting. No patients complained of TNS after discharge.

Selective sensory spinal anaesthesia with hypobaric lidocaine for anorectal surgery.

BACKGROUND: Lidocaine has been used for spinal anaesthesia since 1948, seemingly without causing concern until recently. This study aimed at evaluating the feasibility of performing anorectal surgery in outpatient settings with low hypobaric lidocaine doses. METHODS: Three groups of 50 patients, physical status ASA I-II, undergoing anorectal surgical procedures in a prone jack-knife position, received 3 ml (18 mg), 4 ml (24 mg) or 5 ml (30 mg) of hypobaric 0.6% lidocaine. Sensory and motor blockade, time until first urination, ambulation, complications and the need for analgesics were evaluated. Patients were followed until the third post-operative day. RESULTS: Adequate sensory block was obtained in all patients. Blockade was significantly lower in Group 1. The level at 15 min was L(1) with 3 ml, T(11) with 4 ml and T(10) with 5 ml. Only 24 patients presented a moderate motor block. There was no hypotension, nausea or vomiting, urine retention, transitory neurological symptom or post-dural puncture headache in any patients. There was one case of bradycardia with 4 ml and two cases with 5 ml. CONCLUSIONS: Hypobaric lidocaine predominantly provided a sensory block after injection in the prone jack-knife position. The smallest dose (3 ml=18 mg) provides sufficient analgesia with a lesser dispersion and a shorter duration. The major advantages were haemodynamic stability and a high degree of patient satisfaction.

Hepatopulmonary syndrome: morbidity and survival after liver transplantation.

Hepatopulmonary Syndrome (HPS) is a triad of liver disease, intrapulmonary vascular dilatation (IPVD), and arterial deoxygenation. Orthotopic liver transplantation (OLT) constitutes the only effective treatment; however, adverse outcomes have been reported. The aim of this study was to evaluate the early morbidity and short- and long-term survival after OLT for patients with and without HPS. We studied 59 transplant recipients divided into 2 groups: with HPS (HPS group n = 25) and without HPS (control group, n = 34) before the OLT. IPVD was diagnosed using transthoracic contrast-enhanced echocardiography. Arterial deoxygenation was defined as PA-a,O(2) >or= 15 mm Hg. The HPS and control groups were homogeneous regarding age (P = .36; 43.8 +/- 12.2 vs 46.9 +/- 13.5), gender (P = .47), male/female ratio (68%:32% and 78%:22%, respectively), and severity of liver disease. The PaO(2) was significantly lower (74.9 +/- 12.1 vs 93 +/- 6.4 mm Hg; P < .001) and the PA-a,O(2) was significantly higher in the HPS group (30.3 +/- 10.6 vs 11.0 +/- 7.0; P < .001). The percentage of severe (n = 3) and very severe (n = 1) hypoxemia was 16%. There were no significant differences between HPS and control groups regarding short- (68% vs 77%; P = .27) and long-term survival (60% vs 64%; P = .67) as well as among patients with mild, moderate, severe, or very severe HPS and the control group (P = .53). Also, intensive care unit (ICU) stay (7.0 vs 5.5; P = .41), duration of mechanical ventilation (38.0 vs 27.5; P = .43), reintubation rate (32.0% vs 23.5%; P = .45), and early postoperative complications (P = .72) were not different. In conclusion, there were no significant differences regarding the outcomes of OLT for patients with versus without HPS related to early morbidity or short- and long-term survival.

HFE gene mutations in Brazilian thalassemic patients.

Hereditary hemochromatosis is a disorder of iron metabolism characterized by increased iron intake and progressive storage and is related to mutations in the HFE gene. Interactions between thalassemia and hemochromatosis may further increase iron overload. The ethnic background of the Brazilian population is heterogeneous and studies analyzing the simultaneous presence of HFE and thalassemia-related mutations have not been carried out. The aim of this study was to evaluate the prevalence of the H63D, S65C and C282Y mutations in the HFE gene among 102 individuals with alpha-thalassemia and 168 beta-thalassemia heterozygotes and to compare them with 173 control individuals without hemoglobinopathies. The allelic frequencies found in these three groups were 0.98, 2.38, and 0.29% for the C282Y mutation, 13.72, 13.70, and 9.54% for the H63D mutation, and 0, 0.60, and 0.87% for the S65C mutation, respectively. The chi-square test for multiple independent individuals indicated a significant difference among groups for the C282Y mutation, which was shown to be significant between the beta-thalassemia heterozygote and the control group by the Fisher exact test (P value = 0.009). The higher frequency of inheritance of the C282Y mutation in the HFE gene among beta-thalassemic patients may contribute to worsen the clinical picture of these individuals. In view of the characteristics of the Brazilian population, the present results emphasize the need to screen for HFE mutations in beta-thalassemia carriers.

Influence of host age and sex on the helminth fauna of the yellow-legged gull (Larus michahellis) in Galicia (northwestern Spain).

We studied the influence of host age and sex on the helminth fauna of 324 Larus michahellis captured in different locations in the region of Galicia (northwestern Spain). Gulls were grouped into prefledglings, first-year immature birds, second- and third-year immature birds, and adults. Second-year, third-year, and adult birds were grouped by sex. Thirty-six helminth species were recorded. Total species richness and mean infracommunity species richness were both significantly lower for pre-fledglings than for the other age groups. Prevalence increased significantly with age for Brachylecithum microtesticulatum, probably reflecting changing feeding habits. Likewise, 8 species (Cardiocephaloides longicollis, Microphallus similis, Maritrema gratiosum, Gynaecotyla longiintestinata, Brachylecithum microtesticulatum, Himasthla elongata, Parorchis acanthus, and Renicola sp.) were absent or had very low prevalence in prefledglings. At least 5 of these 8 species are transmitted to gulls through ingestion of molluscs or crustaceans, which suggests that these types of prey are seldom fed to prefledglings. In Gymnophallus deliciosus, G. longiintestinata, and Cosmocephalus obvelatus, mean intensity, and in the latter case prevalence, declined with age, suggesting that protective immunity against these species increase with age. Only G. deliciosus, Microphallus similis, and G. longiintestinata presented significant differences between the sexes.

A scanning electron microscope study of the nematode Spirura dentata (Spiruroidea) with notes on the morphometric variations in a Spanish population of this species.

This work provides a detailed morphological description by optic and scanning electron microscopy of the nematode Spirura dentara (Monnig, 1938), a parasite of Herpestes ichneumon in southern and central Spain, together with an analyses of the morphometric variations within this population. Our findings in adult specimens include some important characters not recorded in previous descriptions, and contradict these in a few details: a) the four denticles arising from the inner wall of the oral opening are double, not simple as reported in the original description, b) four simple denticles are present, each located between the corresponding double denticles and the central protuberance of the pseudolabium, c) lateral crests are present running along the first third of the body in the adult, starting a short distance behind the deirids, and d) the pair of small submedian post-cloacal papillae mentioned in the original description has not been observed. The fourth-stage larva is described for the first time. The relative growth rate (i.e., growth rate with respect to body length) of the reproductive zone was higher in females. In adult males, the growth of the left (longer) spicule was positive, whereas that of the right (shorter) spicule was negative.

Morphometric study by image analysis of Ag-stained nucleoli in thyroids bearing proliferating lesions.

The Ag-NOR staining technique and image analysis were used to evaluate morphological parameters (area, perimeter and axis ratio) in nucleoli from normal thyroids and from thyroids bearing proliferating lesions (carcinomas, adenomas and hyperplasias). Regions with normal appearance located close to adenomatous and carcinomatous regions, in the thyroid of every patient, were also analyzed for comparison with the respective pathological regions and with normal thyroids. Statistical analysis of data for the nucleolar area and perimeter allowed the separation of adenomas and carcinomas from hyperplasias and normal tissue but not the two components in each of these two groups. However, if we look at the numbers, a sequence of increasing nucleolar mean areas in the order: normal, hyperplasia, adenoma and carcinoma may be observed, indicating the sequence of increasing rRNA requirements in these different kinds of cells. The axis ratio that denotes the nucleolar shape (round or oblong) did not show significant differences among tissues, suggesting that shape is not important in the characterization of these pathologies. Differences in nucleolar areas and perimeter between normal and affected regions from each patient were statistically significant for adenomas and carcinomas. When these normal regions were compared with the normal thyroids, significant differences were not obtained in the three evaluated parameters. The observations and their importance for histopathological diagnosis are discussed.

Schistosomiasis mansoni in the municipality of Pedro de Toledo (São Paulo, Brazil) where the Biomphalaria tenagophila is the snail host. I--Prevalence in human population.

Due to the scarce information about the epidemiological features of schistosomiasis in which the vector is Biomphalaria tenagophila, an investigation was carried in Pedro de Toledo in 1980 where such peculiarity is observed. Stool examinations (Kato-Katz method) were performed in 4,741 individuals (22.8% positive to Schistosoma mansoni eggs) of this 583 had previously received chemotherapy and 4,158 remainders, untreated. The schistosomiasis prevalence in those two groups where respectively 31.7% and 21.6%. Epidemiological investigation showed that 83.6% were autochthonous cases from the studied area: the autochthonous prevalence rate, and the intensity of infection in the untreated autochthonous cases were higher in males than in females; the intensity in the latter untreated group was low, 58.5 eggs/g feces (geometric mean). Moreover, according to the age groups the intensity of infections correlated well (rs = 0.745) with the prevalence rates. Schistosomiasis was verified to occur mostly during the leisure time and by the use of water streams for housework in rural zone. Only 0.4% out of 1,137 snails was positive for S. mansoni cercariae, apparently unchanged from the 1978 study when the human prevalence was 12.0%. The studied area presented differences and similarities in relation to the other Brazilian areas were the main intermediate host is B. glabrata.

[Duration and age range of epilepsy and its correlation with work: prospective ambulatory study in 379 epileptics]. / Duração e faixa etária da epilepsia e suas correlações com trabalho: estudo prospectivo ambulatorial em 379 epilépticos.

This study aims to evaluate, prospectively, the relationship of the active epilepsy length and the work, of the 379 out-patients from Hospital de Base, São José do Rio Preto. Epilepsy length was subdivided into 5 time rates and by age, into 3 age-groups. There was no relationship, not considering the age of patient among the epilepsy length and the work, but young patient (14 at 29 years old) and with recent epilepsy (length of 0 at 5 years) lost more work than the adult and elderly epileptic.

[Epileptic syndromes and seizures and their relationship with work: a prospective ambulatory study in 412 epileptic patients]. / As síndromes e crises epilépticas e suas relações com trabalho: estudo prospectivo ambulatorial de 412 pacientes.

This study aims to evaluate, prospectively, the epileptic syndromes and seizures types upon work based on a sample of 412 out-patients from Hospital de Base, São José do Rio Preto, SP, Brazil. It was observed that the epileptic syndromes were significant in relation to the patients' labor skills (p= 0.001): the idiopathic syndromes showed less prejudiced, while the symptomatic was more. The seizures types also had some influence in relation to the patients' labor skills (p=0.016): the generalized non-convulsive seizures had no involvement; the simple partial and the non-classified had moderately involvement; and the simple partial seizures evolving to complex and tonic-clonic generalized were the seizures which mostly have taken the patients away from work. The seizure severity was also analyzed.

[American cutaneous leishmaniasis in the State of Acre, Brazil]. / Leishmaniose tegumentar americana no Estado do Acre, Brasil.

OBJECTIVE: Present a statistical survey of American Cutaneous Leishmaniasis (ACL) in the State of Acre. METHODS: Data were obtained from the forms of the "Campaign against Leishmaniasis", from January 1992 to December 1997. Descriptive statistical analysis was applied. RESULTS: There were 2.557 registered cases. The highest prevalence was found at the microregion of Brasiléia (231.8 cases/10,000 inhab.). The predominant clinical form was cutaneous (84.05%). The disease occurred mostly among males (71.02%). Half of the cases were among people with 24 years of age or younger. Most cases were people with rural occupations. 83.97% of the cases were diagnosed by clinical examination. The longest period to seek medical treatment was registered in the mesoregion of Juruá Valley (10.37 months) CONCLUSION: The high number of cases suggests that it might be necessary to study the psychosocial implications of the disease and identify factors contributing to the delay in treatment.

Intervening factors in forward flexibility of the trunk in adolescents in sitting and standing position.

AIM: Forward flexibility of the trunk (FFT) is used as an indicator of vertebral function and assessed using the sit-and-reach and fingertip-ground tests. METHODS: FFT was investigated in adolescents and comparisons were made among genders, sitting and standing positions, and low and high speed; 102 males and females (16 to 20 years of age) participated in the study. RESULTS: The position of the body and gender factor had no influence over the flexibility assessment. When executed slowly, the values obtained in the test were significantly lower; 60% of the participants were unable to reach their feet in the slow form and 50% were unable to reach their feet in the fast form. Thus, the assessment of vertebral function in adolescents should not use the ability to reach their feet as a criterion of normality. The fingertip-ground and sit-and-reach tests proved to be equally adequate. Greater height and length of limbs are associated to lower FFT values. Greater height and lower trunk-head height explain the lesser FFT in women; greater length of the lower limbs and lesser arm span explain the results for men. CONCLUSIONS: Reaching the feet in either the standing or sitting position is a criterion that excludes approximately 50% of adolescents from the normality of vertebral function, whereas reaching 12 cm above the ground is achieved by 90% of the population. Therefore, the criteria for assessing FFT in adolescents need to be reviewed.

Cell phenotype evaluation at various sites after skin transplantation and FTY720 plus sirolimus therapy.

Cell phenotype evaluation enables better understanding of the rejection process in experimental transplantation. We studied allograft survival and the mechanisms associated with rejection in a murine model of skin transplantation in the absence of immunosuppression or after FTY720 or sirolimus (SRL) administration for 21 days. Leukocyte phenotype was evaluated in the peripheral blood, spleen, axillary lymph nodes, thymus gland, and skin graft using flow cytometry at 5 days posttransplantation. Treatment with FTY720 plus SRL increased skin allograft survival in association with lymphopenia, reduced CD11b+ and CD3+CD4+ cell percentages in the graft, decreased CD3+CD4+, CD3+CD8+, and CD11b+ cell counts in lymphoid organs, and decreased CD4+CD8+ cell count in the thymus. These results suggest that increased allograft survival in animals treated with FTY720 plus SRL is due to possible impairment of antigen presentation or recognition in the graft and secondary lymphoid organs, and decreased emigration of mature thymocytes to the periphery.

Sirolimus in combination with FTY720: analysis of urinary and serum parameters.

The goal in transplantation is to obtain immunosuppressant combinations that decrease the incidence of acute and chronic rejection but cause fewer side effects. FTY720 is a new immunomodulator that prevents experimental allograft rejection without inhibiting T-cell activation. It is currently under clinical investigation for multiple sclerosis. We investigated whether FTY720 in combination with sirolimus (SRL) could cause renal toxicity in C57BL/6 mice when administered for 21 days. Serum creatinine and 24-hour urinary creatinine concentrations were assessed by enzymatic colorimetric assays. Urinary protein concentration was measured by the Bradford protein assay. Whereas serum creatinine levels were increased in FTY720 + SRL-treated animals, there were no changes in urinary volume, urinary protein levels, serum urea concentration, creatinine clearance, and kidney structure. Our findings suggested that FTY720 monotherapy for multiple sclerosis and other diseases could play an important immunomodulatory role without causing the side effects frequently observed with other transplantation regimens.

A randomised, double-blind comparison of three different volumes of hypobaric intrathecal bupivacaine for orthopaedic surgery.

This study was designed to evaluate different doses of hypobaric 0.15% bupivacaine administered to achieve unilateral orthopaedic surgery under subarachnoid block. Using a randomised, double-blinded protocol, 150 ASA I to II patients scheduled for elective unilateral orthopaedic surgery were allocated to received a subarachnoid block with hypobaric bupivacaine 0.15% 4.5 mg (3 ml) (Group 1), 6.0 mg (4 ml) (Group 2) or 7.5 mg (5 ml) (Group 3). Measurements included cardiovascular and haemodynamic stability, incidence of unilateral anaesthesia, time to recover from motor block, postoperative urinary retention, transitory neurological symptoms and postdural puncture headache. There was a dose-dependent increase in the duration of the block, from 1:55 +/- 00:20 hours (4.5 mg) to 2:15 +/- 00:22 hours (6.0 mg) and 3:15 +/- 00:31 hours (7.5 mg). The sensory block in the operated limb was significantly higher than that in the non-operated limb at all times. The increasing dose resulted in an increase of the motor block score. Seventy percent of patients had unilateral block. It was concluded that the spinal anaesthesia in all groups was suitable for single limb orthopaedic surgery. The smallest dose (4.5 mg) of hypobaric 0.15% bupivacaine resulted in more unilateral blocks, with narrower distribution and shorter duration.

Helminth fauna of the yellow-legged gull Larus cachinnans in Galicia, north-west Spain.

Thirty-six helminth species were found in 324 gulls examined during June 1994 to February 1996 from different localities of Galicia: 25 trematodes (Brachylaima sp., Brachylecithum microtesticulatum, Cardiocephaloides longicollis, Cryptocotyle lingua, Cryptocotyle concavum, Diplostomum spathaceum, Echinostephilla virgula, Galactosomum phalacrocoracis, Gigantobilharzia acotylea, Gymnophallus deliciosus, Gynaecotyla longiintestinata, Himasthla elongata, Himasthla quissetensis, Knipowitschiatrema nicolai, Levinseniella (Levinseniella) propinqua, Maritrema gratiosum, Maritrema linguilla, Microphallus primas, Microphallus similis, Ornithobilharzia canaliculata, Parorchis acanthus, Phagicola minuta, Psilostomum brevicolle, Renicola sp. and Stephanoprora denticulata), four cestodes (Alcataenia micracantha, Microsomacanthus ductilis, Tetrabothrius (Oriana) erostris and Wardium cirrosa), six nematodes (Anisakis simplex, Contracaecum rudolphii, Cosmocephalus obvelatus), Eucoleus contortus, Paracuaria adunca and Tetrameres (Tetrameres) skrjabini) and one acanthocephalan (Arhythmorhynchus longicollis). Tetrabothrius erostris was the most prevalent species (79.6%), followed by C. obvelatus (47.8%), C. lingua (37.4%), G deliciosus (30.9%), G. longiintestinata (22.8%), P. adunca (21.9%), B. microtesticulatum (17.6%), E. contortus (14.5%) and M. similis (9.3%). Microphallus similis was the dominant species, with a Berger-Parker index (BP) of 0.32, followed by T. erostris (BP=0.10). All species presented an aggregated dispersion except G. acotylea and G. phalacrocoracis, which showed a random dispersion. Species that seem to have the greatest predilection for specific sites along the intestine are: C. longicollis and A. micracantha (first third), Brachylaima sp., M. similis and G. longiintestinata (last third) and A. longicollis (second half). Eight species are known to be pathogenic to commercially important fish or molluscan species and several are pathogenic to humans.

Estimation of population profiles of two strains of the fly Megaselia scalaris (Diptera: Phoridae) by bootstrap simulation.

Based on experimental population profiles of strains of the fly Megaselia scalaris (Phoridae), the minimal number of sample profiles was determined that should be repeated by bootstrap simulation process in order to obtain a confident estimation of the mean population profile and present estimations of the standard error as a precise measure of the simulations made. The original data are from experimental populations founded with SR and R4 strains, with three replicates, which were kept for 33 weeks by serial transfer technique in a constant temperature room (25 +/- 1.0 degrees C). The variable used was population size and the model adopted for each profile was a stationary stochastic process. By these simulations, the three experimental population profiles were enlarged so as to determine minimum sample size. After sample size was determined, bootstrap simulations were made in order to calculate confidence intervals and to compare the mean population profiles of these two strains. The results show that with a minimum sample size of 50, stabilization of means begins.

Double-blind comparison of levocabastine nasal spray with sodium cromoglycate nasal spray in the treatment of seasonal allergic rhinitis.

Nasal levocabastine (0.5 mg/mL) was evaluated for efficacy and tolerance against sodium cromoglycate (20 mg/mL) in a 2-week double-blind trial in 27 and 29 patients with seasonal allergic rhinitis. Globally at 2 weeks, the investigators found a 74% response rate in the levocabastine patients versus a 50% response rate in the cromoglycate patients (P less than .10). Sneezing responded better to levocabastine than to cromoglycate according to three efficacy indicators derived from patient diary ratings of symptom severity: sum of severity scores over the total treatment period as a percentage of the theoretical maximum sum of severity scores (median: 19% versus 41%, P = .01); percentage of symptom-free days (median: 46% versus 22%, P less than .07); percentage of days with moderate or severe symptoms (median: 0% versus 29%, P = .004). Further, the percentage of days with moderate or severe runny nose was lower than in cromoglycate patients (median: 0% versus 25%, P = .09). Although no significant differences were found for itchy nose, blocked nose, and ocular symptoms, severities tended to be generally less under levocabastine than under sodium cromoglycate. Adverse experiences were low level and of similar incidence in the two groups. It is concluded that in a q.i.d. schedule, levocabastine nasal spray is more efficacious than sodium cromoglycate in relieving sneezing and that it is equally well tolerated.