The importance of Bi-Digital O-Ring Test in the treatment of multiple hepatic abscesses: a case history

The Bi-Digital O-Ring Test has been very useful in the identification of bacterial and viral infections, as well as other etiological agents, in difficult clinical cases. Case report of a patient with multiple hepatic abscesses (pylephlebitis induced hepatic abscess is the most difficult abscess to treat), in which the etiological agent was suggested through Bi-Digital O-Ring Test with excellent clinical evolution after modification of previously ineffective multi anti-microbial treatment is presented. 45 years old, female with a history of pain at right hypochondria for 15 days, with jaundice, oscillating fever and shivering. Computerized tomography showed liver with multiples nodules in the parenchyma with additional appendicitis. An appendectomy was performed with drainage of intra abdominal abscesses. Treatment with metronidazol, ceftazidim and amicacine was performed with no improvement while the general condition of the patient was deteriorating progressively in the following 3 weeks. Bi-Digital O-Ring Test was then performed to determine the etiological agent and the drug compatibility test among effective antimicrobial agents. Based on the Bi-Digital O-Ring Test, the main etiological agent was found to be Enterobacter aerogenes. Amongst the three antibiotics that were being used, only metronidazol was effective and the other 2 was cancelled its effect. Based on Bi-Digital O-Ring Test findings two new antibiotics (cefadroxil and imipenen), were added to metronidazol and additional cilantro tablets by Hayashibara, Japan was given, and Selective Drug Uptake Enhancement Method performed, with excellent clinical, laboratory testing and tomography improvement within 10 days. Bi-Digital O-Ring Test suggested the etiological agent, and effective and mutually compatible antibiotics for treating the abscesses which resulted in a good clinical evolution, characterized by relief of fever and reduction of the hepatic abscesses in a short period and followed complete disappearance of hepatic abscess.

Stunning and myocardial contractile autoregulation studied on the isolated isovolumic blood-perfused dog heart

AIM

To study, for the first time, the effects of stunning on homeometric and heterometric autoregulation.

METHODS AND RESULTS

Ischaemia (15 min)/reperfusion (30 min) was induced in the isovolumic blood-perfused dog heart preparation. Heart rate elevations (n = 9) from 60 to 200 beats min-1, in steps of 20 beats min-1, promoted the same inotropic stimulation in control (C) and stunning (S), indicating that ischaemia/reperfusion does not affect the changes in calcium kinetics elicited by the Bowditch effect. Sudden ventricular dilation (VD) (n = 10) evoked an instantaneous increase in developed pressure (Delta1DP) followed by a continuous slow performance increase (Delta2DP) in C and S. Delta1DP (C: 35 +/- 2.2 mmHg; S: 27 +/- 2.1 mmHg; P = 0.002) and Delta2DP (C: 20 +/- 1.6 mmHg; S: 14 +/- 1.3 mmHg; P = 0.002) decreased proportionally, while Delta2/Delta1DP (C: 0.57 +/- 0.13; S: 0.58 +/- 0.14) and slow response time course (T/2) were unchanged (C: 55 +/- 6.6 s; S: 57 +/- 7.7 s) after ischaemia/reperfusion. The reduction of Delta1DP can be understood as a decline of the myofilaments calcium responsiveness, the main pathophysiological effect of stunning. The reason for the weakening of Delta2DP, due to intracellular calcium gain, was not determined but it was supposed that its complete manifestation could be restricted by cyclic adenosine monophosphate (cAMP) myocardial content reduction. As reported by others, Delta2DP depends on myocardial cAMP, and it has been shown that myocardial cAMP is decreased after ischaemia/reperfusion.

CONCLUSIONS

Contractile depression due to stunning has no effect on the inotropic stimulation generated by the Bowditch phenomenon. Immediate and time-dependent enhancements of contraction evoked by sudden VD are proportionally reduced and the slow response time course is unaffected in the stunned myocardium.

Coenzyme Q10 exogenous administration attenuates cold stress cardiac injury

The influence of coenzyme Q10 (CoQ10) in cold stress test (-15 degrees C for 4 hours) cardiac functional impairment was studied in isolated isovolumic heart of control rats (C; n=12) and of placebo (P; n=11) and treated rats (CoQ10; n=10). In addition, electron microscopic evaluation of left ventricular (LV) slices (n=3 in each group) allowed us to analyze the myocardial ultrastructure. Maximal values of developed pressure (DPmax) were similarly decreased in cold stressed animals (C=129+/-3.9 mmHg; P=106+/-6.7 mmHg; CoQ10=91+/-3.9 mmHg); however, volume-induced enhancement of pressure generation (slope of DP volume relations: C=0.248+/-0.0203 mmHg / microl; P=0.2831+/-0.0187 mmHg / microl; CoQ10=0.2387 ( 0.0225 mmHg / microl; p > 0.05), and the duration of systole (C=80+/-1.6 ms; P=78+/-1.3 ms; CoQ10=80+/-2.7 ms) were not altered. Myocardial relaxation, evaluated by the relaxation constant (C=39+/-1.9 ms; P=42+/-3.4 ms; CoQ10=51+/-6.0 ms), as well as resting stress / strain relations were unaffected by cold stress. Myocardial samples showed that pretreatment with CoQ10 attenuates myofibrillar and mitochondrial lesions, and prevents mitochondrial fractional area increase (P: 53.11%>CoQ10: 38.78%=C: 33.87%; p< 0.005) indicating that the exogenous administration of CoQ10 can reduce cold stress myocardial injury.

Cantrell syndrome. Case report of an adult

Cantrell syndrome is characterized by defects that involve the diaphragm, abdominal wall, pericardium, heart, and lower region of the sternum. It is a rare entity, usually diagnosed at birth and accompanied by high mortality due to the complexity and gravity of the anomalies. In this report, we present a 32-year-old male patient, who was diagnosed in infancy but who reached adult age asymptomatic.

[Ultrastructural features of cardiac muscle fibers of albino rats during the pregnancy and puerperal cycle]

PURPOSE

In the present study we evaluated the morphology of left ventricular cardiomyocytes of albino rats during pregnancy and puerperium by means of transmission electron microscopy.

METHODS

Once pregnancy was confirmed, 77 rats were randomly divided in two groups, respectively, gestation (G) and puerperium (P). The animals of the gestation group were divided into four subgroups, according to gestational age: 1st (G-A), 7th (G-B), 14th (G-C) and 21st (G-D) days of pregnancy. The group defined as puerperium was divided into three subgroups: 7th (P-A), 14th (P-B) and 21st (P-C) days of puerperium. In the end of each established period, the animals were sacrificed and fragments of the medium third of the left ventricle were resected and routinely prepared for electron microscopy analysis.

RESULTS

The results obtained with transmission electron microscopy analysis revealed a gradative increase of the cardiomyocytes during pregnancy (increase of myofibrils, which are permeated by numerous mitochondria at the end of gestation). The blood capillary wall showed progressive thinning, with an increase of pynocytotic vesicles in endothelial cells, and intense sarcolemal folding at T-tubule level (capillary tunnels). In the puerperium group, there is a progressive regression in these alterations returning to pre-gestational level at the end of the puerperium cycle. These findings indicate the occurrence of hypertrophy of cardiomyocytes during pregnancy.

CONCLUSION

The findings indicate the occurrence of hypertrophy of cardiomyocytes during pregnancy.

[Histomorphometric study of cardiomyocytes of the left ventricle of pregnant albino rats]

PURPOSE

In the present study we evaluated, by light microscopy, and throughout morphometry, whether hypertrophy of cardiac striated muscular fibers of left ventricular occur in albino rat, during pregnancy.

METHODS

After maiting, 12 nuliparous rats were divided into four groups with three animals for each group. The female rats corresponding to each group were killed at 1st, 7th, 14th and 21st days of pregnancy.

RESULTS

Observation, on light microscopy (H.E) had at one view, did not display any alterations during pregnancy. However, the morphometry revealed that nuclei of cardiomyocytes are augmented in volume at 14th day of pregnancy and statistically significant data show the hypertrophy.

CONCLUSION

The obtained data show the existence of a dinamic and reversible process of ventricular remodelling in consequence of adaptation physiological alterations of the cardiovascular normal pregnancy.

[Development of a milk beverage based on pumpkin flakes]

Vitamin A deficiency is one of the majors public health problems in Brazilian Northeast, and among other causes may be concerned to precocious weaning. Aiming at reducing this problem, a dehydrated product based on powdered milk and pumpkin flakes was developed to act as a carotene source at weaning period. Pumpkin flakes were obtained by drum drying at a 6 atm steam pressure, 0.75 m2 contact surface and 1 rpm, and had their content of carotenoids, beta carotene, centesimal composition molds and yeast and faecal coliforms evaluated. The flakes were added to sugar and whole powdered milk according to FAO/WHO nutritional recommendation to 6-12 months old children and submitted to acceptability test by a 6 judges' panel. The results showed that the drying process had a 7% efficiency score and the flakes composition presented 4.84% moisture; 4.0% protein; 5.5% ash; 1.30% fat; 6.22% fiber; 78.14% carbohydrates; 115.08 micrograms/g total carotenois and 80.64 micrograms/g beta-carotene content. No coliforms were detected and molds and yeast content was 4.0 x 10(2) CFU/g. The powdered formulation properly diluted in water supports 45% of the RDA for children (calories, protein, carbohydrates and lipids) and 100% vitamin A and protein considering a 400 ml/day ingestion.

Anatomical and clinical aspects of the blood supply of the sinoatrial node

BACKGROUND

The recent study of the variations of the origin of the sinoatrial node and on the "arterial network of the perinodal sinusal area" in normal hearts points out the importance of this network.

PURPOSE

Report on a case of patient with syncope of ischemic etiology.

CONCLUSION

In this patient the arterial network did not protect the node from the ischemia caused by the obstruction of the artery of the sinoatrial node.

[Critical control points in the pasteurized milk processing fluxogram]

With the aim of evaluating the microbiological quality of raw and pasteurized milk and confirm the critical control points in a dairy processing industry (Recife-PE, Brazil), 84 samples of milk were collected from four points of the flow-chart considered critical (raw milk storage tank, outlet of the pasteurizer unit, pasteurized milk storage tank and packing filling machine). All samples were evaluated for the presence of mesophilic and psychotrophics microorganisms. The most probable number (MPN) of total and faecal coliforms were determined. Samples of raw and pasteurized milk (collected from the packing filling machine) were also assessed for the presence of Staphylococcus aureus. The preservation temperature of raw and pasteurized milk in the storage tanks and the MPN of total and faecal coliforms present in the water used by the industry were simultaneously evaluated. High counts of mesophilic and psychotrophics microorganisms, total and faecal coliforms and S. aureus were detect in raw milk production and processing. The pasteurization process reduced the microorganisms to acceptable numbers in the Brazilian standards, however, the statistics analysis showed that the number of microorganisms increased significantly (p < 0.01) in the pasteurized milk storage tank, representing an important point of contamination. The probable reason for this findings was the presence of coliforms in 60% samples of water which was used to clean the milk equipment and the inadequate temperatures in the storage tank. Therefore, the results of the microbiological analysis confirm that the milk maintenance temperature in the storage tanks, the pasteurization and the packaging are critical control points in the pasteurized milk processing fluxogram.

Propranolol-like action of amiodarone. An electronmicroscopic study in rats under cold stress

The cold stress leads to increased levels of catecholamines, of their precursors and metabolites, with increased oxygen consumption by the myocardium. Atrial cardiomyocytes of amiodarone-treated rats, previously stressed by cold, showed a marked decrease of the morphological alterations observed in the animals submitted to cold stress without amiodarone protection. Such results indicate, at the subcellular level, that amiodarone could improve cardiac function by a propranolol-like action when there is heart failure, a condition in which there is a high level of catecholamine.

Rhabdomyolysis due to hyperosmolarity leading to acute renal failure

Authors present the case of a 37-year-old man admitted to the emergency room of Universidade Federal de São Paulo-Escola Paulista de Medicina, with hyperosmolar coma, following progressive muscle discomfort and loss of renal function, with further need of dialysis therapy. Initial laboratory evaluation showed marked hyperglycemia, hypernatremia, hyperosmolarity, and high levels of creatinine. In the evolution he presented an elevation of creatino-phosphokinase levels in parallel with increasing levels of urea and creatinine. Urinalyses showed progressive increase in proteinuria and hematuria. A muscle biopsy was performed and confirmed the presence of muscular necrosis. The purpose of this paper is to emphasize hyperosmolarity as a newly described cause of rhabdomyolysis. The authors point out its multifactorial physiopathology and also stress the relatively common occurrence of acute renal failure (ARF) following an episode of rhabdomyolysis, and the poor prognosis that this complication represents.

[Clinical and surgical importance of anatomosurgical segments and subsegments of the organs of the human body]

OBJECTIVE

To emphasize the ubiquity of the anatomicosurgical segments and subsegments and to underscore their clinical and surgical importance, based upon recent advances in morphology, physiology, pathology, internal medicine and surgery.

PURPOSE

To update basic knowledge of the structure and its application in modern medicine and surgery, for more conservative approach to treat diseases of organs in most systems of the body.

METHOD

Comparative study of the anatomico-surgical segments and subsegments already described.

RESULTS

The data show that the concept of anatomicrosurgical segmentation is applicable to practically all organs.

CONCLUSION

The segmentation of the structures of the body from the anatomical and surgical standpoints is another general principle of construction of the human body and of other mammals as well as in vertebrates. Such a new approach to evaluate the vascular and ductal components of each organ opens broader horizons to the treatment of diseases.

[Critical analysis of the clinical and surgical importance of the variations in the origin of the sinoatrial node artery of the human heart]

There are several clinical controversies derived from the discrepancy on the description and relations of the coronary arteries in human hearts of either sex and in different races. OBJECTIVE--To study the clinical and surgical importance of the variations of the origin of the artery of the sinoatrial node in hearts of human individuals. MATERIAL AND METHOD--Normal hearts of cadavers of 100 individuals (31 females and 69 males), belonging to 24 Caucasians (whites) and 36 non-Caucasians (Negroes and Mulattoes), whose age varied ranged from 7 to 80 years, were studied. The coronary arteries were injected with gelatin mixed to a radiopaque substance (Cylatrast) and a red or blue pigment. RESULTS AND CONCLUSIONS--1) The artery of the sinoatrial node was originated more frequently from the right coronary artery (58%) than from the left. 2) When originated from the left coronary artery the artery of the sinoatrial node was more frequently a branch of the circumflex artery (30%) than from the trunk of the artery (12%). 3) No sexual or racial factor influenced the anatomical variations. 4) The most frequent arteries originating the artery of the sinoatrial node were the right anterior medial atrial artery and the left anterior medial atrial artery. 5) No cases of blood supply to the sinoatrial node were found originating neither from other arteries than the coronary arteries nor from both coronary arteries. 6) The distribution of the coronary arteries allows to understand the possible ischemic etiology of the sinusal node syndrome and permits to the surgeon a safe approach to cardiac disease.

Variations of the origin of the artery of the sinoatrial node in normal human hearts

The artery of the sino-atrial node was studied in 100 normal human hearts after injection of each coronary artery with coloured gelatine containing a radiopaque substance. The hearts belonged to 69 males and 31 females, being 64 Caucasians and 36 non-Caucasians (Negroes and Mulattoes) whose age ranged from 7 to 80 years. Since the individuals had committed suicide or were victims of accidents, their hearts, after pathologists' evaluation, were considered normal. The sinoatrial node of the normal human heart is supplied by the right coronary artery more frequently (58% +/- 4.9% of the cases) than by the left (42% +/- 4.9). The right anterior medial atrial artery, originating from the right coronary at the level of the medial third of the right anterior quadrant of the atrial dome, is most frequently (50% +/- 5) responsible for the blood supply of the sinoatrial node. Among the branches of the left coronary artery, the left anterior medial atrial artery, originating at the level of the medial third of the left. anterior quadrant of the atrial cupola, was the most frequent blood supplier (25% +/- 4.3) of the sinoatrial node. The origin of the artery of the sinoatrial node from the proximal portion or trunk of the left coronary artery was less frequent (12% +/- 3.2) than the origin from the circumflex artery (30% +/- 4.5). Neither sex nor race influenced the variations of the origin of the sino-atrial node.

Anatomical terms of Yanomani Indians translated into Portuguese and English

The authors translated into Portuguese and English the basic anatomical terminology used by the Yanomani indians. The knowledge of the names of organs and other parts of the human body and of a few having a clinical meaning should help those interested in the study of and in interaction with the Yanomanis.

The relationship between the papillary muscles and the anatomicosurgical segments of the left ventricle of the human heart

The relationship between the blood supply of the papillary muscles of the left ventricle of 90 adult human Caucasian hearts and the arteries of the cardiac anatomicosurgical segments was studied after arterial injection of Vinyl acetate and partial or total corrosion. The anterior papillary muscle belongs in most cases to the I SV segment whereas the posterior muscle belongs to the III DV segment, the former pertaining to the left coronary a. and the latter to the right a.