[Prevalence of HTLV-I antibodies and possible risk factors in Chilean prostitutes]

Aiming to know the prevalence of HTLV-1 infection among high risk groups in Santiago, the antibodies against HTLV-1 were measured in 502 prostitutes coming from north and east Santiago. Antibodies were measured using ELISA and the positive samples were confirmed with an indirect immunofluorescence technique. Four subjects were positive, establishing a HTLV-1 infection prevalence of 0.8%. This number similar to that of other groups of prostitutes from South America and lower than that of prostitutes from Central America, region in which this infection is endemic. The measured prevalence was similar to that of other non promiscuous groups, suggesting that sexual transmission does not play an important role in our population.

[Anesthesia in a case of glucagonoma]

The case of a patient with all manifestations of pancreatic glucagonoma is presented. The real prevalence of this disease is unknown for in many cases there are no clinical manifestations. It is usually an accidental finding during autopsy and it is considered as an infrequent entity. Patients with glucagonomas may have different hydroelectrolytic and metabolic changes causing myocardial dysfunction and thromboembolic alterations. Anesthesia for this type of patients requires a strict control of glycemia, a careful evaluation of the nutritional and hydroelectrolytic state and adequate thromboembolic prophylaxis.

[10 years of nosocomial infections at the Santo Tomás Hospital]

The incidence of nosocomial urinary tract infections (UTI) in the medical services of Santo Tomás Hospital from 1980 to 1985 was 56% in Neurology Section, 73% in cardiology and 74% in nephrology. These percentages declined, with epidemiological surveillance, to 21%, 31% and 53% respectively, for the period between 1986 and 1990. In the surgical services the incidence of nosocomial UTI was 85% in urology and 15% in general surgery, from 1980 to 1985. The incidence remained unchanged in urology (81%) and general surgery (17%) despite epidemiological surveillance, but decreased in neurosurgery (from 55% to 37%) for the period between 1986 and 1990. Between 1985 and 1990, Staphyloccocus aureus was the most frequently isolated bacterium from surgical wounds (34%) and from patients with intravenous catheters (23%). Pseudomonas aeruginosa was the most frequently isolated bacterium in nosocomial UTI (26%) and respiratory tract infections (45%) and in patients with nosocomial septicemia, it was a species of Klebsiella.

[Chylothorax. An infrequent complication in surgical exeresis of the esophagus]

We report a case of massive bilateral chylothorax occurring after surgical resection of the esophagus in a patient with esophageal neoplasm. The surgical approach consisted of a thoracotomy and a cervicostomy. The relevance of this case is based on the low incidence of chylothorax after esophageal surgery. The literature indicates an incidence of about 0.9 to 3%. In our series of 200 patients operated on during the last 10 years we found and incidence of 2%. The patient herein reported presented an immediate postoperative clinical picture of respiratory insufficiency associated with the presence of milky fluid in the pleural drainage. Hematologic and biochemical examination of the pleural fluid confirmed the diagnosis of chylothorax. During the first 24 hours we collected a total volume of 2,500 ml of chyle. The patient was treated with conservative procedures including parenteral nutrition and intravenous reposition of fluids. After 48 hours the total volume of chyle reached 8,500 ml and the patient died.

[Herpes simplex virus and cytomegalovirus in pregnant Chilean university students]

Virus isolation tests were performed on a group of 163 students who received prenatal care at the Student Medical and Dental Service at the University of Chile (Santiago) during the 1st, 2nd, and 3rd trimesters of pregnancy to determine the possible existence of genital herpes infection (isolation from vaginal secretions) or cytomegalovirus infection (isolation from urine). The samples were inoculated on cell cultures and were then studied using immunofluorescence with monoclonal antibodies. The herpes simplex virus (HSV) was detected in the vaginal secretions of 5 pregnant women, only one of whom had herpes lesions; in all these cases, the virus isolated was HSV type 2. Cytomegalovirus was detected in 7 of the pregnant women.

Community- and hospital-acquired respiratory syncytial virus infections in Chile

Nasopharyngeal aspirates were obtained on admission from 614 patients younger than 2 years of age who were hospitalized in a ward for acute respiratory infections from June 1988 through October, 1989, in Santiago, Chile. Patients in two rooms were followed during the cold seasons by sampling aspirates every other day during the child's entire hospital stay. Clinical features were recorded daily. Indirect monoclonal immunofluorescent assay and isolation in HEp-2 were used for respiratory syncytial virus (RSV) diagnosis. The mean RSV detection rate was 39% at the time of admission, ranging from 8% in April, 1989, to 62% in July, 1988. During the cold months 43 of 288 (15%) nosocomial RSV cases were detected. Pneumonia and wheezing bronchitis were the principal diagnoses of both groups admitted, whether they were shedding RSV or not. It is concluded that RSV plays a major role in admissions for acute respiratory infections, as well as in nosocomial infections, in Santiago. Because clinical features do not allow one to differentiate viral from bacterial acute respiratory infections, the importance of rapid viral diagnosis is emphasized.

[Prolonged treatment with acyclovir in recurrent genital herpes. Clinical, virological, and immunological response]

The effect of a prolonged course of oral acyclovir was evaluated in 55 pts with recurrent genital herpes (36 men and 19 women). The pts were voluntarily enrolled after an acute episode, with tissue culture viral isolation. All the pts received an initial course with 200 mg of acyclovir x 5 for 10 days. Then they were randomly assigned to two groups (double-blind), one received 400 mg t.d. for 6 months and the other placebo. Clinical, virological and immunological follow-up included: tissue culture viral isolation, HSV antibody detection, serum Igs levels, T and B cell count, T-cell subsets (OKT3, OKT4, OKT8), C3 and phagocytosis test. The drug was well tolerated with hardly any side effects. Recurrences diminished dramatically in acyclovir treated pts, in contrast with those receiving placebo who did not show modification in viral recurrences. The immunological study was normal in most pts and did not change significantly during the trial.

Buttock herpes. High risk in pregnancy

The occurrence of asymptomatic genital excretion of herpes simplex virus in women with clinical buttock herpes was investigated. Inapparent genital viral infection was detected in 21.9% of the population. A history of buttock herpes should be considered when identifying high-risk pregnant women.

[Characteristics of herpes genitalis in university women]

We analyzed 33 patients with herpes genitalis diagnosed at a student medical outpatient facility. 42% corresponded to a first herpetic infection. The HSV-1 was present in 43% of cases, the HSV-2 in the rest. Recurrence of infection was present in 39.5% of patients, 70% of them due to HSV-2. There was a relatively high rate of asymptomatic couples who were the source of primary herpetic infection.

[Congenital infection due to herpes simplex virus]

Five cases of probably intrauterine herpesvirus infection are discussed. Four of them had clinical evidence of neonatal herpes, which was disseminated in two patients, localized to skin in one case and with SNC compromised in other. Natal or post natal infections were not considered to be possible in these infants due to the presence of symptoms in the first 24 hours of life, which made ascending transcervical or transplacental the most probable route for viral transmission. All cases were treated with a ten days course of intravenous acyclovir during 10 days. There of them had satisfactory evolution and the other two died at 9 days and at 2 months of life.

Interaction of some limbic structures which exert inhibitory effect on corticosterone secretion

The interaction between limbic structures which exert inhibitory influence on corticosterone secretion was investigated in the rat. The following experiments were performed: 1) electrical stimulation at mammillary medial nucleus (MMN) in rats with lesioned anterodrosal thalami nucleus (ADTN) or intermediate tegmental area; 2) electrical stimulation at ADTN in rats with lesioned retrosplenial cortex (RC). Bilateral stimulation at MMN in ADTN or RC-lesioned rats produces an increase in plasma corticosterone concentration. In animals with lesioned RC, values of plasma corticosterone after stimulation at ADTN were higher than before stimulation. Taking into consideration that electrical stimulation of MMN or ADTN in intact rats produces a decrease in plasma corticosterone concentration, these studies demonstrate that MMN and ADTN exert inhibitory influence on corticoadrenal activity only when their projection areas remain intact.

[Phenotypic changes in the mononuclear cells of patients with primary immunodeficiencies]

The study of differentiation antigens of circulating mononuclear cells in 70 patients with primary immunodeficiency (PID) using monoclonal antibodies allowed us to define phenotypic profiles that are characteristic of the different described syndromes. In common variable immunodeficiency we found percentages of lymphocytes within normal ranges, and an altered CD4/CD8 ratio. In sex-linked agammaglobulinemia, absence of B lymphocytes with normal distribution of regulatory populations (CD4/CD8) were found. These results allow us to distinguish two clinically and infectologically similar conditions. In selective IgA deficiency, distribution of lymphocytic populations was normal. In immunodeficiency with hyper IgM, considered up to date as an abnormal maturation of B lymphocytes, we observed a deficiency in cellular immune response, and a phenotypic profile characterized by: decreased number of CD3 cells, inverted CD4/CD8 ratio, and increased CD38 population; this profile being similar to the one that we found in predominantly cellular immunodeficiency. In predominantly cell-mediated immunodeficiency and in those immunodeficiencies associated to other defects (such as: hyper IgE syndrome, Di George syndrome), the most important finding was a significative increase in CD38 population. Although it's not possible to consider on this basis that there is a defect at the thymic level of T-cells maturation, the high levels of circulating CD38 cells were a clear indication of altered cellular immune response in our series of patients. Patients with predominantly cell-mediated immunodeficiency showed the lowest levels of CD4 cells and the corresponding inversion of CD4/CD8 ratio. In Di George syndrome we found a markedly diminished CD8 population that differentiates this entity from the rest of the studied syndromes. In chronic mucocutaneous candidosis distribution of lymphocytic populations was normal, but a significative increase in the percentages of CD11b+ cells was observed. In patients with antibodies deficiency that received substitutive treatment with gammaglobulin we found no variations in lymphocytic populations distribution. In the group of patients with altered cellular immunity treated with thymic hormones, observed phenotypic changes (increase in T-cells population, trend to normalization in CD4/CD8 ratio, and decrease in CD38 population) were transient, and lasted only during the treatment period. We considered that describing these phenotypic profiles is a useful diagnosis tool when evaluating patients with PID, since these profiles are characteristic and very stable.

[Viruses relevant to the mother-child relationship]

Virus that may infect the mother with serous consequences for the child include rubella, cytomegalovirus, herpes simplex, hepatitis B, papilloma and AIDS. They may be transmitted from mother to child before, during or after delivery. Preventive measures include: a) vaccination of females against rubella; b) vaccination and administration of gammaglobulin anti-hepatitis B in newborns from infected mothers and c) cesarean section in pregnant women with genital infection by herpes or papilloma. Early treatment with anti-viral agents may help reduce the intensity of viral infections in the newborn. Thus, several measures must be considered in the prevention and treatment of fetal or neonatal viral infections.

The relationship between the mean arterial blood pressure values obtained with the Peñaz non invasive method and those obtained with the invasive intraarterial

It was investigated the relationship between the mean arterial pressure values obtained through the Peñaz method (non invasive) with those obtained intraarterially (invasive) in patients under balanced general anesthesia with the aim of establishing the influence of the different anesthetic stages upon such relationship. Anesthesia was induced with thiopental and anesthetic maintenance with halothane and intermittent doses of fentanyl and a muscle relaxant. EKG, servo-plethysmograph, central venous and radial artery catheter, were placed in each patient thus obtaining in this manner HR, FAP, CVP and IAP readings. The relationship between finger arterial pressure and intraarterial pressure values was high in the different anesthetic stages. It was concluded that the readings obtained with the Peñaz method are not significantly affected by balanced general anesthesia.

[Maternal genital herpes: virus isolation during the third trimester of pregnancy and at delivery]

We followed 42 pregnant women at high risk for genital herpes infection. Viral isolation was attempted weekly from the 34th week of pregnancy. One or more episodes of herpes infection developed in 74% of women. The virus was isolated in 28% after 34 weeks and in 22% after 37 weeks. A prophylactic cesarean section was performed in the latter group; only one of these women had a positive viral isolation at delivery. The HSV-2 of virus was found in 83% of cases and HSV-1 in 17%.

[Markers of HIV infection in prostitutes: analysis of preventive and risk factors]

We studied 501 prostitutes from the northern and eastern areas of Santiago in november and december, 1987. HIV infection was studied by the HIV antibody and also by HIV antigen. At that time no positive reactors were found. Prostitutes from the northern area were older, of a lower socioeconomic background and less promiscuous, in comparison to prostitutes of the eastern area. However, other disorders of sexual transmission were found in 41% of prostitutes of the northern area and in only 28% of those from the eastern area. This difference may be attributed to the more frequent use of preservative in the latter group.

[Genital herpes infection in Chilean female university students]

This article reports on the prevalence of genital herpes infection in a sample of 635 female university students who were seen at the Gynecology Center of the University of Chile Student Medical Service. Viral isolation of genital secretions yielded 18 students (2.8%) with positive results, of whom 28% were asymptomatic shedders. Of the positive cases, 61% were clinically classified as recurrent and 39% as first episodes of genital herpes. Fluorescent monoclonal antibody typing of the isolated strains revealed that 72% were herpes simplex type 2 and 28% were type 1. The results confirm the importance of type 2 virus in genital herpes infections. They also point to asymptomatic shedders as a potential source of infection, and show the importance of a history of genital herpes in the identification of this population.

Diagnostic yield and endoscopic patterns of laparoscopy in the diagnosis of granulomatous hepatitis

In reviewing 54 cases of granulomatous hepatitis (GH) diagnosed among 2,620 laparoscopies, we have been able to classify the capsular GH changes into five patterns: Macular, exudative, pinpoint, granular and cord-like. The exudative pattern was the most frequent one, and predominated in brucellosis. The granular pattern was most common in tuberculosis. Furthermore, 35 additional cases, in whom a laparoscopic diagnosis of GH was not confirmed by liver biopsy, showed a trend to a final diagnosis consistent with multifocal diseases, whenever laparoscopic pictures were similar to the patterns described herein. We speculate with the limits associated with the use of only a single biopsy sample. We conclude that laparoscopy permits the establishment of a tentative diagnosis of GH, which could provide us with valuable information about the usefulness of obtaining multiple hepatic biopsies.

Plasma corticosterone responses to lesions and stimulations of the limbic thalami nuclei, medial mammillary nucleus and cingulate cortex

The influence of extrahypothalamic limbic structures on adrenocortical activity was investigated in female adult rats. Bilateral lesions on the anteromedial thalami nucleus (AMTN), anteroventral thalami nucleus (AVTN) or the posterior cingulate cortex (PCC) all elicited a significant decrease on plasma corticosterone, while their electrochemical stimulation produced a significant increase with respect to animals with sham lesions or sham stimulation. In contrast, after lesions of the dorsomedial thalami nucleus (DMTN), medial mammillary nucleus (pars lateralis) (MMN) or retrosplenial cortex (RC), values of plasma corticosterone were significantly higher than those found in controls, whereas following their stimulation plasma corticosterone levels were lower than in controls. Bilateral lesions or stimulations of anterior cingulate cortex had no significant effect upon corticosterone secretion. These findings may be interpreted as indicative of the existence of excitatory (AMTN, AVTN, and PCC) and inhibitory (DMTN, MMN and RC) central nervous structures for the control of corticoadrenal secretion besides those already known.

Influence of acetylsalicylic acid on bleeding time and serum thromboxane B2 in diabetes mellitus type I

Basal and two hours after 600 mg acetylsalicylic acid (ASA) bleeding times were measured in 21 type I diabetic patients with retinopathy, 24 type I diabetic patients without retinopathy and 21 normal healthy volunteers. There were no significant differences either in basal or in after ASA bleeding times between these groups, but the percentage increase in bleeding time after ASA was significantly higher than normal in both diabetic groups. No correlation was found between basal--bleeding time and glucose, Hb A1 or lipid profile. TXB2 production by spontaneous blood clotting was drastically reduced by ASA in both diabetic and normal groups. Platelet hyperactivity in diabetes mellitus may be due, at least in part, to a predominance of the proaggregatory effects of TXA2 over the antiaggregatory effects of PGI2.

[Recurrent herpes infections. Viral isolation and serological study]

A virological and serological follow up study was carried out on 17 patients with recurrent herpetic infection; labial (5 cases), genital (10 cases) and buttocks infections (2 cases). The follow up of each patient covered, on the average, a period of four months, with a minimum of four samples per patient taken for viral isolation and serological study, in recurrence as well as in latent periods. Viral isolation was obtained in 59% of the samples taken during recurrence period with active lesions and in 6.4% of the samples taken during asymptomatic periods or latent infections. Results suggest the existence of a direct relationship between the number of samples and the detection of asymptomatic viral excretion, a situation which makes us conclude that the excretion is higher to the one we detected. No modifications in antibody titers were observed as measured with the HAI technique, in asymptomatic and symptomatic periods. The serologic typification showed en 83% concordance between the two methods used, indirect hemagglutination with the estimation of an index II/I value and with inhibition of indirect hemagglutination. The results so obtained indicate that 100% of the labial herpes were type 1; of the genital herpes approximately 40% were type 1 and 60% were type 2. It was interesting to note that all the patients with genital herpes type 1 had less than 30 years of age while on the contrary the majority of the cases with genital herpes type 2 were older than 45 years of age.