[Effective renal plasma flow with I-131-hipuran: evaluation of a method with four extractions]

The aim of this work was to evaluate a method for the estimation of the effective renal plasma flow (ERPF) using sodium 131I-o-hippurate (OIH) by means the bicompartmental analysis of the radioactive concentration of 4 plasma samples, analyzing the error obtained respecting to the multi-sample method and comparing it with those obtained with other simplified methods. We calculated the ERPF from 62 patients using the multi-sample method as standard, the method based in a single sample at 44 minutes p.i., a method based in 2 samples from the first exponential, 4 methods based in 2 samples from the second exponential, one method based in 3 samples and 5 methods based in 4 samples (2 from the first exponential and 2 from the second exponential). Each simplified method was compared to the standard method and their absolute error (AE) and standard estimation error (SEE) were calculated. The method based in the 4 samples withdrawn at 4, 10, 30 and 60 minutes p.i. was the best of them with a correlation factor with the standard equal to 0.997, an EA that ranged from -63 ml/min to 49 ml/min (mean: -4 ml/min) and a SEE of 19.5 ml/min.

[Audit of deaths due to cervical cancer in a health service of Santiago. A preliminary analysis]

BACKGROUND

Despite the epidemiological importance and the surveillance programs to detect cervix uterine cancer in Chile, its mortality continues to be high.

AIM

To perform an audit of all deaths due to cervix uterine cancer, that occurred in a health service of Santiago during 1995.

MATERIAL AND METHODS

The clinical records and pathological studies of 46 women, whose death certificates indicated cervix uterine cancer as the cause of death, were audited.

RESULTS

In six women, the audit revealed that the cause of death was not a cervix uterine cancer, and they were discarded from further analyses. The higher mortality rate (36/100,000) occurred in women over 64 years old, those living in the poorest community and with less Papanicolaou vaginal smears coverage (La Pintana). The evolution prior to diagnosis was registered in only four women and was of less than one year. Most women consulted in advanced stages of the disease and only 48% were subjected to some sort of treatment (surgery, radiotherapy or chemotherapy). Mean survival was 3 years and mean age at death was 55.5 years old. There was a great lack of clinical and epidemiological information. In only 13 women information about previous Pap smears was registered.

CONCLUSIONS

Audit of deaths should be an important component of preventive programs for cervix uterine cancer, and the coverage of Pap smears should be improved.

[Prevalence of anti-hepatitis A in patients with chronic liver disease]

The recent availability of an effective vaccine for preventing hepatitis A has led to the performance of a prevalence study of antibodies versus the hepatitis A virus (HAV) in our patients with chronic liver disease by hepatitis B and C, as a step prior to vaccination. The sera of 425 patients with a mean age of 40 years was studied, with the global antibodies versus HAV being determined (Abbott). The prevalence was to 75.2% varying from 20% at 19 years to 93% in those over the age of 40. The prevalence was not related to sex, previous parenteral history, or drug addiction or infection by hepatitis B or C. Due to previous cost-benefit studies and the high prevalence found, the determination of anti-HAV in patients with chronic viral liver diseases prior to vaccination against HAV is recommended.

Serotypes of Escherichia coli isolated from septicaemic chickens in Galicia (northwest Spain)

The purpose of this study was to establish the serogroups of Escherichia coli that cause avian colibacillosis in Spain. The serogroups of 625 avian E. coli isolated between 1992 and 1993 were determined. The 458 E. coli from chickens with septicaemia belonged to 62 different O serogroups; however, 59% were of one of 18 serogroups (O1, O2, O5, O8, O12, O14, O15, O18, O20, O53, O78, O81, O83, O102, O103, O115, O116 and O132). These 18 serogroups were also determined as an important percentage (29%) of control isolates from faeces of healthy birds. Nevertheless, a significant difference (59% versus 29%; P < 0.001) was observed. Furthermore, the serogroups O12, O14, O18, O53, O78, O81, O102, O115, O116 and O132 were almost exclusively identified among septicaemic E. coli (31% versus 3%; P < 0.001). The high prevalence of O18, O81, O115, O116 and O132 isolates was not expected and may indicate the emergence of five new serogroups associated with avian colibacillosis not yet reported.

[Radionuclide scan with TC-99m-tin colloid in the evaluation of orthopedic implant infections]

We have studied 26 patients (32-77 years old, 16 females) with suspicion of joint arthroplasty infection: 11 total hip replacements, 12 total knee replacements and 3 osteosinthesys. A bone scintigraphy with MDP-99mTc, a scintigraphy with HMPAO-WBC and a scintigraphy with 99mTc-stannous colloid were made in all patients. The final diagnostic was based in joint cultures and clinic and radiologic evolution of the patients. The earliest phase of the bone scintigraphy was positive in 18 patients. The later phase was positive in all them. The WBC was positive in 20 out of 26 patients. The bone marrow scintigraphy showed a congruent pattern with WBC in 18 patients (17 infected and 1 without infection). The other ones (8 patients) showed an incongruent pattern (7 with infection and 1 without it). The results show that the bone marrow scintigraphy with 99mTc-stannous colloid improves the accuracy of the diagnostic of bone prosthesis infection and should be included into the diagnosis protocol of this disease.

[Splenic infarction]

A 53-year-old male suffered splenic infarction etiologically related to atrial fibrillation and non-obstructive hypertrophic cardiomyopathy. The main clinical manifestations were a one-month history of epigastric and left upper quadrant pain, with tenderness to palpation in the later zone. Laboratory tests revealed a slight leucocytosis (14.700) with left shift and a marked increase in LDH concentration (945 IU). Abdominal CAT and arteriography established the diagnosis, Echography proved normal. Patient evolution was satisfactory with conservative medical treatment. We conclude that splenic infarction should be considered in all cases of acute or chronic pain in the left hypochondrium. The diagnosis is established by CAT, arteriography and hepatosplenic gammagraphy. Medical management is initially advocated, surgery being reserved for those cases involving complications or in which diagnosis is not clear. Emphasis is placed on the main etiological, clinical, diagnostic and management characteristics of splenic infarction.

Intramammary immunization with live-attenuated Staphylococcus aureus: microbiological and immunological studies in a mouse mastitis model

Mammary infection was induced in lactating mice by intramammary injection of Staphylococcus aureus. Histopathological analysis revealed infiltration and lesions of varying magnitude that were still apparent 21 days after the challenge. Concomitantly, viable S. aureus was recovered from infected mammary glands. Mice were immunized by the intramammary route with 5 x 10(6) colony forming units of a temperature-sensitive mutant of S. aureus and subsequently received a boosting injection seven days later. On day 14 mice were challenged by the intramammary route with the wild-type strain. Intramammary immunization induced a significant increase in milk IgA (P < 0.05), serum IgG (P < 0.05) and serum IgA (P < 0.05) on the day of the challenge, when compared with non-immunized mice. Immunization decreased significantly (P < 0.01) the number of S. aureus colony forming units recovered 96 h after intramammary challenge. In conclusion, the feasibility of immunizing locally with temperature-sensitive S. aureus to induce immunity in the mouse mammary gland was demonstrated. The mouse model of mastitis is proposed as a useful system for screening temperature-sensitive S. aureus strains to be utilized in the development of a vaccine.

[Surgical risk assessment using multivariate analysis]

INTRODUCTION

Over and above the risk of a disease itself, surgical treatment implies additional risk involving possible temporary or permanent deterioration in a patient's health. Most studies of anesthetic-surgical risk are based on mortality or serious morbidity (severe, permanent deterioration). They may therefore be of limited applicability in hospitals where such outcomes are rare due to the types of patients treated. In order to compare and classify patients as well as improve outcome in such health care settings other parameters must be evaluated.

PATIENTS AND METHODS

Indicators presaging adverse situations related directly to surgery in our postoperative intensive care units involve blood transfusion and perioperative events. By applying multivariate (regression) analysis we can determine the factors that condition these unfavorable situations.

RESULTS

In the setting we studied, the main determinants of unfavorable events after surgery are patient health as shown by ASA classification, duration of operation and type of surgery.

CONCLUSIONS

1) Peripheral surgery in patients in good health is very safe. 2) Easily obtained parameters can be used to obtain a fairly efficient prediction of risk. 3) Single-setting risk studies are easy to carry out and useful for providing information about a specific hospital center.

[A case of Prune Belly Syndrome. Prenatal diagnosis]

Prune Belly Syndrome is a rare and complicated condition affecting the genitourinary organs and abdominal wall, it was named after the aspect of the abdomen after the bladder has been drained. In its fully developed form presents with the triad: megalocyst, abdominal muscle deficiency and cryptorchidism. We present a case of a patient with 22 weeks of gestation with ultrasonographic diagnosis of a large thoracoabdominal cyst. The delivery was by cesarean operation. We analyzed the literature.

[Obstetric analgesia using continuous epidural perfusion of bupivacaine, adrenaline, and fentanyl]

OBJECTIVES

To determine the efficacy and complications of continuous epidural perfusion of bupivacaine, adrenaline and fentanyl in the relief of pain during first and second stage labour during vaginal birth.

PATIENTS AND METHODS

Between January 1990 and March 1993 we used continuous epidural perfusion for control of pain during labor in 1307 women. The solution administered through an epidural catheter and maintained until expulsion was one 10 ml bolus of bupivacaine 0.25% with adrenaline 1:200,000 and fentanyl 25 micrograms followed by continuous perfusion of bupivacaine 0.0625% with adrenaline 1:200,000 and fentanyl 2 micrograms/ml at an infusion rate of 12 ml/h. When analgesia was insufficient, a bolus of local anesthetic was administered or a pudendal block was carried out.

RESULTS

Ninety-two percent of the birthing women reported good analgesic effect during the first stage; for 7% the effect was fair and for 0.55% it was poor. During the second stage 88% reported satisfactory analgesia, and 8% fair or poor. Assessment was not possible for the remaining women, who underwent cesarean sections. Complications were few and easily controllable.

CONCLUSIONS

Maintenance of epidural perfusion with 0.0625% bupivacaine with adrenaline 1:200,000 and fentanyl 2 micrograms/ml provides sufficient analgesia during all stages of childbirth.

[Asymptomatic bacteriuria and pyuria during pregnancy]

BACKGROUND

The presence of pyuria and the role of mixed culture in the diagnosis of asymptomatic bacteriuria in pregnant women have been evaluated

METHODS

One hundred and sixty four pregnant women without any symptomatology have been studied using two cultures of mid-stream urine samples and pyuria quantification. In addition culture of bladder urine has been carried out in 17 of these patients (12 with pure cultures and 5 with mixed cultures).

RESULTS

110 samples were culture negative without pyuria; 7 were pure cultures with pyuria; 19 pure culture without pyuria and the remaining 28 patients yielded mixed culture with or without pyuria in the first culture. Twenty of these 28 mixed cultures were negative in the second culture. A estimated frequency of asymptomatic bacteriuria in pregnancy was 16% and pyuria was only found in 27% of pregnant women with asymptomatic bacteriuria.

CONCLUSION

The pyuria is not a useful marker for the diagnosis of asymptomatic bacteriuria in pregnancy.

[Long-term results of endoscopic sphincterotomy]

A review is made of the results of long-term endoscopic sphincterotomy. We studied 81 endoscopic sphincterotomies performed between 1980 and 1985. The technique performed, its indications and immediate complications were evaluated, along with the follow-up carried out in these patients (minimum 6 years). In view of the results obtained, the patients were classified as asymptomatic or symptomatic. Thus, immediate complications (21.9%) were all minor, with the exception of one case (1.2%) of severe complication due to acute pancreatitis. One death was recorded three days after sphincterotomy, corresponding to an elderly patient with in situ gallbladder as a consequence of biliary sepsis. In turn, 91.4% of the patients followed-up at long term remained asymptomatic. The overall results show the method to be effective, with few either immediate or long-term complications.

[The accidents and complications of laparoscopy. A review of 8,915 cases]

Complications occurring in 8,915 laparoscopies done during 1957-1991 are analyzed. Complications were classified as major or minor, according to the need of surgical intervention for their management, and also in relation to pneumoperitoneum, introduction of the laparoscope, during the examination or after laparoscopy. The total number of major accidents was 54 (0.60%). Half of them as a consequence of the instrumentation or of liver biopsy. There were 442 minor complications (4.96%). Mortality included 10 patients (0.11%) as a sequel of uncontrolled haemorrhage, 5 of them after liver biopsy. The complications of laparoscopy cannot be ignored; as all invasive techniques it may have a risk, even in the most expert hands. Half of the major accidents and of the mortality were due to complications from liver biopsy.

[Syncope as presentation form of pulmonary thromboembolism. Study of 15 cases]

BACKGROUND

To evaluate the prevalence of syncope as a form of presentation of pulmonary thromboembolism (PTE) in the emergency department of a general hospital.

METHODS

All the cases of PTE having gone to the emergency department between May 1983 and July 1989 were collected. A radiography of the thorax, arterial gasometry, an electrocardiogram and a pulmonary perfusion scintigraphy were performed in each patient. Ventilation scintigraphy and/or pulmonary DIVAS were also carried out when necessary.

RESULTS

Of a total of 63 patients, 15 (24%) had a syncope as a primary manifestation. No significant differences were observed in regards to predisposing factors between the syncope group (S) and the non-syncope group (NS) with there being a predominance of women in the S group (p less than 0.05). Furthermore, the S group had a greater prevalence of tachycardia, hypotension, electrocardiographic changes, pleural effusion and perfusion defect greater than 50% in the pulmonary scintigraphy.

CONCLUSIONS

PTE should be discarded in any patient with a clinical picture of syncope with hypotension and tachycardia, especially if female. When PTE is presented as a syncope it is generally a massive embolism.

[Antimicrobial activity of ornidazole and 6 other antibiotics against anaerobic bacteria]

The antimicrobial susceptibility of 235 anaerobic bacterial strains to ornidazole, metronidazole, chloramphenicol, clindamycin, penicillin, cefoxitin and imipenem has been studied using agar-dilution technique. Ornidazole and metronidazole were active against 88.6% and 86% of gram-positive cocci. Overall, 99.1% of Bacteroides group fragilis, and 91.3% of non-fragilis Bacteroides were also sensitive to both drugs. We did not find any Clostridium perfringens resistant strain. Cefoxitin and penicillin showed good activity against all Clostridium perfringens strains, and also against 97.7% and 92.5% of gram-positive cocci. We found one single imipenem resistant strain among gram-positive bacteria. Bacteroides fragilis also showed sensitivity to penicillin (41.5%), cefoxitin (85.7%) and imipenem (97.1%). Clindamycin was active against Clostridium perfringens (90.9%), gram-positive cocci (86.7%) and imipenem (68.6%). Chloramphenicol showed good activity against Clostridium perfringens (100%), gram-positive cocci (95.5%) and Bacteroides spp. (99.4%). Our results showed an overall good activity of all the seven drugs tested against anaerobic gram-positive microorganisms. Of notice, we found a good activity of chloramphenicol, imipenem, metronidazole and ornidazole against Bacteroides spp.

The quality control of tuberculin PPD products from seven Latin American laboratories

The Pan American Health Organization, through its Pan American Zoonoses Center (CEPANZO), distributes the concentrated stock solution of PPD batch RT23 (1 mg ml-1 = 50,000 TU ml-1) to national central laboratories. In the laboratories the stock solution is diluted to 2 TU/0.1 ml and dispensed with the addition of Tween 80 and either chinosol or phenol as preservatives in rubber-stoppered vials for use in the Mantoux test. The expiry date is usually fixed at six months after filling. Samples of nine lots of PPD 2 TU from seven countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Paraguay and Uruguay) were received by CEPANZO for quality control. The biological activity and phenol concentrations of these samples were assayed periodically after storage at 4, 25 or 37 degrees C either unopened or opened and re-used in a manner simulating extreme field conditions of use and storage. The object of the study was to determine the stability of the biological activity as well as the maintenance of sterility of these conditions with a view to assessing the need for stricter requirements for the labelling of tuberculin. The results obtained showed that PPD 2 TU with 0.4-0.5% (w/v) phenol added, and dispensed in vials, was stable in its biological activity and maintained its sterility. Therefore, it seems unnecessary to issue stricter requirements than those currently applied.(ABSTRACT TRUNCATED AT 250 WORDS)