Platelet‑to‑lymphocyte ratio, neutrophil‑to‑lymphocyte ratio and monocyte‑to‑HDL cholesterol ratio as helpful biomarkers for patients hospitalized for deep vein thrombosis

There is an increased interest for novel biomarkers in order to improve the diagnostic accuracy for deep vein thrombosis (DVT). Moreover, the link between inflammation and venous thromboembolism has attracted increasing research interests. The present study aimed to evaluate the role of the platelet‑to‑lymphocyte ratio (PLR), neutrophil‑to‑lymphocyte ratio (NLR) and monocyte‑to‑high‑density lipoprotein cholesterol ratio (MHR) as biomarkers for acute DVT. For this purpose, 300 consecutive patients who were hospitalized were considered; 33 patients out of the 300 were admitted for acute DVT of the lower limbs. The PLR, NLR and MHR, as well as the acute phase inflammation markers (leukocytes, neutrophils, C‑reactive protein and fibrinogen) were measured. The patients with DVT exhibited significantly higher levels of PLR, NLR and MHR compared to those without DVT (P<0.001). Simple binary linear regression analysis (without confounding factors) between the NLR, PLR and MHR highest quartile and DVT revealed an odds ratio of 3.149 (P=0.01) for PLR, and an odds ratio of 4.191 (P=0.001) for MHR. Following the correction for the main confounding factors, PLR maintained a significant association with DVT (odds ratio, 3.379; P=0.007) and MHR maintained a stronger significant association with DVT (odds ratio, 4.378; P=0.001). It was thus hypothesized that the assessment of PLR and MHR, but not of NLR may help clinicians to improve the laboratory evaluation in elderly hospitalized patients with suspected DVT.

Hyperinsulinemic hypoglycemia in adolescents: case report and systematic review

Background

Hyperinsulinemic hypoglycemia is the most common cause of severe and persistent hypoglycemia in neonates and children. It is a heterogeneous condition with dysregulated insulin secretion, which persists in the presence of low blood glucose levels.

Case presentation

We report a case of a 15 year-old male with hyperinsulinemic hypoglycemia, who underwent a subtotal pancreatectomy after inadequate response to medical therapy. Pathological examination was positive for nesidioblastosis (diffuse β-cell hyperplasia by H-E and immunohistochemical techniques). The patient’s blood glucose levels normalized after surgery and he remains asymptomatic after 1 year of follow-up. The systematic review allowed us to identify 41 adolescents from a total of 205 cases reported in 22 manuscripts, from a total of 454 found in the original search done in PubMed and Lilacs.

Conclusions

Although very well reported in children, hyperinsulinemic hypoglycemia can occur in adolescents or young adults, as it happens in our reported case. These patients can be seen, treated and reported by pediatricians or adult teams either way due to the wide age range used to define adolescence. Most of them do not respond to medical treatment, and subtotal distal pancreatectomy has become the elected procedure with excellent long-term response in the vast majority.

Constraints on tree seedling establishment after fires: passing the germination bottlenecks

Persistence and colonization by tree species in an environment following a fire depends on the effects on seed germination and seedling development. We used seeds of Kielmeyera coriacea and Qualea parviflora as a model to test the effects of high temperatures on germination and initial development of tree seedlings. We exposed the seeds to heat flow (70, 100, 130, 150 or 170 °C) for 2 or 5 min and compared the germination with that of unheated seeds (control). Seedlings were then harvested after 3, 7 or 15 days to evaluate aerial and root mass, root:shoot ratio, presence of cotyledon opening, true leaves, and secondary roots. We found no effect on germination for seeds exposed to temperatures ≥150 °C. However, germination was significantly reduced for seeds exposed to 100 °C for both 2 and 5 min. The mass of 15-day-old K. coriacea seedlings was smaller when seeds were heated at 70 °C for 5 min or at temperatures higher or equal to 100 °C. Qualea parviflora seedlings did not show any difference in mass, but there were marginal differences in the presence of roots and the opening of cotyledons. Kielmeyera coriacea seedlings allocated biomass faster than Q. parviflora. High temperatures affect both quantity and quality of germinable seeds, as well as biomass allocation during initial seedling development. These factors may explain the decrease in seedlings observed after fire, suggesting a bottleneck effect that influences population dynamics and species persistence in systems with frequent fires.

Platelet‑to‑lymphocyte ratio, neutrophil‑to‑lymphocyte ratio and monocyte‑to‑HDL cholesterol ratio as markers of peripheral artery disease in elderly patients

Solid evidence underlines the pivotal role played by inflammation regarding atherosclerosis. Peripheral artery disease (PAD) is one of atherosclerotic cardiovascular diseases (CVDs), it is highly frequently diagnosed in older individuals. In the present study we carried out an investigation on the association between platelet‑to‑lymphocytes ratio (PLR), neutrophil‑to‑lymphocyte ratio (NLR), monocyte‑to‑HDL cholesterol ratio (MHR) with PAD as favourable markers. We identified 300 subjects aged over 70 years, without any concomitant CVDs. The PLR, NLR and MHR were assessed from peripheral venous blood routinely drawn in the ward during hospitalization. Patients were divided in groups according to ankle brachial index (ABI) value (>0.9; 0.9‑0.99; 1‑1.4; >1.4). Higher PLR (P=0.007), NLR (P=0.0001) and MHR (P=0.0001) were associated with <0.9 ABI. Patients with a >1.4 ABI showed NLR values higher compared to >0.9l ABI (P<0.01). Univariate linear regression analysis demonstrated the direct correlation between increase in PLR (P=0.0023)and MHR (P<0.0001) with the decrease in ABI value. In multivariate linear regression analysis including main cardiovascular risk factors we found that PLR, NLR and MHR were independently associated with lower ABI (P=0.0011). Results show and suggest that the elevated PLR, NLR and MHR are related to PAD evaluated with ABI measurement. PLR and MHR seem to be more reliable markers than NLR in PAD. NLR seems to be more related to incompressibility of arterial wall. It is hypothesized that these three indexes may play a role as simple and repetitive markers of PAD.

Fire-induced damage to Qualea multiflora Mart. seeds depends on fruit protection and the position in the tree crown

Although the Cerrado vegetation is adapted to fire, anthropogenic fires may impair the reproduction of some species. This study aimed to test the role of fruits of Qualea multiflora and their position in the tree crown in protecting the seeds during fires. Ten trees were selected in an area protected from fire (NB) and ten in a biannually burned area (B). Fruits were counted before the 2008 fire and weekly thereafter for 5 weeks. Fruit dehiscence, damage and position in the tree crown were recorded. Seed germination was assessed for seeds from both areas. In NB, 5.7% of fruits were located higher than 2 m, while in B 49.5% were located at this height. One week after the fire, the proportion of dehiscent fruits was lower in NB (19.5%) than in B (34.5%). Five weeks after the fire, all fruits in NB had dispersed their seeds, whereas in B only 47% of the fruits had. Immediately before the fire, the germination rate of seeds collected in NB was 80% (0-1 m), 97% (1-2 m) and 92% (≥2 m). Fifteen days after the fire, the germination rate of seeds in the B area was 3% (0-1 m), 13% (1-2 m) and 78% (≥2 m). Protection of Q. multiflora seeds from high temperatures is related to the fruit position in the tree crown rather than to fruit protection. Therefore, the results suggest that fire may alter the recruitment of new individuals.

Microbiological polyphasic approach for soil health evaluation in an Italian polluted site

The use of microorganisms as bioindicators of soil health is quite a new feature, rarely considered for the soil health evaluation in chronically-polluted industrial sites, and still suffering of the bias related to the technique applied. In this work we applied a microbiological polyphasic approach, relying on soil indigenous microorganisms as bioindicators and combining culture-dependent and -independent methods, in order to evaluate soil health of four sites (1a, 1b, 2a and 2b) inside a chemical factory with a centenary activity. Functional as well as structural aspects were comprehensively considered. Results were related to the kind of pollutants found in each site. Heavy metal pollution was recorded in sites 1b and 2b, while both organic and inorganic substances were detected in sites 1a and 2a. Based on the chemical and physical properties of the four soils, site 1b and 2b grouped together, while 1a and 2a were separated from the others. The density of the culturable bacteria was very low in site 2a, where only gram-positive were found. According to the identification of culturable bacteria, site 2a showed the lowest similarity with the other sites. Microbial activity was detected only in sites 1b and 2b. PCR-DGGE (Denaturing Gradient Gel Electrophoresis), was performed on the culturable, total and active microbial communities. Consistently with the identification of culturable bacterial strains, the molecular profile of the culturable fraction of site 2a, was clearly separated from the molecular profiles of other sites in cluster analysis. Molecular fingerprintings of the whole and active bacterial communities differed among the sites, but clustered according to the pollutants present in each site. The presence of possible key species in each site has been discussed according to the whole and active species. Since the results obtained by microbiological analysis are consistent with the chemical data, we suggest that the use of this microbiological polyphasic approach and of microorganisms as intrinsic bioindicators, can be suitable for the evaluation of soil health.

Toxocara infection is not associated with viral or bacterial central nervous system infection in children

BACKGROUND

Helminth infections with larvae that migrate through the tissues have been considered risk factors for CNS infections.

OBJECTIVES

The present work was designed to investigate the prevalence of anti- TOXOCARA antibodies in the serum and/or in the cerebrospinal fluid (CSF) of children with infectious meningitis or meningoencephalitis and of a control group, without meningitis, admitted at the Children's Hospital NS Glória, Vitória, ES, Brazil.

PATIENTS AND METHODS

After adsorption with ASCARIS LUMBRICOIDES antigen, serum and/or cerebrospinal fluid of 381 inpatients (201 with meningitis and 180 without meningitis) were submitted to an ELISA IgG, for anti- TOXOCARA antibodies using secretion/excretion antigens of third stage larvae of T. CANIS.

RESULTS

No significant differences between the meningitis and the control groups were observed in the frequencies of positive tests for anti- TOXOCARA antibodies in the serum or CSF (respectively for the meningitis and control group: 33/103 or 32 % and 52/152 or 34.2 % for the serum, p = 0.821; 48/184 or 26.1 % and 23/121 or 19.0 % for the CSF; p = 0.196.

CONCLUSION

The results demonstrated that TOXOCARA infection, evaluated by detection of anti- TOXOCARA antibodies in serum or CSF, is not associated with viral or bacterial meningitis or meningoencephalitis in children in our country.

Renal cell carcinoma in peritoneal dialysis patients

Renal cell carcinoma is a rare but serious complication in ESRD patients. In these patients the incidence of renal cell carcinoma (RCC) is 20-40 times higher than in the general population. We performed a retrospective study to measure the incidence rate, prevalence, characteristics and survival among our peritoneal dialysis (PD) patients diagnosed with renal cell carcinoma. The study was carried out among 607 patients who were on the PD program from January 1997 to June 2002. RCC was detected in eight patients (four males and four females) with mean age of 52.1 +/- 10.6 years. Among these eight patients four were new cases that were diagnosed before the patients were started on dialysis (three in native kidneys and one in a transplanted kidney). In the other four patients the RCC was diagnosed after they had been on dialysis for 33-204 months (mean 60.75 +/- 50.48). We found an incidence rate of 1.3 per 1000 patients per year and a prevalence of 1.3%. Six of the eight patients had renal cysts. Tumor size was less than 7 cm in seven patients and in the other patient it was 8.5 cm. Seven of eight patients were alive at the time of study with a survival time ranging from 3-138 months (mean 122.25 +/- 88.2) months. In one patient, the RCC metastasised to the scalp, and, in two other patients, the tumors subsequently involved the second kidney. A cardiovascular complication was the cause of one death. Two patients received a renal transplant 36 and 66 months after diagnosis. We conclude that despite the low rate of metastases and mortality in our study, regular ultrasonography should be added to the follow-up of PD patients. Renal transplantation can be considered in these ESRD patients with RCC; however, close follow-up for metastases is recommended.

[Pseudoneoplastic forms of bronchiolitis obliterans with organizing pneumopathy (BOOP)]

Chronic obstructive bronchiolitis with organizing lung disease is an anatomoradioclinical entity characterized by nonspecific inflammation associated with recurrent migratory minimally dense alveolar opacities on the chest x-ray poorly responsive to corticosteroid therapy. Excepting this typical presentation, other clinical forms may occur. We report the cases of two patients with an exceptional localized presentation raising the differential diagnosis of lung cancer.

[Pancreatic neuroendocrine tumors and von Hippel-Lindau disease]

Pancreatic neuroendocrine tumors are rare in von Hippel-Lindau disease, most often asymptomatic, nonfunctioning, non secreting, and benign. We report a case of low grade malignant pancreatic, secreting and asymptomatic neuroendocrine tumors, occurring in a 27 year old woman in the setting von Hippel-Lindau disease with recurrent pheochromocytoma, retinal and medullary hemangioblastomas, paraganglioma of the carotid body and ovarian cystadenoma. Neuroendocrine pancreatic tumors of von Hippel-Lindau disease are often constituted by clear cells, in the contrary of other neuroendocrine tumors of the pancreas. Occurrence of a pancreatic neuroendocrine tumor, especially in association with pheochromocytoma, may be misdiagnosed with a type 2 multiple endocrine neoplasia syndrom instead of von Hippel-Lindau disease.

Pathology of pyogenic liver abscess in children

Little is known about preexisting lesions in livers of children with pyogenic liver abscess (PLA). Study of these lesions may elucidate possible predisposing factors for the disease. In Vitória, state of Espirito Santo, Brazil, PLA in children is frequently associated with helminthic infections and eosinophilia. We hypothesize that nematode infection with larvae migrating through the liver is a predisposing factor for PLA, because the infection induces immunomodulation and likely trapping of bacteria in liver granulomas. In this report, we describe observations of 22 cases of PLA in children studied at autopsy (16 cases) or in surgical biopsies (6 cases), including 17 boys and 5 girls ranging in age from 1 to 13 years (mean 4.6 years, median 3.5 years). Multiple abscesses in both lobes were found in 13 cases and a single abscess was found in the right lobe in 10 cases. All cases showed histologically classical pyogenic inflammation without morphological evidence of amoebiasis. In six cases there were granulomas similar to those caused by larva migrans visceralis (from Toxocara or other nematodes) in liver tissue not affected by the abscess. Nematode antigens in central areas of necrosis of granuloma in all six cases and fragments of a larva, possibly of Toxocara, were found on samples immunohistochemically stained with polyclonal anti-Toxocara antibodies. There were numerous eosinophils in abscesses with Charcot-Leyden crystals. Eosinophils were found frequently in portal triads far from the abscess wall. In four cases, in which bile duct ascariasis was found, worms were noted in the bile ducts, and eggs were found in liver parenchyma surrounding the abscess in two cases. Foreign-body granulomas were found in one case in which penetrating trauma was the cause of abscess. In one case there was one histiocytic granuloma whose origin was not determined. The observation of six cases of granuloma similar to larva migrans visceralis (or produced by other nematode larva) in liver tissue not directly affected by the abscess supports the hypothesis that helminth infections with larva migrating through the liver are a predisposing factor for pyogenic hepatic abscess in children.

Involvement of the human cerebellum during habituation of the acoustic startle response: a PET study

The present study investigated the involvement of the human cerebellum in the habituation of the acoustic startle response using PET. The startle response was elicited in seven young, healthy subjects by a tone presented via headphones. Startle responses were recorded from the right sternocleidomastoid muscle. Regional cerebral blood flow (rCBF) was assessed in nine scans and one startle stimulus was applied during each scan. The reduction of size of the sternocleidomastoid muscle response was correlated with changes in rCBF during the ongoing process of startle response habituation. A significant decrease of rCBF was found in the medial cerebellum. These data are consistent with an involvement of the medial parts of the human cerebellum in non-associative learning as proposed by previous animal studies.

Isolation and characterization of iridoviruses from the giant toad Bufo marinus in Venezuela

In this communication we describe for the first time the isolation of 7 iridoviruses from the toad Bufo marinus and an unknown species of frog Leptodactylus in Venezuela, South America. The viruses are icosahedral with electron-dense cores, each of which is surrounded by an inner membrane, capsid and a cell-derived envelope. The virus(es) have an average vertex to vertex diameter of 160 nm and replicate in the cytoplasm of a range of cell lines. Within the cytoplasm of infected cells, rarefied areas could be observed; structures lacked cellular organelles and contained complete, empty and developing viruses. Results from antigen-capture enzyme-linked immunosorbent assays (ELISA) with polyclonal antibody raised against epizootic haematopoietic necrosis virus (EHNV) indicated cross-reactivity between these isolates, Bohle iridovirus (BIV) and frog virus 3 (FV3). Comparison of polypeptide and genomic profiles indicated that the Venezuelan viruses shared many polypeptides of equivalent molecular weight with type species FV3. There were, however, differences between the group of Venezuelan viruses and FV3 and BIV. The viruses belongs to the family Iridoviridae and the genus Ranavirus.

Acute brain swelling during removal of supratentorial cystic lesion caused by contralateral extradural hematoma: case report

BACKGROUND

Protrusion of the cortex through a bone flap in the course of surgery is a very serious event and, if it persists, the procedure must be suspended, the cause sought, and the problem resolved.

CASE DESCRIPTION

We report the case of a 13-year-old boy whose brain underwent sudden swelling during removal of a supratentorial cystic lesion. The operation was suspended at once and an emergency CT scan was performed. It revealed a large contralateral extradural hematoma, which was removed immediately.

CONCLUSIONS

We considered the following possible mechanisms of the emergency: bleeding of bone at the site of the supposed piercing by the headrest pin and/or a vacuum mechanism consequent upon removal of the large cystic lesion. Our aims are to emphasize the importance of gauging the thickness of a child's skull before fixing the head in the headrest, especially when chronic intracranial hypertension is present, and the need to suspend the operation for CT scanning in the event of uncontrollable brain swelling.

Pyogenic liver abscess in children: some observations in the Espírito Santo State, Brazil

Pyogenic liver abscess in children is uncommon in developed countries and there are few reports about the disease in developing countries including Brazil. As pyogenic liver abscesses in children are frequently diagnosed in Vitória (E. Santo State, Brazil), the records of admissions at the Children's Hospital (Hospital Infantil N.S. da Glória) were surveyed. Sixty-five cases of pyogenic liver abscess were observed over a period of three years, from May 1991 through April 1994 (mean of admissions of 2800 children/year). Fourty-seven cases occurred in boys (mean of ages 8.1 +/- 3.5 yr, median 8 yr) and 18 in girls (mean of ages 6.1 +/- 3.3 yr, median 7 yr) with a 2.7:1 male/female ratio. Predisposing factors were skin infections (23 cases), bile duct ascariasis (six cases), trauma (two cases) but in 30 cases a predisposing factor was not evident. Staphylococcus aureus was the bacteria most frequently isolated (16/29 examined). Entamoeba histolytica trophozoites were never found in the exudate of abscesses and cysts were found once in fecal examination. Clinical manifestations were similar to those observed in other reports about pyogenic liver abscess in children. There was a high frequency of intestinal helminth infection (80.6% of 36 cases in which a fecal examination was recorded) and eosinophilia in the peripheral blood (36.2% of 61 cases). In addition most cases came from the urban periphery of Vitória, where intestinal parasites are frequent. These data showed that the frequency of pyogenic liver abscess is higher in Vitória (one case/138 admissions) than in developed countries (25 cases or less/10,000 admissions in USA). We hypothesyse that the helminth infection (mainly with ascaris and toxocara), whose larvae migrate through the liver inducing granulomas, could enhance the localization of bacteria, increasing the risk for pyogenic liver abscess.

[Pyogenic liver abscess and schistosomiasis mansoni in the state of Espírito Santo]

A possible association of the acute toxemic form of schistosomiasis and pyogenic liver abscess (PLA) has been recently suggested. As in the west of the Espírito Santo state schistosomiasis is endemic and PLA are frequently diagnosed in the Children's Hospital of Vitória we reviewed the records of the Hospital during the period from May 1991 to April 1993 to: a) identify all cases of PLA in which Schistosoma mansoni infection was present and b) annotate the procedence of each case to verify if there is an association of the two diseases. 65 cases of PLA were recorded and 39 had the result of a stool examination, being three positive for Schistosoma mansoni (7.6%) and 26 for other helminth (mainly Ascaris and Trichocephalus). The procedence of the patients showed that only 7 (10.7%) came from endemic areas. These results show that an association of Schistosoma mansoni infection and PLA was not significative in the country, where the acute toxemic form is not frequent. The great majority of PLA in this study came from the urban periphery of Vitória, where transmission of schistosomiasis does not occur but intestinal helminth infections are extremely frequent. The great majority of PLA in this study came from the urban periphery of Vitória, where transmission of schistosomiasis does not occur but intestinal helminth infections are extremely frequent. As 40% of these PLA were cryptogenetic it is possible that the immunomodulation induced by intestinal parasites and the liver granulomas produced by the larvae of these helminths would be predisposing factors for pyogenic liver abscess.

Labrea-like hepatitis in Vitoria, Espirito Santo State, Brazil: report of a case

A case of fulminant hepatitis with microvesicular steatosis resembling Labrea's fever, diagnosed in Vitoria (ES) is reported. The 16 year old boy presented with severe epistaxis, agitation, jaundice and hemorrhagic vomiting and died two days after admission to the emergency unit of the University Hospital. The disease started five days before with fever, myalgias, dark urine and jaundice and progressed with psychic agitation, torpor and coma. The liver and spleen were not palpable. HBsAg was negative in the serum. The autopsy showed acute hepatitis with lytic necrosis confluent in the midzonal and periportal areas with massive microvesicular steatosis in the remaining hepatocytes. Mononuclear cells predominated in the exudate. The reticulum showed condensation in the necrotic areas without typical bands of collapse. The portal tracts were edematous with mononuclear infiltration and mild bile duct proliferation. Absence of cholestasis. Except for the confluent midzonal and periportal necrosis this case showed several clinical and morphological aspects of the Labrea fever described from the East Amazon, demonstrating that the anatomical picture of this disease probably is not in related to a factor peculiar to the Amazon region.

Variations in regional cerebral blood flow investigated by single photon emission computed tomography with technetium-99m-d, l-hexamethylpropyleneamineoxime = l-h during temporary clipping in intracranial aneurysm surgery: preliminary results

Single photon emission computed tomography with technetium-99m-d, l-hexamethylpropyleneamineoxime was used to assess variations in regional cerebral blood flow during temporary clipping in the course of intracranial aneurysm surgery and during the postoperative period in 20 patients, 14 of whom underwent temporary clipping. Of these 14 patients (Group A), 9 had aneurysms of the anterior communicating artery, 2 had aneurysms of the middle cerebral artery, and 3 had aneurysms of the carotid siphon. Temporary clips were applied, according to the site of the lesion, on A1, on the trunk of the middle cerebral artery, or on the trunk of the internal carotid artery. The occlusion time ranged from 2 to 31 minutes. The six patients who did not undergo temporary clipping served as controls (Group B), as follows: three had aneurysms of the posterior communicating artery, one of the anterior communicating artery, one of the middle cerebral artery, and one of the internal carotid artery. All patients were investigated with cerebral single photon emission computed tomography preoperatively, perioperatively, and postoperatively. In all the patients of Group A, the preliminary results of the study show a sharp fall in the perfusion of the territories of the temporarily clipped parent vessel and practically a complete recovery within 2 to 7 days of surgery, with no significant neurological symptoms. No similar disturbance of perfusion was found in the patients of Group B.

[Primary non-Hodgkin's lymphoma of the liver: report of two cases and review of the literature]

Two cases of primary non-Hodgkin lymphoma of the liver are presented, with comments about the main clinical and pathological aspects of the disease based on literature review. Both patients were woman (19 and 62 years old) and presented the same complaints: severe weight loss and presence of fast growing abdominal mass. In both cases the histologic diagnosis showed a non-Hodgkin, diffuse, large cell lymphoma (centroblastic-centrocytic diffuse lymphoma) with intermediate grade of malignancy. One case (19 years) died before treatment. The autopsy showed a large solitary tumor (18 cm in diameter) in the right liver lobe and two small nodules (1 cm) in the subcutaneous tissue of the abdominal wall. The other case (62 years), was treated by partial hepatectomy and chemotherapy. There was a round, solitary tumor (8 cm in diameter) in the left lobe. The patient remains without manifestations of disease relapse 18 months after the treatment. In both cases the tumor did not spread to lymph nodes, spleen and other viscera.

Clinical and neuroradiological correlations in a patient with a wandering retained air gun pellet in the brain

The authors present the case of a patient with an air gun pellet that moved from the ventricular system into the subarachnoid space of C2-C3, from where it was successfully removed by interlaminotomy.

Lithium absorption prevented by sodium polystyrene sulfonate in volunteers

STUDY OBJECTIVE

To determine if sodium polystyrene sulfonate prevents absorption of lithium in human beings.

DESIGN

Prospective, crossover study.

TYPE OF PARTICIPANTS

Healthy volunteers age 22 to 34 years (three women and three men).

INTERVENTIONS

After an eight-hour fast, subjects ingested 0.5 mEq/kg (18.5 mg/kg) lithium carbonate. One hour later, they ingested either 857 mg/kg sodium polystyrene sulfonate in 4 mL water/g sodium polystyrene sulfonate (experimental) or an equal volume of water without sodium polystyrene sulfonate (control).

MEASUREMENTS AND MAIN RESULTS

Serum lithium levels were drawn zero, one, two, three, four, six, eight, ten, 12, and 24 hours after lithium ingestion. The sodium polystyrene sulfonate group had a smaller mean area under the serum concentration curve (11.6 +/- 1.0 mEq/L.hr versus 13.6 +/- 1.5 mEq/L.hr, P < .001) and lower mean highest measured lithium level (0.85 +/- 0.11 mEq/L versus 1.05 +/- 0.10 mEq/L, P < .05) compared with the control group. There was no significant difference in 24-hour urine lithium excretion or in serum sodium and potassium levels.

CONCLUSION

Sodium polystyrene sulfonate administration decreased absorption of lithium after a lithium carbonate overdose. Sodium polystyrene sulfonate may be useful clinically for gastric decontamination after lithium overdoses.

Ascaris lumbricoides: reinfection in children bearing an established worm burden

To clarify the existence of reinfection in children bearing an established Ascaris lumbricoides infection, the authors evaluated the weight and the length of worms collected from ten cases of ascaridiasis. The worm burden was greater than 27 worms in nine cases. In seven cases the weight and the length of worms showed little variation, with unimodal distribution of values, suggesting that all the worms in each case belong to the same population, originated from a single brood infection or from successive infections over small time intervals. In three cases there was great variation in worm size indicated by the different values for the means and medians and by the high values for the standard deviation and coefficient of variation. In these three cases there was a bimodal distribution of worm's size suggesting the coexistence of two distinct populations: one, less numerous, composed of mature worms and the other, more numerous, composed of immature worms, in two cases, and two distinct populations of immature worms in one case. The existence of worms in different stages of maturation indicates that the less mature population was acquired when the mature worms were established in the gut. These results indicate that the reinfection with Ascaris in children bearing an established infection is not rare and resistance induced by a preexisting infection is not the rule.

Turcot syndrome. Autosomal dominant or recessive transmission?

The authors analyzed a family in which three descendants presented with adenocarcinoma of the colon. In two of them the presence of colonic adenomatosis was observed. Another family member, a 13-year-old girl, presented with Turcot syndrome, that is, brain tumor associated with colonic adenomatosis. The nature of the hereditary transmission of Turcot syndrome is hence analyzed, discussing whether it happens through an autosomal recessive or a dominant gene. Undoubtedly the family has colonic adenomatosis, a disease considered of autosomal dominant transmission. Based on the clinical observation, the authors suggest that Turcot syndrome may be determined by an autosomal gene with a pleiotropic effect and variable expressivity.