Biomedical subjects
Publications and source records attributed to E Cardoso.
The uterine inversion is a rare but serious pathology of the delivery. We describe two cases of uterine inversion of secondary and quaternary degree; the first had a delay diagnosis and the second having a return after the manual replacement, finishing both on surgical resolution. The authors describe the causal factors, the diagnosis and the therapeutic of uterine inversion.
Kaposi's sarcoma (KS) developed among 11 of 416 renal allograft recipients transplanted between 1985 and 2000. Only 3 among 364 Caucasian recipients developed KS, while it affected 8 of 52 Black patients, all of whom had been born in African countries (P <.001). All patients had their immunosuppression reduced; two also received daunorubicin and one received electrotherapy. Three patients developed accelerated renal allograft dysfunction, probably due to the reduced immunosuppression. Remission of KS was observed in seven patients, while lesions stabilized or improved partially in the other four. After resuming dialysis 2 of 11 patients died; both were in KS remission. Human herpes virus-8 (HHV-8) serology and DNA analysis was evaluated in sera obtained from seven donors: all were negative. Conversely, among eight sera collected pretransplant from the nine living recipients, HHV-8 IgG was detected in six and DNA was present in one. HHV-8 IgG was expressed in all patients (9/9) at some point posttransplant; DNA was detected in three patients. Therefore, the robust ethnic predisposition to KS was associated with a high pretransplant prevalence of HHV-8 among African recipients. Although some seroconversions were detected posttransplant, there was no evidence for donor-to-recipient transmission.
Preclinical Cushing's syndrome (PCS) is a condition in which cortisol excess is not associated to clinical features of Cushing's syndrome. The aim of this study was to detect PCS in 48 ambulatory overweight type 2 diabetic patients (DM). Controls were 40 normoglycemic obese (Ob) and 36 normo-weight healthy subjects (N). In DM (47/48) total urinary cortisol (UF) levels were similar to those found in Ob and N. Evening urinary cortisol (Spot F) was significantly higher than either Ob (p: 0.0001) or N (p: 0.03), although values did not overcome the upper normal limit (44 ng/mg creatinine). False positive results to the overnight 1 mg dexamethasone suppression test were found in 31% and 22% of DM and Ob, respectively. In a DM female an elevated UF and Spot F associated to absence of cortisol inhibition to the overnight 1 mg dexamethasone suppression test was repeatedly detected. Diagnosis of PCS was performed. Remission of hypercorticism and glycemic control were achieved after pituitary surgery. It would be useful to screen DM patients with poor glycemic control for PCS.
Diagnostic measurements and pharmacokinetic studies were performed in 17 patients with various kinds of malignant, premalignant and benign lesions in the head and neck region by means of point monitoring laser-induced fluorescence. For marking different types of tissue, delta-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) was used. The ALA-induced PpIX synthesis was monitored at different time intervals after oral administration of ALA in low doses, 5 and 15 mg/kg b.w. Besides the porphyrin-related signal the tissue endogenous fluorescence was also recorded. The fluorescence spectra were evaluated at two different wavelengths corresponding to the specific drug-related fluorescence peak and the endogenous tissue fluorescence emission at 635 and 490 nm, respectively. The evaluated fluorescence data were correlated to the histopathological tissue investigation. A fall-off in the overall fluorescence intensity at 490 nm was obtained for all the malignant and premalignant areas, as well as an increased red fluorescence. A ratio between the red and the blue/green fluorescence intensity was formed for each time interval after the ALA administration. The lower drug dose seems to be sufficient to obtain a useful demarcation ratio between normal and diseased tissue with a very low PpIX fluorescence intensity in the normal tissue. A PpIX fluorescence maximum seems to occur between 3 and 4 h in normal tissues, whereas malignant tumour tissue shows a higher level for a longer period of time.
OBJECTIVES: The aim of the study was to look for a rise in reticulocyte levels in workers exposed to various solvents, in comparison to non exposed control subjects. METHODS: A cohort of exposed workers was selected on the criterion of exposure to solvents, among employees regularly attending the Centre of Occupational Medicine of Molsheim (France) during the second trimester of 1995. Controls were selected over the same period from the voluntary blood donors of the Transfusion Centre of Strasbourg (France). Complete blood counts and flow cytometric reticulocyte counts were determined in all blood samples. RESULTS: Analysis of the haematological parameters displaying significant differences revealed the existence of higher levels of circulating reticulocytes and lymphocytes in workers exposed to solvents than in control subjects. These variations did not appear to depend on the intensity or length of exposure. CONCLUSIONS: This study demonstrates the occurrence of an increase in circulating reticulocytes in relation to occupational exposure to solvents, without as yet providing sufficient information to allow elucidation of the underlying mechanism. An increase in total circulating lymphocytes was observed in the same group of exposed workers. The concomitant rise in absolute values of these two elements of the blood counts is to our knowledge described here for the first time in an epidemiological study.
Six cases of nonunion of subcapital (neck) fractures of the proximal phalanx of the thumb in children were seen over a period of 5 years. Ages at the time of injury ranged between 2 and 3 years. Entrapment of the thumb in a closing door was the mechanism of injury in all cases. All fractures were closed and were significantly displaced. Immediate management was by closed reduction and splinting in four cases, closed reduction and K-wire fixation in one case and no treatment in one case, which was later treated by delayed open reduction and K-wire fixation. Only two of the six ununited fractures were eventually treated with bone grafts and both fractures united resulting in a stable thumb but with a limited range of flexion of the interphalangeal joint. Factors that may increase the risk of nonunion of these fractures in children are discussed.
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We have previously reported that seminal plasma (SP) pool from donors and azoospermic patients can inhibit the NK response in vitro. In this study we investigated whether SP also inhibits the interleukin -2-activated natural cytotoxicity (LAK). Pools of SP from 10 healthy donors and 17 azoospermic patients were used. They were sterilized by filtration and stored at -20 degrees C until use. Anti-sperm antibodies were negative in all samples. Peripheral blood lymphocytes (PBL) obtained from volunteer donors were incubated during 16 hours in culture medium, RPMI alone, with 10% fetal calf serum (FCS) or with 10% human serum (HuS). The NK and LAK cytotoxicity assay was performed using the cell line K 562 labeled with 51Cr. In view of our results, we conclude that LAK activity is inhibited by SP when PBL are incubated in the absence of FCS. This inhibitory effect of SP is unrelated to cellular death and there is no difference between healthy and azoospermic seminal plasma.
One hundred and seventy-nine consecutive cases of facial clefts that were treated at the King Khalid University Hospital, in Riyadh, Saudi Arabia, were analyzed for an epidemiologic study. Isolated cleft lip was present in 38 percent, cleft of lip and palate in 37.4 percent, and cleft of the posterior palate in only 22.4 percent. There was a male preponderance in all types. In cases of cleft lip with or without cleft palate, the more commonly affected side was the left, followed by bilateral cases. Associated malformations were present in 13.4 percent. A positive family history was found in 26.8 percent of cases. A significant number of patients (7.8 percent) were first seen at more than 10 years of age. The incidence of facial clefts at this hospital was 0.3 per 1000 live births, computed over a period of 6 years. This incidence is significantly lower than that reported from European and Far Eastern countries.
We have examined the effect of human alpha-fetoprotein (h-alpha FP), at concentrations ranging from the physiological to pathological circulating levels, on the native and alpha IFN- and IL2-boosted NK activity of normal peripheral blood lymphocytes (PBL). The cytotoxic function of unstimulated PBL was unchanged after a 16 hr incubation with 200 to 8000 ng/ml h-alpha FP. By contrast, this treatment significantly reduced the responsiveness of PBL to the NK-enhancer factors IFN and Interleukin 2. Optimal inhibition was observed when cells were pre-incubated with h-alpha FP before being stimulated with IFN. The sensitivity of PBL to the h-alpha FP mediated inhibition was restricted to the very early times (30 min) of incubation with the stimulating agents.
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A total of 25 cases of acute injuries caused by a meat mincer are presented. Of these, 20 were children. The pattern of injury and the extent of damage to individual digits of the hand are defined. Due to the mutilating nature of the injury, attempts at replantation or revascularization failed in all but two of the ischaemic digits. Emphasis must be placed on the safety and prevention of these dreadful accidents.
This is a review of 70 patients with traumatic limb and digit amputations treated at King Khalid University Hospital, Riyadh in Saudi Arabia from April 1984 to April 1988. Out of 70 cases 34 were not suitable for replantation. In the remaining 36 patients replantation or revascularization was attempted on 46 units. The data are discussed and compared with other published series. Our net survival rate was 67.4 per cent. The survival rate improved from 62.8 per cent in the first 2 years to 81.8 per cent in the subsequent 2 years. The average hospital stay (34 days) was much longer than that reported from developed countries. The increased emergency workload due to a high incidence of referral of unsuitable cases and the longer hospital stay should be taken into account while establishing a replant service in a developing country. Eighteen cases were followed up for more than 1 year; of these, 61 per cent had good (grade I or grade II) functional recovery. The survival rate and functional recovery improved with increased experience and this is a strong argument in favour of centralizing the replant services.
It is at present not clear whether alpha interferon (INF-alpha) can participate in the control of glucocorticoid blood levels through direct action on the adrenal gland. In this study, the possible action of INF-alpha on cortisol release by adrenal tissue was tested in vitro. Slices of normal human adrenals were incubated with INF-alpha for 3 h at 37 degrees C in 95% air and 5% CO2. Cortisol release by adrenal tissue was stimulated by INF-alpha, showing a dose-response curve from 20 IU/ml, the lowest dose that gave a response, to a maximal dose of 60 IU/ml when the response reached a plateau. The effect of INF-alpha on cortisol liberation by adrenal tissue in vitro may be implied in neuroimmune regulatory interactions.
The effect of 1-thyroxine treatment on the distribution of testosterone and estradiol serum fractions was studied in 10 normal weight hirsute women with ages ranging from 18 to 25 years. Six of the patients had menstrual irregularities. Treatment consisted in one month of thyroxine (1-T4) at a dose of 2 micrograms/Kg body weight. Serum sex hormone binding globulin (SHBG) was measured by saturation analysis and serum testosterone (T), estradiol (E2), androstenedione (delta 4-A), dehydroepiandrosterone sulphate (DHAS), LH, FSH, PRL, T4, T3, by RIA. Serum T and E2 fractions were calculated by an equation derived from the law of mass action. Before and after T4 treatment serum SHBG was, respectively, (X +/- ES) 30.3 +/- 3.8 and 45.4 +/- 4.6 nmol/l (p less than 0.001), non-SHBG-bound T 25.7 +/- 8.1 and 18.8 +/- 6 ng/dl (p less than 0.001), free T 1.09 +/- 0.2 and 0.8 +/- 0.5 ng/dl (p less than 0.01), non-SHBG-bound E2 40.9 +/- 13.7 and 19.2 +/- 2.4 pg/ml (p less than 0.001). No significant changes were observed in total T and E2 or free E2. Serum DHAS and delta 4-A decreased significantly after treatment from 3977 +/- 601 to 3480 +/- 250 ng/dl and from 4.7 +/- 0.61 to 3.34 +/- 0.34 ng/ml respectively (p less than 0.001). Serum basal levels of FSH, LH, PRL, T4, T3 and TSH were normal. A significant increase of serum T4 was observed after treatment from 8.4 +/- 0.4 to 11.7 +/- 1.1 ng/dl (p less than 0.01). However, the post-treatment value was within the limits of the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
Extracranial shunting of cerebrospinal fluid is a well-known neurosurgical procedure for the treatment of normal pressure hydrocephalus. Research indicating reasonable success using this technique has been based primarily on subjective and global neurosurgical opinion. Given that the treatment carries morbidity risks, and that decisions to shunt are related to increasing adaptive functioning, attention must be paid to adequate measurement of surgical outcome. As part of a larger study, we report pre and postsurgical neuropsychological, neuroradiological, and clinical data on hydrocephalic patients, as well as presurgical intracranial pressure data. Prior to shunting, increase in ventricular dilatation and cerebral atrophy were associated with decreased cognitive functioning, gait disturbance, and bladder dysfunction. Following shunting, there were significant improvements in neuropsychological functioning in terms of attention, concentration, verbal and nonverbal memory, language and communication skills, and constructional skills, as well as clinical improvement in gait and bladder functioning. Improvement was related to presurgical dilatation of the temporal horns of the lateral ventricles and mental status, particularly memory functions.
Natural Killer (NK) activity has been shown to be depressed under stressful conditions. Glucocorticoids, which are known to increase during stress, seem to negatively regulate the activity of NK cells. In the present study we have explored the effect of cortisol (hydrocortisone, HC) on NK activity. A significant inhibitory effect could be observed as early as 6 hr after the addition of HC at the concentration of 0.5 microM, corresponding to the upper physiological circulating level. Both the lysis and the binding of the K562 target cells were affected by HC, indicating that the hormone acts on the target recognition phase. The HC-mediated inhibition of the NK activity was fully reversed after 6 hr incubation in a HC-free medium. The observation of comparable levels of NK-inhibition using unseparated PBL or purified LGL, show that HC acts directly on LGL to inhibit their cytotoxic function. The effect of HC on the responsiveness of NK cells to the modifiers beta-interferon (beta-IFN) and recombinant interleukin 2 (rIL2) was also studied. Pre-incubation with HC did not alter the enhancement of the activity induced by beta-IFN, demonstrating that the HC- and beta-IFN-mediated effects occur in separate NK subsets. By contrast the increase of NK cytotoxicity induced by rIL2 was lower in the HC-treated compared to the untreated cell cultures (35.8 +/- 6.2 and 20.7 +/- 4.3% respectively, p less than 0.05) which could indicate that a portion of the cells triggered by rIL2 belong to the HC-sensitive NK subpopulation.