Biomedical subjects
Publications and source records attributed to R Palma.
Overdose of paracetamol is associated to varying degrees of hepatic necrosis and may lead to severe hepatic failure. In this paper, we report 2 patients with paracetamol overdose for suicidal purposes who were successfully treated using the antidote N-acetyl-cysteine orally. A brief analysis of the literature follows.
The clinical records and the ultrasound findings of 48 patients studied because of a presumptive diagnosis of acute appendicitis in a one-year period were reviewed. Ultrasound examination was performed using graded compression and high resolution probes when acute appendicitis was suspected and the clinical history or physical examination was unclear. The ultrasound findings were correlated with the clinical course or surgical and pathological findings. This procedure was useful in the diagnosis of acute appendicitis, with 84.6% sensibility and 95.5% specificity. Predictive value for positive results was 95.7% and 84% for negative results. These figures agree with results previously communicated in the literature. It is concluded that high resolution ultrasonography is useful in the differential diagnosis of atypical acute appendicitis.
To establish the epidemiology of viral hepatitis B (HBV) infection in hospital staff the sera of 2462 workers and 176 professional nursing students were examined. The prevalences of HBsAg and anti-HBs among the workers were 4.5 and 42.2% and among the students were 2.3 and 15.3%, respectively. The risk of infection showed a correlation with the profession of the hospital workers, the various jobs carried out in different departments, age, and the number of working years. The anti-hepatitis vaccination with HBVax and HEVAC-B vaccines was used on 142 professional students and 996 hospital workers. Five years after the beginning of the vaccine cycle the percentage of responders observed among the students was 75 (HBVax) and 79% (HEVAC-B). Among the hospital staff the response registered was 66 and 71%, respectively. The best recorded response among the youngest subjects suggests that the anti-hepatitis vaccination should be obligatory for hospital workers at the beginning of their working period or professional training.
Intrahepatic cholestasis of pregnancy is characterised by clinical and biochemical fluctuations and further diagnostic tools are required. The aim of this study was to investigate serum copper and copper oxidase during the course of intrahepatic cholestasis of pregnancy (ICP). Twenty eight ICP patients and twenty healty pregnant women were included. Routine liver tests, fasting serum bile acids (FSBA), serum copper and serum copper oxidase were measured. In ICP, serum copper was significantly higher than in controls (274 +/- 49 micrograms/dl vs 176 +/- 34 micrograms/dl, p less than 0.001). Copper oxidase rose in ICP (78 +/- 15 mg/dl) different than healthy pregnant women (64 +/- 8 mg/dl); p less than 0.02. In contrast to marked oscillations in FSBA, serum copper remained elevated during the follow-up with only minor fluctuations and no correlation was demonstrated between changes in FSBA and those noted in serum copper (r:0.17, NS). At labor, a significant rise in serum copper was demonstrated in ICP (from 251 +/- 50 micrograms/dl to 297 +/- 55 micrograms/dl, p less than 0.01) and in controls (from 168 +/- 34 to 192 +/- 42 micrograms/dl, p less than 0.01). This increment in serum copper was associated with a peak in serum copper oxidase activity. Serum copper and copper oxidase are elevated in ICP and may be considered as adjuvant diagnostic tests. Disturbances in copper metabolism reported in this study are consistent with the hypothesis that normal pregnancy is associated with a mild cholestasis effect and ICP represent a form of improperly controlled response.
The early appearance of cholesterol gallstones is very common in Chile. To elucidate the mechanisms involved in this phenomenon, the size of the bile acid pool and the secretion of biliary lipids were studied in two groups of young women with normal weights and radiologically functioning gallbladders: nine with cholesterol gallstones and 14 healthy volunteers. The bile acid pool was similar in control and gallstone patients. The secretory rates of bile acids and phospholipids were comparable and significantly correlated in both groups. On the other hand, cholesterol output was higher in gallstone patients. In controls there was a significant correlation between the output of bile acids and cholesterol, but no correlation was found in the gallstone group. This study suggests that cholesterol hypersecretion into the bile is a major factor in the pathogenesis of cholesterol gallstone disease in young Chilean women with normal weights.
The relationship between changes in intestinal lactase activity and monosaccharide uptake was studied in rats of different ages using the technique of intestinal everted sacs. In the postweaning period there is a sharp decrease in the rate of glucose and galactose uptake by the small intestinal mucosa. This change occurs simultaneously with a decrease in lactase activity in the tissue. The kinetic analysis showed a lower Vmax for monosaccharide uptake in the 50-days-old rats as compared with the fifteen-days-old animals, with no change in the apparent Kt. The addition of Tris+ (40 mM) to the incubation media was found to produce a decrease in Vmax for monosaccharide uptake only in the suckling rats but not in the 50-days-old animals; the K1 remained unchanged. Tris+, at the concentration used had previously been shown to completely inhibit lactase activity in homogenates of small intestinal mucosa. These observations lead us to postulate the lactase in the suckling rat might possess a translocating role for sugar, in addition to its hydrolytic function. The decrease in sugar uptake after weaning could be explained by the disappearance of this role.
A description of the preliminary steps in establishing a food and nutrition surveillance system in a country of Central America is presented in outline. The system will provide the basis for policy formulation, program planning, and evaluation. It is organized on the basis of the participation and resources of seven national agencies and will operate at the local, regional, and central level.
Biliary lipid composition was determined in fasting gallbladder bile of 12 young and 12 elderly asymptomatic Chilean women with normal weights and recent, normal cholecystograms. The proportion of biliary cholesterol and the lithogenic index were significantly higher in elderly females. Moreover, supersaturated bile was present in 8.3% of the young and in 41.7% of the older women studied. Obesity enhances the saturation of bile in older females: lithogenic bile was found in 100% of 4 elderly, obese women with radiologically normal gallbladders. The bile acid pool and cholic acid metabolism were studied in 5 young and 4 older normal females. Both groups showed similar values of bile acid pool, cholic acid synthesis, and turnover. These results indicate that aging per se modifies the proportions of biliary lipids in Chilean women, and provide a partial explanation for the frequency of gallstones observed among them. The increment in the lithogenic index of gallbladder bile with age takes place without significant changes in bile acid metabolism, suggesting that the canalicular secretion of cholesterol increases with aging.
An evaluation of the functional state of the left ventricle through an estimate of the mean Vcf (Vcf) and the ejection fraction (EF) was made i- 30 patients, subdivided into groups according to average blood pressure rate, degree of severity of the retinographic alterations and ECG pattern. In addition, the thickness of the interventricular septum (S), the posterior wall (PP) and the S/PP were measured. Lastly, the mass of the left ventricle was determined through the following formula: mass = (h1+h2+Dd)3 -- Dd3X1,050. Only one patient was under treatment with beta-blocking drugs, and no patient presented clinical symptoms of cardiac decompensation. The Vcf and the EF did not deteriorize when the hypertensive pattern worsened, while there was an expansion of the thickness of the S and an increase in the mass of the left ventricular. The increase of the ventricular mass, however, was not always found to be associated with normal functionality, nor was an increase of the mass always present even in cases of highly evident hypertension. It is likely, therefore, that other factors not taken into consideration (time factor, for example) play an important role in determining the functional state of the left ventricle and degree of hypertrophy.
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A group of 8 patients (M) with liver cirrhosis were studied. Each subject was standardized with rest time extending from 22,00 to 05,00 and meals scheduled at 08,00-08,30, 12,00-12,30, 17,30-18,00. Then was sampled at 04,00, 08,00 12,00, 16,00, 20,00, 24,00. In each sample of serum were determined iron, T.I.B.C. and L.I.B.C. All data were analyzed by macroscopic approach (chronograms) and by mean cosinor. A significant circadian rhythm was detected in all parameters, with a statistically valid difference between normal subjects and patients with liver cirrhosis in the mesor of T.I.B.C. and L.I.B.C.
The mean conisor technique reveals statistically significant circadian rhythms for serum concentrations of iron, chloride, cortisol, PBI, the fibrinolytic activity of blood, urinary iron excretion and gastric acid secretion in studies covering a 24-h span for presumably healthy subjects. Quantification of these rhythms provides internationally comparable reference values both for the conventional clinical laboratory and for any special chronobiologic applications.
We have studied the post-surgical results of 48 perforations of the nasal septum, regarding their etiology, location and size, which must be taken into account when deciding which closure technique to use.