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Following the degradative pathway, vesicles loaded with extracellular material, eventually, dock and fuse with lysosomes, acquiring specific membrane markers of these organelles and acid hydrolases responsible for digest their content. The lysosomal-associated membrane protein 2 (LAMP-2), the best characterized lysosomal membrane protein, is found in late stages of endosome maturation and may be used as a marker of lysosome-associated membranes. Lysosomal storage disorders (LSDs) are described by the absence or deficiency in hydrolase activity leading to substrate accumulation within lysosomal components and to the onset of several diseases. It is known that lymphocytes infected by Epstein-Barr virus (EBV) are able to form cytoplasmic vacuoles, which work as a storage compartment for lysosomal acidic hydrolases. At the present study, we validate the EBV as a transforming agent of B lymphocytes in stability studies of long-term stored samples, since the methods used to keep samples in liquid nitrogen and thaw them have all proven to be efficient in samples frozen for up to 2 years. To confirm and investigate some of the most prevalent LSDs in the South of Brazil-Pompe, Fabry and Gaucher diseases-we first measured the enzymatic activity of α-glicosidase, α-galactosidase, and β-glicosidase in those cytoplasmic-formed vacuoles and then looked to LAMP-2 immunoreactivity by employing confocal microscopy techniques.

The conservation of archaeological marine iron artefacts requires chloride ions removal. In this study, the removal of chloride ions was undertaken by two electrochemical methods: the electrolytic and the galvanic reduction in alkaline media.The results were compared with those obtained by the washing and the sulphite reduction methods, under identical conditions. The experiments were performed on samples coming from an 18th century cast iron cannon-ball

P-glycoprotein (P-gp), the product of ABCB1 gene, is thought to play a role in the biliary excretion of a variety of drugs, but specific studies in dogs have not been performed. Because a number of endogenous (ABCB1 polymorphisms) and exogenous (pharmacological P-gp inhibition) factors can interfere with normal P-gp function, a better understanding of P-gp's role in biliary drug excretion is crucial in preventing adverse drug reactions and drug-drug interactions in dogs. The objectives of this study were to compare biliary excretion of technetium-99m-sestamibi ((99m)Tc-MIBI), a radio-labelled P-gp substrate, in wild-type dogs (ABCB1 wild/wild), and dogs with intrinsic and extrinsic deficiencies in P-gp function. Dogs with intrinsic P-gp deficiency included ABCB1 mut/mut dogs, and dogs with presumed intermediate P-gp phenotype (ABCB1 mut/wild). Dogs with extrinsic P-gp deficiency were considered to be ABCB1 wild/wild dogs treated with the P-gp inhibitor ketoconazole (5 mg/kg PO q12h x 9 doses). Results from this study indicate that ABCB1 mut/mut dogs have significantly decreased biliary excretion of (99m)Tc-MIBI compared with ABCB1 wild/wild dogs. Treatment with ketoconazole significantly decreased biliary excretion of (99m)Tc-MIBI in ABCB1 wild/wild dogs. P-gp appears to play an important role in the biliary excretion of (99m)Tc-MIBI in dogs. It is likely that concurrent administration of a P-gp inhibitor such as ketoconazole will decrease P-gp-mediated biliary excretion of other substrate drugs as well.

Dietas enterais não-industrializadas variam quanto à sua composição e características, em função dos alimentos empregados, dos procedimentos e técnicas adotados e, por isso, considera-se que são de composição estimada. O objetivo do trabalho foi desenvolver e caracterizar dietas enterais não-industrializadas tendo em vista a avaliação de sua qualidade nutricional. Uma proporção de 25% de solutos (p/v) foi estabelecida em um ensaio experimental e, considerando-se a contribuição dos macronutrientes (carboidratos, proteínas e lipídeos) no total energético, foram elaboradas, a partir de dados de tabelas de composição de alimentos, três dietas (D1, D2 e D3). As seguintes análises foram realizadas: composição centesimal, densidade calórica, osmolalidade, pH e minerais (cálcio, ferro, sódio, potássio, zinco, fósforo, magnésio, cobre e manganês). Comparando- se as três dietas, a D2 apresentou melhores características físico- químicas e melhor perfil de minerais, e a D3 melhor distribuição do valor calórico total entre os macronutrientes (carboidratos, proteínas e lipídeos). Todas as dietas apresentaram- se levemente hipertônicas. Conclui-se com este trabalho que a realização das análises físico-químicas contribui para o monitoramento da qualidade e do conteúdo nutricional de dietas, importantes para o ajuste às necessidades dos pacientes.

Gaucher's disease (GD) is caused by a β-glucocerebrosidase deficiency, leading to the accumulation of glucocerebroside in the reticuloendothelial system. The prevalence of GD in Tabuleiro do Norte (TN) (1:4000) is the highest in Brazil. The purpose of this study was to present evidence of consanguinity and founder effect for the G377S mutation (c.1246GA) among GD patients in TN based on enzyme, molecular and genealogical studies. Between March 2009 and December 2010, 131 subjects at risk for GD (GC in dried blood ≤2.19 nmol/h/ml) and 5 confirmed GD patients from the same community were submitted for molecular analysis to characterize the genetic profile of the population. Based on the enzymatic and molecular analysis, the subjects were classified into three categories: affected (n = 5), carrier (n = 20) and non-carrier (n = 111). All carriers were (G377S/wt). Affected subjects were homozygous (G377S/G377S). The identification of a single mutation in carriers and homozygotes from different generations, the history of the community and the genealogy study suggest that the high prevalence of GD in this population may be due to a combination of consanguinity and founder effect for the G377S mutation.

It is controversial whether rotation is necessary for patients undergoing pleurodesis. In addition, the optimal volume of the injectate remains to be determined. The purpose of this study was to determine the importance of rotation and the volume of the agent on the intrapleural dispersion of agents injected into the pleural space of rabbits. Technetium 99m pertechnetate ( 99m Tc) in 0.5, 1.0, or 2.0 ml of saline solution was injected into ten lightly anesthetized rabbits, half of whom were rotated for 1 min after the injection. Static images were obtained in the anterior projection 1 and 5 min after the injection. After the second scan, the limits of the lung were defined by obtaining a perfusion scan immediately after the intravenous injection of macroaggregates of 99m Tc-labeled serum albumin. The degree of dispersion was significantly greater in the nonrotated groups both at 1 min (F=8.11, p=0.0085) and at 5 min (F=5.89, p=0.0274). In addition, the homogeneity of the distribution of the injectate was not improved with rotation. From this study, we conclude that rotation of the animal for 1 min after the intrapleural injection does not improve the distribution of the injectate throughout the pleural space. Furthermore, a volume of 0.5 ml is sufficient for all pleural surfaces to be exposed.

This study was designed to evaluate the effect of mycoplasma contamination on acid hydrolase activity and the action of the mycoplasma removal agent (MRA), in cultures of human fibroblasts from individuals with lysosomal diseases. For this purpose, we measured the activity of the b-galactosidase, arylsulphatase B (ASB), hexosaminidase A and a-glucosidase enzymes. The activity of the above mentioned enzymes in fibroblasts contaminated by mycoplasma was measured before and after the addition of the MRA. The results were then compared to the enzymatic activity in contamination-free cultures. Only the ASB enzyme showed significant alteration in activity both in the presence of mycoplasma and MRA. The remaining enzymes did not suffer significant interference by the presence of the two agents. Of the four enzymes tested, three did not suffer significant alterations by the presence of the mycoplasma nor from the MRA. However, the activity measured in the ASB enzyme increased significantly in the presence of mycoplasma and MRA and could lead to a doubtful diagnosis. Therefore, we suggest that contamination should be prevented by using aseptic techniques as well as the MRA in those fibroblast cultures that cannot be discarded.

Hepatocellular carcinoma is one of the most common malignancies worldwide. Liver transplantation has emerged as a good option for early-stage hepatocellular carcinoma yielding survival rates as good as for recipients without this type of tumor.To assess the outcome of cirrhotic patients with hepatocellular carcinoma undergoing liver transplantation at the Liver Transplantation Service of the "Hospital de Clinicas", Federal University of Paraná, Curitiba, PR, Brazil.Retrospective study of cirrhotic patients with hepatocellular carcinoma undergoing orthotopic liver transplantation at the mentioned Institution between September 1991 and September 2000. The diagnosis of hepatocellular carcinoma was established during the pretransplant workup in five patients and the tumor was an incidental finding in the native liver in three. The indication for liver transplantation was restricted to solitary tumor equal to or less than 5 cm or up to 3 nodules, with each nodule measuring less than 3 cm, and no evidence of vascular invasion or extrahepatic spread. Patient survival and evidence of tumoral recurrence posttransplant were evaluated.The most common cause for pretransplantation liver disease was hepatitis C virus (50%). On examination of the explanted liver, the majority of patients (6/8, 75%) had a single lesion; one patient had two nodules and one had a multifocal hepatocellular carcinoma found incidentally in the native liver. Tumor size ranged from 0.2 to 5.0 cm. All cases had neither vascular invasion nor linfonodal envolvement. All patients remained alive and free of tumor recurrence at the time of the study with a mean follow-up of 18.5 months (range, 5-29 months).Liver transplantation is a good therapeutic option for early stage hepatocellular carcinoma arising in cirrhotic patients. With proper selection, liver transplantation can offer excellent survival rates free of tumor recurrence.

Orthotopic liver transplantation is an established therapy for patients with end-stage liver disease. In the last years more attention has been given for the improvement of the quality of life after liver transplantation, and the return to important life pursuits, such as employment, are important goals of this type of therapy.To assess the work's return rate in liver transplant recipients and the reasons for inability after liver transplant.Forty-one adults (ageor = 18 years) who underwent liver transplantation at our institution, between September 1991 and June 1999, with a post-transplant survivalor = 9 months, good graft function and a regular clinical follow-up were enrolled for the study. A questionnaire that measured aspects of inactivity before and after liver transplantation had been applied.Thirty-one of 41 patients were unable to work due end-stage liver disease before liver transplantation. Return to work was observed in 28 of 41 patients (68%) in a mean time of 5.9 months after the surgical procedure. Eleven of 28 active patients after liver transplant (39%) contribute significantly to family income. The reasons for inactivity after liver transplantation were: early retirement (n = 5), unemployment (n = 4), and physical disability (n = 4).Successful liver transplantation not only improves the survival rate but allows patients to return to social function and workforce.

Free radicals superoxide (O(2)(-)) and nitric oxide (*NO) are generated by blood vessels and can rapidly react to produce a peroxynitrite anion (ONOO(-)), a powerful oxidant that modifies lipoproteins making them more atherogenic. The aim of this study was to investigate the effect of peroxynitrite-induced modifications on beta-very-low-density lipoprotein (beta-VLDL) as to its biodistribution and plasma clearance rate, as well as the uptake of these particles by THP-1 cells. After being injected into New Zealand White rabbits, the peroxynitrite-modified beta-VLDL (99mTc-per-beta-VLDL) was cleared from circulation faster than the native beta-VLDL (99mTc-nat-beta-VLDL) in both normocholesterolemic rabbits (NC) and in hypercholesterolemic rabbits (HC). In HC rabbits, the fractional clearance of 99mTc-labeled beta-VLDL was significantly lower than in NC rabbits. The in vivo studies showed that accumulation of 99mTc-labeled beta-VLDL, expressed per gram of tissue, followed the decreasing order: kidneyliverspleenadrenal glandor= lungaortic archheartor= abdominal aortathoracic aortapsoas muscle. The high accumulation in the kidneys suggests the processing of 99mTc-labeled apolipoproteins by receptors present in kidney cells. The accumulation of 99mTc-nat-beta-VLDL in the whole organ was the following: liverkidneyheartspleenadrenal glandaorta in HC and NC rabbits. The uptake of 99mTc-per-beta-VLDL by the spleen was greater than the uptake by the heart in both groups. The in vitro studies showed that the uptake of 99mTc-per-beta-VLDL by THP-1 cells was higher than that of 99mTc-nat-beta-VLDL. These results show that peroxynitrite-modified beta-VLDL is rapidly removed from plasma and accumulates in several tissues, mainly in the liver and kidney. This may be particularly important in hypercholesterolemic situations that could favor the accumulation of native and peroxynitrite-modified beta-VLDL in several tissues.

Benign recurrent intrahepatic cholestasis is a rare autosomal recessive disorder characterized by repeated episodes of intense pruritus and jaundice. Patients are completely asymptomatic for months to years between symptomatic periods. We report a case of a patient with a 7-year history of benign recurrent intrahepatic cholestasis. During the follow-up period the patient has suffered three attacks of cholestasis, confirmed by biochemical tests and histological exam. Liver enzymes were normal between the cholestasis episodes. Despite multiple attacks of cholestasis, no permanent liver damage has occurred. Although the diagnosis of benign recurrent intrahepatic cholestasis is rare, it should be included in the evaluation of a patient with cholestasis. The patients should be reassured of the benign course of this disorder.

The objective of the present study is to evaluate the effects of successful liver transplantation on menstrual cycles abnormalities and on reproductive function of women with chronic liver disease. Twelve women with age between 17 and 54 years who underwent liver transplantation were evaluated. The following variables were analyzed: age, etiology of chronic liver disease, pattern of menstrual function and period of amenorrhea before and after transplantation, and occurrence of pregnancy after transplantation. The mean age of patients was 36 +/- 12.6 years. Patients with primary biliary cirrhosis did not have menstrual abnormalities before transplantation. The other patients presented amenorrhea for 3 months to 11 years before the transplantation. Rapid recovery of menstrual function was observed in all patients after the transplantation (3.1 +/- 1.2 months). Two patients became pregnant one and three years after the transplantation. It is concluded from this study that most women who present amenorrhea secondary to chronic liver disease have normal menstrual cycles in approximately three months following liver transplantation and they may become pregnant.

Neutrophil accumulation in the first hour of myocardial reperfusion was assessed in dog hearts submitted to ischemia with and without necrosis. In anesthetized dogs, the left anterior descending coronary artery was occluded for 20 min (group IS-20 n = 7) and for 90 min (group IS-90 n = 6). Immediately after reperfusion, 99m Tc-Ceretec (Exametazime-Amersham) labeled neutrophils were injected into a central vein and 60 min later the dogs were killed. The left ventricle was isolated, weighed, and sliced. Six sections, 3 from normal and 3 from reperfused regions, were divided into endocardial and epicardial layers. Myocardial and blood radiometry were used to evaluate the neutrophil accumulation during reperfusion. The differences between leukocyte accumulation in both groups were assessed comparing the ischemic/ normal relations in the endocardial and epicardial layers. A second comparison considered myocardium/ blood relations to allow the evaluation of differences between remote normal myocardial areas of the two experimental groups. In dogs submitted to 20 min of ischemia, leukocytes accumulated significantly more (P < 0.01) in the reperfused myocardium as compared with the non-ischemic region. The increase occurred both in the endocardial (1.49 ± 0.20) and epicardial (1.48 ± 0.29) regions. After 90 min ischemia, leukocyte accumulation was more intense and predominant in endocardium where there was a 4-fold (3.97 ± 1.28) increase over the non-ischemic region, while in the epicardium this relation was only 2.5-fold (2.56 ± 0.98). In the remote non-ischemic myocardium, leukocyte accumulation was greater in dogs submitted to 90 min of ischemia compared to the 20 min group (P < 0.01), without distinction between endocardial and epicardial layers. This accumulation in territories of non-culprit coronary arteries may be related to the blood flow abnormalities and matrix structure changes that occur in these regions during the development of an acute myocardial infarction and its natural repair.

The objective of the present study was to determine the prevalence of gallstones in the population of Curitiba, Brazil. A total of 1000 persons was randomly recruited among individuals who were visiting two shopping centers of the city in order to represent the Brazilian population in relation to age and sex. The selected people underwent ultrasonographic examination of the upper abdomen immediately after a medical interview. Of the 1000 persons evaluated, 93 (9.3%) had gallstones (64 persons) or had been subjected to cholecystectomy due to cholelithiasis. The gallstone prevalence increased from 2.4% in persons of 20-29 years of age to 27.5% in persons of more than 70 years (chi2 = 37.29; P0.001). The prevalence was 2.4 greater in females (12.9%) than in males (5.4%) (chi2 = 16.34; P0.001). The prevalence increased with the number of pregnancies from 4% in nulliparous women, to 34.6% in persons with a history of six or more pregnancies (chi2 = 200.1; P0,001). The prevalence also increased according to the body weight (chi2 = 30.08; P0.001). There was no difference in the prevalence between individuals with diabetes mellitus and controls. It is concluded from this study that the prevalence of gallstones in the city of Curitiba is elevated.

GM1-gangliosidosis is a lysosomal storage disease caused by a deficiency of acid beta-galactosidase. Three clinical forms are recognized-infantile, juvenile, and adult-based on age of onset and severity of the symptoms. We have performed molecular analysis of a large cohort of GM1 patients (19 Brazilian and one Uruguayan), using nonradioactive single-strand conformation polymorphism (SSCP) and restriction enzyme analysis of genomic DNA. Six novel mutations (R121S, V240M, D491N, 638-641insT, 895-896insC, 1622-1627insG) and two previously described point mutations (R59H, R208C) were identified. Together they accounted for 90% of the disease alleles of the patients. Two mutations, 1622-1627insG and R59H, were present in 18 of 20 patients. In addition, four polymorphisms (L10P, L12L, R521C, S532G) were identified. All cases reported are infantile GM1 gangliosidosis. This report constitutes the most comprehensive molecular study to date of this disorder in infantile patients. Since GM1-gangliosidosis is the most common lysosomal storage disorder in Southern Brazil, molecular diagnosis will be important for genetic counseling, carrier detection and prenatal diagnosis in index families.

A patient with a history of intermittent and intense pain in the upper abdomen secondary to an ulcer of a duodenal diverticulum underwent laparoscopic treatment. The diverticulum measured 2.5 cm in diameter and it was located on the lateral wall of the second portion of the duodenum. The diverticulum was inverted and the duodenal muscular defect was closed with interrupted sutures. Ambulation and a clear liquid diet was started on the same day as the operation, and the patient was discharged on the first postoperative day.

Background: Diagnostic laparoscopy has been used in abdominal trauma patients, although its role is not well defined. The safety of laparoscopic evaluation in trauma patients with severe intraabdominal hemorrhage has not yet been analyzed. The purpose of this study is to evaluate the hemodynamic and metabolic effects of CO2 pneumoperitoneum (COI) in hemorrhaged animals through a retroperitoneal hematoma (RH). Methods: Twenty-two 15–20-kg mongrel dogs were monitored for systemic and pulmonary hemodynamics, inferior vena cava pressure, and arterial blood gases. After 1 h of baseline, all animals were submitted to a RH. After 45 min the dogs were randomized into two groups. Control (CTR): dogs were submitted only to a RH; pneumoperitoneum (PN): dogs were submitted to a RH and 45 min later they were insufflated to an intraabdominal pressure of 10 mmHg with medical-grade CO2 gas for 30 min. Echocardiography was performed, only in PN animals, at baseline, 45 and 60 min after RH. Results: RH induced a shock condition with low, sustained levels of arterial pressure, cardiac index, left ventricular stroke index, base excess, and oxygen delivery which were further depressed following COI. Three deaths occurred in the PN group, all of them toward the end of COI. During COI, hypercapnia was observed in one animal. COI did not impair systolic function or ejection fraction. Conclusions: COI with an IAP of 10 mmHg may be deleterious in animals with hemorrhagic shock due to an intraabdominal lesion. These findings could be clinically significant in abdominal trauma patients.

The number of diagnosed inborn errors of metabolism (IEM) is growing constantly due to the improvement and widespread availability of analytical techniques. In 1982, a laboratory for the detection of IEM was set up in Porto Alegre, Brazil, and became a national reference centre for the diagnosis of these disorders. Ten thousand patients with signs and symptoms suggestive of IEM were investigated in our laboratory from 1982 to 1995 using specific protocols which included tests for the detection of glucosaminoglycans (GAGS), amino acids, sugars, oligosaccharides, sialyloligosaccharides, organic acids, as well as various metabolites. The biochemical investigation was completed in 9,901 patients and an IEM was detected in 647 cases (6.5%). Groups of IEM of higher incidence in our sample were lysosomal storage disorders (59.8%) and aminoacidopathies (21.2%). The disorders most frequently diagnosed were classical phenylketonuria, GM1 gangliosidosis, mucopolysaccharidosis type I, mucopolysaccharidosis type VI and metachromatic leukodystrophy. Conclusion This study shows that the establishment of reference centres for the investigation of rare genetic diseases is a suitable approach to the study of IEM in developing countries such as Brazil.

To determine the cost of liver transplantation at the Clinical Hospital of the Federal University of Parana.The data of 24 patients subjected to 25 liver transplantations were evaluated from the day of hospital admission until the day of discharge to determine the length of hospitalization, quantity of material and medications used, and exams and procedures performed. Professional fees were not included in the study.The age of the patients varied from 6 to 56 years. Six patients were younger than 14 years of age. Five patients died during hospitalization. Retransplantation was performed in only one patient. The average cost for liver procurement was US$ 2,783.19. The total cost of the liver transplantation varied, depending on the occurrence of complications, length of hospitalization and the amount of blood products transfused. The total cost varied from US$ 6,359.84 to US$ 75,434.18, with an average of US$ 21,505.53. The most expensive item of the liver transplantation was blood products transfused, followed by medications, and intensive care and room charges.The cost of liver transplantation varies among the patients and may be performed in Brazil at a cost less than that reported in the United States and Europe.

In pressure-driven hemorrhage (PDH), where the rate of bleeding is a function of prevailing arterial pressure, survival time, arterial pressure, cardiac output, oxygen consumption, and base excess are functions of initial bleeding rate. The quantitative rate of transcapillary refill (TR) throughout PDH leading to death was determined in splenectomized dogs, through serial analysis of Cr51-tagged red cell dilution. Mild, moderate, and severe levels of PDH were produced by varying initial bleeding rate (10, 25, and 50 ml/min, respectively). The rate of TR is a function of the severity of PDH, but does not correlate with arterial pressure, cardiac output, or systemic resistance. The volume of transferred fluid represents an ever increasing fraction of total plasma volume, and accounts for more than 75% of plasma volume in preterminal stages of shock. TR sustains a relatively fixed level of plasma volume, equivalent to two-third of the initial plasma volume, irrespective of the rate of bleeding. Hypertonic NaCl (7.5%) enhances TR, while isotonic NaCl reverses it.

The present work analyses the abundance and species composition of mesozooplankton in relation to different patterns of wind speed and tides in Admiralty Bay. The plankton was sampled on 12, 13 and 15 March 1989 with a 385 μm mesh size conical-cylindrical net by R.V. “Barao de Teffe”. In Martel Inlet, the zooplankton standing stock reached 25,223 individuals 100 m−3 during the high tide. Under north-west winds, the abundance of the dominant species Ctenocalanus citer and Fritillaria borealis followed the tidal cycle. Weak south-west winds promoted the input of plankton even during low tide. Throughout the Bay, the highest densities of plankton (446–2,899 individuals 100 m−3) were observed in surface waters flowing towards the Bransfield Strait. Surface waters flowing through the Bay and the inlets showed different species composition to surface waters flowing towards the Bransfield Strait.

Electromyographic recordings were obtained from a patient with short-bowel syndrome. Eight recording sessions were performed in almost 3 mo, during both fasting and fed states. Slow waves were always present, and their frequencies were similar during both states. Phase III of the migrating motor complex (MMC) was not identified in any of the four recordings performed in the 1st mo after the operation. Afterward, phase III was observed in three of four recordings. Ingestion of milk caused substitution of the MMC by the fed pattern in all eight recordings. We conclude that extensive small-bowel resection causes temporary disappearance of phase III of the MMC. A change from a fasting to a fed pattern after food ingestion is normal.

To present our experience of progressive preoperative pneumoperitoneum in the preparation of patients for repair of large hernias of the abdominal wall.Prospective selected series.A university hospital and a district hospital.36 Patients of the 252 who presented for abdominal hernia repair between January 1977 and April 1992.Air was insufflated into the peritoneal cavity through a 19 gauge spinal needle, and between 500 and 2000 ml was usually injected at the first session. Amounts were gradually increased daily or every other day for a period of 6-15 days; the total amount insufflated ranged from 4500-18,500 (mean 7700) ml.Whether the hernia could be repaired directly without recourse to polypropylene mesh, complications of pneumoperitoneum, and recurrence rate.In one patient air was insufflated into the colon, one developed temporary but severe respiratory distress, and 4 developed moderate subcutaneous emphysema. 30 hernias were repaired directly, and 6 required polypropylene mesh. There were three wound infections (two after direct repair), and two recurrences (both after direct repair). Mean length of follow up was 10 months (range 1-48).Progressive preoperative pneumoperitoneum allows direct repair of some large abdominal hernias with a low recurrence rate, and few complications.

The prevalence of gallstones was determined in Curitiba. A total of 384 patients older than 20 years of age was randomly selected from four general hospitals and subjected to ultrasonographic examination of the gallbladder. Of the 384 patients, 327 had normal gallbladder (85.2%) and 57 (14.8%) had gallstones (48 patients) or had been previously subjected to cholecystectomy due to gallstones (9 patients). Six out of the 48 patients with gallstones referred biliary colic (12.5%). Gallstone prevalence increased with age and number of pregnancies.

Thirty-two patients with acute acalculous cholecystitis are presented. The age of the patients ranged from 1 to 80 years, with an average of 46.3 years. Acute acalculous cholecystitis occurred during the postoperative period in only four patients. Three patients were receiving total parenteral nutrition and 16 patients had one or more associated medical diseases. One patient had acute acalculous cholecystitis due to mechanical obstruction of the cystic duct caused by a diaphragmatic hernia. The most frequent signs and symptoms were right upper quadrant abdominal pain, nausea, vomiting, fever, abdominal mass, and jaundice. All patients were subjected to cholecystectomy. Nine (28.1%) gallbladder specimens had gangrene. Pericholecystic perforation was observed in four patients (12.5%) free perforation in one patient (3.1%), and empyema of the gallbladder in one patient (3.1%). Bacteria were cultured from 18 of 24 bile specimens. E. coli was the most common organism isolated. The overall postoperative mortality and complication rates were 15.6% and 40.6% respectively. The average hospital stay was 16.4 days.

Recently, a Roux-en-Y stasis syndrome was described in a few patients after gastric operations. Although the clinical long term results are usually good, the motility of Roux-en-Y biliary limb has not been evaluated yet. In the present study, we report electromyographic studies of the gastrointestinal tract of two patients with chronic Roux-en-Y hepaticojejunostomy. These two patients provided a unique opportunity to evaluate the electromyographic activity of chronic Roux-en-Y limb in humans after one to five years. Seven pairs of bipolar extracellular electrodes were implanted in the antrum, duodenum, proximal part of the jejunum (15 centimeters proximal to the jejunojejunostomy), distal part of the jejunum (15 centimeters distal to the jejunojejunostomy), ileum, proximal Roux-en-Y limb and distal Roux-en-Y limb. All four phases of the migrating motor complex (MMC) were identified in the antrum and small intestine, including the Roux-en-Y limb, almost simultaneously to phase III in the duodenum. In the other two recordings (25 per cent), there was no relationship between phase III in the Roux-en-Y limb and that in the duodenum. Ingestion of food caused substitution of the MMC by the fed activity pattern in all recordings in the antrum and small intestine, including the Roux-en-Y limb. The findings of the present study indicate that the electromyographic activity of the Roux-en-Y limb may remain normal during fasting and fed states even many years after its creation.

The skin microbial flora of 18 patients was evaluated during prolonged preoperative hospital stay. Five cultures for bacteria and fungi were obtained on different days: on admission one, three and seven days after admission and after skin disinfection with povidone-iodine solution. There was no change in the mean bacterial count from the admission day to seven days after admission. All but one culture obtained following skin disinfection were negative. Pathogenic bacteria were isolated in only one of each of the following culture day: admission, three and seven days after admission. All cultures were negative for yeasts. The findings suggest that the higher rate of wound sepsis observed in patients with long preoperative hospitalization may not be due to bacterial flora change.

Real-time high resolution ultrasound imaging was employed during reconstructive vascular operation in 165 patients. The purpose of this diagnostic procedure was to detect unrecognized strictures, thrombi, and intimal flaps in order to permit their surgical correction at the primary operation. Defects were discovered in 48 patients (29%). In 34 patients (21%), because of size and location, defects were not considered sufficiently significant to warrant re-exploration. In 14 patients (8%), ultrasound revealed defects that prompted immediate re-exploration. Patients with ultrasound defects considered to be insignificant did as well as patients with no demonstrable defects. In the 14 patients who were re-explored, 12 had major defects that were corrected. These 12 patients also did well after operation. In two of the 14 patients, defects could not be found at re-exploration. Both these patients experienced early thrombosis of bypass grafts. In 56 patients, ultrasound was compared with arteriography at the same operation. The accuracy of operative ultrasound and operative arteriography was 96% and 85%, respectively. Operative ultrasound is more accurate, simpler and safer than arteriography and may be the preferred method for detection of vascular defects at reconstructive surgery.

A case of Pulmonary Alveolar Proteinosis (PAP), in association with tuberculosis, is described in a 35-year-old diabetic patient. Lung biopsy showed an intra-alveolar accumulation of PAS-positive material, and multifocal granulomas compatible with tuberculosis. The bronchoalveolar culture was positive for Mycobacterium tuberculosis. PAP results from an imbalance of the mechanisms that regulate the homeostasis of the surfactant, where specific proteins are involved, especially SP-A and SP-D, the cytokines, IL-10 and GM-CSF, in addition to alveolar macrophages and type-II pneumocytes. Chemotaxis and phagocytic capacity are reduced. PAP and diabetes share several immunological disfunctions that may increase the risk for tuberculosis. Although there are no controlled studies, the diagnosis of PAP in diabetic patients with tuberculosis must be considered.

The skin bacterial flora of subjects who scrub their hands routinely was compared to subjects who usually do not scrub their hands, to determine the influence of the surgical scrub on the skin bacterial population. Aerobic, anaerobic and yeast cultures of 15 surgical residents and 15 internal medicine residents were obtained. The skin bacterial population of 15 medical students rotating through surgery was also determined to assess the influence of hand contact with infected wounds on the bacterial flora. The medical students had been in contact with infected wounds as had the surgical residents, but they had not been scrubbing their hands. The internal medicine residents had not been in contact with infected wounds or scrubbing their hands. The number of bacteria cultured from the medical students was superior to the bacterial count obtained from internal medicine residents, but inferior to the number of microorganisms isolated from surgical residents (p less than 0.01). Pathogenic bacteria were isolated from cultures of eight surgical residents, five medical students and one internal medicine resident. Yeast was cultured from one surgical resident's hand. This study indicates that both the frequent contact with infected wounds and the routine use of the ten minute surgical scrub may modify the bacterial flora of the hand. The alterations observed in the two situations were an increased number of both pathogenic and nonpathogenic bacteria.

In this study, a series of 705 patients with chronic cholecystitis and 203 with acute cholecystitis were surgically treated. The age distribution for the two groups was similar. Operative cholangiography was performed upon 661 patients (94.0 per cent) with chronic cholecystitis and upon 182 patients (90 per cent) with acute cholecystitis. The common bile duct was explored in 146 patients (20.7 per cent) with chronic cholecystitis and in 41 patients (20.1 per cent) with acute cholecystitis, and bile duct calculi were found in 106 patients (15 per cent) with chronic cholecystitis and in 29 patients (14.2 per cent) with acute inflammation of the gallbladder. The total number of postoperative complications and the operative mortality were similar for the two groups. It is concluded that the incidence of common bile duct stones in patients with acute cholecystitis is the same as for those with chronic cholecystitis.

Myoelectric activity of the sphincter of Oddi and duodenum was correlated with pancreatic and biliary duct pressures in eight opossums, in both the fasted and fed states. Four bipolar electrode pairs were implanted in the sphincter of Oddi and duodenum. A polyethylene T tube was placed in the pancreatic duct. The common duct was cannulated through a small bile duct. This method allowed pressure recording for several weeks and avoided interference with the flow of bile or pancreatic juice into the duodenum. The frequency of slow waves was the same in the sphincter of Oddi and duodenum (19 per minute). The variation in the frequency of spike potentials in the sphincter of Oddi correlated to that of the migrating myoelectric complex in the duodenum. The average frequency of slow waves that have superimposed spike potentials in the sphincter of Oddi and duodenum was 3.0 and 0 in phase 1, 4.7, and 6.2 in phase II, 6.1 and 15.1 in phase III, and 3.4 and 6.3 in phase IV, respectively. The average duration of a migrating myoelectric complex cycle was 92 minutes. After feeding, the interdigestive phases of the migrating myoelectric complex were abolished and substituted by a feeding activity pattern that was characterized by an average number of sphincter of Oddi and duodenum spikes of 6.6 and 10.7, respectively. The mean fasting pressure in the pancreatic and biliary duct was 15 and 13 mmHg, respectively. Pressure changes were of two types--synchronous with respiratory movements and with each sphincter of Oddi spike potential. There was no variation in the baseline pressure during the migrating myoelectric complex phases and the fed state. It is concluded that the sphincter of Oddi of the fasting opossum exhibits cyclic changes in the number of spike potentials that correlate with the migrating myoelectric complex in the duodenum. However, the number and amplitude of spike potentials are different in the sphincter of Oddi and duodenum. There is no change in the baseline pressure during fasting and feeding states, and a temporary pressure elevation synchronic with each sphincter of Oddi spike potential was observed.

The accuracy of arteriography in detecting vascular defects similar to those encountered during vascular surgery was evaluated experimentally. Intimal flaps, thrombi, and strictures were created in dog aortas and studied under circumstances resembling operating room conditions by single-view portable and serial biplanar contrast arteriography. The specificity of both types of arteriography was comparable and high for detecting vascular defects. The sensitivity for diagnosing strictures was also comparable and high. However, both radiographic techniques were relatively insensitive in the detection of small intimal flaps and thrombi. In the detection of these two types of defects, serial biplanar arteriography was significantly more sensitive than portable arteriography. The degree of the superiority of serial bi-plane and the possible clinical insignificance of small defects indicates that portable arteriography in the operating room may still be an adequate methodology.

Myoelectric activity of the antrum, duodenum and sphincter of Oddi was recorded from 12 conscious opossums. The common duct and the pancreatic duct were cannulated for pressure measurements. Recordings were made in the fasted state and after gastric or duodenal administration of ethanol. Alcohol was instilled during phase I (55 experiments) or phase II (ten experiments) of the migrating myoelectric complex. Administration of alcohol caused the appearance of phase III-like activity in five to ten minutes in 91 per cent of the experiments. Pancreatic duct and common duct pressure oscillations occurred synchronously with respiratory movements and with sphincter of Oddi spike potentials. There was an increase in the number of pressure elevations related to the increase in sphincter of Oddi spike potentials after alcohol administration; however, base line pressures remained constant. It is concluded that the administration of alcohol into the stomach or duodenum causes the appearance of phase III-like activity and that there is no change in the base line pressure after the instillation of alcohol.

We have evaluated the effect of various autonomic drugs on the electromyographic activity of the sphincter of Oddi and the small intestine of seven opossums. Hexamethonium bromide and atropine sulfate abolished and bethanechol increased the frequency of spike bursts in the sphincter of Oddi and duodenum. Phenylephrine and epinephrine increased the number of spike bursts in the sphincter of Oddi after a short period of stimulation. No spike potentials were seen in the duodenum after infusion of norepinephrine. Clonidine and dobutamine decreased spike burst activity in the sphincter of Oddi and duodenum. Terbutaline also decreased the frequency of spike bursts in the sphincter of Oddi but did not change the number in the duodenum. Prior infusion of antagonists blocked partially or totally the effect of all respective agonists except for yohimbine, which did not inhibit the effect of clonidine. These findings suggest that the sphincter of Oddi may have cholinergic, alpha 1, alpha 1, beta 1 and beta 2-adrenergic receptors. Cholinergic agonists stimulate and alpha 2, beta 1 and beta 2-adrenergic agonists inhibit the motility of the sphincter of Oddi and the small intestine. Alpha-adrenergic agonists stimulate the motility of the sphincter of Oddi and inhibit the motility of the small intestine.

A new experimental model was developed for dynamic in vitro evaluation of clamp effects in normal and atherosclerotic human arteries. Five normal and 25 atherosclerotic arteries obtained at autopsy were perfused by a pulsatile blood pump. Five vascular clamps--DeBakey, Satinsky, Fogarty, bulldog and Potts--were applied separately to 150 arterial segments, 30 each. The arterial segments were examined by single exposure arteriography and real time ultrasonography. The arteries were opened longitudinally and examined for traumatic lesions and atherosclerotic plaques. Except for a single intimal tear, there were no lesions produced by the clamps applied to normal arteries. In atherosclerotic arteries, the number of traumatic lesions, intimal tears and flaps, was comparable for all five clamps except the bulldog clamp which caused no intimal flaps. Intimal tears and flaps were observed in 14 and 26 per cent of all atherosclerotic vessels, respectively. The occurrence of clamp trauma in atherosclerotic arteries was independent of the age, sex and direct clamp application to plaques. Sensitivity of intimal tears by arteriography and ultrasonography was comparable low. Intimal flap sensitivity and accuracy of ultrasonography were greater than that of arteriography, p less than 0.01. It is concluded that the occurrence of important trauma by vascular clamps in atherosclerotic arteries is high and occurs whether or not discrete plaques are clamped. Clamp trauma is minimal in normal arteries. Imaging ultrasonography is superior to arteriography in detecting intimal flaps and can demonstrate the majority of intimal flaps produced by vascular clamps.

The myoelectric activity of the sphincter of Oddi was studied both in the fasted and fed states and following administration of gastrointestinal hormones. Electromyographic recordings were obtained from 21 opossums in the fasted state and following administration of 20 Cal/kg of fat, protein, carbohydrate or isocaloric mixture of these three aliments. The proximal segment of the sphincter of Oddi generated spontaneous spike potentials that migrated to the distal segment of the sphincter. The frequency of spike potentials correlated with the migrating myoelectric complex in the duodenum. Following feeding, the migrating myoelectric complex was abolished and substituted by a fed pattern. The duration of the fed pattern and the frequency of spike potentials depended on the kind of aliment. Cholecystokinin and pentagastrin increased and glucagon and secretion decreased the frequency of spike potentials in the sphincter of Oddi. It is concluded from these studies that the sphincter of Oddi may play an important role in controlling the time and rate of biliary drainage into the duodenum.

A new operative procedure for the preservation of pancreatic fragments is introduced ("intestinalization") in which vascularized fragments are placed inside a jejunal pouch. This step is done to manage all secretions, lymph and potential debris coming from the pancreas; to maintain the primary portal drainage of insulin; to avoid vascular operations, and to keep the fragment in a denervated state and still preserve its endocrine function to prevent diabetes. The procedure was compared with conventional end to end pancreaticojejunostomy. Sixteen dogs were studied. Group 1 consisted of four dogs that had intestinalization of the pancreatic tail. Group 2 is made up of eight dogs that had complete resection of the remaining duodenal portion of the gland as well as intestinalization of the pancreatic tail. Group 3 consisted of four dogs that had end to end pancreaticojejunostomy to the isolated tail and complete resection of the duodenal portion of the gland as those dogs in group 2. No dog became diabetic during the time of observation (up to one year)--fasting glucose levels and K values in glucose tolerance tests remained normal. Insulin peak values at ten minutes were lower postoperatively. However, return to fasting levels occurred equally fast postoperatively. There was no difference among the groups. The most important morphologic finding in the intestinalized fragments was a firm capsule surrounding the tissue after two weeks. Exocrine atrophy was present in both groups 2 and 3 after one year. No reinnervation of intestinalized pancreas was seen. Intestinalization may offer an alternative to pancreatic resection especially when heterotopic autotransplantation is considered.