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OBJECTIVES To examine the presence of intestinal protozoan and helminth infections and their association with clinical signs and symptoms in children in Trujillo, Venezuela. METHODS Conventional microscopic methods (thick-smear, saline and iodine solutions) were used to identify parasites in stool samples of 301 children attending day care centres. A subgroup of 45 children was evaluated clinically and parasitologically five times during a 1-month period using conventional methods and the Kinyoun acid-fast stain for Cryptosporidium identification. RESULTS The point prevalence of protozoan infections was 21% for Giardia duodenalis, 1.0% for Entamoeba histolytica/dispar, 4% for Entamoeba coli, 16% for Blastocystis hominis, and 89% for Cryptosporidium parvum. Prevalence of helminth infection was 11% for Ascaris lumbricoides, 10% for Trichuris trichiura, 0.3% for Strongyloides stercoralis, and 1.3% for Hymenolepis nana. Over a 1-month time frame, new infections were observed at a rate of 11% for G. duodenalis, 4% for E. histolytica/dispar, 7% for A. lumbricoides, 11% for T. trichiura, 0% for S. stercoralis, and 2% for H. nana. Intestinal symptoms (diarrhoea, vomiting, gas, stomach pain, and loss of appetite) were associated with presence of one or more of C. parvum or B. hominis organisms in stool samples. CONCLUSIONS Intestinal parasitic infections contribute significantly to the enteric disease burden experienced by this group of children. The organisms most strongly implicated by this study are common and difficult-to-treat protozoan pathogens.

The western mosquitofish (Gambusia affinis affinis) is a useful model for the study of sexual dimorphism and the neural circuits associated with sexual differentiation. This is largely because of its anal fin, which undergoes radical postnatal transformation in males. Understanding the neural mechanisms involved in this process may also help elucidate basic principles of the nervous system. The authors describe the mosquitofish as a model for research and present guidelines for the care and use of this species.

Although treadmill exercise testing (TET) has been used to identify ischaemia and determine clinical prognosis after myocardial revascularization, considerable controversy remains on its role in the detection of obstructive lesions of the arterial grafts.To assess the value of TET in determining the patency of arterial conduits after coronary bypass surgery with complete revascularization.Twenty five patients - 21 men and 4 women; age 53.7 +/- 8.7 years - submitted to complete myocardial revascularization exclusively with arterial conduits (CABG-A), undergoing coronary angiography and a symptomlimited TET (Bruce protocol) within 9 months after CABG-A. Angiograms were visually classified in 2 groups (Group I - conduits without lesions, n = 14; Group II50% stenosis or occlusion ofor = 1 conduit, n = 11). Clinical characteristics and the following parameters of the TET were compared: total exercise time (ETime); metabolic equivalents (METS); % of predicted maximal heart rate (% MHR); exercise-induced ST depression (decreases ST); and occurrence of angina. The arterial conduits used were: left internal mammary artery -24-; right internal mammary artery -11-; gastroepiploic artery -14-.There were no differences in age, gender, left ventricular systolic function, severity of coronary artery disease, and number of conduits per patient. Group I attained superior values for the following parameters: ETime (p0.01) and METS (p0.01). Among Group II there were more patients with angina (p = 0.03). Fourteen patients exceeded 8 METS (11 from Group I and 3 from Group II - p = 0.002-). There was no statistical difference among the number of patients with ST depression during exercise.After CABG-A the exercise tolerance seems to be related with the patency of the conduits and may play an important role in the detection of graft abnormalies. On the contrary, exercise-induced ST depression had low specificity in detecting obstructive lesions of the conduits.

To analyse early and medium-term results of patients (pts) with acute aortic dissection (DAO) regarding the importance of the different therapeutic modalities adopted.Retrospective study of the cases with DAO admitted in the cardiology intensive care unit of Santa Marta Hospital.46 pts (aged 25 to 80 years) with the diagnosis of DAO from January/1989 throughout December/1993.early mortality rate (30 days) was 36%. DAO type A Two cases were treated only with medical therapy for they suffer from severe associated pathology. Twenty eight pts were treated surgically. In this group mortality concerning time passed from the beginning of the symptoms throughout the surgery was:24 h-31%, 24-72 h-40%,72 h-63%. Among 17 discharged pts mortality occurred in 7% during the first year. DAO type B In pts with uncomplicated Stanford type B DAO survival was 90%. Emergency surgery was performed in pts who developed complications such as rupture of the aorta, occlusion of major arteries or extension of dissection. In this particular group mortality was 66%. Among 11 discharged pts with type B DAO 9% died within one year. During the follow-up period of 17.4 +/- 14.8 months one third of the pts discharged from hospital had clinical events.despite new advances in diagnostic and therapeutic approaches, DAO still's reported as a relatively high hospital mortality situation. Remove pts to an institution with ability to perform quickly the correct diagnosis and treatment becomes essential. Clinical presentation, type of DAO, surgery timing when indicated and major complications were of particular importance in the prognosis of pts with DAO. The frequency of cardiovascular events in pts who left the hospital alive emphasized the need to maintain blood pressure within normal limits.

Aortic Dissection seldom affects young women. Nevertheless, the structural changes in the arterial wall, that occur during pregnancy, may predispose women to this complication, particularly in the third trimester and peripartum period. Aortic Dissection in gestation is associated specially with the Marfan's syndrome. The authors report a case of a pregnant woman in the 35th week of gestation, without Marfan's disease, admitted to Hospital on suspicious of type A aortic dissection.

To present the initial experience of a surgical team from Santa Marta Hospital using exclusive arterial grafts on coronary bypass surgery.Cardiology and Cardiothoracic Departments.From November 1987 to May 1994, 176 consecutive patients were submitted to surgical myocardial revascularization with the exclusive use of arterial grafts. The patients were operated by one cardiothoracic surgical team. A revision of clinical and angiographic characteristics of the patients was done along with the surgical procedure and intrahospital morbidity. After hospital discharge, follow-up was done by direct evaluation and/or by a questionnaire made using phone or letter on a periodical basis.The medium number of coronary bypasses performed were 2.07 +/- 0.8. The left internal mammary artery was the vessel more frequently used, specially to the myocardial area supplied by the left coronary descending artery. The right internal mammary artery was the second arterial graft more currently used. Gastroepiploic artery was utilized preferentially to coronary arteries supplying the inferior wall of the heart. Hospital mortality was 3.4%-6 patients. One hundred twenty patients have a normal life, without physical restrictions, 25% of the patients have symptoms of angina that is severe in 9. Mean follow-up time was 34 +/- 10 months.Coronary artery bypass surgery with exclusive use of arterial grafts can be executed with an acceptable mortality and low morbidity rates, even in urgent cases, with relieve of cardiac symptoms and good quality of life.

In 1960 Holt and Oram reported a family in which upper extremity malformations were associated with a secundum atrial septal defect. Since then, more than 200 cases have been reported with a wide spectrum of phenotypes. The authors present the cases of one mother and daughter with Holt-Oram Syndrome (SHO).

A 48 year-old female patient, admitted with an ischemic stroke, had a transesophageal echocardiogram (TEE) that revealed a dense vegetation in the noncoronary aortic cusp, which was considered the probable source of embolism. The clinical investigation did not identify any other disease or infectious process. However the lack of histologic proof, the absence of fever, the fact that the blood cultures were persistently negative, the patient recovery with no need of antibiotics, and the results of the TEE, are highly suggestive of the presence of a non infectious thrombotic endocarditis. After 18 months of anti-platelet treatment, the patient showed no new embolic episodes and TEE demonstrated the resolution of the vegetation.