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Chemical compounds containing platinum have been employed since 1978 as drugs to beat certain type of tumours. Nevertheless, besides of their exceptional antitumoral properties, these drugs also have important deleterious side effects, such as, nephrotoxicity and ototoxicity. A study of Pt accumulation and a speciation analysis has been performed by ICP-MS in samples from kidney and inner ear in a controlled population of Wistar rats treated with, either, cisplatin, carboplatin or oxaliplatin. The results on Pt accumulation point out to drug structure and not only to Pt content as the responsible for the alteration of organ functionality. Speciation studies in the samples from kidney and inner ear were performed coupling two-dimensional liquid chromatography (2D-LC) to ICP-MS. Size exclusion (SEC) and anion exchange fast protein liquid chromatography (FPLC) was employed for 2D orthogonal separation. After these separations, free drug peaks were not observed in any of the samples. The binding of Pt to biomolecules was demonstrated by SEC and, independently of the drug used, Pt eluted as two main bands with molecular weights of 12kDa and 25-65kDa for inner ear samples, and as two different bands with 20kDa and 50-60kDa in the samples from kidney. However, the relative band intensity presented important differences for the three drugs. Using the same chromatographic conditions, it was shown that a metallothionein (MT) standard eluted in the same position as some of the cytosolic Pt-biomolecules. High Pt-containing fractions eluting from the SEC column were analysed by anion exchange FPLC after a preconcentration step. Among the different preconcentration methods tested, sample focusing on the head of the FPLC column shows main advantages. In this way, the separation by 2D chromatography of the high molecular Pt-species has been considerably improved.

Objective: To determine risk factors of mortality in the infant of a toxemic mother., Material and Methods: A case-controls study, single products only, of 28-42 weeks of gestation; cases were either stillborn and neonatal deaths. Where controls were survivors., Results: There were 57 cases and 114 controls. Significant risk factors were: eclampsia (OR = 4.25, 95%CI 1.76-10.39, p = 0.0002), placental detachment (OR = 8.13, 95%CI 2.29-31.4, p = 0.00007), general anesthesia (OR = 5.32, 95%CI 1.74-16.51, p = 0.0005), respiratory distress syndrome (OR = 23.68, 95%CI 3.31-478 p = 0.00004), mechanic ventilation (OR = 334, 95%CI 42.63-7084, p = 0.000000001), peri-intraventricular hemorrhage (OR = 64.57, 95%CI 8.36-1361, p = 0.0000001), acute renal failure (OR = 26.13, 95%CI 5.21-177, p = 0.0000002) and pulmonary hemorrhage (OR = 8.40, 95%CI 2.71-27.11, p = 0.000006). We observed as protective factors: high maternal educational level (OR = 0.110, 95%CI 0.01-0.66, p = 0.02), intrauterine malnutrition (OR = 0.39, 95%CI 0.18-0.84, p = 0.008) and transient tachypnea of the newborn (OR = 0.021, 95%CI 0.00-0.15, p = 0.00000001)., Conclusions: We found as maternal risk factors: eclampsia; premature placental detachment; general anesthesia, and maternal death, in the newborns they were respiratory distress syndrome, mechanical ventilation and peri-intraventricular hemorrhage. The finding of protection factors is interesting.

Introduction: Wilms' tumor (WT) is the most frequent embryonic renal neoplasia in children., Objective: This study was carried out to investigate risk factors in the development of WT., Material and Methods: A design of cases and controls, proactive, of incident cases, with four controls per case. The study population of cases were children of two oncologic reference Center of the Mexican Institute of Social Security (IMSS) in the Mexican Federal District during 5-year period. For the control group, children were frequency matched by age and sex at with cases from the same clinic. A questionnaire, previously validated, was applied to determine risk factors in both groups., Results: During the period of study, 34 cases and 136 controls were revised. Significant risk factors were: antecedent of a relative with Down syndrome (OR = 7.6, 95%CI 1.4-51.1, p = 0.008), eczema (OR = 3.7, 95%Cl 1.1-12, p = 0.01); having been conceived in autumn (OR = 5.4, 95%CI 1.3-31.6, p = 0.007) or winter (OR = 4.9, 95%Cl 1.1-29.9, p = 0.01), and beet ingestion (OR = S. 7, 95%Cl 1.7-19.4, p = 0.0007)., Conclusions: In this study, influence of prenatal factors are shown and we attempt to explain the etiology of WT, the important of beet ingestion, and conclusions suggest that that more epidemiologic studies are necessary to determine the chain of events that causes Wilms' tumor.

Background: One of the objectives of the geriatric home care teams is that of the follow-up of elderly patients having a high risk of hospital readmission. Although they have been operating in our country for years, no data shows the impact on the use of hospital resources in accordance with this follow-up. The objective of this study is that of analyzing the effect which the monitoring, by geriatric home care unit, involves on patients having very advanced chronic cardiorespiratory disease., Methods: The patients with chronic cardiorespiratory disease followed up by the unit during the January 1995-January 1999 period were included, excluding those on follow-up for less than 3 months. A comparison is drawn among the number of hospital emergency room visits, hospital admissions and days of hospitalization for the year prior to the care provided by the unit and throughout the follow-up time thereof are compared., Results: Eighty-one (81) patients, mean age 80.57 years (DE 7.39) and a median length of care per unit of nine (9) months (5-13.5), were included in the study. The uses per patient and month of follow-up decreased by 0.07 Emergency Room visits (0.02-0.11) (p = 0.04), 0.10 hospital admissions (0.07-0.14) (p < 0.001) and 2.01 days of hospitalization (1.87-2.15) (p < 0.001)., Conclusions: A specialized geriatric home care unit reduces the use of hospital resources on elderly people diagnosed as severe chronic cardiorespiratory disease.

The epidemiologic, clinical and prognostic characteristics of Stenotrophomonas maltophilia bacteremias for a six-year period (January 1993 to December 1998) were reviewed. Twenty episodes of S. maltophilia bacteremia were include, which represented 0.62% of all bacteremias caused by gram-negative rods during that period. Seventy percent of bacteremias were clinically significant. The most common predisposing factors were the previous use of antimicrobial agents and the presence of vascular catheters. In most cases (57%), the origin of bacteremia was the intravascular catheter. The course of patients was favorable and all patients cured.

The search for risk factors for development of germ cell tumors (GCT) in children who lived in Mexico City (MC). A protective, observational, case-control study was conducted in children under 15 years of age resident in MC, insurer by the Mexican Institute of Social Security. The study population was selected between January 1st, 1990 and December 31st, 1994. Parents of the children were interviewed with a 230-items precoded questionnaire, validated previously with a pilot study. For analysis were obtained simple frequencies and odds ratios (OR) and 95% confidence interval (95%CI). There were 21 cases and 105 controls. The most significant risk factors were winter conception (OR = 7.6, 95% CI 1.5-39.3; P = 0.007); low parental education level (OR = 2.9, 95% CI 1.1-7.5; P = 0.026); and parental combined dust and electricity exposure before pregnancy (OR = 26, 95% CI 2.28-1291.86; P = 0.0007). during (OR8.58, 95% CI 0.89-106.55; P = 0.041) and after pregnancy (OR = 9.66, 95% CI 0.99-120.22; P = 0.027). There was a protective effect with repetitive infections during infancy. In conclusion, Winter conception is in accordance with infectious etiology theory of GCT development. The low parental education level and the combined exposure to dust and electricity are very important. The protective effect of repetitive infections and other factors make necessary more epidemiologic studies in this field.

At the Hospital de Ginecobstetricia del Centro Médico "La Raza", were taken EKG to 30 healthy premature newborn during a six month period. The first EKG was recorded 3 hours after birth, the second in 8 hours, the third in 24 h, the fourth in 48 h, the fifth in 72 hours, the sixth at the end of the first week, the seventh at the fifteen days and the eighth at 30 days after birth. The mean heart rate was 135 +/- 10 beats/min in the first week. There were heart rate elevation for the first three days after birth. The QRS mean axis were + 130 +/- 25 degrees, without changes during the study time. The QTc interval in all cases was higher than 0.42 sec. The voltage of waves R and S at right and left precordial leads were similar. At this gestational age the ventricular masses are equals. The T waves changes reflected hemodynamic changes. It is concluded what the healthy premature newborn had a typical EKG as a reflex to the cardiocirculatory adaptations.

Objective: Shows the general findings in a cohort of newborn babies born to diabetic mothers., Design: Prospective and observational study, during a year (1988)., Place: Hospital de Ginecoobstetricia del Centro Médico "La Raza", a terciary Center., Results: There were 92 newborn babies born to diabetic mothers; 62 were delivery with cesarean section and 30 were vaginally; 51 were males and 41 females; with 49% prematurelly born, 38% with macrosomia; there were eight stillbirths and four neonatal deaths, with a perinatal mortality of 13%. From the live born babies in 50% had any problem with icterus in 40%, respiratory insufficiency in 22.5%, hypoglycemia in 16.2% and polycytemia in 13%; 44.5% had an uncomplicate course. There were five patients with congenital anomalies., Conclusions: The newborn baby born to diabetic mother needed a special control from early stages of pregnancy, preferable for a interdisciplinary medical team, with the goal to obtained in our perinatal mortality rate will be similar to published in the international literature, lesser of 2%.

The medical records of children who died from asthmatiform syndrome at Hospital de Pediatría del Centro Médico Nacional, during 1963 through 1980. were examined. There were sixteen asthmatic deaths; out of these, ten were males and six females; 88% occurred before the age of five years. Half of the deaths occurred during the first asthmatiform attack. In 69%, an upper respiratory tract infection was the precipitating factor and in 31%, bronchopneumonia was associated. There were cardiac failures in 88%. A poor medical management was the main factor in about 66%. The mortality rate was 0.5%. The significance of the clinical course is discussed and a program for treatment outlined.

The present study describes the results achieved 6 months after the establishment of a health examination, with different features depending on age and sex groups, which was progressively applied to the population of the C.A.P. "Virgen de la Fuensanta" (Valencia). The preventive activities included: vaccination (rubella, tetanus and influenza), tuberculin skin testing, determination of body weight and mass (BMI), measurement of blood pressure and heart rate, cervical cytology, breast examination and search for occult blood in feces. Among the 388 evaluated individuals (69.4% females and 30.6% males), 10 cases of hypertension, 2 of diabetes, 65 of obesity, 20 of hypercholesterolemia, 23 women with benign breast abnormalities and 8 instances of occult blood in feces were detected. In the age group of 15-26 years, 7 positive tuberculin reactions were detected. In 175 cytological studies no case of malignant disease was discovered. The degree of acceptance of the program by the users was satisfactory, as assessed by the compliance with both the appointments (85%) and the individual interventions (88-100%).

The study shows the gasometric and electrolytic features during the first five day from newborns from toxemic mothers. It is a prospective study, carried out during a four month period at the obstetrics premature ward at the Gynecological-Obstetrics Hospital of "La Raza" Medical Center. Thirty-three newborn babies with evidences of toxemia and who had not received any intravenous therapy were studied. Blood samples were taken and serum calcium, phosphorus and magnesium levels were measured at 24, 48, 72 and 120 hours after birth. The results showed that six patients (18%) were anemic, and another had polycythemia. Twelve others (36%) had plaquetopenia, one had hypercalcemia, another hypocalcemia, and eleven (33%) presented hypophosphatemia. Of the initial 33 patients, 75% presented metabolic acidosis which spontaneously corrected itself within the following 72 hours. Three showed signs of hypernatremia, four hyponatremia, and two others hyperkalemia, with a return to normal levels within the next 24 hours. No chloride alterations were found in any of the patients. Some newborn babies born from toxemic mothers can spontaneously correct their electrolytic and acid-base imbalance within 72 hours of their birth. Electrolytes; toxemia.

We present the clinical picture of a patient with the fetal hydantoin syndrome. A review was made on etiology, pathogenesis, in this syndrome and the recommended medical management for the epileptic mother during pregnancy.

A case of severe asthma which did not improve with the usual management is presented. Ventilations was assisted with an orotracheal cannula and the patient was given halothane with a good response and improvement of his crisis. Halothane must be considered as a possibility in the treatment of severe asthma. However, further studies in this area are necesary.

We describe the clinical course of 120 children with tricuspid atresia (TA) attended in the Hospital de Cardiología y Neumología, "Dr. Luis Méndez", del Centro Médico Nacional. There were 61 males and 59 females. The age of presentation was in 79 newborn babies, seventeen between one and six months old, 20 between six and 24 months old, and four with two or more years old. The clinical picture was hypoxic spells in 89% and congestive heart failure in the others. The chest film showed cardiomegaly in 85%, with diminished pulmonary flow in 48%, increased flow in 27.5%, and normal in 9%. The electrocardiogram with superior left axis deviation in 94%, right atrial hypertrophy in 58%, left atrial hypertrophy in 47.5% and left ventricular hypertrophy in 96%. TA was classified as type I in 103 children, type Ic in 70, Ib in 27 and Ia in six, and type II in seventeen children, with eight IIc, six IIb and three IIa. In 44 the management was medical, 63 underwent systemic-pulmonary anastomosis, 37 of them with Blalock-Taussig shunt and Fontan procedure in thirteen children. There were 21 deaths. This survey is compared with the literature and from this point we make management recommendations.

A case of non-coronary myocardial infarct in the newborn period is reported. There are only 25 cases in the world literature. A review is made of the the etiology, pathogenesis and of the news methods used for diagnosis.

We describe the results of surgical repair of atrial septal defects in 36 children who did not undergo pre-op cardiac catheterization. These cases were seen at the Hospital de Cardiologia y Neumología Dr. Luis Méndez del Centro Médico Nacional. There were 24 (67%) females and twelve (33%) males. The mean age was 6.4 +/- 2.4 years with a range from three to thirteen. All cases had auscultatory findings typical of atrial septal defect. Five patients with associated tricuspid murmur (chest film showed grade I cardiomegaly in 21 (58.3 per cent), grade II cardiomegaly in fifteen (41.7 percent). Pulmonary artery shadow was normal in 24 (66.6 percent) and increased in twelve (33.3%). Pulmonary blood flow was increased in all of them. Electrocardiogram showed sinus rhythm in 35 (97.2%). In one instance left atrial rhythm; all EKGs demonstrated right axis deviation, complete right bundle branch block and right ventricular hypertrophy with diastolic overload. Only three had right atrial hypertrophy. The M-mode echocardiogram showed right ventricular dilatation in all and paradoxically septal motion in 26 (72.2%). Two-dimensional echo with the subxiphoid view allowed direct visualization of the defect in all cases. We performed contrast echocardiogram in eight cases and Doppler echocardiogram in six of them. Cardiac surgery findings were ostium secundum atrial septal defect in 34 (94.4%). Two of them also had partial anomalous venous connection. All had uneventful recovery. We conclude that in typical atrial septal defects operative repair is feasible without prior cardiac catheterization.