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The standard (p0 = 0.1 MPa) molar enthalpies of formation, Delta fH(0)(M), for liquid 2,4,6-trichloropyrimidine and for crystalline 2-chloropyrimidine, 2,4- and 4,6-dichloropyrimidine, and 2,4,5,6-tetrachloropyrimidine compounds were determined at T = 298.15 K by rotating-bomb combustion calorimetry. The standard molar enthalpies of vaporization or sublimation, Delta (g)(cr,l) H(0)(M), of these compounds at T = 298.15 K were determined by Calvet microcalorimetry. The experimental standard molar enthalpies of formation of those compounds, in the gaseous state, at T = 298.15 K, were thus obtained by combining these two sets of results. The latter values have been employed in the calibration of the computational procedure, which has been used to estimate the gas-phase enthalpies of formation for the other chloropyrimidines that were not possible to obtain in a pure form for the experimental study. It is found that the exchange-correlation functional based on the local spin density approximation (LSDA) seems to be a cheap choice for the estimation of enthalpies of formation for heterocycles containing nitrogen atoms; the well-known B3LYP hybrid method yields larger differences, with respect to the experimental values, for 2,4,6-tri- and 2,4,5,6-tetrachloropyrimidines.

A 42-year-old male complaining of thoracic spine pain was admitted to the hospital for evaluation. An X-ray and computer tomography of the thoracic spine showed spondylodiscitis of the L3 lumbar and L2-L3 intervertebral disk. The tuberculin skin test (PPD) was strongly positive. A radioscopy-guided fine needle aspirate of the affected area was cultured but did not reveal the cause of the disease. Two biopsy attempts failed to reveal the cause of the disease by culturing or by acid-fast-resistant staining (Ziehl Neelsen) of the specimens. A third biopsy also failed to detect the infectious agent by using microbiological procedures, but revealed the presence of a 245-bp amplicon characteristic of the Mycobacterium tuberculosis complex after PCR of the sample. The result demonstrates the efficacy of PCR for the identification of M. tuberculosis in situations in which conventional diagnosis by culturing techniques or direct microscopy is unable to detect the microorganism. Following this result the patient was treated with the antituberculous cocktail composed by rifampicin, pirazinamide and isoniazid during a six-month period. At the end of the treatment the dorsalgia symptoms had disappeared.

A well-characterized matched pair of fluconazole (FLU)-susceptible and FLU-resistant isolates, in addition to a clinical resistant isolate, was analyzed. It was found a differential expression of genes: the resistant strains experimentally induced after fluconazole exposure in vitro were associated mainly with up-regulation of ERG11 gene and a clear trailing growth in broth microdilution tests, whereas the isolate with clinically acquired resistance expressed constitutively high level of CDR gene and fluconazole MIC >64 mg mL(-1) within 24 h of incubation. The phenotype of resistant cells generated in vitro was reversible, implying that an induced transcriptional up-regulation of ERG genes would be one adaptive mechanism allowing the cells to grow in the presence of azole drugs. These drugs could have a potential role in modulating genes whose up-regulation would allow cells to remain in the hosts, providing a source for further development of resistance.

Objective: To investigate the long-term effect of oral magnesium supplementation on clinical symptoms, bronchial reactivity, lung function and allergen-induced skin responses in children and adolescents with moderate persistent asthma., Design: A double-blind randomized parallel placebo-controlled study., Setting and Subjects: The patients were recruited from the Pediatric Outpatient Clinic, Division of Pulmonology, Allergy and Immunology, and followed at the Center for Investigation in Pediatrics at State University of Campinas Hospital, Brazil. Thirty-seven out of 72 patients met the study criteria. There were no dropouts., Intervention: The 37 patients (aged 7-19 years, 19 males) were randomized in two groups: magnesium (n=18, 300 mg/day) and placebo (n=19), during 2 months. Both patient groups received inhaled fluticasone (250 microg twice a day) and salbutamol as needed. The primary outcome was bronchial reactivity evaluated with methacholine challenge test (PC20)., Results: After a follow-up of 2 months, the methacholine PC20 for testing bronchial reactivity has augmented significantly in the magnesium group only. The skin responses to recognized antigens have also decreased in patients treated with magnesium. The forced vital capacity (FVC), the forced expiratory volume at first second (FEV1), the forced expiratory flow at 25-75 and the FEV1/FVC ratio were similar in both groups. The magnesium group presented fewer asthma exacerbations and used less salbutamol compared to the placebo group., Conclusions: Oral magnesium supplementation helped to reduce bronchial reactivity to methacholine, to diminish their allergen-induced skin responses and to provide better symptom control in pediatric patients with moderate persistent asthma treated with inhaled fluticasone.

A computational study on the thermodynamic properties of 13 beta-diketones is presented. The B3LYP//6-311+G(2d,2p)//B3LYP/6-31G(d) theoretical approach was employed to compute the O-H and C-H bond dissociation enthalpies and enthalpy of tautomerization and to estimate standard gas-phase enthalpies of formation for the radicals and for the parent molecules. The gas-phase enthalpies of formation for the neutral molecules are in excellent agreement with available experimental data, supporting the estimates made for the radicals. The latter are very important for the clarification of the thermochemistry of many beta-diketonato metal complexes previously reported in the literature. Importantly, when substituents R = -CHR' are attached to the beta-diketone's scaffold, C-H homolytic bond cleavage is always favored with respect to O-H bond scission.

Rationale: Since ovarian function is only temporarily compromised by radioiodine therapy, many women with thyroid cancer treated with radioiodine can become pregnant. The present study evaluated the evolution of these pregnancies and the consequences for the offspring., Patients and Methods: We retrospectively analyzed 78 pregnancies of 66 women submitted to total thyroidectomy, followed by radioiodine therapy 3.75-5.5 GBq (131)I, mean 4.64 GBq). In all patients, conception occurred one year after ablative therapy (mean of 30 months). Age ranged form 19 to 36 years (mean of 30.6 years) at the time of radioiodine treatment and from 23 to 39 years (mean of 32.8 years) at the time of conception., Results: Four (5.1%) of the 78 pregnancies resulted in spontaneous abortions. Three (4%) of the 74 deliveries were preterm and there was no case of stillbirth. The birthweight was > 2500 g in 94.6% of the children (+/- SD: 3350 +/- 450 g) and only one infant (1.3%) presented an apparent malformation at birth (intraventricular communication). No difference in the age at the time of radioiodine therapy or conception or in radioiodine dose was observed between pregnancies with an unfavorable outcome and those with a favorable outcome., Conclusion: We conclude that pregnancies that occur 12 months after ablative therapy are safe.

This study evaluated the follow-up of high-risk patients with thyroid cancer after initial therapy. A total of 125 high-risk patients (tumor >4 cm and/or extrathyroid invasion and/or lymph node metastases, and age >45 years), with complete resection of the tumor, were selected. All patients underwent total thyroidectomy and ablation with (131)I[3.7-5.5 GBq (100-150 mCi)]. Eighteen patients (14.8%) presenting metastases on post-dose whole-body scan (RxWBS) were excluded. The negative predictive value of stimulated Tg < or =1 ng/ml in combination with neck US during first assessment (612 mo. after ablative therapy) was 96.2% for the absence of recurrence up to 5 years. This value increased to 98.7% when adding WBS performed with 185 MBq (5 mCi) (131)I (DxWBS). The positive predictive value (PPV) of stimulated Tg >1 ng/ml was 52% for the detection of the presence of metastases up to 5 years; however, considering only patients with initially negative DxWBS and US, the PPV was 19% (9% if Tg of 110 ng/ml vs. 40% if Tg >10 ng/ml). Tg levels decreased spontaneously in patients with stimulated Tg >1 ng/ml during first assessment, negative US and DxWBS, and no recurrence during follow-up, with Tg being undetectable in half these patients at the end of 5 years. Twenty patients presented uptake in the thyroid bed upon DxWBS during the first year after ablative therapy, with stimulated Tg and US being negative, and were not treated with 131I; these patients did not relapse and no uptake on DxWBS was observed in 60% after 5 years. Recurrence after 5 years was only 1.3% in patients without apparent disease (negative US and DxWBS) and stimulated Tg <1 ng/ml. An algorithm for the follow-up of high-risk patients after initial therapy is presented in this study.

Background and Objectives: Venous thromboembolism (VTE), with includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in critically ill patients, resulting in high morbidity and mortality., Contents: Most patients treated in intensive care units (ICU) face a high risk of thromboembolic complications. Despite these considerations, the prevention of VTE may not be as high a priority in ICU patients as it is in other high-risk patient groups. Low molecular weight heparin (LMWH) may be the optimal prophylaxis in most ICU patients, but there is a lack of sufficient data including the paucity of VTE consensus and guidelines documents pertaining to critically ill patients., Conclusions: This article reviews background, current options, and recommendations regarding VTE in intensive care population emphasizing special diagnostic and treatment considerations in the ICU setting.

The purpose of this literature review is to survey the scholarly work done in the field of Complementary and Alternative Medicine (CAM) as it relates to breast cancer treatment, accenting studies done on diverse ethnicities of Hawai'i. This study reviews articles published in biomedical literature from 1999-2005 that report findings related to the themes recognized in this area of study.

This qualitative investigation examined complementary and alternative medicine (CAM) by Hawai'i Asian women breast cancer survivors. The majority of participants felt that the conventional treatment they received was adequate in treating their cancer but was impersonal in nature leaving them feeling abandoned. Many sought CAM to improve their quality of life. Additional research on CAM and the patient-physician relationship is urgently needed.

Background: The formation of a pseudoaneurysm of the cystic artery is a rare occurrence after laparoscopic cholecystectomy., Case Outline: Seven weeks after laparoscopic cholecystectomy, a 31-year-old woman presented with a picture of obstructive jaundice. The diagnosis of cystic artery aneurysm was verified by arteriography, CT and MRCP. At laparotomy the pseudoaneurysm was found to be compressing the common bile duct. It was successfully managed by ligation of the right hepatic artery., Discussion: Although this complication is rare, the surgeon must have a high index of suspicion to make the diagnosis.

This research aimed to design, implement and evaluate a distance learning course (DLC), using the Internet, in a virtual environment named TelEduc. Thirty-eight nurses were invited, 28 of whom registered and 17 concluded the course. The specialists and the students evaluated the course and diagnostic (pre-test), process and final (post-test) evaluations were made. Specialists in distance learning and wounds considered the course as adequate but recommended minor adjustments. Most of the students showed a positive opinion about the course. A comparison between pre- and post-test results showed that students scored better on the post-test (p<0.0001). The course reached its objectives, although some adjustments are needed.

Objective: Memory is composed of several systems and processes, and recognition can be accompanied by two subjective states of consciousness: autonoetic awareness, which characterizes conscious recollection; and noetic (or semantic) awareness, related to feelings of familiarity. The objective of this study was to describe the adaptation to Portuguese of an experiential procedure for investigation of states of awareness that accompany recognition., Methods: Development of the material (word list and instructions permitting manipulation of the level of information processing); translation/adaptation of the original instructions to Portuguese; and application of the procedure in healthy volunteers and patients with schizophrenia. Manipulation of the level of processing consisted in requiring, during the learning phase, that subjects form a phrase or count the number of letters of the words presented. The level of processing, documented in healthy volunteers, should be expressed by greater conscious recollection of words used to form phrases than of words for which letters were counted. In addition, there should be no change in the proportion of recognition based on feelings of familiarity., Results: The procedure was first applied in six healthy volunteers, in whom the processing level effect was clearly reproducible. Subsequently, it was used in patients with schizophrenia, who understood and followed the instructions perfectly. There was also a clear processing level effect in the patient group., Conclusion: The Portuguese version of this method can be used in our milieu, even in patients with schizophrenia, allowing the study of memory alterations accompanying this mental disorder.

We conducted a study to determine the antifungal susceptibility of vaginal Candida isolates from HIV-infected Brazilian women. Among 127 women enrolled, positive cultures for yeast were obtained from 31 of 38 (81%) women with symptomatic vulvovaginitis, and from 41 of 89 (46%) asymptomatic women. Susceptibility testing demonstrated 11 of the 72 isolates had either resistance or dose-dependent susceptibility to azole drugs, including four Candida albicans strains. Expression of the MDR1, CDR1, CDR2 and ERG11 genes was evaluated in all of the C. albicans isolates, and all four of the strains with reduced susceptibility to fluconazole had increased expression of CDR1 as compared to the fluconazole-sensitive strains. No increased expression of the other genes was identified. This large survey of Candida isolates from HIV-infected women from Brazil demonstrates that reduced susceptibility to azoles occurs at a low frequency among vaginal yeast isolates, and when present in C. albicans, azole resistance is associated with increased expression of CDR1.

Objective: The purpose of this study was to evaluate the ultrasonographic characteristics of metastatic lymph nodes in patients with papillary thyroid carcinoma., Methods: The ultrasonographic characteristics of lymph nodes were analyzed in 112 consecutive patients who underwent thyroidectomy and lymph node dissection, with the diagnosis being confirmed by anatomopathologic examination., Results: A total of 198 lymph nodes were metastatic, and 152 were benign (normal or with nonspecific lymphadenitis). Minimum axial diameters of 7 mm for level II (upper internal jugular chain) and 6 mm for the rest of the neck were observed in 93% of metastatic lymph nodes, absence of an echogenic hilum in 88%, hyperechogenicity in relation to the adjacent muscles in 86%, a round shape in 80%, calcifications in 49.5%, and intranodal cystic necrosis in 20%. These ultrasonographic characteristics were observed in 17%, 10%, 4.5%, 29.5%, 0%, and 0% of benign lymph nodes, respectively., Conclusions: Even basic ultrasonographic characteristics (shape, echogenicity and echogenic hilum, calcifications, and intranodal cystic necrosis) help in the differentiation between metastatic and nonmetastatic lymph nodes in patients with papillary thyroid carcinoma.

A sample of 198 unrelated males distributed among the five geopolitical regions in Brazil were typed for the minimal Y-STR haplotype composed of microsatellite loci DYS19, DYS385I/II, DYS389I, DYS389II, DYS390, DYS391, DYS392 and DYS393. Gene frequency data, gene diversity, haplotype diversity and power of discrimination were estimated. An AMOVA indicated that 99.97% of the haplotypic variation is found within regions and only a small 0.03% and non significant variation is found among the five regions (Fst=0.00031, P-value=0.43). This result suggests that a single national database of Y-STR haplotypes can be used in the quantitative assessment of matches in forensic casework in the Brazilian population. A significant haplotype diversity of 99.8% was found and 172 different haplotypes were observed in 198 chromosomes. Haplotype (14-11, 14-13-29-24-11-13-13) with five occurrences in 198 chromosomes was the most frequent in Brazil.

Background/aims: Variant hepatic anatomy must be recognized and appropriately managed during split-liver transplantation to ensure complete vascular and biliary supply to both grafts. The aim of this study was to demonstrate the importance of an assessment of the hepatic anatomical structures for the purpose of split-liver transplantation., Material and Methods: Human cadaveric livers (n = 60) were obtained during routine autopsies. The cadavers and the livers had to comply with the following requirements: (1) minimum age 18 years, (2) no liver pathology expected from medical history, and (3) no liver pathology noted at autopsy. Resections were carried out en bloc with liver, celiac trunk, left gastric artery, lesser omentum, superior mesenteric artery, and head of the pancreas. The main anatomical structures of the liver as hepatic artery, portal vein, biliary tree, and hepatic veins were dissected and correlated hepatic segments for the application of liver splitting., Results: The right the median, and the left hepatic veins were unique, with in 59 (98.3%), 53 (88.3%) and 46 (76.3%) cases, respectively. The portal vein trunk divided into right and left branches in 59 (98.3%) cases. A median branch appeared in 9 (15.2%) cases and no bifurcation of the portal vein occurred in 1 (1.6%) case. The right and left hepatic ducts were multiple in 47 (78.3%) and 57 (95%) cases, respectively, however, the median, hepatic duct was unique in 16 (26.6%) cases. Examining the intrahepatic distribution of the right hepatic duct, we found 4 branches in 28 (59%) cases (segments V, VI, VII, and VIII) 2 branches in 11 (23%) cases, (segments V and VI) and 2 branches in 8 (17%) cases (segments VII and VIII). Fifty-seven cadavers had multiple left hepatic ducts. The intrahepatic dissection showed that the distribution of the major branches were toward hepatic segments II and III. Three separate branches of the left hepatic duct were found in 11 (19%) cases (segments II, III, and IV). Two intrahepatic ducts coming from hepatic segments V and VI drained separately into the left intrahepatic biliary tree in 1 (2%) case. The arterial supply of the liver was by right and left hepatic artery with only 9 (15%) cases there being median hepatic artery. The right hepatic artery, coming from the superior mesenteric artery, was present in 15 (25%) cases and a left hepatic artery originating from the left gastric artery in only 2 (3.3%) cases. The left hepatic artery had 2 exceptional origins, in 1 (1.6%) case coming directly from the abdominal aorta and in the other from the superior mesenteric artery. The right and left hepatic artery was accessory, in 11 (18.3%) and 2 (3.3%) cases, respectively. The right hepatic artery was dominant in 4 (6.6%) cases. The median hepatic artery was directed to segment IV in 6 (10%) cases and to segment II and III in 3 (4.9%) cases., Conclusion: The study showed that the technique of controlled liver splitting for transplantation in 2 recipients is an acceptable method to increase the number of liver allografts. The anatomical and technical details of the splitting procedure are critical for the success of this technique. Good graft function and avoidance of complications depend on each graft having an intact arterial and portal blood supply as well as biliary and venous drainage from all retained liver segments. The absence of a bifurcation of the portal vein is a rare anomaly and would certainly contraindicate a partition.

Objective: To determine the usefulness of thyroglobulin (Tg) stimulation in low-risk patients with undetectable Tg on T4 and negative neck ultrasound (US) after initial therapy of thyroid carcinoma., Methods: We evaluated 122 consecutive patients classified as low risk 6 months to 1 year after total thyroidectomy and remnant ablation. All patients had a normal clinical exam, Tg < or = 1 ng/ml during suppressive therapy (TSH < 0.1 mIU/l), and undetectable antithyroglobulin antibodies., Results: After T4 withdrawal and elevation of TSH to values > 30 mIU/l, 26 patients (21.3%) converted Tg to levels > 1 ng/ml. Metastases were detected in 10 patients, nine showing stimulated Tg levels > 1 ng/ml. Cervical metastases were observed in 9/10 patients and lung metastases in one patient. Neck US identified all cervical metastases. Seventeen patients with stimulated Tg levels > 1 ng/ml initially showed no apparent disease, with a reduction in Tg being observed upon subsequent measurements, and 13 patients presented undetectable Tg off T4 at the end of the study. Undetectable Tg on T4 showed a high negative predictive value (NPV; 91.8%), which increased to 99.1% when combined with neck US. Stimulated Tg levels < 1 ng/ml presented a 98.9% NPV. A total of 113 patients with undetectable Tg on T4 and negative US had to be exposed to hypothyroidism in order to diagnose one further case of metastases., Conclusion: Undetectable Tg on T4 combined with negative neck US presented a high NPV in low-risk patients and Tg stimulation might be avoided in these patients.

Objective: To find scientific evidence that can prove or refute the assumption that nocturnal and on demand breastfeeding are associated with caries in infants and preschool children., Sources of Data: MEDLINE, Lilacs, and SciELO articles were searched, as well as important internet sites, technical books and consensus publications of national and international organisms. The following keywords were used: "early childhood caries", "dental caries", "dental decay" and "breastfeeding". References cited in the articles selected were also included., Summary of the Findings: Studies associating caries with breastfeeding invariably observe factors associated with how this disease develops, letting aside those associated with breastfeeding. Many of these factors act as confusing variables because in the same way as they interfere in breastfeeding, they also influence the development of caries. Besides, current studies have already demonstrated the cariogenic potential of some types of aliments given to children against the non-cariogenic potential of the human milk., Conclusions: There is no scientific evidence proving that human milk can be associated with the development of caries. This is a complex relation to be established, as it is often blurred by too many variables.

Lyophilized aqueous extract of Maytenus ilicifolia leaves (LAEMIL) is commonly used in Brazilian folk medicine in the treatment of dyspepsia as well as gastric ulcers. We have investigated the effect and the possible mechanism of action of the LAEMIL on acid secretion in isolated frog gastric mucosa incubated in an Ussing chamber. It was observed that LAEMIL (7-28 mg%) as well as cimetidine (125-4,000 microM), a well-known histamine H2 receptor antagonist, decreased basal acid secretion in a concentration-dependent manner. Similarly to cimetidine (190 microM), LAEMIL (21 mg%) also inhibited gastric acid secretion induced by increasing concentrations of histamine (50-800 microM). The EC50 values for histamine alone and histamine in the presence of LAEMIL or cimetidine were 94.6 microM (71.1-125.9 microM), 244.9 microM (209.4-286.4 microM) and 142.2 microM (23.6-855.0 microM), respectively. LAEMIL, histamine and cimetidine were effective on acid secretion only when added to the serosal surface of the mucosa. Furthermore, simultaneous addition of LAEMIL and cimetidine at concentrations, per se, ineffective, caused a 16% reduction in the basal acid secretion [from 8.3 +/- 0.3 to 6.9 +/- 0.2 microEq g(-1) (15 min)(-1), n=4]. Although effects such as inhibition of histamine biosynthesis and/or histamine release can not be ruled out, our data suggest that LAEMIL, like cimetidine, reduces acid secretion in the isolated frog gastric mucosa by antagonising histamine H2 receptors., (Copyright 2004 Springer-Verlag)

This bibliographical research and analysis of official documents on social policies and violence aims to present a great and rewarding challenge that is oriented by a new municipal administration guideline, implementing a Network for Children's and Adolescent's Care-RAICA. This Network is aimed at articulation with a view to the integration of different services and their professionals in order to intervene in the problems children and adolescents are facing due to increased violence in several areas.

A cross-sectional study was performed to evaluate the prevalence and the aetiology of forms of mucosal fungal infections of HIV-negative and HIV-positive women. Candida albicans was the predominate specie isolated from both groups of patients, with remarkable proportion of isolation from symptomatic women. All 239 C. albicans isolates, regardless of their source, showed activity of proteinase and phospholipase. It was verified that isolates with particularly higher levels of exoenzymes production were significantly more common in HIV-positive patients. However, isolates obtained from the HIV-positive patients in use of HAART, with protease inhibitor, presented lower levels of these exoenzymes, similar to the levels observed in the isolates from HIV-negative patients.

We investigated the attitudes of nurses and physicians from a public hospital in Campinas, SP, Brazil, towards computer use in health care, by means of a questionnaire composed of two parts. The first one shows the characteristics of the sample population under study, while the second consisted of a validated Likert style scale with 20 items, six of which show positive attitudes and 14 negative attitudes. We interviewed 20 nurses and 32 physicians. The obtained coefficients for Cronbach's alpha showed a high internal consistency between the items for both groups (nurses and physicians). A positive global attitude was disclosed, indicating receptiveness towards introducing computerized systems. It was also verified that many professionals had been using computers in the last years, coinciding with the evolution of Internet.

This study analyzes the characteristics of sexual abuse committed within the family against age groups classified according to the Brazilian Statute for Children and Adolescents (the prevailing legislation on matters pertaining to minors) and treated at the Reference Center for Children and Adolescents and the Guardianship Councils in Ribeirão Preto, São Paulo State, Brazil, from 1995 to 2000. Some 234 abuses were identified, committed by 217 aggressors, against 210 families and a total of 226 victims. A total of 131 children (48.7%) and 95 adolescents (41.2%), predominantly females, were victimized. Children ranging from 10 to 12 years were the most frequently abused (19.5%), as well as adolescents from 12 to 14 years old (17.3%). The majority of the victims live in families with 3 (19.9%) or 4 children (177%), and the firstborn are the most frequently abused (33.6%). The majority of aggressors who acted alone victimized only one individual (86.7%). Fathers (34.2%) and stepfathers (30.3%) were the most frequent aggressors, with the former victimizing more children (19.7%) and the latter adolescents (17.1%).

Sodium currents were recorded in CA1 hippocampal cells from new-born (P(4-10)) and older (P(>22)) rats, using whole-cell voltage clamp techniques. The effects of local anaesthetics (procaine and lidocaine) were studied in both cell populations. Parameters defining steady-state inactivation, removal of inactivation and the affinity of the anaesthetic molecules to the inactivated state were determined at both stages of maturation. Procaine and lidocaine induced a hyperpolarizing shift in steady-state inactivation curves, and slowed the rate of recovery from the inactivated state. Procaine disclosed differences between immature and older cells in what concerns block of the closed (resting) channels, drug affinity and binding to the inactivated state, i.e. the binding rate of procaine was found higher and the affinity lower in younger cells. The characteristics of procaine and lidocaine block on CA1 sodium currents differed in some particular aspects: magnitude of block on resting channels, shift in the voltage dependence and voltage sensitivity of steady-state inactivation, slow recovery from inactivation and use-dependent block.

Schistosoma mansoni is the primary causative agent of schistosomiasis, which affects 200 million individuals in 74 countries. We generated 163,000 expressed-sequence tags (ESTs) from normalized cDNA libraries from six selected developmental stages of the parasite, resulting in 31,000 assembled sequences and 92% sampling of an estimated 14,000 gene complement. By analyzing automated Gene Ontology assignments, we provide a detailed view of important S. mansoni biological systems, including characterization of metazoa-specific and eukarya-conserved genes. Phylogenetic analysis suggests an early divergence from other metazoa. The data set provides insights into the molecular mechanisms of tissue organization, development, signaling, sexual dimorphism, host interactions and immune evasion and identifies novel proteins to be investigated as vaccine candidates and potential drug targets.

This study aims at reporting an experience of offering a course in the master program of the Universidad Nacional de Rosário. The purpose is to offer elements for a reflection on a conception of long-distance education, as an adequate and efficient modality of education, aiming at enabling a teaching with quality to a determined clientele. The course was developed in three moments: video-conference, long-distance didactic activities and a seminar. The tutoring was shared by establishing the challenge of having a dialogic relation with the students. Authors believe that long-distance education is an adequate pedagogical tool to qualify nurses who have no access to traditional graduate studies. Therefore it enables the qualification of a greater number of nurses, geographically dispersed, who are unable to scape from the routine of their personal and professional lives. Facing the need to form the country's nursing workers and qualify nurses to act as teachers, long-distance learning is an effective and possible pedagogical strategy.

The emphasis of this qualitative investigation was to get to know the significance system, its values and beliefs through the male nurse's perspective in his confrontation with the new methodological proposal of care in a Hospital Institution. Ethnographic interview and data analysis, which was fundamental in James Spradley's studies, were the methods used for collecting data. From data immersion and inventory approach immerged the following theme: "Sequence in care makes the difference", which constitutes the main purpose of this study, providing us with opportunities to reflect about and reveal an activity that up until now ha been nebulous and reticent in the Brazilian nursing scenario. In this way, the male nurses are taken into a perspective concerning the understanding and action of the methodology of assistance.

Introduction: Mesothelial/monocytic incidental cardiac excrescence (cardiac MICE) is a rare intracardiac lesion, which can cause severe disease and lead to misdiagnosis., Material and Methods: A 66-year-old woman with floppy mitral valve and coronary atherosclerosis underwent diagnostic coronary angiography, mitral valve surgery and aortocoronary bypass. During surgery, a thrombus was detected inside the left atrium and sent for pathology analysis. The sample was routinely processed, stained with histochemical dyes and immunomarked for epithelial (keratin) and mesenchymal cells (vimentin), histiocytes (lysozyme) and endothelial cells (Factor VIII)., Results: Histologically, the lesion contained mesothelial cells (keratin/vimentin coexpression), histiocytes (lysozyme/vimentin positive) and fibrin, leading to a diagnosis of MICE., Discussion and Conclusions: Cardiac MICE is a benign cardiac tumor-like lesion. It may be misdiagnosed as a thrombus or neoplasia, either primary or metastatic. Through embolization, it may cause myocardial or multiorgan infarctions, in some cases fatal. Developments in cardiothoracic surgery and interventional cardiology may increase its incidence; hence the importance of recognizing this entity.

Background: After an acute myocardial infarction, women have a higher risk of death or reinfarction. In unstable angina, female gender seems to be protective. On the other hand, studies suggest that women are less frequently given coronary angiography., Objectives: To evaluate, in our population of patients admitted for non-ST-elevation acute coronary syndrome (ACS), the influence of gender in prognosis and in the use of invasive procedures., Population and Methods: We studied 387 consecutive patients, 20% female, admitted to our ICU for non-ST-segment elevation ACS. We compared demographic and clinical variables, the use of coronary angiography and myocardial revascularization procedures, according to gender. We analyzed the combined endpoint of death or (re)infarction at 30 days and for the total follow-up period of 420 +/- 322 days., Results: The women were older (65 +/- 10 vs. 62 +/- 11 years, p = 0.05), and more frequently had a history of hypertension (p = 0.005), diabetes mellitus (p = 0.07), previous surgical myocardial revascularization (p = 0.048) and higher heart rate on admission (p = 0.048). Smoking was more frequent in men (p < 0.001). The most frequent diagnosis was unstable angina; 76% for women vs. 66% in men (p = 0.12). Coronary angiography was performed during hospitalization in 87%, in both genders. Myocardial revascularization was performed in 62% of the women and 69% of the men (p = 0.26). At 30 days, the frequency of death or (re)infarction was 11% for women and 10% for men (log-rank, p = 0.79). By multivariate analysis (Cox regression), the independent predictors of outcome at 30 days were previous myocardial revascularization and heart failure on admission. For the total follow-up, we did not find differences in the occurrence of the combined endpoint, and the independent predictors of outcome were previous surgical myocardial revascularization, heart failure on admission, ST segment depression on the admission ECG and surgical myocardial revascularization., Conclusions: In non-ST-elevation ACS, women present some differences in their demographic and clinical profile. We did not find differences in the use of invasive procedures or prognosis in the short and medium term.

Enteropathogenic Escherichia coli (EPEC) has been associated with infantile diarrhea and mortality in humans in developing countries. While diarrhea is also a major problem among primates kept in captivity, the role of E. coli is unclear. This study was designed to characterize diarrheagenic E. coli recovered from the feces of 56 New World nonhuman primates, primarily marmosets (Callithrix spp.). Seventeen of the 56 primates had signs of diarrhea and/or enteritis. E. coli recovered from feces from these animals was tested by PCR for genes encoding virulence factors of diarrheagenic E. coli and for patterns of adherence to HeLa cells. In addition, isolates were characterized by the fluorescence actin staining test and by their ability to induce attaching and effacing lesions. PCR for the eae gene was positive in 10 of the 39 (27%) apparently healthy animals and in 8 of the 17 (47%) animals with diarrhea and/or enteritis. Colonies of eae(+) E. coli were serotyped and examined by PCR for genes encoding EPEC virulence markers. The eae(+) E. coli isolates recovered from both healthy and sick nonhuman primates demonstrated virulence-associated attributes similar to those of EPEC strains implicated in human disease and are designated monkey EPEC. The results presented here indicate that EPEC may be a significant pathogen for nonhuman primates, deserving further investigation. The similarities between the affected animals investigated in this study and human EPEC infections suggest that marmosets may represent an important model for EPEC in humans.

Background: Comparing the prognostic value of peak oxygen uptake (VO2max) in absolute values and percentage of predicted VO2max (%PredVO2) in terms of prognostic stratification, contradictory references are found in the medical literature. In theory, the measurement of VO2max relative to a normal subject should improve its predictive capacity, because VO2max is influenced by gender, weight, physical activity and age., Objectives: To compare the prognostic value of VO2max and %PredVO2 (Jones equation) in an adult population (> or = 20 years) of patients with left ventricular systolic dysfunction and to study the influence of age on these parameters., Population and Methods: We review data from the first cardiopulmonary stress test performed in 295 consecutive patients with left ventricular systolic dysfunction (ejection fraction < or = 40%); mean age was 52 +/- 10 years, 81% were male, and 76 aged > or = 60 years. In 52%, the etiology was ischemic. We evaluated demographic and clinical variables, the baseline ECG and the medication used before the test. We compared VO2max (ml/kg/min) and %PredVO2 in terms of prognostic stratification for the combined endpoint (death and/or heart transplant) for 2 years of follow-up., Results: We detected 60 patients with events (42 deaths and 18 transplants). ROC curve analysis was used to determine the best cut-off value for VO2max and %PredVO2 to identify patients with events. The best cut-off for VO2max was < or = 19 ml/kg/min and < or = 49% for %PredVO2 in the total population, and in the event-free survival analysis, by log-rank test, we obtained p < 0.001 for both cut-offs. Considering the two extreme age groups (20-40 years and > or = 60 years), we found different cut-off values. In the youngest group we obtained VO2max of < or = 23 ml/kg/min and %PredVO2 of < or = 59%, and in the elderly < or = 12.5 ml/kg/min and < or = 64% respectively. For the intermediate group, the cut-off values were the same as for the total population. In the youngest patients, the new cut-offs did not offer an improvement in accuracy. In the elderly, for VO2max, we obtained an improvement in specificity from 28 to 86% and a reduction in sensitivity from 95 to 50%, with an improvement in accuracy from 46.8 to 75.9% (p = 0.05). With regard to %PredVO2, specificity fell from 86 to 61% and sensitivity increased from 50 to 82%, with similar accuracy (75.9 to 67%, p = 0.78)., Conclusions: In the extreme age groups, we obtained different cut-off values, but only for the elderly (VO2max < or = 12.5 ml/kg/min and %PredVO2 < or = 64%). A benefit in terms of accuracy was only obtained in respect of VO2max, because for %PredVO2, there is already a correction for age through the Jones equation.

Objective: Cystic fibrosis has become, in the last 70 years, the most important potentially fatal inherited disease that affects white individuals around the world. Although it is considered a genetic disorder, which strikes cells of different organs, not all patients present similar clinical response. Many clinical manifestations, mainly pulmonary and gastrointestinal, may develop in cystic fibrosis patients. The aim of this article is to offer pediatricians an updated review of the controversies and recent advances in the treatment of cystic fibrosis., Sources: Systematic review in the Medline database., Summary of the Findings: Seventy-nine articles about cystic fibrosis published in international journals were reviewed. This article presents an updated and critical review of the main events related to the incidence, pathophysiology, diagnosis and treatment of cystic fibrosis., Conclusions: Even though no treatment is available for this disease, new findings about its etiology and pathophysiology have been discovered in the last two decades, improving treatment and survival of cystic fibrosis patients.

It is difficult to use tissue culture assays to investigate adherence and other properties of Edwardsiella tarda because the organism is invasive and produces a potent hemolysin. We therefore relied on polymerase chain reaction (PCR) to determine the occurrence of genes for enterotoxins (LT-I, EAST-1), Shiga toxin (Stx-1, Stx-2), cytotoxic necrotizing factors (CNF-1, CNF-2), aerobactin, invasion plasmid of enteroinvasive Escherichia coli, EPEC adherence factor (EAF), intimin (Eae), enterohemolysin (EntHly) and hemolysin (Hly) in 53 isolates of E. tarda from humans and fish from several countries. All isolates were negative for all genes investigated by PCR. Adhesion to and invasion of HeLa cells were determined by using the unusually short incubation time of 1h or 30 min. All isolates adhered and invaded in these tests. Finally, a random amplified polymorphic DNA (RAPD) test distinguished, with a few exceptions, isolates of human and fish origin.

The role of nitric oxide (NO), K(+) channels, and arachidonic acid metabolism, via cytochrome P450 and cyclooxygenase pathways, in the renal vasodilatory effect of bradykinin was examined in the isolated rat kidney perfused ex situ with a blood-free solution. Bradykinin (BK, 0.25-1.0 microM) induced a dose-dependent reduction of 10-35% in the relative renal vascular resistance (rRVR) of isolated kidneys preconstricted with phenylephrine (PHE, 0.17-0.35 microM). The vasodilating effect of 0.5 microM bradykinin was significantly inhibited by the nitric oxide synthase inhibitors, N(G)-nitro-L-arginine (95% inhibition) and N(G)-nitro-L-arginine methyl ester (45-75% inhibition). Clotrimazole, an inhibitor of cytochrome P450 pathway but not indomethacin, a cyclooxygenase inhibitor, reduced the renal vasodilator response to bradykinin by 84%. The nonspecific K(+) channel inhibitor, tetraethylammonium ion (TEA) and the selective inhibitor of Ca(2+)-activated K(+) channels, charybdotoxin (ChTX) greatly attenuated the vasodilator response to bradykinin by approximately 84% and 79%, respectively. These two K(+) channel inhibitors showed similar effects on vasodilatation induced by S-nitroso-acetyl-D,L-penicillamine (1 microM), a nitric oxide donor. The results suggest that bradykinin releases nitric oxide which, by opening potassium channels specifically the Ca(+)-dependent type, mediates the renal vasodilator response to bradykinin in the isolated kidney perfused ex situ.

Introduction: The prognostic value of peak oxygen uptake (peak VO2) in patients with left ventricular systolic dysfunction is currently recognized and accepted. Some studies have shown that other cardiopulmonary exercise test (CPET) parameters have additional value., Objectives: To evaluate whether our population of patients with left ventricular dysfunction had similar results to those found by other investigators who showed that a slow normalization of oxygen uptake (VO2) during the recovery period of a CPET has prognostic value, and whether the recovery phase parameters have additional prognostic value to peak VO2 in these patients., Methods: We studied 292 consecutive adult patients (81.5% male; mean age 52.4 +/- 10.6 years) with an ejection fraction below 40% (mean 23.6 +/- 8.8%) given their first symptom-limited CPET between 03/1993 and 08/2000. The etiology was ischemic heart disease in 154, idiopathic cardiomyopathy in 130 and other in 8 patients. NYHA class was I in 7%, II in 50.6% and III in 42.4% of the patients. Two years was defined as the maximum follow-up time; it was 551.5 +/- 242.2 days on average, and 62 events (death or cardiac transplantation) occurred. The following parameters were analyzed: peak VO2 (l/min and ml/kg/min), percent predicted peak VO2 (pred VO2) (l/min and ml/kg/min), VO2 every 15 seconds (sec) of the first 3 minutes of recovery (the difference between peak VO2/kg and VO2/kg every 15 sec in the recovery period (dif VO2), expressed in ml/kg/min, and also the time (sec) to reach 50% of peak VO2 (T1/2). It was considered that a combined end-point was reached if patients died or underwent cardiac transplantation., Results: ROC curves of these parameters showed the following as cut-off values (area under the curve > 0.7) for the occurrence of events: peak VO2 < 60% of pred VO2, dif VO2 at 60 sec (< 3 ml/kg/min), 90 sec (< 5), 120 sec (< 8), 150 sec (< 8.6) and 180 sec (< 10.5) of the recovery and T1/2 > 115 sec. Survival analysis was performed considering pred VO2 < 60%, dif VO2 at 150 sec (the largest area under the curve) and T1/2 > 115 sec. In the survival analysis, when the decrease in VO2 at 150 sec was less than 8.6 ml/kg/min the number of patients with events increased from 9.2% to 43.5% (p < 0.001; log-rank), and when T1/2 was less than 115 sec the number of events increased from 12.3 to 34.2% (p < 0.001; log-rank). When the criteria of T1/2 and dif VO2 at 150 sec were considered together with pred VO2 < 60%, mortality increased from 31 to 54% and from 33 to 51%, respectively (p < 0.001, for both parameters; chi-square)., Conclusions: A slow VO2 kinetics in the recovery period of the CPET by itself identified groups of patients with poor prognosis. The association of these parameters with peak VO2 enhanced the identification of groups at greater risk for events. A global evaluation of the CPET should be performed, considering other parameters besides peak VO2, particularly those related to VO2 kinetics in recovery (T1/2 and dif VO2 at 150 sec) as identified in this study.

This article is a partial result of an ethnographic study that had the purpose to describe the culture of intensive care unit nurses. Considering that the ICU is a subculture of the hospital, and that the professionals share symbols and meanings that were developed through social interactions in the context of Intensive Care, the symbolic interactionism and the ethnographic description were used as a theoretical and methodological basis for this study. The participant observation, the ethnographic interview and the documented analysis were used to understand the process of internalization of the symbolic universe of the ICU. Among the described cultural elements, authors identified knowledge and technology myths. They conclude that knowledge and technology myths were socially established as a survival strategy in the daily routine of intensive care full of risks and uncertainty.

Objectives: To evaluate the influence of prior medication on mode of presentation and short-term prognosis of acute coronary syndromes (ACS)., Design: Prospective study., Setting: Coronary intensive care unit in Santa Cruz Hospital., Population: We included 425 consecutive patients admitted for ACS., Methods: Prior medication with anti-platelet agents, beta-blockers, nitrates, calcium channel blockers, statins and angiotensin-converting enzyme (ACE) inhibitors was recorded on admission. Medication introduced in the last 7 days was excluded. Using a multivariate analysis model we examined the impact of baseline characteristics and previous medication on mode of presentation of ACS. We also evaluated their influence on short-term prognosis (death or non-fatal myocardial (re)infarction in the first 30 days)., Results: Of the 425 patients studied 228 (53.6%) presented with unstable angina (UA), the remainder with acute myocardial infarction (AMI) (24.7% with ST elevation). Medication prior to admission included anti-platelet agents in 53.7% of patients, beta-blockers in 44.2%, nitrates in 48.2%, calcium channel blockers in 36.9%, statins in 28.9% and ACE inhibitors in 38.6%. During the first 30 days, 14 deaths (3.3%) and 37 (re)infarctions (8.7%) occurred. The combined occurrence of death or (re)infarction was 10.8%. Variables with significant and independent influence on mode of presentation of ACS were male gender, presence of known coronary artery disease and previous medication with anti-platelet agents and beta-blockers. Male gender was a predictor of AMI as mode of presentation, whereas a previous history of coronary artery disease and medication with anti-platelet agents or beta-blockers predicted UA. Short-term prognosis was influenced by heart failure symptoms on admission, but not by previous medication., Conclusion: Previous medication with anti-platelet agents and beta-blockers was associated with an increased frequency of UA as mode of presentation of ACS. No relation between previous medication and short-term prognosis was observed in the present study.

OBJECTIVE: To evaluate the effect of cisapride and chest physical therapy on the gastroesophageal reflux of wheezing babies. METHODS: We prospectively assessed the presence of technetium ((99)Tc) in the upper, middle, and lower esophagus of 25 wheezing babies (13 with GERD and 12 without GERD) using scintigraphy. Both groups underwent clinical investigation, including laboratory, X-ray and scintigraphy tests, for the etiology of the wheezing baby syndrome (WBS) and GERD. Expiratory Flow Acceleration (EFA) was performed before and after treatment with cisapride. The total time of GER episodes was accounted for each portion of the esophagus during scintigraphy and during EFA. RESULTS: Cisapride significantly reduced the total reflux time in the upper esophagus (P<0.05), but showed no influence during EFA. After cisapride therapy, EFA increased the total reflux time in the upper and medium esophagus; however, no statistical significance was found. Infants with GERD presented a shorter total reflux time in the distal esophagus (P<0.05) during EFA. After cisapride treatment, no statistical significance was found. Infants without GERD also presented reduced total reflux time in the distal esophagus during EFA (P<0.05). Those with GERD had increased total reflux time in the distal esophagus (P<0.05) before and after cisapride treatment during EFA and scintigraphy. CONCLUSIONS: Cisapride was effective in reducing the total reflux time, mainly in the upper esophagus. EFA apparently increased the number of episodes of GER, without achieving statistical significance. Further studies are necessary to investigate the effects of chest physical therapy according to body positions.

Vaginal specimens for culture were obtained from two hundred and five immunocompetent, non-hospitalized patients selected among all women attending the Gynecology and Obstetric Ambulatory Clinic of the University of Espírito Santo, Brazil, during a 2-year period (From 1998 to 1999). Patients were checked for signs and symptoms of vulvovaginitis and previous use of topical and systemic antifungal drugs. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to NCCLS microbroth assay. The prevalence of vaginal yeast isolates from asymptomatic women was 25% (30/121) and 60% (50/84) among patients with symptoms of vulvovaginitis. Candida albicans was the most frequently isolated species in both groups (46% and 90%, respectively), followed by C. glabrata (13% and 6%, respectively). All isolates were susceptible to amphotericin B. Only ten isolates had dose dependent susceptibility (DDS) or resistance to azoles; and seven of these were non-albicans species. Based on our results we suggest that species identification and antifungal susceptibility testing need not be routinely performed in immunocompetent women, and may be reasonable only for the minority of patients with complicated vulvovaginal candidiasis that fail to respond to therapy.

Calcium currents were recorded in CA1 hippocampal cells from immature (P(4-10)) and older (P(22-55)) rats, using whole-cell voltage clamp techniques. Parameters defining the voltage-dependence of activation (tau(m)) and inactivation (tau(h)), steady-state inactivation and activation were determined at both stages of maturation. Current density increased with maturation. A transient low voltage activated (l.v.a.) current was found in P(4-10) cells, but not in the older cells. At voltages less negative than -30 mV, current inactivation was best described by two exponentials (tau(hf), tau(hs)); the ratio of the amplitudes of the two components changed with maturation, with a dominance of the faster component (tau(hf)) in the younger cells. The voltage dependence of tau(hf) followed a simple dependence model, decreased with increasing depolarization, in all cells at both stages of maturation. In P(4-10) cells, tau(hs) was voltage insensitive (range -25 to +30 mV); in P(22-55) cells, the voltage dependence of tau(hs) was found to be complex. Two current components were identified from the voltage dependence of the conductance in both groups. The first, more hyperpolarized component, the l.v.a. current found in P(4-10) cells; this was absent in the older cells, in which we found a component with a different voltage dependence. The voltage dependence of the conductance of the second, more depolarized component did not differ in younger and older cells. In the course of maturation, the steady-state inactivation of the second component underwent a hyperpolarizing shift and a decrease in voltage sensitivity.

This article is concerned with the establishment of the Brazilian pharmaceutical industry. It addresses some issues of relevance to social-economic history, such as the emergence of the public health system, procedures for combating infectious disease, the relations between disinfection campaigns and the chemical industry, serotherapy and the production of serums and vaccines by public research institutions and private pharmaceutical companies. Focusing on the private pharmaceutical industry in Brazil, with special reference to the Instituto Pinheiros - Produtos Terapêuticos S.A., this article highlights the relations between scientists technology and product development. It also considers the debate which involved the scientific community and some governmental research institutions for public health policy development in the state of São Paulo.

Unlabelled: Coronary angioplasty (PCI) of chronic total occlusions (CTO), even when successful, are associated to less favourable long term results. The recent use of coronary stents has improved the long term outcome of those interventions., Purpose: To evaluate the short term results and long term occurrence of major adverse coronary events (MACE): death, MI, urgent revascularization and the need for a new target vessel revascularization (TVR) in patients with CTO who had previously been submitted to a PCI with excimer laser for plaque debulking followed by a provisional stent., Population: From our database, we selected 19 patients with a mean age of 51 +/- 13 years (18 male) submitted to PCI between 1994 and 1998. Of those patients, 10 had had of a previous MI. Hypertension, smoking habits and hypercholesterolemia were present in 9 patients (42%). Two patients had diabetes. The main reason for PCI was stable angina in 16 patients (84%) and unstable in 3 patients (16%). Single-vessel disease was present in 18 patients (94%) and multiple-vessel in 1 patient (6%); left ventricular ejection fraction was preserved in 18 patients (94%). Single vessel PCI was performed in 16 patients (84%) and double vessel in 3 patients. Plaque debulking with excimer laser was performed in all patients, followed by 23 stents (Multilink--8; Gianturco Roubin--5; Palmaz Schatz--4; others--6). The mean clinical follow-up was 19 months., Results: There were no major short-term clinical events (death, MI or urgent revascularization). During follow-up, TVR was only required in 5 patients (26%), all of them in the first 7 months after PCI., Conclusions: In the highly selected population, PCI for chronic total occlusion, with excimer laser plaque debulking followed by provisional stents, was a safe procedure with a very acceptable rate of new target vessel revascularization in the follow-up period.

Several morbid conditions may necessitate extensive intestinal resection, leading to short-bowel syndrome. When clinical treatment becomes inefficient, a surgical approach is necessary. Distal colon interposition is one of the viable techniques. The interposition of colon segments between remnants of the small bowel improved lifestyle, increased transit time, and diminished diarrhea. The aim of this study is to observe the longitudinal muscular contractions after distal colon interposition. Sixteen male Wistar rats (EPM-1) were submitted to an 80% small bowel resection associated with a partial colectomy of the distal colon immediately after the bifurcation of the middle colic artery followed by a 3-cm isoperistaltic distal colon interposition. After 70 days, the animals were submitted to euthanasia and segments of the jejunum, ileum, remnant colon, and interposed colon were prepared for pharmacological tests. The isometric contractions were measured by a polygraph. After 30 minutes, the dose/effect curves were obtained for both metacholine and barium chloride stimulation through the extraluminal surface (serosa). After this period, we observed a significant increase in the length, diameter, and thickness of the intestinal wall. Regarding the sensibility (pD(2)), no difference was found (interposed colon = 7.21 +/- 0.2; remnant colon = 7.65 +/- 0.1; remnant jejunum 7.46 +/- 0.1; and remnant ileum 7.57 +/- 0.1), even though the animals were submitted to different procedures. In relation to the maximal effect (E(max)), the longitudinal muscle contraction responses (interposed colon = 11.79 +/- 0.1; remnant jejunum = 15.42 +/- 0.2; and remnant ileum = 11.48 +/- 0.2) were lower than those of the remnant colon (E(max) = 22.42 +/- 0.1). This means that there was a possible adaptation of colonic segments to their new location., (Copyright 1999 Wiley-Liss, Inc.)

C-reactive protein has been a measure of acute phase reactions to inflammation for 40 years. Recently improved quantitative assays in serum and cerebrospinal fluid (CSF) have allowed a re-evaluation of its potential as a diagnostic laboratory test. The main advances in the newer methods have been that they can provide rapid (hours) information on the hepatocyte synthesis of this molecule during immune response. We have tested its value in patients with presumed bacterial meningitis. Based on our experience, newer standardized, quantitative assessments of C-reactive protein can be very useful in distinguishing between bacterial and other forms of meningeal irritation during the first few days of hospitalization. Other investigators have indicated that by serial measurements important information on the resolution or continuation of inflammatory processes can be obtained. We recommend improved standardization of this test, and recalculation of its usefulness as a diagnostic laboratory test.

C-reactive protein (CRP) was measured by ELISA in the sera of 165 healthy blood donors and 125 normal children 1 to 14 years old. The serum levels of blood donors ranged from 0.05 to 57.6 mg/l with median and mean values of 1.8 mg/l and 4.86 mg/l, respectively. CRP levels ranged from 0.02 to 14.4 mg/l in the children's sera, the median being 0.45 mg/l and the mean 1.65 mg/l. No individual lacking CRP was detected. The high CRP levels observed in the present study suggest that the population of the State of São Paulo may usually be exposed to subacute infections and/or inflammation without presenting clinical symptoms.