Sobre a morte da cobaya consecutiva á dupla Vagotomia

1. A secção dos vagos na cobaya produza morte em prazos que variam de meia hora a algumas horas. 2. A morte se dá por intensas lesões pulmonares, caracterisadas por congestão e edema. 3. As cobayas introduzidas em camaras em que a atmosphera tem altas tensões de gaz carbonico, caem anesthesiadas ao fim de alguns segundos, seguindo-se logo depois a morte. Na autopsia, se encontram lesões pulmonares muito semelhantes ás que se verificam nas cobayas vagotomisadas. 4. Nas cobayas profundamente anesthesiadas pelo chloral, a sobrevida á vagotomia é muito maior que nas cobayas não anesthesiadas. Nesses casos a morte muitas vezes se dá quando o animal vem a despertar da anesthesia. 5. Foram feitas novas experiencias que demonstram produzir a novocaina uma interrupção completa de todas as fórmas de conductibilidade dos nervos. 6. Quando se produz a secção physiologica pela novocaina dos vagos na cobaya, observam-se modificações do typo respiratorio que se caracterisam por diminuição consideravel da frequencia e augmento da amplitude. A respiração não apresenta porém, o typo francamente dyspneico, istoé, ella não se faz com difficuldade. 7. A secção physiologia dos pneumogastricos permitte uma sobrevida muito maior que a secção cirurgica. 8. A morte nas condições da conclusão precedente se dá pelas mesmas lesões pulmonares que se encontram habitualmente depois de secção cirurgica, mas é produzida unicamente pela irritação dos pneumogastricos exercida pelas gotteiras de borracha e pelo algodão, depois que a novocaina é absorvida e que se dissipa a anesthesia local. 9. Quando se operam as secções dos vagos com irritações variaveis as sobrevidas são differentes. 10. A sangria immediata não tem effeito sobre o tempo de vida da cobaya vagotomisada. 11. A sangria tardia parece augmentar ligeiramente essa sobrevida. Todos os factos expostos neste trabalho demonstram: 1) De um lado a irritação sem secção dos vagos na cobaya produz congestões e edemas pulmonares que levam o animal á morte; 2) a secção sem irritação não dá logar a esses phenomenos. Dahi a conclusão principal destas pesquizas: se porventura existem excitações normalmente transmittidas pelos vagos aos centros nervosos respiratorios, não é a falta dessas excitações a causa primeira dos phenomenos produzidos pela vagotomia bilateral. Esses phenomenos são devidos a irritações do pneumogastrico. A dyspnéa encontrada nos animaes vagotomisados parece ser tambem um effeito directo ou indirecto dessas irritações. Conquanto pouco inclinados a admittir que seja essa dyspnéa a causa directa das lesões pulmonares, reconhecemos que essa questão não pode ser ainda inteiramente resolvida. As irritações dos vagos podem ter influencia sobre muitas e variadas funcções, cujas perturbações assim produzidas, têm um papel preponderante no mechanismo da morte consecutiva á dupla vagotomia. Temos o prazer de agradecer ao Snr. Dr. Paulo de Proença o seu valioso auxilio prestado em todo o curso das pesquizas que foram expostas neste trabalho.

Estudos sobre a atividade dos extratos da suprarenal

Studies have been carried out on the method of Britton and Silvette modified by Reinecke and Kendall, for the evaluation of cortico-adrenal extracts, based on the deposition of glycogen in the liver of adrenaletomized rats. The test was performed in a total of 180 normal and adrenalectomized rats. The extracts tested were: a) an aqueous extract of cortico-adrenal cortex prepared by the Swingle and Pfiffner technique; b) the same extract added with ascorbic acid (Supracortin Labor); c) desoxycorticosterone acetate (Percortol Ciba and Syncortyl Roussell). Male rats were used, ranging from 40-200g, fed since the 18 th days old with a special diet, in which they were maintained until the day before the injection. Adrenalectomy was performed under urethane anesthesia. The fourth day after operation, food was removed and they were fasted for 24 hours. In the morning of the fifth day, injections of the material to be assayed were given at hourly and two hours intervals, during four to eight hours. One or two hours after the last injection, the animals were sacrified, the livers removed and dropped into a hot 30% solution of potassium hydroxide, and worked by Good, Kramer and Somogyi method. The glycogen was calculated as milligrams per lOOg of body and liver weight. The results obtained are shown in the tables I, II, and III. When several dosages of the same sample of extract were made (5 animals each dose), the amount of glycogen deposited in the liver per lOOg of body and liver weight, was found to be a positive function of the dose injected. The graph 2, shows these results. The synthetic compounds were ineffective. Our results are in agreement with those of Reinecke and Kendall and of Olson et al.

Clínica e terapêutica da doença de Chagas

1 - Baseados na experiência adquirida nos últimos cinco anos em Bambuí, Minas Gerais, onde mais de seiscentos casos de doença de Chagas tém sido estudados, os autores fazem uma revisão das manifestações clínicas desta doença. mencionam alguns dados sôbre a incidência da esquizotripanose e chamam a atenção para a importância social desta moléstia. 2 - Sugerem a seguinte sistematização das fórmas clinicas da esquizotripanose: a) Forma aguda; b) Formas crônicas: 1 - Forma indeterminada (cardiacos potenciais), 2 - Forma cardíaca (cardiopatia crônica). Os autores não encontraram no material estudado em Bambuí casos classificaveis como forma nervosa crônica. 3 - Apresentam evidências de ordem clínica e experimental que justificam admitir-se a cardiopatia crônica da doença de Chagas como entidade clinica definida. 4 - As manifestações da infecção aguda são estudadas à luz da experiência adquirida com os 103 casos agudos diagnosticados em Bambuí. Dois tipos de fenômenos edematosos podem ocorrer em pacientes com esquizotripanose aguda: o edema local, de porta de entrada do parasito, e o edema generalizado (o chamado "mixedema"). A patogenia dêste último é revista e sugere-se que ele seja devido a uma hipoproteinemia. O edema local parece de natureza inflamatória. As manifestações da cardiopatia aguda da doença de Chagas são descritas. Ritmo de galope, aumento da area cardíaca (em alguns casos devido a transudato pericárdico), prolongamento do espaço P-R, alterações primárias da onda T e extra-sístoles ventriculares - constituem os sinais mais importantes para o diagnóstico da cardiopatia aguda. Bloqueio de ramo direito foi encontrado em três casos fatais de cardiopatia aguda, um dos quais apresentou também pronunciado desnivelamento de ST (padrão de injúria). A morte durante a infecção aguda é usualmente precedida por manifestações convulsivas. Na maioria dos casos as manifestações, da infecção inicial regridem e o paciente passa à condição de cronicidade em aparente cura espontânea. Esta, entretanto, parece não ocorrer. 5 - Pacientes com infecção crônica e sem evidências de comprimento cardíaco são classificados como cardíacos potenciais ou forma crônica indeterminada. A infecção em regra permanece ativa e os sinais da cardiopatia podem desenvolver-se mais tarde. 6 - A cardiopatia crônica é usualmente manifestação tardia da infecção. Ela incide em cerca de 50% dos pacientes com infecção crônica. Suas manifestações dependem da extensão das alterações miocárdicas. Palpitações, dispnéia, crises convulsivo-sincopais (bloqueio A-V intenso), precordialgias atípicas e dôr no hipocôndrio direito (congestão passiva do fígado) são os sintomas mais comuns. Alguns casos não apresentam sintomas, o coração não se mostra aumentado e a única evidência da cardiopatia é fornecida pelo eletrocardiograma (cardiopatia assintomática). Irregularidades do ritmo cardiaco, desdobramento da 2ª bulha no foco pulmonar e ritmo de galope são achados auscultatórios frequentes. O aumento do coração é de grau variavel; ele atinge a todas as cavidades cardíacas. Doentes com insuficiência cardíaca em regra apresentam aumento pronunciado do coração. Predominam sinais de dilatação cardíaca sôbre os de hipertrofia. Não se encontram sinais de lesão valvular ou de alterações estruturais dos grandes vasos. A pressão arterial é usualmente normal; em casos de insuficiência cardíaca pode a pressão sistólica estar reduzida e a direfencial ser muito pequena. Sinais de insuficiência valvular funcional são muito comuns em casos com insuficiência cardiaca. Usualmente do tipo direito ou do tipo bilateral, a insuficiência cardiaca raramente assume o tipo insuficiência ventricular esquerda isolada. Na grande maioria dos casos o eletrocardiograma evidencia distúrbios da condução ou da formação do estímulo, ou ambos. Extrasistoles ventriculares, bloqueio de ramo direito, bloqueios A-V de todos os graus e altrações atípicas do complexo ventricular são os achados eletrocardiográficos mais importantes. O bloqueio de ramo direito é excepcionalmente comum neste tipo de cardiopatia e possúe grande valor diagnóstico em areas endêmicas. Os critérios para o diagnóstico diferencial com outros tipos de cardiopatia crônica são expostos. A evolução da cardiopatia crônica é variável, dependendo principalmente da atividade da infecção. A sobrevida é geralmente longa; entretanto, a maioria dos doentes morre antes dos 50 anos de idade. O prognóstico depende principalmente de gráu de aumento do coração e de redução da sua capacidade funcional, do tipo de arritmia presente e do potencial evolutivo da infecção crônica. A morte súbita é muito comum nesta cardiopatia; a maioria dos doentes, porém, morre em insuficiencia cardiaca. Não se dispõe ainda de medicamento eficaz para o tratamento etiológico da doença de Chagas. No tratamento da insuficiência cardíaca da cardiopatia crônica da doença de Chagas obtém-se frequentemente melhores resultados com a estrofantina ou a ouabaina do que com a digital.

Miocardite na forma aguda da doença de Chagas

The autopsy of a case of CHAGAS'S disease or American tryponosomiasis (a girl, 5 years old), dead in the 22nd day of illness is reported. The anatomic diagnosis was a follows: Acute diffuse chagasic nyocarditis. Chagasic encephalitis. Chagasic lymphadenitis of the right posterior auricular node. Tuberculosis of the bronchial and pulmonary nodes. Chronic passive hyperemia and atelectasia of the lungs. Chronic passive congestion and hemorrhages of the spleen. Serous hepatitis. Parotiditis. Edema of the right eyelids. Bilateral hydrothorax. Hydropericardium. Hydroperitoneum. The morphology of Schizotrypanum cruzi in the myocardium is considered. Besides agglomerates with typical small oval or round intracellular bodies, pre-flagellate and flagellate organisms, others are found in which the great amount of parasites and marked pressure exerted by them against each other render very difficult their identification; sometimes the similitude of such agglamerates to Toxoplasma is striking (Fig. 1 and 1 A). In such a case, the structure of the blepharoplast (Fig. 1 and IA), usually preserved, is profitable and allows the identification of the pre-flagellate and flagellate forms of Schizotrypanum cruzi. Most of the small sensitive nerves in the epicardium shows mononuclear infiltration of the perineurium (perineuritis, Figs. 12-14). Microscopically there is extensive Zenker's degeneration (Figs. 6-8) and parasitism of the heart muscle fibers, marked cellular infiltration of the interstitial connective tissue, which are found in the ordinary musculature of every chamber of the heart (Figs. 10-11) as well as in Tawara's node (Fig. 9), main bundle (Fig. 2) and right (Fig. 4) and left (Fig. 5) septal divisions of the bundle of His, and perineuritis. Those anatomic changes are associated to an abnormal electrocardiogram presenting some similitude to that of an anemic infarct of the anterior wall of the heart and which will be discussed elsewhere (unpublished paper by Dias, Nobrega & Laranja).

Current Account imbalances, thriftiness and the real exchange rate in a growing economy

This paper analyses the theoretical relevance of the dynamical aspects of growth on the discussion about the observed positive correlation between per capita real income and real exchange rates. With this purpose, we develop a simple exogenous growth model where the internal, external and intertemporal equilibrium conditions of a typical macroeconomic model are imposed; this last one through the inclusion of a balanced growth path for the foreign assets accumulation. The main result under this consideration is that the relationship defended by the Balassa-Samuelson hypothesis is no more so straightforward. In our particular approach, the mentioned bilateral relationship depends on a parameter measuring thriftiness in the economy. Therefore, the probability of ending up with a positive relationship between growth and real exchange rates -as the classical economic theory predicts- will be higher when the economy is able to maintain a minimum saving ratio. Moreover, given that our model considers a simple Keynesian consumption function, some explosive paths can also be possible.

Mediation incomplete information bargaining with filtered communication

We analyze a continuous-time bilateral double auction in the presence of two-sided incomplete information and a smallest money unit. A distinguishing feature of our model is that intermediate concessions are not observable by the adversary: they are only communicated to a passive auctioneer. An alternative interpretation is that of mediated bargaining. We show that an equilibrium using only the extreme agreements always exists and display the necessary and sufficient condition for the existence of (perfect Bayesian) equilibra which yield intermediate agreements. For the symmetric case with uniform type distribution we numerically calculate the equilibria. We find that the equilibrium which does not use compromise agreements is the least efficient, however, the rest of the equilibria yield the lower social welfare the higher number of compromise agreements are used.

Repeated games played in a network

Delayed perfect monitoring in an infinitely repeated discounted game is modelled by letting the players form a connected and undirected network. Players observe their immediate neighbors' behavior only, but communicate over time the repeated game's history truthfully throughout the network. The Folk Theorem extends to this setup, although for a range of discount factors strictly below 1, the set of sequential equilibria and the corresponding payoff set may be reduced. A general class of games is analyzed without imposing restrictions on the dimensionality of the payoff space. This and the bilateral communication structure allow for limited results under strategic communication only. As a by-product this model produces a network result; namely, the level of cooperation in this setup depends on the network's diameter, and not on its clustering coefficient as in other models.

Patterns of oxygen consumption during establishment of cephalocaudal polarity in the early chick embryo.

Oxygen uptake was studied during the establishment of cephalocaudal polarity in the very early chick embryo, i.e., 10 hr before (stage VI) and at laying (stage X). Oxygen fluxes in minute regions of the intact blastoderms were measured in vitro by scanning microspectrophotometry in the presence or absence of glucose. The oxygen consumption of the whole blastoderm remained constant (6 nmol O2 X hr-1) throughout the period studied, although the number of cells increased more than twofold. The regional oxygen fluxes varied from 0.41 to 1.13 nmol O2 X hr-1 X mm-2 at stage VI and from 0.42 to 0.70 nmol O2 X hr-1 X mm-2 at stage X. At stage VI, the oxygen flux in the center of the blastoderm was significantly higher than that in its periphery. This pattern remained evident when the values were corrected for cell number or for cytoplasmic volume. At stage X, there was a tendency for the oxygen fluxes to decrease from the posterior to the anterior regions of the area pellucida. Thus the pattern of oxidative metabolism in the late uterine embryos seems to change from radial to bilateral. This change of symmetry probably reflects the process of formation of the embryonic axis. In addition, the fact that the oxygen uptake was similar in the presence or absence of glucose suggests that early chick embryos metabolize essentially intracellular stores.

Pseudohypoaldosteronisms, report on a 10-patient series.

BACKGROUND: Type 1 pseudohypoaldosteronism (PHA1) is a salt-wasting syndrome caused by mineralocorticoid resistance. Autosomal recessive and dominant hereditary forms are caused by Epithelial Na Channel and Mineralocorticoid Receptor mutation respectively, while secondary PHA1 is usually associated with urological problems. METHODS: Ten patients were studied in four French pediatric units in order to characterize PHA1 spectrum in infants. Patients were selected by chart review. Genetic, clinical and biochemistry data were collected and analyzed. RESULTS: Autosomal recessive PHA1 (n = 3) was diagnosed at 6 and 7 days of life in three patients presenting with severe hyperkalaemia and weight loss. After 8 months, 3 and 5 years on follow-up, neurological development and longitudinal growth was normal with high sodium supplementation. Autosomal dominant PHA1 (n = 4) was revealed at 15, 19, 22 and 30 days of life because of failure to thrive. At 8 months, 3 and 21 years of age, longitudinal growth was normal in three patients who were given salt supplementation; no significant catch-up growth was obtained in the last patient at 20 months of age. Secondary PHA1 (n = 3) was diagnosed at 11, 26 days and 5 months of life concomitantly with acute pyelonephritis in three children with either renal hypoplasia, urinary duplication or bilateral megaureter. The outcome was favourable and salt supplementation was discontinued after 3, 11 and 13 months. CONCLUSIONS: PHA1 should be suspected in case of severe hyperkalemia and weight loss in infants and need careful management. Pathogenesis of secondary PHA1 is still challenging and further studies are mandatory to highlight the link between infection, developing urinary tract and pseudohypoaldosteronism.

Autofluorescence Findings Of A Novel Maculopathy In Patient With Spinocerebellar Ataxia Type 1 And Of A Cone - Rod Type Retinal Dysfunction In Three Generation Family With Spinocerebellar Ataxia Type 7

Purpose: To report a novel maculopathy in a patient with SCA1. To describe autofluorescence findings in family with SCA7 and associated cone-rod retinal dysfunction.Methods: 4 affected patients from two families were assessed to investigate a progressive loss of visual acuity (VA). Examinations included fundus photography, autofluorescence (AF) fundus fluorescein angiogragraphy (FFA) and optical coherence tomography. Electroretinogram (full-field) was performed in 2 affected patients. All patients had color vision testing using Ishihara pseudoisochromatic plates. Molecular analysis was performed in family 2.Results: The patient with known diagnosis of SCA1 had a visual acuity of 20/200 bilaterally and dyschromatopsia. He had saccadic pursuit. Fundus examination showed mild retinal pigment epithelium (RPE) changes at the macula. OCT showed bilateral macular serous detachment, which was not obvious at the FFA and explained his VA. AF imaging showed a central hyperfluorescence. The 45 year old proband from family 2 had a visual acuity of 200/20 and dyschromatopsia. ERG testing showed cone type dysfunction of photoreceptors. Her daughter affected at a younger age had the same ERGs findings. Fundus examination showed mild RPE changes in proband, normal findings in her daughter. AF imaging of both patients showed a ring of high density AF around the fovea. The ring was also obvious on near infrared AF. Later onset of gait imbalance led to the diagnosis of SCA7Conclusions: Within the group of spinocerebellar ataxias, only the type 7 is associated with retinal dysfunction. We present the first report of maculopathy associated with SCA1 causing severe vision loss. The ring of high density AF in SCA7 confirmed an early retinal photoreceptor dysfunction in patient with normal fundus.

Accuracy of Brain Multimodal Monitoring to Detect Cerebral Hypoperfusion After Traumatic Brain Injury.

OBJECTIVE:: To examine the accuracy of brain multimodal monitoring-consisting of intracranial pressure, brain tissue PO2, and cerebral microdialysis-in detecting cerebral hypoperfusion in patients with severe traumatic brain injury. DESIGN:: Prospective single-center study. PATIENTS:: Patients with severe traumatic brain injury. SETTING:: Medico-surgical ICU, university hospital. INTERVENTION:: Intracranial pressure, brain tissue PO2, and cerebral microdialysis monitoring (right frontal lobe, apparently normal tissue) combined with cerebral blood flow measurements using perfusion CT. MEASUREMENTS AND MAIN RESULTS:: Cerebral blood flow was measured using perfusion CT in tissue area around intracranial monitoring (regional cerebral blood flow) and in bilateral supra-ventricular brain areas (global cerebral blood flow) and was matched to cerebral physiologic variables. The accuracy of intracranial monitoring to predict cerebral hypoperfusion (defined as an oligemic regional cerebral blood flow < 35 mL/100 g/min) was examined using area under the receiver-operating characteristic curves. Thirty perfusion CT scans (median, 27 hr [interquartile range, 20-45] after traumatic brain injury) were performed on 27 patients (age, 39 yr [24-54 yr]; Glasgow Coma Scale, 7 [6-8]; 24/27 [89%] with diffuse injury). Regional cerebral blood flow correlated significantly with global cerebral blood flow (Pearson r = 0.70, p < 0.01). Compared with normal regional cerebral blood flow (n = 16), low regional cerebral blood flow (n = 14) measurements had a higher proportion of samples with intracranial pressure more than 20 mm Hg (13% vs 30%), brain tissue PO2 less than 20 mm Hg (9% vs 20%), cerebral microdialysis glucose less than 1 mmol/L (22% vs 57%), and lactate/pyruvate ratio more than 40 (4% vs 14%; all p < 0.05). Compared with intracranial pressure monitoring alone (area under the receiver-operating characteristic curve, 0.74 [95% CI, 0.61-0.87]), monitoring intracranial pressure + brain tissue PO2 (area under the receiver-operating characteristic curve, 0.84 [0.74-0.93]) or intracranial pressure + brain tissue PO2+ cerebral microdialysis (area under the receiver-operating characteristic curve, 0.88 [0.79-0.96]) was significantly more accurate in predicting low regional cerebral blood flow (both p < 0.05). CONCLUSION:: Brain multimodal monitoring-including intracranial pressure, brain tissue PO2, and cerebral microdialysis-is more accurate than intracranial pressure monitoring alone in detecting cerebral hypoperfusion at the bedside in patients with severe traumatic brain injury and predominantly diffuse injury.

Official Central Bank Interventions in the Foreign Exchange Markets: A DCC Approach with Exogenous Variables

This paper assesses the impact of official central bank interventions (CBIs) on exchange rate returns, their volatility and bilateral correlations. By exploiting the recent publication of intervention data by the Bank of England, this study is able to investigate fficial interventions by a total number of four central banks, while the previous studies have been limited to three (the Federal Reserve, Bundesbank and Bank of Japan). The results of the existing literature are reappraised and refined. In particular, unilateral CBI is found to be more successful than coordinated CBI. The likely implications of these findings are then discussed.

A Bootstrap Neural Network Based Heterogeneous Panel Unit Root Test: Application to Exchange Rates

This paper proposes a bootstrap artificial neural network based panel unit root test in a dynamic heterogeneous panel context. An application to a panel of bilateral real exchange rate series with the US Dollar from the 20 major OECD countries is provided to investigate the Purchase Power Parity (PPP). The combination of neural network and bootstrapping significantly changes the findings of the economic study in favour of PPP.

The effects of entry in thin markets

We consider entry of additional firms into the market for a single commodity in which both sellers and buyers are permitted to interact strategically. We show that the market is quasi-competitive, in that the inclusion of an additional seller lowers the price and increases the volume of trade, as expected. However, whilst buyers benefit from this change under reasonable conditions on preferences, we cannot conclude that sellers are always made worse off in the face of more intense competition, contrary to the conventional wisdom. We characterize the conditions under which entry by new sellers may raise the equilibrium profit of existing sellers, which will depend in an intuitive way on the elasticity of a strategic analog of demand and the market share of existing sellers, and encompass completely standard economic environments.

First-line chemotherapy with local treatment can prevent external-beam irradiation and enucleation in low-stage intraocular retinoblastoma.

PURPOSE: To evaluate the efficacy of first-line chemotherapy (CT) in preventing external-beam radiotherapy (EBR) and/or enucleation in patients with retinoblastoma (Rbl). PATIENTS AND METHODS: Twenty-four patients with newly diagnosed unilateral or bilateral Rbl received CT associated with local treatment (LT). Two to five courses of etoposide and carboplatin were administered at 3- to 4-week intervals, depending on tumor response, and were completed each time by LT. RESULTS: Tumor response was observed in all eyes. Twenty-one of 24 patients showed a complete response (CR) that persisted at a median follow-up (FU) of 31 months (range, 4 to 41 months). Among the three patients who relapsed, two were lost to FU and one died of progressive disease. CR was achieved by CT and LT alone in 15 (71.4%) of 21 patients with less advanced disease (groups I to III). Six other patients with advanced disease (groups IV and V) experienced treatment failure and needed salvage treatment by EBR and/or enucleation. The difference between the two patient groups with regard to disease stage was statistically significant (P <.0001). EBR could be avoided in 13 (68.4%) of 19 patients, who presented with groups I to III (15 eyes) and group V (one eye) disease, whereas enucleation could be avoided in only two (40%) of five. CONCLUSION: CT combined with intensive LT is effective in patients with groups I to III Rbl, permitting the avoidance of EBR in the majority of these young children and, thus, reducing the risk of long-term sequelae. This is in contrast with the disappointing results for patients with groups IV and V Rbl, in whom EBR and/or enucleation was needed.