Posttraumatic cerebral hemispheric disconnection syndrome

Gross and microscopic lesions of the corpus callosum and neighboring structures are common in severe closed head injury. This report is the first, to our knowledge, to confirm neuropathologically the occurrence of extensive traumatic destruction of the corpus callosum in a patient with left-sided apraxia and agraphia. It also demonstrates that large traumatic lesions of the corpus callosum may occur without prolonged posttraumatic coma, vegetative state, or death. In our patient, coexisting extracallosal hemispheric lesions may have modified the effects of callosal pathology. Cases of this type may be more common than generally appreciated, but since symptoms of hemispheric disconnection are not apparent in ordinary behavior, specific tests of callosal function must be employed if disconnection phenomena are to be detected in the posttraumatic period.     

The homeostatic function of the colon in acute gastroenteritis

Infants and young children with acute gastroenteritis have been studied with regard to stool electrolyte composition, external electrolyte balance, and aldosterone excretion. At the height of fluid depletion the stool sodium concentrations are low (median 8 m-equiv/1, range 3-58 m-equiv/1). The results indicate that in gastroenteritis the colon is responding homeostatically to a state of secondary hyperaldosteronism, thus assisting in sodium conservation.     

Phlebotomine sandflies of Southern Brazil

OBJECTIVE: To identify the sandfly fauna and some aspects of their behavior in forest and anthropic environments. METHODS: Sandfly captures were undertaken in farm (23 degrees 6' S; 50 degrees 22' W), in Southern Brazil. Falc?o light traps were set in forest, domicile and domestic animal shelters and mosquitoes were collected monthly, between 17h and 7h, from March 1997 to February 1998. RESULTS: A total of 3,655 specimens representing 13 species were captured. Nyssomyia whitmani and Nyssomyia neivai were the predominant species, with a total of 2,977 specimens (81.0%). Of these two species, a total of 2,552 (85.7%) specimens were captured in intradomiciliary and peridomiciliary environments, 2,332 (91.3%) of them in a pigsty. These two species predominated between 20h-21h when 90.4% of the specimens were captured. CONCLUSIONS: Five sandfly species, N. whitmani, N. neivai, Migonemyia migonei, Pintomyia pessoai and Pintomyia fischeri, potential vectors of cutaneous leishmaniasis, were captured. The importance of the two former species is emphasized, since both presented similar behavior in regard to seasonal period, hourly frequency and predominance in the anthropic environment. Besides, N. whitmani was the most predominant species.     

Delayed thrombin generation with hirudin anticoagulation during prolonged cardiopulmonary bypass

Patients with heparin-induced thrombocytopenia requiring urgent cardiac surgery present a unique challenge that must be addressed by the use of nonheparin alternatives for anticoagulation during cardiopulmonary bypass. Although isolated cases have been presented involving the use of antithrombin III independent thrombin inhibitor hirudin in this situation, its ability to completely inhibit thrombin activity has not been demonstrated. In this report we describe the efficacy of this drug in inhibiting thrombin during a case requiring prolonged cardiopulmonary bypass.     

Linear equations with random variables

A system of linear equations is presented where the unknowns are unobserved values of random variables. A maximum likelihood estimator assuming a multivariate normal distribution and a non-parametric proportional allotment estimator are proposed for the unobserved values of the random variables and for their means. Both estimators can be computed by simple iterative procedures and are shown to perform similarly. The methods are illustrated with data from a national nutrition survey in Japan.     

First efficacy and safety results with the antibody containing leukocyte inhibition module in cardiac surgery patients with neutrophil hyperactivity

Systemic administration of immune modulating antibodies may play an important role in reducing neutrophil hyperactivity, for example, in patients undergoing cardiac surgery with extracorporeal circulation or in trauma patients. However, this strategy has extremely high costs and is often associated with severe adverse effects. We developed the Leukocyte-Inhibition-Module (LIM), an extracorporeal circulation (ECC) device housing a polyurethane matrix with covalently bound Fas (CD95; APO-1) stimulating antibodies to rapidly prevent neutrophil hyperactivation. A feasibility study with 14 patients undergoing cardiac surgery with the use of immunogenic ECC without (n = 5) and with (n = 9) LIM (venous line) was performed. Our data show that the usually observed ECC associated perioperative increase in neutrophils (control) was prevented by LIM (p = 0.023). Moreover, the increase of the proinflammatory markers tumor necrosis factor (TNF)-alpha and polymorphonuclear elastase was limited by LIM (p = 0.038 and p = 0.002). In both groups, no significant changes in liver enzymes or in clotting were detected after surgery, and up to 12 months follow up, no unusual complications were reported. This study shows for the first time to our knowledge the feasibility, efficacy, and safety of a new cost effective, immune management strategy in patients with aberrant immune activation by exposing the blood stream to immobilized agonistic anti-Fas antibodies.