[The radiotherapy of advanced breast cancer]

The authors discuss the indications for radiotherapy in late breast cancer, retrospectively analysing the experience of the Radiotherapy Department of the Portuguese Institute of Oncology in Lisbon. Treatment results of locally advanced cancer (T4a-b-c) with megavoltage machines (telecobalt therapy) using two different types of fractionation regimes are discussed. They conclude that conventional fractionation remains the best option. In elderly patients, those with ulcerated and bleeding lesions and those with socio-economic problems, it is acceptable to use non-conventional fractionation regimes with a high dose per fraction for the first part of the treatment. Advantages are overall shortening of treatment time without an increase in morbidity although survival is somewhat lower (30% versus 40% at 5 years). The authors also discuss the role of radiotherapy in disseminated disease which, in combination with systemic treatment, may be extremely useful in improving the patient's quality of life--as a way of stopping haemorrhage in bleeding lesions, for pain relief in secondary deposits, to treat superior vena cava syndrome and spinal cord compression, to prevent pathological fractures and last, but not least, to relieve or prevent symptoms such as those caused by brain metastases. The results presented in this paper are in agreement with current literature. Finally, the authors mention the most frequent complications of radiotherapy in late breast cancer as well as the guidelines for supportive care of the irradiated patient with the aim of a complete re-habilitation.

The growth and signalling defects of the ggs1 (fdp1/byp1) deletion mutant on glucose are suppressed by a deletion of the gene encoding hexokinase PII

Yeast cells defective in the GGS1 (FDP1/BYP1) gene are unable to adapt to fermentative metabolism. When glucose is added to derepressed ggs1 cells, growth is arrested due to an overloading of glycolysis with sugar phosphates which eventually leads to a depletion of phosphate in the cytosol. Ggs1 mutants lack all glucose-induced regulatory effects investigated so far. We reduced hexokinase activity in ggs1 strains by deleting the gene HXK2 encoding hexokinase PII. The double mutant ggs1 delta, hxk2 delta grew on glucose. This is in agreement with the idea that an inability of the ggs1 mutants to regulate the initiation of glycolysis causes the growth deficiency. However, the ggs1 delta, hxk2 delta double mutant still displayed a high level of glucose-6-phosphate as well as the rapid appearance of free intracellular glucose. This is consistent with our previous model suggesting an involvement of GGS1 in transport-associated sugar phosphorylation. Glucose induction of pyruvate decarboxylase, glucose-induced cAMP-signalling, glucose-induced inactivation of fructose-1,6-bisphosphatase, and glucose-induced activation of the potassium transport system, all deficient in ggs1 mutants, were restored by the deletion of HXK2. However, both the ggs1 delta and the ggs1 delta, hk2 delta mutant lack detectable trehalose and trehalose-6-phosphate synthase activity. Trehalose is undetectable even in ggs1 delta strains with strongly reduced activity of protein kinase A which normally causes a very high trehalose content. These data fit with the recent cloning of GGS1 as a subunit of the trehalose-6-phosphate synthase/phosphatase complex.(ABSTRACT TRUNCATED AT 250 WORDS)

EEG activity during cognitive performance in women

EEG activity of 20 female volunteers was monopolarly recorded at P3, P4, C3 and C4 during four resting periods and three series of cognitive tasks: one analytic, one spatial and one demanding analytical and spatial processing or mixed task. Relative power and inter and intrahemispheric correlations were analysed. Beta relative power was significantly higher during the resting periods at the right parietal and the same pattern of asymmetry was maintained during the three series of tasks. Alpha relative power decreased and theta increased during the three series of tasks regardless of their cognitive nature as compared to baseline. Interhemispheric correlation for theta frequencies, and intrahemispheric correlation for the full band were significantly different during task solution. There were no significant differences between left and right intrahemispheric correlations.

Spectral analysis of heart rate variability in athletes

The objectives of the study were to characterize power spectrum pattern of the heart rate variability and assessment of the relative contributions of sympathetic and parasympathetic cardiac nervous system control in athletes. Thirty-three male athletes, swimming (1), canoeing (10), cycling (6), athletics (4), football (3), roller-skating (2) and volleyball (7) aged 23.4 +/- 5.5 years, with a mean athletic level of 18 hours/week (8-45) and 33 sedentary healthy control subjects were included. Ecg signals were recorded after a period of 15 minutes in supine rest with controlled breathing at 15 cycles/min. Signal acquisition was done at 300 samples/sec. From 512 consecutive heart beats, we calculated mean average, standard deviation, maximum and minimum R-R intervals and, after computing the fast Fourier transform, total spectrum power, low frequency (LF), high frequency (HF) components and its ratio (LF/HF). The average R-R interval was 987.7 +/- 168.8 ms and 762.7 +/- 125.3 ms, the variance was 5.44 and 2.51 ms2 and ratio of R-R interval maximum/minimum (E/I ratio) 1.53 +/- 0.16 and 1.41 +/- 0.16, respectively for athletes and control group. Differences between groups were significant (p < 0.01) for all parameters, with higher variability in the athletes. Both spectral bands (LF and HF) had higher power in athletes (LF = 925 +/- 920 and HF = 2258 +/- 2349 ms2) than in the control group (LF = 442 +/- 446 and HF = 1179 +/- 1542 ms2) (p < 0.01). There were no significant differences for LF/HF ratio, or normalized LF (LF%) or normalized HF (HF%) between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronic viral hepatitis C and interferon: results after a year and predictive factors of response (a multivariate study with 35 patients)]

Six months alpha IFN therapy was efficient for chronic viral hepatitis C in 31% patients after six months and in 17% after one year. Cirrhosis, low serum albumin or prealbumin levels and elevated IgA seric level were non responsiveness predictive factors.

Changes in the waking EEG as a consequence of sleep and sleep deprivation

Electroencephalographic (EEG) activity was monopolarly recorded during resting wakefulness in 10 volunteers under the following conditions: at night before going to sleep, at night before total sleep deprivation, in the morning after waking, in the morning after sleep deprivation and at night after having slept during the day. Absolute and relative power and inter- and intrahemispheric correlation were established. After diurnal and nocturnal sleep as compared to sleep deprivation, we obtained the following significant results: interhemispheric correlations were higher; intrahemispheric correlations were lower; absolute power of alpha 2, beta 1 and beta 2 was lower; and relative power of alpha 2 and beta 2 was lower. EEG changes as a consequence of sleep or lack of sleep are dependent on prior sleep and/or wakefulness and not on circadian phase. EEG activity during wakefulness is a sensitive parameter and a useful tool to assess the consequences of sleep on brain functional organization.

EEG activity during estral cycle in the rat

EEG activity was recorded from right and left parietal cortex in adult female rats daily during 6 days. Immediately after EEG recording vaginal smears were taken and were microscopically analyzed to determine the estral stage. Absolute and relative powers and interhemispheric correlation of EEG activity were calculated and compared between estral stages. Interhemispheric correlation was significantly lower during diestrous as compared to proestrous and estrous. Absolute and relative powers did not show significant differences between estral stages. Absolute powers of alpha1, alpha2, beta1 and beta2 bands were significantly higher at the right parietal cortex. Comparisons of the same EEG records with estral stages randomly grouped showed no significant differences for any of the EEG parameters. EEG activity is a sensitive tool to study functional changes related to the estral cycle.

Occipital encephalocele associated with a dermoid cyst

The case of a neonate with a dermoid cyst originating within an occipital encephalocele is reported. The finding of the tumor was made during the routine repair of the meningoencephalocele. To our knowledge this is the first time that this association has been described.

[Gammagraphic findings in hepatic focal nodular hyperplasia]

Two cases, of focal nodular hyperplasia (FNH) are presented which were detected by chance and in which the gammagraphic study was the only parameter which indicated the changes that occurred in the hyperplasia revealing a hypervascular mass, colloid capture and 99mTc-DISIDA retention in the later image. These liver masses are now seen more frequently given the wide use of echography and the gammagraphic studies could be useful in the orientation of their nature in a non aggressive manner.

Activation of the potassium uptake system during fermentation in Saccharomyces cerevisiae

Fermentable sugars activated the K+ uptake system, increasing the Vmaxs of Rb+, Na+, and Li+ influxes, but sugars did not affect the effluxes of these cations. This activation seems to be a direct effect of fermentation and not the consequence of the H+ pump ATPase activation or internal pH decrease produced by fermentation.

The antrum exclusion technique in cholesteatoma surgery

A new surgical technique for the treatment of cholesteatoma is reported. The technique involves auto-exclusion for exteriorization of the attic and tympanic box only. The resulting cavity is rather small. The technique allows visual post-operative control of the attic and tympanic membrane. There is no visual access to the mastoid cavity which, however, is the most unlikely site for occurrence of a residual cholesteatoma. The proposed technique was applied to 102 patients and both the anatomic and functional results obtained are reported.

Ureteral triplication with contralateral ureter duplication

A rare case of ureteral triplication with contralateral duplication is reported. The incidence, embryology, classification and symptomatology are commented. The most relevant literature is reviewed.

[Renal actinomycosis: presentation of a case]

Renal actinomycosis is rarely suspected and is difficult to diagnose, limited to a few cases in any series. A 56-year-old man with renal actinomycosis and Rendu-Osler disease is described. Long-term therapy with penicillin resulted in a clinical cures. A case report is presented.

[Histochemical and immunohistochemical study of the lymphoid tissue of swine: lymphatic ganglia, spleen and thymus]

Immunohistological (S-100, cIg) and enzyme histochemical (ANAE/ANBE, beta-glu, ATPase, AcP) investigations were carried out to identify lymphocyte and reticular cell subpopulations "in situ", in pig lymphoid tissue (lymph node, spleen, and thymus) of a 6 months old group, and a 6-9 days old one. By means of immunohistological techniques, in the 6 month old pigs we could detect S-100 protein (PAP), chiefly in T-areas lymphocytes, but we also found some S-100 positive lymphocytes in spleen follicles. Also S-100 protein were detected at Follicular Dendritic Cells (FDC) in lymph node and spleen; and Reticular Fibroblastic Cells (RFC) only in the first one. Finally, S-100 were noted in Hassall corpuscles (thymus), nervous fibres, and endothelial cells too. Using PAP (IgG, IgM) and IPI (IgA) techniques we could detect lymphocyte cytoplasmatic surface immunoglobulins (cIg) in lymphocytes, lymphoblastoid and plasmacytoid cells in nearly all tissue compartments. By means of histochemical techniques we could identify T-area lymphocytes ANAE/ANBE and beta-glu positives (cytoplasmatic spots) and B-area lymphocytes ATPase positive; macrophages, and polymorphonuclear eosinophiles PHNE being ANAE/ANBE and beta-glu positives (diffuse cytoplasmic stain); and Hassall corpuscles ANAE/ANBE and AcP positives. Concerning to reticular cells, we found FDC and RFC in lymphoid follicles, and Interdigitating Reticular Cells (IDC) in lymphoid diffuse tissue, with enzyme activity (all the enzymes studied) in nearly all the cases. In piglets, the immunohistological and histochemical pattern was nearly the same.

[Spectrum analysis of the variability of heart rate in athletes]

OBJECTIVES

Characterize power spectrum pattern of the heart rate variability and assessment of the relative contributions of sympathetic and parasympathetic cardiac nervous system control in athletes.

STUDY DESIGN

Prospective study of athletes and sedentary healthy control group sex and age matched.

SUBJECT AND METHODS

8 athletes, 3 female and 5 male, swimming (4), canoeing (2) and cycling (2), aged 17.4 +/- 3.6 years, and 8 sedentary healthy controls. ECG signals were recorded after a period of 15 minutes in supine rest with controlled breathing at 15 cycles/min. Signal acquisition was done at 300 samples/sec. From 512 consecutive heart beats, we calculated the average, the standard deviation, the maximum and the minimum values and the rate between the longest and the shortest R-R interval (E/I). We also calculated, after computing the fast Fourier transform, the total spectrum power, the low frequency component (LF, from 0.01 to 0.15 Hz) and the high frequency component (HF, greater than 0.15 Hz) and its ratio (LF/HF).

RESULTS

The average R-R interval was 921 +/- 154.2 msecs and 673.2 +/- 98 msecs, the standard deviation was 72.5 and 29.4 msecs and the ratio E/I 1.63 +/- 0.14 and 1.28 +/- 0.08, respectively for athletes and control group. Differences between groups were significant (p less than 0.01) for all parameters, with higher variability in the athletes. Both spectral bands (LF and HF) and higher power in athletes (LF = 0.54 +/- 0.23 and HF = 0.76 +/- 0.14) than in the control group (LF = 0.14 +/- 0.10 and HF = 0.18 +/- 0.15) (p less than 0.001). There were no significant differences for LF/HF ratio, or normalized LF (LF%) or normalized HF (HF%) between groups.

CONCLUSIONS

The present results indicates higher power of both spectral bands (LF and HF) and higher amplitude of the respective peaks in athletes when compared with healthy sedentary, with a clear predominance of the HF band in the total spectral power density, which suggest that the higher heart rate variability observed in athletes reveals the predominance of parasympathetic activity, without reduction of the sympathetic tone.

Regulation of potassium fluxes in Saccharomyces cerevisiae

To investigate the regulation of K+ fluxes in Saccharomyces cerevisiae the dependence of K+ efflux and Rb+ influx on [K+]i, pHi, [Na+]i, membrane potential, cell volume, and turgor pressure were studied in cells with different K+ contents. By decreasing the cell volume with osmotic shocks and the cellular pH with butyric acid the following was found. (1) The K+ efflux induced by uncouplers decreases simultaneously with the decrease of the K+ content of the cell, but the process was insensitive to [K+]i, pHi, cell volume and turgor pressure. The internal presence of Na+ inhibited this K+ efflux. (2) The increase of the Vmax of Rb+ influx observed in low-K+ cells is due to the decrease of the pHi and probably mediated by the increase of the activity of the plasma membrane ATPase. The Vmax is independent of [K+]i, [Na+]i, cell volume and turgor pressure. (3) The decrease in the Km of Bt+ influx observed in low-K+ cells does not depend directly on [K+]i, pHi, cell volume or turgor pressure. If Na+ is present, [Na+]i might be directly involved in the regulation of the Km.

[Leiomyoma of the bladder as a cause of unilateral ureteral obstruction associated with uterine leiomyoma and polycystic ovary]

A case of a female patient with bladder leiomyoma associated to uterus containing several leiomyomatous nodules and polycystic ovaries is presented. The diagnostic convenience that ecography can provide, showing neoformations and their definition with regard to neighbouring organic structures, is highlighted. The existing relationship between uterine leiomyomas and estrogens is outlined, as well as the action of GnRH agonists on such leiomyomas after long-term therapy.

Transcutaneous electrical nerve stimulation (TENS) for the treatment of primary dysmenorrhea: a randomized crossover comparison with placebo TENS and ibuprofen

In a randomized four-way crossover study, 32 women with primary dysmenorrhea were treated with transcutaneous electrical nerve stimulation (TENS) for two cycles, placebo (sham) TENS for one cycle, or ibuprofen 400 mg four times a day for one cycle. The TENS setting used was 100 pulses per second with 100-microsecond pulse widths. The subjects were allowed to adjust the amplitude to a comfortable level. The pain rescue medication was ibuprofen 400 mg as needed, up to 1600 mg/day. Significantly more subjects who had TENS treatment did not require rescue medication or required less backup ibuprofen at 0-4, 4-8, and 8-12 hours after the onset of dysmenorrhea and starting treatment, as well as during the first 24 hours and for the duration of the menstrual flow, when compared with placebo TENS or ibuprofen-treated cycles (Tukey multiple comparison, P less than .01). Transcutaneous electrical nerve stimulation significantly delayed the need for ibuprofen by an average of 5.9 hours, compared with 0.7 hours when using ibuprofen alone (P less than .05, paired t test). Transcutaneous electrical nerve stimulation alone provided good to excellent subjective pain relief in 42.4% of subjects, compared with 3.2% with placebo TENS, and significantly reduced diarrhea, menstrual flow, clot formation, and fatigue compared with placebo TENS. Transcutaneous electrical nerve stimulation plus less ibuprofen provided pain relief equivalent to that obtained with ibuprofen alone (71 and 75% of the subjects, respectively). We conclude that TENS is a safe, effective, non-medication method for managing primary dysmenorrhea and that TENS plus ibuprofen was the best overall treatment, as indicated by pain relief.

[Effect of in vitro infection with dengue virus (DEN-2) on various cellular immune response functions in the mouse]

When Dengue type 2 virus (DEN-2) is put in contact with spleen cells from DBA/2 mice that had been stimulated with Concanavalin A, it was found a decrease in the incorporation of (3H) Thymidine. Furthermore it was observed that the number of Antibody forming cells (Plaque forming cells) against SRBC was decreased, when lymphocytes from DBA/2 mice spleen in culture, had been stimulated with sheep red blood cells (SRBC) in vitro and then infected with DEN-2 virus and the interleukin-1 (IL-1) biosynthesis was quantified in the thymocyte system it was shown that macrophages produced high levels of IL-1 compared with non-infected cells, and that this increased levels could be similar to that produced when macrophages are stimulated with lipopolysaccharide form E. Coli (LPS). The above mentioned results suggest that DEN-2 virus is able of altering some functions of the immune response concerning T and B lymphocytes. Furthermore, the infection of P388D1 cells induce in the first 24 hours an over production of IL-1 that could be the reason why in the natural infection in humans, patients run a fever in the beginning of the viremia caused by DEN-2 virus related with the property of IL-1 reported as endogenous pyrogen.

The supraoptic nucleus: a morphological and quantitative study in control and hypophysectomised rats

Several quantitative and morphometric parameters were analysed in the pars principalis of the supraoptic nucleus (SON) of the hypothalamus in control and hypophysectomised rats at several postnatal ages. The cell number in the control group remained approximately constant from Day 1, when it was 5034 +/- 348 (mean +/- S.D.M.), until Day 90 when the number of cells was 5234 +/- 110. In the group that was hypophysectomised on Day 60, the number of neurons on Day 90 was 1366 +/- 131, which represents a loss of 74% of the neurons. Morphometric parameters on Day 90 indicated a significant difference in nuclear size, 52.1 +/- 6.7 microns 2 in controls and 57.3 +/- 6.8 microns 2 in the hypophysectomised group. Based on these results, it is concluded that there is no postnatal loss of neurons in the pars principalis of the SON in normal rats. As a consequence of the stress induced by hypophysectomy, the remaining cell population undergoes adaptive changes in the nuclear RNA synthesis machinery of neurohypophyseal hormone precursors in order to compensate for the reduction in the number of neurosecretory neurons.

Priapism and Fabry disease: a case report

A 10-year-old boy presented with priapism of 10 h duration which after unsuccessful conservative measures, was relieved by a saphenocorporeal shunt. A 4-year history of intermittent vague aching of fingers and toes accompanied by low-grade fever was reported. Fabry disease was confirmed by the lack alpha-galactosidase activity in serum and leucocytes. Other characteristic features of Fabry disease were not present. The condition was also diagnosed in his 14-year-old brother and suspected in his maternal grandfather who died at the age of 49 from renal failure of unknown aetiology.

[Extracorporeal biliary lithotripsy: results in 60 cases of single calculus]

The outcome of 60 cases of single biliary stone with a maximum diameter of 25 mm was evaluated. The patients were symptomatic, with functioning gallbladder, and were selected from a group of 180 to evaluate the effects of electrohydraulically generated shockwaves on a priori ideal cases for this procedure. In seven patients fragmentation was not achieved, probably because of the pigmentary character of the stone, that was later verified at cholecystectomy. In 20 out of the 53 in whom fragmentation was satisfactory (38%), fragments were not observed after 24 hours. 32 patients (54%) had a stone-free gallbladder 3 months afterwards; at six months, the number had increased to 40 (66%). This rate becomes 77% if only the cases with fragmentation are considered. In 29% of patients episodes of colicky biliary pain developed as complication. No case of pancreatitis or stuck in gallstone were observed. We conclude that shock waves appear as an excellent therapeutic alternative in single gallstones up to 25 mm in size.