Evidence for a role of MEK and MAPK during signal transduction by protein kinase C zeta

Protein kinase C zeta (zeta PKC) is critically involved in the control of a number of cell functions, including proliferation and nuclear factor kappa B (NF-kappa B) activation. Previous studies indicate that zeta PKC is an important step downstream of Ras in the mitogenic cascade. The stimulation of Ras initiates a kinase cascade that culminates in the activation of MAP kinase (MAPK), which is required for cell growth. MAPK is activated by phosphorylation by another kinase named MAPK kinase (MEK), which is the substrate of a number of Ras-activated serine/threonine kinases such as c-Raf-1 and B-Raf. We show here that MAPK and MEK are activated in vivo by an active mutant of zeta PKC, and that a kinase-defective dominant negative mutant of zeta PKC dramatically impairs the activation of both MEK and MAPK by serum and tumour necrosis factor (TNF alpha). The stimulation of other kinases, such as stress-activated protein kinase (SAPK) or p70S6K, is shown here to be independent of zeta PKC. The importance of MEK/MAPK in the signalling mechanisms activated by zeta PKC was addressed by using the activation of a kappa B-dependent promoter as a biological read-out of zeta PKC.

[Chronic gastritis and Helicobacter pylori in patients with non-ulcerous dyspepsia. Role and significance of age]

Patients with recurrent upper abdominal complaints and without peptic ulcer or definite evidence of organic disease have been labelled as suffering from nonulcer dyspepsia and included in the study. A total of 125 patients were studied and upper gastrointestinal endoscopy performed. Histology, urease rapid test and ELISA serology were done in order to detect Helicobacter pylori infection. Age groups were done. The most frequent endoscopic and histological finding was chronic gastritis in all age groups of patients. In patients under 30 years old, the highest rate of normal endoscopy was found. Chronic gastritis was associated with Helicobacter pylori infection in 89.8% of all patients. The highest rate of chronic gastritis non associated with Helicobacter pylori infection was found in the age group of patients younger than 30 years old. Other factors as biliary reflux, gastroduodenal dismotility, decreased pain tolerance or stress have been proposed to be the etiology of chronic gastritis in young patients.

Identification of heterogeneous ribonucleoprotein A1 as a novel substrate for protein kinase C zeta

The zeta isoform of protein kinase C (zeta PKC) has been shown to be an important step in mitogenic signal transduction. Using a yeast interaction screen to search for potential novel substrates of zeta PKC, we identified the heterogeneous ribonucleoprotein A1 (hnRNPA1). This protein specifically interacts with the catalytic domain of zeta PKC but not with its regulatory region or with the full-length protein, or with a kinase-defective mutant of the zeta PKC catalytic domain. In addition, no interaction was detected with other kinases such as Raf-1 or Mos, that, like zeta PKC, are critically involved in signal transduction, or with the catalytic domain of epsilon PKC, which is the PKC isotype with the highest homology to zeta PKC. hnRNPA1 is directly phosphorylated by both recombinant and native zeta PKC, and this phosphorylation is increased when zeta PKC is immunoprecipitated from mitogen-activated fibroblasts. As an additional control, hnRNPA1 is not phosphorylated appreciably by catalytic epsilon PKC or by a mixture of highly purified classical PKC isotypes maximally activated by phosphatidylserine and Ca2+. Treatment of quiescent cell cultures with a potent mitogen such as platelet-derived growth factor promotes a significant phosphorylation of hnRNPA1 in vivo that is impaired by expression of a dominant negative mutant of zeta PKC. Furthermore, expression of a catalytically active zeta PKC mutant phosphorylates hnRNPA1 in vivo. These findings suggest that zeta PKC could be critically involved in a novel pathway that connects membrane signaling to nuclear regulatory events, at the level of RNA transport and processing. Results also shown here by using different zeta PKC mutants suggesting the control of the cytoplasmic localization of hnRNPA1 by zeta PKC. Also of potential functional relevance are the results demonstrating that the phosphorylation by zeta PKC severely impairs both hnRNPA1 RNA binding and its ability to promote strand annealing in vitro.

Overproduction, purification, and biochemical characterization of a xylanase (Xys1) from Streptomyces halstedii JM8

Streptomyces halstedii JM8, isolated from straw, produces and secretes into the culture supernatant at least two proteins with hydrolytic activity towards xylan. The cloning of a DNA fragment of this microorganism in several Streptomyces strains permitted us to overproduce both proteins. N-terminal sequence analyses, immunoblot assays, and time course overproduction experiments allowed us to ensure that both xylanases were encoded by the same gene and that the smallest form (35 kDa) originated from the large one (45 kDa) by proteolytic cleavage on the C terminus. The production of both forms was studied in different strains carrying the gene in a multicopy plasmid. The best production was obtained with Streptomyces parvulus transformed with the plasmid pJM9, a pIJ702 derivative, which yielded 144 U/ml. Both forms of the xylanase were purified with a fast-performance liquid chromatography system and characterized biochemically. The optimal pH and temperature, for both, were 6.3 and 60 degrees C, respectively, in 7.5-min assays. Both proteins were highly stable in a wide range of pHs (4 to 10) and temperatures (4 to 50 degrees C); nevertheless, after 1-h incubations, both enzymes lost most of their activity at temperatures over 55 to 60 degrees C. Endoxylanolytic activity was demonstrated in both enzymes, but no beta-xylosidase activity was detected.

An easy method for the removal of Epon resin from semi-thin sections. Application of the avidin-biotin technique

A simple procedure is described for removing Epon resin from semi-thin 1 micron sections, which permits excellent postembedding immunohistochemical staining (avidin-biotin complex technique). The procedure was developed for the detection of growth hormone and prolactin in bovine adenohypophysis fixed with 2% paraformaldehyde and 0.5% glutaraldehyde in 0.1 M sodium cacodylate buffer pH 7.4-7.6. The results indicate that the removal of the epoxy embedding medium prior to the application of the immunohistochemical reagents was essential for the successful localization of the antigenic determinants of the two hormones. The immunocytochemical reactivity was obtained only after treating the sections with a solution of potassium hydroxide in a mixture of absolute methyl alcohol and propylene oxide (Maxwell's solution). An enhanced immunoreactivity was obtained when this treatment was followed by an additional treatment with either 4% hydrogen peroxide or a saturated aqueous solution of sodium metaperiodate. Because of the easy preparation of the Epon removal solution and the good structural preservation without damage to the antigenic determinants, Maxwell's solution is suggested as a good etching agent which can be used in immunohistochemical studies on semi-thin sections with excellent results.

[Usefulness of the breath test with urea-13C in the diagnosis of Helicobacter pylori infection]

BACKGROUND

Many diagnostic methods of variable diagnostic profitability are available to detect infection by Helicobacter pylori. The aim of this study was to evaluate the usefulness of the European method of the breath test with urea-13C and compare the results with common histologic methods, the rapid urease test and serology.

METHODS

Thirty-six patients who attended the Endoscopy Unit for recurrent symptomatology of the upper digestive tract were included in the study. A patient was considered to present infection by Helicobacter pylori on positivity of 2 of the usual methods: histology, rapid urease test and serology.

RESULTS

The breath test with urea-13C was positive in 25 patients (13CO2 > 5 per 1,000) and negative in 10 patients with 100% specificity and 96% sensitivity. The specificity of the rapid urease test, histology and serologic tests were 90, 90 and 80%, respectively with 92, 88, and 88% sensitivity, respectively.

CONCLUSIONS

The European method of the breath test with urea-13C is simple, non invasive and achieves the greatest profitability in the determination of Helicobacter pylori.

Occupational allergy to mites in salty ham, chorizo and cheese

We present three cases of occupational allergy caused by the manipulation of food: cheese, chorizo (typical Spanish salami) and salty ham. A IgE-mediated sensitization is demonstrated by skin tests, RAST and positive challenge tests to Acarus siro and Blomia kulagini of the cheese rind, Euroglyphus maynei of the "chorizo" and Tyrophagus putrescentiae of the salty ham.

Interaction between probucol and cyclosporine in renal transplant patients

OBJECTIVE

To investigate a possible interaction between probucol and cyclosporine during coadministration.

DESIGN

Before/after trial of 15 weeks' duration.

SETTING

Clinical pharmacokinetics laboratory of a teritiary care center.

PATIENTS

Ten renal transplant patients who were immunosuppressed with cyclosporine therapy for at least six months and who had been receiving probucol for more than eight weeks.

METHODS

Patients continued to receive probucol during the first five weeks of the trial (phase A). Probucol then was discontinued until the end of the trial (phase B). Blood samples from each patient were collected at weekly intervals during phase A and again during the last five weeks of phase B. Samples were assayed by fluorescence polarization immunoassay (TDx) to determine trough concentrations of the cyclosporine parent compound in whole blood, and of cyclosporine and metabolites in whole blood and in plasma. Comparison of the data was performed using a paired t-test.

RESULTS

An increase in trough concentrations of cyclosporine was observed in phase B (without probucol) with respect to phase A (with probucol). These differences were statistically significant for the cyclosporine parent compound in whole blood (p = 0.02), and for cyclosporine and metabolites in whole blood (p = 0.02) and in plasma (p = 0.001).

CONCLUSIONS

When cyclosporine and probucol are coadministered in transplant patients, a close monitoring of cyclosporine concentrations is advised because probucol can induce a decrease in trough concentrations of cyclosporine.

[Partial deletion of the D antigen in a family group. Determination of its antigenic density by flow cytometry]

Mutations within the genetic Rh system can produce partial deletions of one or more epitope of the D antigen, known as incomplete D. These people, classified Rh positive, are capable of producing anti-D antibodies when exposed to D positive red blood cells (rbcs). We describe the study of a Rh positive, 34 year old, spanish-indian ("mestiza") female patient, in whose blood anti-D antibodies were detected after a blood transfusions. The results of the tests showed a partial deletion of the D antigen in the patient and three of her family members.

PATIENTS AND METHODS

The following tests were done to the patient and her family members: 1) ABO and Rh typing; 2) Direct antiglobulin test; 3) Detection of irregular antibodies in their blood serum; 4) Rh genotype; 5) Cross matching of the patient's serum with rbcs of her Rh positive relatives; 6) Titration of a monoclonal anti-D (IgM) and a polyclonal anti-D (IgG) of human origin with the patient's rbcs and with Rh positive rbcs of her family members whose erythrocytes didn't react with the patient's serum; 7) Measurement of the antigenic density of the D antigen by flow cytometry (indirect immunofluorescence) in the rbcs of the patient and in those family members who had the defect, using a polyclonal anti-D (IgG).

RESULTS

1) An anti-D antibody which didn't react with its own Rh positive rbcs was found in the patient's serum; 2) This antibody didn't react with the Rh positive rbcs of her father and two out of her 4 brothers; 3) The cytometric study of these cells (R)r) showed a immunofluorescence pattern weaker than the control cells of the same genotype, but with a variable expression between 15 to 41%.

CONCLUSIONS

The study showed: 1) The presence of an anti-D antibody in a Rh positive patient who had been previously sensitized (by blood transfusion); 2) This antibody was able to react with Rh positive rbcs but not with those of the patient and her family members who had the same partial deletion; 3) The defect was transmitted heterozygously, with a high degree of penetration, but with variable expression; 4) A low antigenic density for her D antigen by flow cytometry.

[Pulmonary infection by M. kansasii following cytomegalovirus pneumonia in a kidney transplant patient]

We report the case of a 55-year-old woman who developed a lung infection by cytomegalovirus (CMV) with overlapping infection by M. kansasii after receiving a kidney transplant. The second germ infection was subclinical, with unusual nodules showing in X-rays. We describe procedures used and diagnostic criteria applied in determining the nature of this atypical mycobacteria in an immunosuppressed patient. The outcome was good with treatment that included rifamycin, cyprofloxacin, streptomycin and ethambutol.

Immunocytochemical study of the growth hormone and prolactin pituitary cells in male and female suckling mink

Adenohypophyseal growth hormone (GH) and prolactin (PRL) cells of suckling mink of both sexes at different stages of lactation were studied by the immunogold method and morphometry for electron microscopy. Hypophyses were perfused with fixative, postfixed in osmium tetroxide, and embedded in Epon 812. Ultrathin sections were labeled by the immunogold method with anti-human GH and anti-human PRL sera. Two PRL cell types were identified based on their morphology and the development of cytoplasmatic organelle. Significant differences in the granular sizes of GH and PRL cells were found between males and females at different stages of suckling. The results suggest that the changes in secretion and storage in GH and PRL cells of suckling mink during lactation depend upon sex and age, and that the granular polymorphism is not an unequivocal criterion for the identification of PRL cells in suckling mink.

[Acute renal failure after the administration of enalapril as presentation form of Takayasu's arteritis]

The case of a 19 year old patient with Takayasu arteritis with exclusive involvement of the abdominal aorta and without involvement of the renal arteries who presented severe arterial hypertension during the acute phase of the disease is referred. The administration of a dose of 20 mg of enalapril maleate was followed in less than 24 hours by lameness of the lower limbs and acute oligoanuric renal failure, both of which were reversible after discontinuation of the drug. During the inflammatory phase of the disease, treatment with high doses of prednisone was effective in the control of the general symptoms and the biologic parameters of inflammation. Surgical revascularization was successfully carried out 5 months after diagnosis. Two years later the patient continues to be normotense and asymptomatic.

Ciprofloxacin and trimethoprim-sulfamethoxazole versus placebo in acute uncomplicated Salmonella enteritis: a double-blind trial

The role of ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMZ) was evaluated in empiric treatment of uncomplicated Salmonella enteritis in a comparative, double-blind trial. Patients were randomized to receive ciprofloxacin (500 mg), TMP-SMZ (160/800 mg), or placebo orally twice daily for 5 days. There were 65 evaluatable patients with acute, uncomplicated, culture-confirmed Salmonella enteritis. Duration of diarrhea, abdominal pain, or vomiting and time to defervescence were not significantly different for patients treated with ciprofloxacin, TMP-SMZ, or placebo; there also were no significant differences with respect to full resolution of symptoms for ciprofloxacin versus placebo (point estimate, 0.2 days; 95% confidence interval [CI], -0.5 to 0.9 days) or for TMP-SMZ versus placebo (point estimate, 0.2 days; 95% CI, -1.0 to 0.6 days). The rate of clearance of salmonellae from stools was not significantly different among the groups.

Urticaria by Blastocystis hominis. Successful treatment with paromomycin

Urticaria and angioedema are easily recognized disorders, but in at least 70 percent of individuals, chronic episodes of urticaria are of unknown causes. We present 10 cases of chronic urticaria associated parasitation by blastocystis hominis. This parasite has not been previously related with urticaria. Both intestinal parasitation as well as urticaria responded successfully to paromomycin sulfate.

Asthma and vasculitis. Response to intravenous immunoglobulins

A 17-year old woman suffered progressively worse asthma attacks with hypereosinophilia, patchy lung infiltrates, and acute ischemic lesions of the fingers and purpuric lesions suggesting vasculitis. She developed hypoxemic respiratory failure despite treatment with high-dose corticosteroids. Intravenous cyclophosphamide was introduced with good clinical response, but had to be discontinued because of intolerance. Intravenous immunoglobulins were given in monthly doses for 10 months while the corticosteroid dose was tapered off. This treatment was associated with rapid clinical and biochemical improvement without adverse effects. We conclude that intravenous immunoglobulins is a useful complementary treatment for patients with severe asthma associated with pulmonary vasculitis refractory to corticosteroid therapy alone.

[Genetic manipulation of the synthesis of fungal enzymes for use in the food industry]

Food industries use a great variety of enzymes as additives. The main percentage of them are produced by species of filamentous fungi. In this review we present the strategies to purify and overproduce this kind of enzymes using recombinant DNA techniques.

[Immunoglobulins, beta-2 microglobulin and lymphocyte subpopulations in patients addicted to parenteral drugs (IVDA)]

Disorders in serum immunoglobulins, beta-2 microglobulin and lymphocyte subpopulations in parenterally drug-addict patients (PDAP) are analyzed. The study is divided in three parts. In the first one, a group of 33 HIV-negative PDAP without intercurrent diseases is compared with a control group of healthy non-addict persons. In the second part, the differences between a group of 58 HIV-negative PDAP and a group of 95 HIV-positive PDAP are studied. In the third part, the differences between the group of HIV-negative PDAP without associated procedures and a subgroup of HIV-positive patients including 31 asymptomatic carriers in phase II, are studied. No statistically significant differences were detected between the control group and the HIV-negative PDAP group. The HIV-positive PDAP group showed lymphocytes CD3, CD4 and a CD4/CD3 ratio statistically lower than the HIV-negative group, as well as a significant increase of the immunoglobulin IgG and beta-2 microglobulin. The same results were obtained when the subgroup of HIV-positive patients in phase II was compared with the group of HIV-negative PDAP without intercurrent diseases. According to these results, we conclude that the immunological disorders detected in PDAP patients seem to be more related with the infection by the human immunodeficiency virus and with other associated infections than with the drug-addiction itself.

Application of morphometric methods to the cytologic study of intradermal nevi

Twenty-one intradermal nevi were studied by morphometric methods in an attempt to morphologically characterize the two types of nevus cell--epithelioids, type A, and fusiforms, type C--and to quantify the differences between them. Morphometric parameters of the intradermal nevi were compared with similar parameters of melanocytes and melanoma cells so that the maturation rates of the nevi cells could be established and to see if the parameters might indicate the degree of malignancy. Superficial nevus cells were differentiated from deep cells by their larger size and larger nuclear area. Nuclear area appeared to have potential for differentiating benign from malignant tumors. Decrease in cellular area appeared to indicate maturation rather than atrophy. Melanoma cells were differentiated by their larger size. Cell nuclear perimeter appeared to have confirmatory value, while cell perimeter was inconclusive.

Cloning and nucleotide sequence of celA1, and endo-beta-1,4-glucanase-encoding gene from Streptomyces halstedii JM8

The celA1 gene encoding an endo-beta-1,4-glucanase from a mesophilic actinomycete, strain JM8, identified as Streptomyces halstedii, was cloned and expressed in S. lividans JI66. From the nucleotide sequence of a 1.7-kb DNA fragment we identified an open reading frame of 963 nucleotides encoding a protein of 321 amino acids, starting at TTG (instead of ATG). The Cel1 mature enzyme is a protein of 294 amino acids (after signal peptide cleavage) and can be included in the beta-glycanase family B (N. R. Gilkes, B. Henrissat, D. G. Kilburn, R. C. Miller, Jr., and R. A. J. Warren, Microbiol. Rev. 55:303-315, 1991). The Cel1 enzyme lacks a cellulose-binding domain as predicted by computer analysis of the sequence and confirmed by Avicel binding experiments. The promoter region of celA1 was identified by S1 mapping; the -35 region closely resembles those of housekeeping Streptomyces promoters. Three imperfectly repeated sequences of 15, 15, and 14 nucleotides were found upstream from celA1 [ATTGGGACCGCTTCC-(N85)-ATTGGGACCGCTTCC-(N2)-TGGGAGC GCTCCCA]; The 14-nucleotide sequence has a perfect palindrome identical to that found in several cellulase-encoding genes from Thermomonospora fusca, an alkalophilic Streptomyces strain, and Streptomyces lividans. This sequence has been implicated in the mechanism of induction exerted by cellobiose. Using an internal celA1 probe, we detected similar genes in several other Streptomyces species, most of them cellulase producers.

[Prognostic value of local vascular infiltration in infiltrating transitional carcinoma of the bladder]

The present retrospective study analyzes the evolution and survival of 79 patients with bladder infiltrant transitional carcinoma (T2-T3), which were treated with radical cystectomy and bilateral ilio-obturating lymphadenectomy. Pre-operative radiotherapy (57/79) and neo-adjuvant chemotherapy (24/79) was used as supplementary therapy. The univariate analysis showed the relationship between tumour vascular infiltration (TVI) and presence of nodes micrometastasis (p = 0.002). The variables with greater forecast power in the multivariate analysis for survival were a decline in the post-radio and/or neo-adjuvant chemotherapy tumoral stage (p = 0.000) and TVI (p = 0.001). Survival decreased significantly in patients with TVI (p = 0.008), this finding denoting a worse prognosis than the presence of nodular micrometastasis (p = 0.01).

[An analysis of the obligatory reporting of meningitis in a pediatric area]

AIMS

To find out the validity, reliability and quality of the epidemiological information which comes from the System of Statutory Declarations. The example used is the incidence of Meningitis.

DESIGN

Descriptive study of the coverage of the Declaration, with the help of the EDO (Illnesses requiring a Statutory Declaration) index, of the pediatric (up to 14 years old) cases of meningitis attended in our Area between 1984 and 1989. We analysed how the Declaration had been filled in and the agreement between the information gathered through the notification system and clinical records. SITE. The whole network of epidemiological vigilance: hospitals, provincial epidemiological services and primary care services.

PATIENTS

All the cases of child meningitis (120 cases) seen in the Mother and Child Hospital in our area between 1984 and 1989.

MAIN MEASUREMENTS AND RESULTS

The meningitis declaration covered 47.5% of the total number of cases seen. In the cases declared, the diagnosis of meningococcal meningitis on the EDO index was 89.5%, whereas the rate in the clinical reports was only 20%. Thus agreement in the diagnosis does not exceed what could be produced by chance (Kappa = 2.5%; p = NS), as agreement for all diagnoses is 7.1%.

CONCLUSIONS

Our results demonstrate a low level of declaration, poor standard of compliance and scant agreement between the Statement of Declaration and the clinical report. The validity and reliability of this information is extremely low and suggests a need to re-consider the usefulness of this vigilance system for health-service practice, especially in Primary Health Care.

[Hospital personnel who are nasal carriers of methicillin-resistant Staphylococcus aureus. Usefulness of treatment with mupirocin]

BACKGROUND

The evaluation of health care workers role in methicillin-resistant Staphylococcus aureus outbreaks and the efficacy of mupirocin as a topical agent for nasal carriers.

METHOD

Microbiologic study of nasal microflora of 1547 health care workers from the San Carlos University Hospital and 108 health care workers from related hospitals while an outbreak of methicillin-resistant Staphylococcus aureus nosocomial infections is in progress at San Carlos University Hospital. Assessment of the efficacy of mupirocin nasal ointment for nasal carriers using microbiologic controls of nasal and pharyngeal swabs at the end of treatment and two weeks after.

RESULTS

In San Carlos University Hospital a total of 53 health care workers with nasal carriage of methicillin-resistant Staphylococcus aureus were found. That figure represents a 3.4% of all health care workers studied and also a 15.4% of methicillin-resistance among all S. aureus isolated. Among health care workers from related hospitals, only one nasal carrier was found. Forty-seven of all 53 methicillin-resistant Staphylococcus aureus isolated from San Carlos University Hospital health care workers and the strain isolated from the related hospitals health care worker were similar to the epidemic strain responsible for the outbreak. Mupirocin, as nasal ointment, was useful in eliminating nasal colonization in all cases.

CONCLUSIONS

When a nosocomial outbreak of methicillin-resistant Staphylococcus aureus infections is detected, health care workers are one of the most important reservoirs. Topical treatment with mupirocin (nasal ointment) is useful for eliminating the nasal carrier status.

Uptake of rhodamine 6GO into a specific zone of the mouse epididymis

Doses (2.5 mg/kg) of rhodamine 6GO were given subcutaneously to five Charles-Rivel mice. After 15 minutes the testis and epididymis were observed with a fluoroscope and a fluorescent microscope which showed that rhodamine 6GO was present in a rhodamine-fluorescent zone (RF-zone) of the caput epididymidis. In this RF-zone, the fluorochrome was localised in the epithelial cells of the epididymal duct but not in the lumen nor the vascular system. At the edge of the RF-zone a wide band of connective tissue was present; the epithelium of the epididymal duct in this zone was higher and its tubular diameter greater than in the rest of the epididymal duct and spermatozoa were usually not present in the lumen. A possible role played by the epididymis in the endocrine control of the testicular function is suggested.

[Personality and triggering life events in the affective psychoses]

60 bipolar patients and 30 patients with recurrent major depression, both fulfilling DSM-III criteria, were studied in terms of sociodemographic profile, personal and family antecedents, clinical psychopathology, personality type and triggers of the first episodes. We found a greater frequency in the bipolar group of personality disorders of the hypomanic, cyclothymic and sociopathic types; the melancholic-anancastic being more associated with unipolar depression. The bipolar patients in our study had a higher socioeconomical and cultural level compared with the unipolar patients. More than 50% of the depressive episodes of each group had unfavourable life event triggers; 45% of the manic episodes also had previous unfavourable life events; 44% of the patients of this later group, exhibited a previous hypomanic, sociopathic or cyclothymic personality.

[Refractory depression: therapeutic alternatives]

A group of 89 patients admitted to the Psychiatric Unit of a General Hospital, with diagnosis of depression according to ICD-9 criteria and randomly chosen were studied. 26 of them (29.2%) were resistant depressions and 63 (7.82%) responded to treatment. Both groups were composed retrospectively in order to analyse resistance or lack of response to a first treatment with tricyclic or tetracyclic antidepressants in effective dosages. We considered: the personality type; the associated somatic pathology; prolonged social stress; period of evolution of the disorder; previous treatments; type of disorder uni or bipolar; familial morbidity; diagnosis reconsideration; analysis of therapeutic compliance; side effects and intolerance. We observed a statistically significant difference with regard to prophylactic treatment (38.4% resistant versus 98.3% non-resistant, p less than 0.0001); a greater suspicion of psycho-organicity in the resistant group (p less than 0.05); a longer interval of time for the resistant group between the beginning of the disorder and the beginning of treatment in our service (F: 1.45, t: 2.58, p less than 0.01). The alternatives used with our patients are analysed and we propose schedules for tackling this kind of problem.

[Hysterical psychosis: clinical aspects and disease course]

30 patients admitted to our psychiatric service with the initial diagnosis of psychogenic psychosis, dissociative psychosis or hysterical pseudo-psychosis are studied anamnestically and in their catamnesis (average follow up 5.1 years). The objective of the study was to see if these disorders are independent nosologic entities or are masking other ones, such as affective, schizophrenic or neurotic disorders. In this study we found a greater percentage of women (3/1) with a previous hysterical personality in more than 50%; many of the patients were hospitalised in order to clarify the diagnosis; in 70% we found psychogenic triggers; a greater predominance of an abrupt onset of the disorder (which would favour the concept of reaction); 60% had fluctuating symptoms (not so common in endogenous psychosis). In almost 100% there was a complete remission during the hospitalization period (average 22.7 days), which would bring them closer to the present concept of brief reactive psychosis. With a follow up of an average of five years, the diagnosis is maintained in 93.3% of the cases. The majority of the patients fulfilled the criteria for hysterical psychosis as defined by Hollender and Hirsch. We think that these disorders are well delimited, both clinically and nosologically, not having received up until now an exact placing in modern classification systems (DSM-III, ICD-10, etc.).

Four-day continuous infusion of cisplatin and 5-fluorouracil in head and neck cancer

A combination of cisplatin and 5-fluorouracil, both administered 4 days continuously as infusion, was assessed in advanced head and neck cancer. Of the 37 patients studied, there were 15 complete and 17 partial responses (40.5% and 45.9%, respectively). Survival is 79.1% at 22 months. None of the patients in complete response has relapsed. In general toxic effects were moderate. Given as initial treatment, the regimen is effective and of considerable use in this type of patient.