Experiencing genetic counselling for hereditary cancers: the client's perspective

As genetic health care expands and genetic testing becomes more widely available, it becomes relevant to understand how individuals involved in genetic counselling are integrating this new information in health management and into their lives. This article examines the client's experiences of genetic counselling for hereditary cancers, which definitely play a major role in the assessment of their needs and also lead to improvement of the psychosocial focus in genetic counselling protocols. Methods include a semi-structured interview, administered in two focus groups, comprising 10 (5 + 5) participants after attending genetic counselling for hereditary cancers at a Portuguese public hospital. Findings suggest an experience embedded in two dimensions: (1) instrumental (goals, needs and decision making); and (2) emotional (uncertainty regarding genetic risk screening and an emotional complex). Ambiguity plays a crucial role, especially in two moments: (1) the hiatus between genetic testing and the screening results; and (2) after being confirmed as carrying a cancer susceptibility gene mutation. The spectrum of genetic illness comprises an intensely complex emotional experience that challenges individuals and their families in terms of health management, and personal and family planning. Recommendations are included in order to enhance the services available by expanding psychosocial support.

Sexuality perceptions of people with schizophrenia: preliminary results in a portuguese sample

Introduction

Sexuality is an important dimension of life. To promote the well-being and quality of life of people with Schizophrenia, they must experience their sexuality in healthy ways. However, the lack of studies about this topic makes difficult to develop interventions in this area.

Aims

Understand the knowledge, beliefs and attitudes related with sexuality of schizophrenic individuals.

Methods

Data were collected using a questionnaire intentionally prepared for this study, with questions related to biologic, emotional and social dimensions of sexuality, evaluating: knowledge, beliefs and attitudes about sexuality; sexual activity; emotional intimacy, friendship and social life. The sample was composed by 35 individuals with Schizophrenia: 83% male and 17% female; mean age 41 years.

Results

The data revealed that 86% of the sample is single and only 6% have an affective relationship. They have difficulties to have friends, to have a satisfactory social life, and only 20% have a job. Despite the correct knowledge about sexuality, they reveal difficulties in fulfilling emotional or intimate relationships, they feel lonely and unsatisfied about their sexual life. They also feel negative effects of anti-psychotic drugs, often neglected by health professionals, views as non-preoccupied with the quality of the sexual life of the patients.

Conclusions

The sample valorized being asked about their sexuality, revealing that this topic is forgot by the professionals. It seems necessary to develop interventions regarding the sexuality of those individuals. Our future research is to ameliorate the questionnaire, preparing it to be useful when professionals discuss sexuality with schizophrenic individuals.

Barrier effects on vertebrate distribution caused by a motorway crossing through fragmented forest landscape

Anti–predator training of juvenile little owls was tested in a sample of recovered owls raised in captivity in Brinzal Owl Rescue Center (Madrid, Spain). Mortality caused by predators has been described previously in released individuals. Nine little owls were conditioned during their development to a naturalized goshawk and a large live rat, whose presence was paired to the owl’s alarm call. All nine owls and seven non–trained individuals were then released during the late summer and autumn and radio–tracked for six weeks to test their survival. In total 71.4% of the trained owls survived while only the 33.3% of the untrained group were alive at the end of week six. The only cause of death that was detected was predation. Antipredator training, therefore, seems to be beneficial in maximizing survival after the release of juvenile little owls.

Grapevine under deficit irrigation: hints from physiological and molecular data

BACKGROUND

A large proportion of vineyards are located in regions with seasonal drought (e.g. Mediterranean-type climates) where soil and atmospheric water deficits, together with high temperatures, exert large constraints on yield and quality. The increasing demand for vineyard irrigation requires an improvement in the efficiency of water use. Deficit irrigation has emerged as a potential strategy to allow crops to withstand mild water stress with little or no decreases of yield, and potentially a positive impact on fruit quality. Understanding the physiological and molecular bases of grapevine responses to mild to moderate water deficits is fundamental to optimize deficit irrigation management and identify the most suitable varieties to those conditions.

SCOPE

How the whole plant acclimatizes to water scarcity and how short- and long-distance chemical and hydraulic signals intervene are reviewed. Chemical compounds synthesized in drying roots are shown to act as long-distance signals inducing leaf stomatal closure and/or restricting leaf growth. This explains why some plants endure soil drying without significant changes in shoot water status. The control of plant water potential by stomatal aperture via feed-forward mechanisms is associated with 'isohydric' behaviour in contrast to 'anysohydric' behaviour in which lower plant water potentials are attained. This review discusses differences in this respect between grapevines varieties and experimental conditions. Mild water deficits also exert direct and/or indirect (via the light environment around grape clusters) effects on berry development and composition; a higher content of skin-based constituents (e.g. tannins and anthocyanins) has generally being reported. Regulation under water deficit of genes and proteins of the various metabolic pathways responsible for berry composition and therefore wine quality are reviewed.

Hoarding and Shopping: What is Compulsive and What is Not - Two Case Reports

Compulsive hoarding has been generally described as the compulsive acquisition of possessions and the inability to discard them. It has been considered as a syndrome consisting of compulsive acquisition, difficulty discarding and clutter. It is described mainly in association with obsessive-compulsive disorders (OCDs) and in geriatric populations, although it may be seen in a range of other disorders.

Compulsive buying or shopping disorder has been characterized by excessive or poorly controlled preoccupations, urges, or behaviours regarding shopping and spending that lead to subjective distress or impaired functioning. Although it has been considered as part of impulse control disorders, it has also been reported associated with other disorders.

These two entities have raised relevant questions regarding whether they are part of dimensional or categorical constructs, symptoms or well established disorders. By presenting two case reports, the authors address some of these issues and the existing scientific literature.

Wernicke-Korsakoff Syndrome: A Common Yet Elusive Diagnosis

In 1897, Murawieff proposed that a common cause was responsible for the two syndromes previously described by Carl Wernicke and Sergei Korsakoff. More than 100 years afterwards, the neuropsychiatric nosological entity known as Wernicke-Korsakoff syndrome remains one of the most significant, yet under-recognized, consequences of long-term alcohol abuse.

Prompt recognition and treatment of Wernicke's encephalopathy with parenteral thiamine can prevent permanent cognitive impairment, involving severe short-term memory loss - Korsakoff's amnesic syndrome. Such condition has devastating consequences for patients, not infrequently demanding long-term institutionalization.

Based on two clinical vignettes, the authors review some epidemiological, clinical and neuropathological features of Wernicke-Korsakoff syndrome, besides issues concerning differential diagnosis, treatment and prognosis.

Priapism secondary to perineal abscess in a dog - a case report

A 7-year-old intact male Boxer was referred to our services at the Veterinary Teaching Hospital of the University of Trás-os-Montes and Alto Douro, suffering from a persistently erect penis (including the bulbus glandis) that had been exposed for several days. Radiographic and ultrasonographic examinations detected a 5.0 x 3.5 cm mass located dorso-laterally to the urinary bladder. The microbial culture of the mass revealed Staphylococcus spp. At that time, we suspected the involvement of an abscess in the origin of the priapism. Medical and surgical treatments were promptly instituted, which allowed for penile withdrawal into the prepuce; however, the resolution of the penile erection was not accomplished in the following days and penile amputation was required. Histological evaluation of the excised penis revealed extensive infarction of the erectile tissue of the pars longa and bulbus glandis, and also of the blood vessels of the penis. Following penile amputation and antimicrobial therapy, the animal fully recovered. Ultimately, the animal died as a consequence of gastric torsion. At necropsy, some lesions compatible with a previous perforation of the intestinal wall were recorded. The data gathered from the anamnesis, the physical and imaging examinations, along with the post-mortem findings, allowed us to conclude that in this clinical case the primary cause of priapism was a perineal abscess due to bowel perforation.

[Importance of multiplane transesophageal echocardiography in the diagnosis of pulmonary embolism]

Pulmonary thromboembolism (PTE) is a clinical entity difficult to diagnose, its setting is often confused with other pathological entities. The inexistence of isotopic techniques in most centres and the difficulty and delay in performing a pulmonary angiography leads transesophageal echocardiography (TEE) to be, a method of increasing importance for its diagnosis. From January 1996 to November 1997, echocardiographic evaluation was requested for 33 patients due to clinical suspicion of pulmonary thromboembolism. A transthoracic assessment was made previously in 21 patients (average ages 58.3 years, 52% males) which had signs of right overload (dilatation of the right cavities, anomalous movement of the intraventricular septum and pulmonary hypertension) a TEE was performed. The TEE was negative in 10 patients (TEEn) without evidence of thrombi in the trunk and main branches of the pulmonary artery (PA); there was one death on this group for repeated pulmonary microembolisms confirmed by necropsy. The TEE was positive in 11 patients (TEEp) with evidence of thrombi in the PA trunk in 3 patients, bilaterally in both branches in 3 patients and in the right branch in 5 patients. There were dilatations of the right cavities in all patients, paradoxal movement of the interventricular septum and bulging of the intra-auricular septum to the left atria. Foramen ovale was detected in 2 patients. The best visualisation of the PA was achieved in the intermediate planes between 30-70 degrees and between 90-130 degrees (plane for transverse slice of the right branch of the pulmonary artery). In 7 patients with TEEp, PTE was confirmed by CT-scan (visualisation of the thrombi in the trunk and main branches of the PA) and/or ventilation-perfusion scintigraphy and/or pulmonary angiography. In three cases of massive pulmonary embolism in young patients, with severe pulmonary hypertension, thrombolysis was performed with rTPA, under TEE control before and after rTPA in one of the cases. In conclusion, transesophageal echocardiography is an easy technique to be performed in the case of clinical suspicion of PTE. The existence of a negative examination does not invalidate the existence of PTE since only the trunk and the main branches of the PA are accessible by this technique. The detection of thrombi at this level in patients with clinical suspicion of massive pulmonary embolism confirms the diagnosis and supports the indication of thrombolysis.

Properties of a novel pH-dependent Ca2+ permeation pathway present in male germ cells with possible roles in spermatogenesis and mature sperm function

Rises of intracellular Ca2+ ([Ca2+]i) are key signals for cell division, differentiation, and maturation. Similarly, they are likely to be important for the unique processes of meiosis and spermatogenesis, carried out exclusively by male germ cells. In addition, elevations of [Ca2+]i and intracellular pH (pHi) in mature sperm trigger at least two events obligatory for fertilization: capacitation and acrosome reaction. Evidence implicates the activity of Ca2+ channels modulated by pHi in the origin of these Ca2+ elevations, but their nature remains unexplored, in part because work in individual spermatozoa are hampered by formidable experimental difficulties. Recently, late spermatogenic cells have emerged as a model system for studying aspects relevant for sperm physiology, such as plasmalemmal ion fluxes. Here we describe the first study on the influence of controlled intracellular alkalinization on [Ca2+]i on identified spermatogenic cells from mouse adult testes. In BCECF [(2',7')-bis(carboxymethyl)- (5, 6)-carboxyfluorescein]-AM-loaded spermatogenic cells, a brief (30-60 s) application of 25 mM NH4Cl increased pHi by approximately 1.3 U from a resting pHi approximately 6.65. A steady pHi plateau was maintained during NH4Cl application, with little or no rebound acidification. In fura-2-AM-loaded cells, alkalinization induced a biphasic response composed of an initial [Ca2+]i drop followed by a two- to threefold rise. Maneuvers that inhibit either Ca2+ influx or intracellular Ca2+ release demonstrated that the majority of the Ca2+ rise results from plasma membrane Ca2+ influx, although a small component likely to result from intracellular Ca2+ release was occasionally observed. Ca2+ transients potentiated with repeated NH4Cl applications, gradually obliterating the initial [Ca2+]i drop. The pH-sensitive Ca2+ permeation pathway allows the passage of other divalents (Sr2+, Ba2+, and Mn2+) and is blocked by inorganic Ca2+ channel blockers (Ni2+ and Cd2+), but not by the organic blocker nifedipine. The magnitude of these Ca2+ transients increased as maturation advanced, with the largest responses being recorded in testicular sperm. By extrapolation, these findings suggest that the pH-dependent Ca2+ influx pathway could play significant roles in mature sperm physiology. Its pharmacology and ion selectivity suggests that it corresponds to an ion channel different from the voltage-gated T-type Ca2+ channel also present in spermatogenic cells. We postulate that the Ca2+ permeation pathway regulated by pHi, if present in mature sperm, may be responsible for the dihydropyridine-insensitive Ca2+ influx required for initiating the acrosome reaction and perhaps other important sperm functions.

Platelet function in patients with chronic coronary heart disease on long-term anticoagulant therapy: effect of anticoagulant stopping

Plasma beta-thromboglobulin (beta TG), platelet procoagulant activity (PPA) and malondialdehyde were evaluated in a control group and in 59 patients with chronic coronary heart disease (CHD) undergoing long-term anticoagulant therapy (ACT) with acenocoumarol, and within 2 months after its termination. The patients were clinically stabilized after more than 1 year of an acute myocardial infarction. An increase in beta TG and PPA was found in the patients, both with or without ACT, when compared to the control group. In addition, PPA was found to be higher in older and hypercholesterolemic patients on ACT. After ACT suppression, PPA activity increased significantly, particularly in younger and normocholesterolemic patients. The results of the present study suggest that CHD patients on ACT have some platelet hyperactivity and that the termination of ACT induces an increase in platelet function, particularly in PPA.

[Pulmonary emphysema in a patient with Turner's syndrome]

Turner's Syndrome was first described in 1938 by Henry Turner and has an incidence of 1:3000 live female births. The authors present an unusual case of a 48-year-old woman with late diagnosed Turner's Syndrome. Whose karyotype was (46,X,i(Xq)), associated with a pulmonary emphysema and pulmonary hypertension. The case and the methods of study are presented. Some aspects of this case, namely the hypothesis of an association between the pulmonary emphysema and Turner's Syndrome are discussed.

The evaluation of the abdominal aorta: a "how-to" for cardiac sonographers

A thorough evaluation of the abdominal aorta can be readily achieved by use of the standard views of the echocardiographic examination. The ultrasound evaluation of the abdominal aorta represents a logical extension of the standard echocardiographic examination of the adult patient. This article provides the information needed to carry out a complete ultrasound examination of the abdominal aorta including the anatomy, the vascular disease, and the steps involved in accomplishing the ultrasound examination of the abdominal aorta.

Contribution of platelets to increased plasminogen activator inhibitor type 1 in severe preeclampsia

Plasminogen activator inhibitor activity and antigen were evaluated in plasma, serum and platelet lysate in patients with severe preeclampsia (n = 12), and in normal pregnant women (n = 21). Other parameters, including beta-thromboglobulin and platelet count, were also evaluated. A significant increase (p less than 0.05) in beta-thromboglobulin was observed in platelet poor plasma of preeclamptic women when compared with that of normal pregnant women, and the platelet count was lower in the preeclamptic group than in the normal pregnant group. A significant increase in plasminogen activator inhibitor activity and antigen was observed in platelet poor plasma of the preeclamptic group as compared with normal pregnant women, whereas platelet lysate from preeclamptic women showed a significant decrease in both plasminogen activator inhibitor activity and antigen as compared with that of normal pregnant women. No correlation between beta-thromboglobulin and plasminogen activator inhibitor type 1 antigen in platelet poor plasma was observed, but a significant inverse correlation (r = -0.78, p less than 0.05) between beta-thromboglobulin in platelet poor plasma and plasminogen activator inhibitor-1 antigen in platelet lysate was obtained in preeclamptic patients. However, in platelet poor plasmas obtained from normal platelet rich plasmas activated with thrombin (0.1 IU/ml, 37 degrees C, 1 min), an increase of about 300 ng/ml in beta-thromboglobulin was observed while the increase in plasminogen activator inhibitor was only 4 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

"Ex vivo" influence of fatty acids from plasma cholesterol and triglycerides on the fatty acid pattern of platelets

We have studied "ex vivo", in 92 normal subjects, the influence of fatty acids (FA) that esterify plasma cholesterol and triglycerides on the fatty acid composition of phospholipids, triglycerides and free fatty acid fractions in platelets. High and significant correlations (p less than 0.001) were found for some of the platelet phospholipid FA and the same FA that esterify plasma cholesterol [18:1 (r = 0.56); 18:2 (r = 0.71) and 20:5 (r = 0.42)] and plasma triglycerides [18:1 (r = 0.57) and 18:2 (r = 0.66)]. Some significant correlations were also found between some of the platelet triglyceride FA and the same FA that esterify plasma phospholipids [18:1 (r = 0.58)], triglycerides [18:1 (r = 0.51), 18:2 (r = 0.52)] cholesterol [18:1 (r = 0.44)] and plasma free fatty acids [18:1 (r = 0.39); 18:2 (r = 0.40)]. By evaluating these results in conjunction with those of an earlier study, it can be concluded that "in vivo" the FA from different plasma lipid fractions and especially those esterifying the plasma cholesterol and phospholipid fractions, can influence the FA composition of platelet phospholipids in normal subjects. In trying to interpret the role played by plasma lipids in platelet lipids, it may be of interest to take into account the interrelationships found in this study.

Developmental modulation of DNA methylation in the fungus Phycomyces blakesleeanus

DNA methylation is a rather sparse event among fungi. Phycomyces blakesleeanus seems to be one of the few exceptions in this context. 5-Methylcytosine represents 2.9% of the total cytosine in spore DNA and is located in approximately the same amount at any of the four CA, CT, CC or CG dinucleotides. A progressive and gradual drop in total 5-methylcytosine parallels the development of the fungus. This demethylation is non random but sequence specific and is not accounted for equally by the four different methylated dinucleotides, CG being much less affected (20% demethylated) than CA, CT and CC (more than 90% demethylated at the same time). "De novo" methylation to restore the initial pattern probably takes place during spore maturation. By using specific hybridization probes we have been able to show that the rRNA genes are not significantly methylated at any stage of development, regardless of their transcription status.