[Common places on clinical management of acute renal failure]

Acute renal failure (ARF) is an abrupt decline of renal function, and acute tubular necrosis (ATN) is its more frequent expression. Recent contributions in physiopathological knowledge, specially in post-ischemic ARF, are scarcelly reflected in therapy. Morbidity and mortality due to ARF are very high, mainly in critically ill patients. Prevention and treatment of ATN are based in avoiding nephrotoxicity and renal ischemia. An adequate evaluation of renal risk factors in hospitalized patients is important. Maintaining euvolemia, effective cardiac output and adequate renal perfussion pressure are three paramount factors in ischemia prevention. The best dialytic schedule is not universally accepted. ARF replacement therapy must be flexible, tailoring techniques (IHD, SLED, CRRT) to the clinical situation of patients. There is not a consensus in dialysis dose in ARF. Nevertheless, despite a robust scientific evidence is lacking, some data suggest that a delivered minimum dose of sKtV >1 in IHD or >35 ml/kg/h in CRRT would be beneficial for patient survival.

199 BASIC CHARACTERISTICS AND CRYOBANKING OF BARBARY SHEEP (AMMOTRAGUS LERVIA) SEMEN

Barbary sheep (Ammotragus lervia) are considered vulnerable species by the World Conservation Union (IUCN). The purpose of this study was to describe the basic characteristics of fresh semen, test the efficacy of commercial extender Triladyl, and collect necessary data that may help to create a frozen semen bank for the Barbary sheep in Spain. A total of 21 ejaculates were collected by rectal-probe electroejaculation from one dominant (D) and three minor (M) adult males housed in the Madrid Zoo. After ejaculation, semen volume, concentration, and mass motility were assessed. Remaining raw semen was diluted at 37°C with TRIS-based extender Triladyl (Minitüb, Tiefenbach, Germany) and 20% egg yolk to a final concentration of 200 × 106 sperm per mL. Diluted samples were kept at 5°C for 4 h and then loaded into 0.25-mL French straws, frozen at 5 cm above liquid nitrogen (LN2) for 10 min and then plunged into LN2. Samples were thawed in a water bath at 37°C for 30 s. Post-thaw semen survival was evaluated by sperm motility (%M), quality of movement (Q), normal acrosome status (%NAS), normal sperm morphology (%NOR), membrane integrity (hypo-osmotic test; %HOST), and sperm viability (eosin-nigrosin vital staining; %V), and were compared with the same parameters in the fresh semen. Data between D and M males were analyzed by one way ANOVA. Mean volume of ejaculates, total sperm concentration and mass motility of raw semen were respectively; 5.2 ± 1.56 mL, 2800.0 ± 1290.5 × 106 and 3.4 ± 0.4 for the D male, and 3.5 ± 3.2 mL, 251.2 ± 103.9 × 106, and 1.88 ± 1.4 for M males (P < 0.05). Remaining semen parameters evaluated in raw semen showed no differences between D and M males. However, post-thaw semen quality was significantly (P < 0.05) reduced in all analyzed parameters except %NAS and %NOR in M males groups as compared to the D male (Table 1). It can be concluded that Barbary sheep raw semen collected by electroejaculation is of sufficient quality to be used in an artificial insemination program and can be successfully frozen in commercially available Triladyl extender. However, the post-thaw viability of semen may considerably depend on the male reproductive status in the flock. Table 1. Characteristics of fresh and cryopreserved Barbary sheep semen This work was supported by CAM 07B/007/1999 (Analysis of ejaculate traits and development of methods of semen preservation in wild ungulates from the Madrid Zoo).

Development of a new disease-specific quality-of-life questionnaire to adults living with haemophilia

A haemophilia-specific health-related quality-of-life questionnaire (named 'Hemofilia-QoL') was developed to assess quality-of-life in adults with haemophilia, and was psychometrically tested. Seventy-three interviews with haemophilia patients and health care professionals were used to generate the items included in the questionnaire, and expert ratings on the items formulated were used to screen them for potential omission. This was followed by psychometric testing in a sample of 35 patients. Preliminary psychometric testing of the revised questionnaire version, which contains 10 domains (physical health, physical role, joint damage, pain, treatment satisfaction, emotional role, mental health, social support), showed acceptable reliability (alpha = 0.94 for the Hemofilia-QoL total score) and validity, and this will be examined in a subsequent study with a larger patient sample.

Controlled nucleation and growth of thin hydroxyapatite layers on titanium implants by using induction heating technique

This paper reports the results obtained by the development of a new wet method of hydroxyapatite (HA) thin layer deposition. The method is based on the localized precipitation of HA on metallic substrates activated by induction heating. The technique developed has been shown to allow for the complete coating of substrates with micrometric thin films of HA within a low processing time. The method has been successfully applied to coat Ti plaques and Ti-6A1-4V cylinders.

Validity of a measure of readiness to recover in Spanish adolescent patients with anorexia nervosa

The objective of the present study was to evaluate readiness to recover in adolescent patients with anorexia nervosa with a Spanish version of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). Three measures-the ANSOCQ, the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI)-were administered to a group of 70 anorexia nervosa patients (mean age = 15.6 yrs) who were receiving treatment at a specialized eating disorder unit and had reached different stages of the treatment programme. The ANSOCQ was administered again after one week in 42 patients to evaluate test-retest reliability. The ANSOCQ demonstrated good internal consistency (Cronbach's alpha =.94) and one week test-retest reliability (r =.90). Negative, significant correlations were found between the ANSOCQ and several scales on the EDI-2 (r between -.50 and -.72) and the BDI (r = -.68). The Spanish version of the ANSOCQ seems a reliable instrument to evaluate readiness to recover in adolescents with anorexia nervosa.

[Respiratory emergencies]

Respiratory emergencies in a patient with cancer can have their origin in pathologies of the airway, of the pulmonary parenchyma or the large vessels. The cause can be the tumour itself or concomitant complications. Obstruction of the airway should be initially evaluated with endoscopic procedures. Surgery is rarely possible in serious situations. The endobronchial placement of stents or radioactive isotopes (brachytherapy), tumoural ablation by laser or photodynamic therapy can quickly alleviate the symptoms and re-establish the air flow. Treatment of haemoptysis depends on the cause that is provoking it and on its quantity. Bronchoscopy continues to be the front line procedure in the majority of cases; it provides diagnostic information and can interrupt bleeding through washes with ice-cold serum, endobronchial plugging or topical injections of adrenaline or thrombin. External radiotherapy continues to be an extraordinarily useful procedure in treating haemoptysis caused by tumours and in carefully selected situations of endobronchial therapy with laser or brachytherapy, and bronchial arterial embolisation can provide a great palliative effect. Respiratory emergencies due to pulmonary parenchyma disease in the oncology patient can have a tumoural, iatrogenic or infectious cause. Early recognition of each of these will determine the administration of a specific treatment and the possibilities of success.

[Medullar compression]

Medullar compression is an oncological and neurological emergency, whose diagnosis and early treatment are key factors for avoiding severe and irreversible neurological damage. Paralysis, loss of consciousness and alteration in control of the sphincters are the final consequence of the process, and represent an important source of morbidity of the oncology patient, besides being related to a shorter time of survival. The invasion of the vertebral body by haematogenous dissemination is the most frequent cause of medullar compression. On occasions it can create mechanical vertebral instability which represents a real orthopaedic emergency. Pain is the earliest and most frequent symptom. The signs and symptoms appear to the degree that the process advances, passing through motor weakness, alterations in consciousness until paralysis and incontinence of the sphincters are reached, as a result of complete neurological damage. Clinical history and physical exploration should lead to suspicion about the level at which medullar compression is developing, and the most important complementary exploration is MR of the entire spine, which should be requested immediately in order to decide on starting treatment. Treatment is individualised and must be started early. In general, corticoids in combination with radiotherapeutic oncological treatment and/or surgery are the therapeutic weapons to employ.

[Acute dysphagia of oncological origin. Therapeutic management]

Dysphagia is one of the most frequent syndromes in patients with tumours of the head and neck, and the oesophagus. This can be the initial symptom or, more frequently, related to the oncological treatment. We review the most important therapeutic and physio-pathological aspects of acute dysphagia of oncological origin. Deglutition is a complex process in which numerous muscular-skeletal structures intervene under the neurological control of different cranial nerves. The complex neuro-muscular coordination needed for a correct deglutition can be affected by numerous situations, both from the effect of the tumours and from their treatment, basically surgery or radiotherapy. In conclusion, it can be affirmed that for a suitable treatment of oncological dysphagia, a correct initial evaluation and an active treatment are required, since not only the patient's quality of life but, on numerous occasions, the possibility of continuing the treatment and thus maintaining the possibilities of a cure depend on control of the dysphagia.

[Malign obstruction of the superior vena cava]

The present paper offers a review of the malign syndromes of the superior vena cava, their clinical expressions related to the anatomical characteristics of the compartment where the superior vena cava runs, the diagnostic requirements for realising treatment under the best conditions and the ensemble of measures that must be adopted in dealing with this.

Analysis of nonylphenol polyethoxylates and their metabolites in water samples by high-performance liquid chromatography with electrospray mass spectrometry detection

Evidence that some alkylphenol polyethoxylates (APEOs) breakdown products are estrogenic has intensified the interest over their environmental and human health effects. Different quantitative methods but one single preparation and extraction method for the analysis of nonylphenol polyethoxylates (NPEOs) and their metabolites in water samples using solid-phase extraction (SPE) and high-performance liquid chromatography (HPLC) with electrospray mass spectrometry detection (ESI-MS), are described. Quantification limits range about the low ng/l for the enrichment of 500 ml water samples and mean recoveries of 70% are achieved. These methods were subsequently applied to water samples coming from Austrian treatment plants.

[Neutropenia and fever in the patient with cancer]

Infection in the immunocompromised host is a serious clinical situation due to its high morbi-mortality and is one of the most frequent complications in the patient with cancer. In patients treated with chemotherapy, the risk of infection basically depends on the duration and intensity of the neutropenia. It is essential to evaluate, the most probable pathogen involved to initiate, a priori, the most suitable treatment, and also to evaluate the general clinical situation of the patient, because from the very beginning the treatment is quite aggressive. Outpatient care is possible for patients at "low risk" of complications. By evaluating the antecedents and clinical history of the patient, through physical exploration and from the data of laboratory and radiological explorations these points can be acknowledged. The early start of broad spectrum antibiotherapy is crucial, and in this chapter we review the most recent therapeutical recommendations.

Selective efficacy of culture media recommended for isolation and enumeration of Fusarium spp

Selective culture media, such as Nash and Snyder medium (NS), dichloran-chloramphenicol peptone agar (DCPA), modified Czapek-Dox agar (MCz), Czapek Dox iprodione dichloran agar (CZID), potato dextrose iprodione dichloran agar (PDID), or malachite green agar (MGA 2.5), have been developed for isolating and enumerating Fusarium spp. from natural samples. However, some of these culture media are not very selective because they allow the growth of many other fungal species. In this study, a comparison of the selective efficacy of these culture media, using different strains of Fusarium spp. (F. anthophilum, F. culmorum, F. dlamini, F. graminearum, F. napiforme, F. nygamai, F. oxysporum, F. proliferatum, F. semitectum, F. solani, F. subglutinans, and F. verticillioides) and natural samples has been carried out. Among the six recommended selective culture media assayed, no statistical differences were detected in colony counts of the Fusarium spp. strains tested, although the colony diameters in MGA 2.5 were significantly lower than in NS, MCz, DCPA, CZID, and PDID media. With natural samples, MGA 2.5 performs as a potent selective medium for Fusarium spp., whereas the other recommended selective media allow the growth of many other different fungal species including Zygomycetes and yeasts.

Prophylactic treatment of episodic cluster headache with intravenous bolus of methylprednisolone

We evaluated the efficacy of intravenous boluses of methylprednisolone followed by prednisone as a prophylactic treatment for episodic cluster headache. Fourteen male patients (mean age, 42.54 years) with episodic cluster headache were treated with 250-mg boluses of methylprednisolone on 3 consecutive days, followed by prednisone (90 mg/day orally) with gradual tapering in four weeks. Headache parameters of the active phases treated with methylprednisolone were compared with those of previous active phases in the same patients treated with other prophylactic medications. The primary efficacy criterion was decrease in the frequency of attacks during the first month of treatment. The statistical differences were calculated using Wilcoxon's test. The attacks were significantly less frequent in the active phases treated with methylprednisolone boluses than those treated with other medications ( p<0.05). This treatment seems to be more effective than the usual prophylactic treatments for episodic cluster headache.

The reassurance of experience

Stavudine is a potent nucleoside analogue and a well-recognized component of highly active antiretroviral therapy. Clinical trials have shown stavudine to have a superior or at least comparable virological efficacy and immune reconstitution when compared with other nucleoside analogues. Studies have shown that the prevalence of phenotypic resistance to stavudine is low compared with that of zidovudine, lamivudine and abacavir, and any loss of sensitivity to stavudine is slow to develop and of low intensity. Stavudine has a low incidence of clinically significant adverse events, and those experienced are generally long-term, manageable class effects.

Comparisons of activity measurements with radionuclide calibrators

The correct administration to a patient of the prescribed activity of a radiopharmaceutical is an important factor to ensure the confidence in the diagnosis or the therapeutic efficiency, while at the same time keeping the unnecessary human exposure as low as possible. Comparisons of activity measurements for 131I, 201Tl and 99mTc with radionuclide calibrators were organized the first time in Cuba during 2002 with the aim of obtaining information about the quality of administration of radiopharmaceuticals. Ten Cuban nuclear medicine departments and the laboratories involved in the production of these kinds of compounds participated in the comparison runs. The results presented in this paper facilitated the identification of several problems and initiated corrective actions. In addition, they indicate the necessity of establishing Quality Systems in nuclear medicine in Cuba.

Sandpile formation by revolving rivers

Experimental observation of a new mechanism of sandpile formation is reported. As a steady stream of dry sand is poured onto a horizontal surface, a pile forms which has a thin river of sand on one side flowing from the apex of the pile to the edge of its base. The river rotates about the pile, depositing a new layer of sand with each revolution, thereby causing the pile to grow. For small piles the river is steady and the pile formed is smooth. For larger piles, the river becomes intermittent and the surface of the pile becomes undulating. The essential features of the system that produce the phenomenon are discussed, and the robustness of the phenomena is demonstrated with experiments using different boundary conditions and sands.

[Radiologic evaluation of idiopathic congenital clubfoot and its clinical correlation in Codivilla's surgical technique]

Thirty-seven patients (52 idiopathic clubfeet) were treated with Codivilla's technique between 1971 and 1985. Radiological measurements and clinical evaluation before and after surgery were performed; a correlation was carried out between these evaluations and personal satisfaction. The results were rated as follows: poor in 4 feet (7.7%), fair in 18 feet (34.6%), good in 24 feet (46.2%) and excellent in 6 feet (11.5%) with a total percentage of satisfactory results amounting to 57.7%. Our conclusion is that when the indications are properly established, Codivilla's technique is a good procedure to correct clubfoot.

Cough reflex testing with inhaled capsaicin in the study of chronic cough

OBJECTIVES

To assess the utility of capsaicin test in the differential diagnosis of non-productive causes of chronic cough and to examine the effects of treatment on this reflex.

PARTICIPANTS

86 healthy volunteers and 101 patients with chronic cough: asthma (n: 54) gastroesophageal reflux (n: 35) and post-nasal drip syndrome (n: 12).

DESIGN

Prospective intervention trial. Spirometry, bronchoprovocation test with histamine (PC20), and cough challenge with ascending concentrations of capsaicin (0.49-500 microM) were initially performed in all subjects. Patients were treated for 3 months according to the origin of the cough. Concentrations that elicited two (C2) and five or more coughs (C5) were determined before and after treatment.

RESULTS

In healthy subjects, cough sensitivity to capsaicin was not influenced by gender or smoking status; however, women with chronic cough were more sensitive to cough challenge than men. C2 and C5 were significantly lower in patients with asthma or gastroesophageal reflux than in post-nasal drip syndrome. No significant correlation was observed between the capsaicin cough threshold and PC20. Cough sensitivity did not improve significantly in most patients with asthma or gastroesophageal reflux despite adequate medical treatment during 3 months. Discriminative value of capsaicin test to differentiate healthy subjects from patients with asthma or reflux was poor.

CONCLUSIONS

Cough sensitivity to inhaled capsaicin is a safe and reproducible tool in the study of chronic cough. However, its usefulness for the management and differential diagnosis is limited.

Development of a rapid polymerase chain reaction-ELISA assay using polystyrene beads for the detection of Toxoplasma gondii DNA

AIMS

To develop a rapid colourimetric assay for the detection of Toxoplasma gondii DNA using polystyrene beads as solid support.

METHODS AND RESULTS

A nested-polymerase chain reaction (PCR)-ELISA assay for the detection of T. gondii DNA was standardized by optimizing the hybridization time and probe concentration. Its detection threshold was then determined and compared with Southern blotting hybridization. These were found to be equivalent, but the PCR-ELISA-beads test is easier to perform and the turnaround time is much shorter than with Southern blot.

CONCLUSIONS

The PCR-ELISA-beads assay is a valuable tool for the detection of T. gondii DNA.

SIGNIFICANCE AND THE IMPACT OF THE STUDY

Our results demonstrate that this PCR-ELISA assay, using polystyrene beads, can be used as a routine diagnostic test for the detection of T. gondii in clinical laboratories.

[Progressive cranial neuropathy due to perineural spread of a facial squamous cell carcinoma]

The paper aims to present the case of a progressive and unilateral cranial polyneuropathy due to perineural spread of cutaneous squamous cell carcinoma. This is a case of a 73 year old man with a history of squamous cell carcinoma in the right temporal region that was removed in 1992. In May 2000 he first presented pain and numbness in the distribution of the first branch of right trigeminal nerve and weakness of the ipsilateral frontal muscle. Later on he presented right ophthalmoplegia, and damage of lower cranial nerves, leading to dysphagia and respiratory distress. He was admitted in March 2001 for a gastrostomy for feeding, when ataxia and recurrence of the right temporal lesion ensued. After three examinations with MRI, the fourth study showed meningeal carcinomatous and a metastatic lesion in the brainstem. Histopathologic examination demonstrated dermal and perineural invasion by squamous cell carcinoma. The necropsy also showed meningeal, perineural and endoneural infiltration of atypical epidermal cells and a pons mass composed of the same cells. We conclude that the perineural spread of the cutaneous carcinoma is an exceptional cause of cranial neuropathy, however it must be ruled out in patients with progressive and unilateral cranial neuropathy. In these cases, when no radiological abnormalities are noted, a biopsy may be performed on the peripheral branches of the cranial nerve to confirm the diagnosis.

Rapid urinary antigen test for diagnosis of pneumococcal community-acquired pneumonia in adults

Streptococcus pneumoniae is suspected to cause an important proportion of community-acquired pneumonia (CAP) whose aetiology cannot be detected with conventional tests. In this study, the authors evaluated the diagnostic yield of a new immunochromatographic membrane test (ICT) for the detection of the S. pneumoniae antigen in the urine of patients admitted with diagnosed CAP. ICT was performed in unconcentrated and concentrated urine from all the patients. ICT was repeated 1 month after discharge in a group initially testing positive. The authors also studied the ICT in clinically stable human immunodeficiency virus type 1 (HIV1)-infected patients. S. pneumoniae antigen was detected in all of the 68 (100%) patients tested with definitive pneumococcal pneumonia. In five of these cases ICT was only positive when it had been performed on the patients. The S. pneumoniae antigen was also detected in 36 (69.2%) of 52 patients with probable pneumococcal pneumonia and in 50 of 277 (18%) patients without pneumococcal pneumonia. ICT remained positive in 16 (69.5%) of 23 patients, 1 month after hospital discharge. Nasopharyngeal colonisation with S. pneumoniae was detected in 8 (12%) of 68 clinically stable HIV1 infected patients, but none tested ICT positive. The Binax NOW it immunochromatographic membrane test is a rapid, sensitive and specific test for detecting pneumococcal community-acquired pneumonia in adults. The test may remain positive for several weeks after pneumococcal pneumonia.

Comparison of the sodium dodecyl sulfate-sodium hydroxide specimen processing method with the C18-carboxypropylbetaine specimen processing method using the MB/BacT liquid culture system

The ability of physicians to diagnose tuberculosis is impacted by the use of smear and culture techniques combined with specimen processing methods. The objective of this study was to evaluate the effects of specimen processing on smear and culture sensitivity by comparing the specimen processing method that uses C(18)-carboxypropylbetaine with the method that combines sodium dodecyl sulfate and sodium hydroxide. A total of 1,201 specimens were entered into this study. Specimens were split approximately equally such that one-half of each specimen was processed with sodium dodecyl sulfate-sodium hydroxide, while the other half was processed with C(18)-carboxypropylbetaine. All sediments were subjected to acid-fast staining and then analyzed using the MB/BacT liquid culture system (bioMérieux, France) and solid media. The sensitivity of smear following processing with sodium dodecyl sulfate-sodium hydroxide and C(18)-carboxypropylbetaine was 61.2% and 58.6% (P>0.05), respectively, while the specificities were identical (99.7%). The sensitivity of culture was 84.2% and 96.1% (P<0.05), respectively. The time to detection in the MB/BacT liquid culture system was 13.2+/-5.6 and 15.0+/-8.8 days (P>0.05), respectively, and 20.0+/-7.6 and 15.7+/-8.9 days (P<0.05), respectively, on solid media. The contamination rates in the MB/BacT system were 0.8% and 8.7%, respectively, whereas the contamination rates on solid media were 2.6% and 4.3%, respectively. C(18)-carboxypropylbetaine specimen processing was less labor-intensive than sodium dodecyl sulfate-sodium hydroxide processing and improved the ability of laboratory staff to detect the presence of mycobacteria by culture.

Threonines at position 174 and 235 of the angiotensinogen polypeptide chain are related to familial history of hypertension in a Spanish-Mediterranean population

This study investigates the association between the allelic distribution of two polymorphisms of the angiotensinogen (AGT) gene (T174M and M235T in the polypeptide chain) and blood pressure (BP) in a Mediterranean population in the south-west of Europe. The sample consists of 1322 participants from urban and rural areas, from the province of Albacete (218,462 inhabitants), located in the south-east of Spain. The subsample of this study, adjusted by age (over 18 years old) and sex, consists of 401 individuals. A case-control study is conducted which analyses 205 individuals from the group with the highest BP (fifth quintile) and 196 from the group with the lowest BP (first quintile). In addition, a comparative and associated analysis of these polymorphisms with BP level and family history of hypertension is carried out. The T174 allele proved to be more common in the fifth quintile group, although not statistically so. When the presence of threonine was analysed in both polymorphism positions (174 and 235), the TTTT genotype was found to be more common in the fifth quintile than in the first quintile. Moreover, the TTTT genotype was significantly more common in individuals with a family history of hypertension, indicating that it could be considered a predisposing factor to high BP in individuals from such families. In addition, the T174M-T235T genotype was more common in the first quintile group, and showed significant association (P=0.05) with the group that had no family history of hypertension.

Analysis of NLS and rRNA binding motifs in the L25 ribosomal protein from Leishmania (viannia) braziliensis: investigation of its diagnostic capabilities

A cDNA clone codifying ribosomal protein L25 was isolated from a Leishmania braziliensis cDNA gene library. The alignment of the amino acid sequence deduced from this gene with other proteins revealed that this protein is related to the L23/25 rihosomal protein family. This is so because this protein shows, in its C-terminal end, the rRNA binding domains characteristic of these proteins and at the N-terminal end the NLS sequence necessary for its entry into the nucleus. Southern blot analysis showed 2 copies of gene L25 per genome arranged in tandem position and pointing in the same direction. Northern blot analysis showed that this gene is transcribed in 2 mRNAs when parasite promastigotes are in the logarithmic phase. In order to analyse the antigenic properties of L. braziliensis RPL25, it was purified as a recombinant protein and ELISA-tested against cutaneous, mucocutaneous and Chagasic sera. The results indicate that the recombinant RPL25 from L. braziliensis presents a non-specific reaction that disqualifies it for the diagnosis of cutaneous leishmaniasis. In contrast, some of the synthetic peptides derived from its sequence may serve as promising tools for the diagnosis of this disease.

The EORTC QLQ-C30 (version 3.0) Quality of Life questionnaire: validation study for Spain with head and neck cancer patients

The EORTC Quality of Life Study Group has developed a questionnaire for evaluating Quality of Life in international clinical trials: QLQ-C30. The purpose of the present work is to validate the third version of this questionnaire (3.0) for use in Spain. Two hundred and one head and neck cancer patients completed the QLQ-C30 at one or two time points during the treatment and follow-up periods, and a subsample completed the questionnaire on three occasions. Psychometric evaluation of the structure, reliability and validity of the questionnaire was undertaken. The data support the structure and the reliability of the scales. Validity was confirmed in three ways: the interscale correlations are statistically significant and moderate, several scales and items discriminate among groups of patients with different scores on the clinical variables, and some scales reflect significant changes during treatment and the follow-up period. The EORTC QLQ-C30 (version 3.0) is a reliable and valid questionnaire when applied to a sample of Spanish head and neck cancer patients. These results are in line with previous studies.

Cloning and molecular characterization of the cDNA encoding histone H1 from Leishmania braziliensis

The isolation and molecular characterization of the histone H1-encoding gene from Leishmania braziliensis was carried out. The gene is present in the genome as a single copy and transcribed as a polyadenylated transcript of 830 nucleotides. The deduced amino acid sequence has in its central region the DNA binding K-[K/R]-A-A-[A/P] motif, which is repeated in tandem 9 times.

Thermoluminescent response of ZrO2 + PTFE prepared in Mexico to 90Sr/90Y beta particles

Results of studying the thermoluminescent response of undoped ZrO2 + PTFE pellets irradiated with 90Sr/90Y beta particles are presented. Previously, TL characteristics of ZrO2 films doped with rare earths were studied. Phosphor powder was obtained by evaporating a solution of zirconium nitrate in ethanol. In order to stabilise the traps in ZrO2 this phosphor was submitted to different thermal treatments. Optimal thermal treatment consisted in heating at 1100 degrees C for 24 h. With this powder. pressing at room temperature a mixture (2:1) of ZrO2 and polytetrafluoroethylene (PTFE), pellets of 5 mm diameter and 0.8 mm thickness were made. The glow curve of ZrO2 + PTFE pellets exhibited two peaks at 200 and 250 degrees C: its TL response as a function of beta particles dose was linear in the range from 2 to 60 Gy. Repeatability over 10 cycles was 1.8%. Fading at room temperature was 3.8% per month.

Preparation and thermoluminescence properties of aluminium oxide doped with europium

There is little information concerning the use of rare earths as dopants of Al2O3. This paper presents the preparation method and the results of studying the thermoluminescence characteristics of Al2O3:Eu exposed to ultraviolet light. Phosphor powder was obtained by the evaporation method. Optimum dopant concentration was 10% at an evaporation temperature of 700 degrees C. The powder obtained was submitted to thermal treatments at high temperatures in order to stabilise the traps. Diffraction patterns showed amorphous powder up to 500 degrees C; as the temperature was raised crystalline phases of Al2O3 appeared. The photoluminescence spectrum induced by 250 nm UV light exhibited four well defined peaks characteristic of the Eu3+ ion. The glow curve exhibited two peaks at 180 and 350 degrees C. The sensitivity of Al2O3:Eu was 10 times lower than Al2O3:C. The thermoluminescence response was linear from 2.4 to 3000 microJ.cm(-2) of spectral irradiance, and the fading 2% in a month. From these results it can be concluded that Al2O3:Eu has potential as an UV dosemeter.

Polyamine metabolism and glutamate receptor agonists-mediated excitotoxicity in the rat brain

Putrescine (PUT) increases have been seen in a range of models of neuropathological disturbances. The present study was designed to compare the ability of various types of glutamate receptor agonist to promote excitotoxic brain damage and to examine whether a PUT increase is a general marker of excitotoxic brain damage. To that end, we evaluated features of brain damage associated with the excitotoxicity induced by both ionotropic glutamate receptor (iGluR) and metabotropic glutamate receptor (mGluR) agonists in the conscious rat and the changes produced in the regulation of polyamine metabolism. Intracerebroventricular infusion of N-methyl-D-aspartate (NMDA; 80 nmol), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA; 15 nmol), kainic acid (KA; 2.3 nmol), (R,S)-3,5-dihydroxyphenylglycine (3,5-DHPG; 1.5 micromol), and (1S,3R)-1-aminocyclopentane-1,3-dicarboxylic acid (1S,3R-ACPD; 2 micromol) produced similar seizure incidences (76-84%) in the rat. The convulsant episodes appeared sooner after iGluR (13-22 min) than after mGluR agonists (50-179 min). Histological analysis of the hippocampus 24 hr after seizures indicated several degrees of excitotoxic injury after equiconvulsive doses of the iGluR and mGluR agonists assayed. The agonists can be placed in the following order, according to the degree of damage they produce: AMPA > 3,5-DHPG approximately KA > NMDA > 1S,3R-ACPD. In the frontal cortex, moderate to low levels of damage were observed after all GluR agonists. Both iGluR- and mGluR-induced seizures produced an overshoot in the hippocampal and cortical PUT concentration, whereas spermidine and spermine levels were similar to control. Moreover, a concurrence of increased PUT levels and brain damage was observed, indicating that PUT is a general marker of excitotoxic brain damage.

Erectile dysfunction in a primary care setting: results of an observational, no-control-group, prospective study with sildenafil under routine conditions of use

In order to assess the effectiveness of sildenafil under routine conditions of use in primary care settings and to evaluate its impact on patient's life satisfaction and partner's satisfaction with treatment for erectile dysfunction (ED), an open, multicentre, observational, prospective study was designed in which 2816 patients were treated with sildenafil for at least 10 weeks. Effectiveness was assessed using the International Index of Erectile Dysfunction (IIEF), life satisfaction was measured with 'Life-satisfaction Check List' (LISAT 8), and EDITS was optionally used to assess the partner's satisfaction with ED therapy. Sildenafil was effective in 86.6% of patients. All dimensions of IIEF significantly increased with sildenafil, particularly erectile domain which overall sample mean score improved was 13.2 points (P < 0.001). The greatest increases in satisfaction with all aspects of life were seen in sex life and relationship with partner dimensions. The patients' partners, answered by a minority of partners, were highly satisfied with the treatment and its rapid action, therefore they were in favour of continuing with same. The adverse events occurring were similar to those seen in clinical research on sildenafil in the premarketing phase. No control group was included in this study.

Pulmonary reactions during treatment with amphotericin B: review of published cases and guidelines for management

Acute respiratory events occasionally have been observed during the infusion of amphotericin B. Herein we analyze the 21 cases that have been reported, including a fatal reaction observed by us. Some useful guidelines are provided that likely will allow treatment to be continued safely for patients who have experienced such reactions.

Adult and nymphs of Microtriatoma trinidadensis (Lent, 1951) (Hemiptera: Reduviidae) caught from peridomestic environment in Bolivia

This is the first report of adult and nymphs (20 nymphs of all stages and 4 adults) of Microtriatoma trinidadensis (Lent 1951) (Hemiptera: Reduviidae: Triatominae) collected in peridomestic environment, in the department of La Paz, Bolivia. These specimens were associated to Rhodnius stali Lent, Jurberg & Galvão 1993. The exceptional finding of M. trinidadensis in peridomestic environment, illustrates the general tendency of triatominae to adapt to human dwellings and dependences.

Further ultrastructural characterization of the intranuclear ring-shaped bodies of the plant Lacandonia schismatica

Ring-shaped bodies are found in the nucleus of Lacandonia schismatica, a rare plant with the sexual organs inverted. They are 0.5-microm-diameter structures that present an electron-dense external ring surrounding a central core. Ultrastructural studies indicate that these bodies contain RNA. The external ring is labeled with antibodies against small nuclear ribonucleoproteins, suggesting that they may be involved in pre-mRNA metabolism. In the present work we further characterized these intranuclear ring-shaped structures by serial-sectioning analysis. Moreover, we tested the presence of additional molecular elements related to pre-mRNA metabolism, such as SR proteins and poly(A)(+) RNA, using immunoelectron microscopy and ultrastructural in situ hybridization. Our results show that these nuclear bodies are spherical. They contain SR proteins involved in splicing and postsplicing events and little to no poly(A)(+) RNA. We also found similar nuclear bodies in other plant and animal species. Therefore, ring-shaped bodies in L. schismatica are spherical, highly compartmentalized nuclear structures that may be involved in pre-mRNA metabolism.

Comparison of the clinical and laboratory features of muscle infections caused by Salmonella and those caused by other pathogens

Muscle infections caused by Salmonella constitute an uncommon complication of extraenteric salmonellosis. The aim of this study was to compare the clinical features of Salmonella muscle infections with those reported in several large series of typical, both tropical and non-tropical, pyomyositis, caused mostly by Staphylococcus aureus. A literature survey of Salmonella muscle infections was carried out by using MEDLINE files 1966 through 2000, and cross-references from the selected articles, as well as major reviews of Salmonella infections and of pyomyositis. The survey yielded 32 cases suitable for analysis. The sex distribution, duration of symptom at presentation, degree of fever, involvement of multiple muscle groups, and leukocyte counts were not significantly different between patients with muscle infections caused by Salmonella and typical pyomyositis patients. In contrast, the median age of the patients with Salmonella muscle infections, and the rate of underlying conditions, were significantly higher than those in typical pyomyositis. Psoas muscle was involved more commonly in Salmonella infections than in typical pyomyositis, and the yield of positive blood cultures and, particularly, the mortality rate, were substantially higher in Salmonella muscle infections than in typical pyomyositis. We conclude that patients with Salmonella muscle infections seem to have some different characteristics with respect to typical pyomyositis, such as older age, and higher rates of associated conditions, psoas muscle involvement, bacteremia, and mortality.

Synthesis and hypolipidemic activity of modified side chain alpha-asarone homologues

A series of homologues of alpha-asarone (1), containing variable size and functionality on the side chain attached to the aromatic ring, has been subjected to a study of structure-activity relationship. For most of the prepared derivatives, either with a carbonyl (8a-8e), a hydroxy group (9a-9e), or with a conjugated double bond (10a-10d), significant effects on serum lipoprotein cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were displayed. The results showed an enhancement of the hypocholesterolemic activity as the length of the chain is decreased. Theoretical conformational and electrostatic potential analyses of I and olefins 10 suggest unfavorable steric interactions in the bulky superior side-chain homologues as the deactivating biological effect.

Lymphoid tissue viral burden and duration of viral suppression in plasma

OBJECTIVES

To assess virological response in lymphoid tissue and its impact on the durability of response in plasma in HIV-1-infected persons who achieved sustained suppression of plasma viraemia with different antiretroviral regimens.

METHODS

Consecutive patients on first-line antiretroviral therapy were included if they had a plasma HIV-1 RNA viraemia < 20 copies/ml within the last 6 months and tonsillar tissue accessible for biopsy. First-line therapy contained two nucleoside analogues: alone (2NRTI group, n = 3); plus a HIV-1 protease inhibitor (PI group, n = 11) or plus nevirapine (NVP group; n = 16). Patients were followed until virus was detectable in plasma, they changed therapy or were lost to follow-up.

RESULTS

Tonsillar HIV-1 RNA could be detected (> 100 copies/mg) in 10 patients: one in the PI group (9%), six (38%) in the NVP group and in all three patients in the 2NRTI group. Primary resistance mutations could be detected in only 2 of these 10 patients. After a median of 9 months after the biopsies, viral suppression in plasma had failed in 6 of these 10 patients whereas failure had only occurred in 1 out of 20 with initially undetectable viral load in lymphoid tissue (P = 0.01; log rank test).

CONCLUSIONS

In patients with sustained viral suppression in plasma, triple therapy including a HIV-1 protease inhibitor was more potent than triple therapy containing nevirapine or dual therapy with nucleoside analogues to reduce viral burden in lymphoid tissue. A worse response in lymphoid tissue could not be explained by local selection of resistance and was associated with a less durable virological response in plasma.