Neurogenic bladder in patients with acquired immunodeficiency syndrome

We have performed a urodynamic study on 3 patients with acquired immunodeficiency syndrome (AIDS), presenting with a neurogenic bladder. The first patient had an ascending myelitis of probable herpetic origin, the second patient had a cerebral abscess caused by Toxoplasma gondii, and the third patient had an AIDS dementia complex. The urodynamic study showed an areflexic detrusor in the first 2 patients, and a hyperreflexic detrusor in the third patient.

Chronic idiopathic thrombocytopenic purpura in the elderly

From a group of 118 patients with chronic idiopathic thrombocytopenic purpura (ITP), 43 were older than 60 years at diagnosis. In this report, we describe the clinical evolution and therapeutic response in young and old patients. The overal rate of hemorrhagic manifestations was similar in the two age groups, but a greater risk for severe bleeding was observed in elderly patients. There were no significant differences between old and young patients in response to steroids. In none of our patients was mortality associated with bleeding or side effects of the treatment. In conclusion, we have observed a more benign clinical course in elderly patients with chronic ITP as compared to previous reports.

Recognition of a CD4+ mouse medullary thymocyte subpopulation by Amaranthus leucocarpus lectin

We have used the Gal beta(1-->3)GalNAc-specific Amaranthus leucocarpus lectin to isolate a thymus cell subpopulation which is different from that sorted with Arachis hypogaea lectin. The cells recognized by A. leucocarpus lectin were predominantly CD4+, whereas a minor proportion of CD8+ cells (approximately 11%) were also identified. The A. leucocarpus-positive cells were located in the thymus medulla and the cortico-medullary junction. The cortex was negative for A. leucocarpus cells.

[Treatment of promyelocytic leukemia with retinoic acid: results in Cuba]

PURPOSE

To assess the results attained with all-trans-retinoic acid (ATRA) in a group of Cuban patients with acute promyelocytic leukaemia (PML).

PATIENTS AND METHODS

Twenty-one patients with PML were studied. Their cytogenetic study was performed with G-band techniques. ATRA was given orally as a single dosis of 50 mg/m2 a day, or divided in two doses. After attaining complete remission (CR), ATRA was maintained for 1-3 months in association with minimal doses of Ara-C or alpha-interferon. A rotation of three therapeutic regimes (TRAP, POMP and DOAP) was subsequently administered.

RESULTS

Twelve of the patients were women and 9 men; 15 were adults and 6 were children, the median age being 19 years (range: 6-60 years). Only two patients had leucocytosis, all others presented with leucopenia. Platelet count below 30 x 10(10)/L was found in 67% of the cases, while some sort of bleeding was present in 81% of them. Laboratory evidence of disseminated intravascular coagulation was seen in 52% of the cases, and t (15; 17) appeared in 67% of the evaluable cytogenetic studies. CR was attained in 17 patients (81%) within a mean of 40 days. Headache was the commonest untoward effect of the treatment. Eight patients developed leucocytosis during treatment, white-cell count being over 20 x 10(9)/L in six of them. Fever without infectious signs was present in 5 patients, and in 3 of them the temperature recovered with steroid therapy. Two patients had retinoic acid syndrome prior to achieving CR. Four patients relapsed and 13 (76%) have maintained CR after 1 to 24 months.

CONCLUSIONS

The incidence of CR in this series is within the limits reported in the literature. The secondary effects of the treatment are the same than those reported by others, and they were transient and well tolerated. The response to steroids of those patients with fever secondary to ATRA is noteworthy. The efficacy of ATRA, in general terms, in the induction of CR in PML seems confirmed by these results.

Human glabrous skin autografts partially reinnervated without sensory corpuscles. An immunohistochemical study

The reinnervation of human glabrous skin autografts was investigated in biopsy specimens obtained four weeks to 15 months after transplantation. The grafted skin was taken from the volar aspect of the wrist and transplanted to the fingers. Immunohistochemical methods were used to detect the presence of nerve fibres and sensory corpuscles, using monoclonal antibodies against neurofilament proteins and S-100 protein. In normal skin, immunoreactivity of neurofilament proteins was localised in the axons of nerves and sensory corpuscles, while S-100 protein immunoreactivity was found in Schwann cells, lamelar cells and inner core cells of sensory corpuscles. In the transplanted skin, there was no positive immunoreactivity in the youngest grafts (four weeks), but in eight week old grafts immunoreactivity to both proteins, identified as axons or Schwann cells, respectively, were seen in the deep nerve plexus, and these reached subepithelial dermis in the 15 month old grafts. In no case, however, were immunoreactive structures found that resembled reinnervated or regenerated sensory nerve corpuscles. Clinical assessment of sensibility was consistent with morphological findings. These results suggest that reinnervation of human skin autografts is far from normal, and that sensory corpuscles are not able to regenerate in grafted human glabrous skin, at least during the times studied.

[Hydatidosis control in the province of Río Negro, Argentina: evaluation of the veterinary health care activities. 1]

BACKGROUND

Hydatidosis constitutes a serious Public Health problem in the Province of Rio Negro, Argentine. This situation has promoted the implementation of a Control Programme, carried out in 1979. The accumulated experience of 13 years works is presented in this study.

METHODS

The strategy used is that of the Primary Health Care; and community participation is a fundamental component of the programme as well as local planning and the approach of risk in the allocation of resources. The activities included the systematic dogs deparasitation with Praziquantel, carried out by health agents from the system rural hospitals (health promoters not professional staff); the surveillance of dogs rate of infection by means of diagnostic deparasitations made with hydrobromide or arecoline, educational talks at schools, the use of mass media, an the determination of ovine parasitism in studies carried out in the area abattoirs.

RESULTS

The information registered indicates that 1,86,156 dog deparasitations with Praziquantel were carried out with a consumption of 443,533 tablets and 11,178 deparasitations with hydrobromide and Arecoline. A continuous decrease of rates appears during the Period 1979-1992. So, dog Echinococcosis was reduced from 41.5% to 4.24% and ovine Hydatidosis from 61% to 12.7%. Consequently, Human Hydatidosis has decreased from an incidence rate of 64.11 x 100,000 in the age group of 0 to 10 years to and incidence rate of 4.46 x 100,000.

CONCLUSIONS

Finally, the results of the Programme are analyzed in the light of other global experiences of control; and the strategies that should be put into practice in the future with a view to a final limitation of the rate of transmission to man are analyzed.

[Polydactyly in the Old Testament]

The study of passage 2 Sam 21: 20-21 allows us to assert that the biblical writer registered a case of polydactyly, specifically a hexadactylia of the four limbs. The documental evidence certifies the presence of this orthopedic lesion in ancient times. It is probable that this was a case of post-axial, non crossed and non syndromic polydactyly.

Effect of zinc treatment on serum thyroid hormones in uremic patients under peritoneal dialysis

In order to evaluate the effect of zinc (Zn) deficiency on thyroid abnormalities in chronic renal failure, a Zn supplement (100 mg/day, p.o.) was given for four weeks to eight uremic patients under peritoneal dialysis. Zn supplementation increased plasma levels of TSH (5.8 +/- 0.7 to 7.4 +/- 0.7 mU/l, p < 0.02), T4 (61.6 +/- 3.9 to 93.9 +/- 6.2 nmol/l, p < 0.01), T3 (1.31 +/- 0.14 to 1.70 +/- 0.18 nmol/l, p < 0.01) and Zn (7.23 +/- 0.45 to 12.27 +/- 0.76 mumol/l, p < 0.01). A close correlation was found between changes in plasma levels of Zn and changes in TSH (r = 0.82), T4 (r = 0.55) and T3 (r = 0.64), suggesting that Zn deficiency may play a role in the biosynthesis or release of hormones of the hypothalamic-pituitary-thyroid axis in chronic renal failure.

[Efficacy of the proteic redistribution diet (PRD) in the antiparkinsonian effect of L-dopa]

The efficacy of PRD was evaluated in 21 patients with Parkinson's disease who presented motor fluctuations or a bad quality "on" time despite treatment with L-dopa or dopaminergic agonists. Eighteen of the 21 patients completed three months of treatment and only 14 (66.6%) were able to complete 12 months. The four patients who stopped treatment in this period did so because of subjective complaints despite obtaining good clinical response to PRD. Only three patients suspended the dietetic regime during first month of treatment. The 14 who completed the year of treatment showed a decrease in the "off" time (4.10 to 1.65: p < 0.01) and an improvement in motor response (14.89 to 10.39; p < 0.05) during the follow up period. Improvement appeared at the end of the second week of initiation of treatment. The diet was well tolerated with scarce complications, with only one patient presenting visual hallucinations. Other secondary effects were mild and did not require discontinuation of the diet. We conclude that proteic redistribution diet improves the "on" time in patients with Parkinson disease receiving L-dopa and delays the possibility of increasing the doses of L-dopa. The dietetic regimens with proteic redistribution seems a simple, useful and cheap approach without morbidity for the patients with Parkinson's disease showing a poor response or oscillation to L-dopa treatment.

[Hydatidosis control in the province of Río Negro, Argentina: development of primary care programs]

Hydatidosis is a serious Public Health problem in the Province of Río Negro, Argentina. This situation has promoted the implementation of a control programme based on the canine systematic deparasitation with Praziquantel, health education, work control and care of persons. The accumulated experience of 15 years works, carried out to develop the last work--line mentioned above, is presented in this study. The activities includes the registry of human cases, the early identification of asymptomatic carries, the infected persons derivation to the hospital system in order to allow their appropriate treatment, the longitudinal follow up of the operated cases and the epidemiologic surveillance of the human hydatidosis situation. A network of laboratories was organized, as a support to satisfy the hospital demand, under the coordination of a central laboratory of reference and serologic surveys, among the groups at risk, were also carried out. The information registered indicates that a total of 60,078 serologic tests were carried out in the whole Province: out of them, 22,899 corresponded to hospital demand (DD5) and 37,179 to serologic surveys (originally latex, then DD5, and now Elisa). 65% of the cases, diagnosed by official register, is derived from rural areas to complexity hospitals, to be put under surgical treatment, and, out of these operated persons, only 3.9% is derived from the appearance of clinical symptomatology. A sustained reduction in the average days of stay, in lethality and in the rate of serologic prevalence in school children from 7 to 13 years of age, are achieved.(ABSTRACT TRUNCATED AT 250 WORDS)

[Community participation in health at the Instituto Mexicano del Seguro Social in Jalisco]

This paper describes the achievements and problems of a community participation model in health care, developed by the Mexican Social Security Institute since 1985. The health team involved between 10 and 20 percent of the personnel due to the slow adoption this program requires in new of the cultural change it implies. The community's answer has been satisfactory, as it can be seen by the ware of 100 neighbours and school committees, and around the 2,000 housewives and school students who are been working as promoters. This figures stand monthly. The self-care groups on chronic diseases constitute another form of participation. The community activities are progressively focused on causes of health and disease, embracing our 70 per cent of health promotion and disease prevention actions. The work realized by the community over cause one third of that realized by the preventive medicine personnel. This health community participation model represents a valuable and viable alternative.

The impact of a hospital and clinic-based breastfeeding promotion programme in a middle class urban environment

Hospital interventions in support of breastfeeding have been highly successful in areas where the indigenous population has a well established environment of breastfeeding. However, programmes designed to improve breastfeeding patterns in urban populations have met with mixed success. This paper presents a prospective intervention study with a control group in which a health system-based breastfeeding promotion programme was initiated to support optimal breastfeeding for both child health and child spacing. Following collection of control data, a four-step intervention programme (Breastfeeding Promotion Program) was instituted. This paper reports the process of the development of the intervention programme as well as the comparison of the control and study populations. Major findings include significant increases in duration of full breastfeeding from 31.6 per cent at 6 months in the control group to 66.8 per cent in the intervention group. The duration of lactational amenorrhea was similarly increased: 22 per cent of the control mothers and 56 per cent of the intervention group women were in amenorrhoea at 180 days. The cost-effectiveness of the hospital changes is illustrated.

Production of transgenic mice and rabbits that carry and express the human tissue plasminogen activator cDNA under the control of a bovine alpha S1 casein promoter

One-cell embryos from mice and rabbits were microinjected with a hybrid gene composed of 1.6 kilobases (kb) promoter/regulatory sequences of the bovine alphaS1 casein gene fused to the complementary DNA (cDNA) encoding for the human tissue plasminogen activator (htPA) and 3'untranslated sequences from rabbit beta-globin and SV 40 genes. Transgenic mice and rabbits that carry the htPA gene were obtained. In mice, 11 founder females were generated, and 6 of them expressed low levels (about 50 mug/ml) of htPA in their milk. Some of the transgenic mice showed rearrangements of the microinjected DNA sequences as judged by Southern blot analysis. A position-dependent expression of the transgene is suspected to occur. The only live-born founder transgenic rabbit obtained was a male, and it transmitted the transgene in a Mendelian fashion to F1 females, which expressed htPA at very low levels (8 to 50 ng/ml). Although the 1.6-kb bovine alphaS1 casein promoter that was used directs the synthesis of htPA specifically to the mammary gland, it may not be sufficient for a high level of expression.

[Acute lymphoblastic leukemias off therapy: course of 80 cases after treatment cessation]

PURPOSE

To retrospectively analyse all the patients diagnosed and treated in the same hospital for acute lymphoblastic leukaemia (ALL) in whom therapy was suppressed after sustained complete remission (CR) for a variable period.

PATIENTS AND METHODS

Eighty cases of ALL treated at the Jiménez Díaz Foundation between 1968 and 1991 were revised. Treatment had been suppressed after 60 months of maintained CR (1968-1974) or after 28 months (1986-1991), with a median follow-up after suppression of 6 years. All the patients had been treated with several protocols (FJD-68, FJD/BFM, APO, BFM-83, BFM-86 and BFM-90). Maintained CR, relapses and course after therapy cessation were analysed. Actuarial curves of RC duration and survival were drawn according to the Cutler and Ederer life tables.

RESULTS

The age at diagnosis ranged from 1.5 to 68 years. Childhood (< 15 years) ALL presented in 49 cases; 25 were young adults (15-30 years), and 6 others were over 30 years of age. Two of the 80 patients (2.5%) died in CR (astrocytoma and demyelinating leukoencephalopathy). Fifty-eight patients (72.5%) are living in maintained CR; 20 others relapsed (25%), 14 of them (70%) attaining a second CR. Allogenic BMT was carried out in 4 such cases. Four patients are out of any treatment after the second CR. The actuarial curves of CR duration after suppression of therapy gave a stable plateau at 73% for children, at 75% for young adults and at 22% for patients over 30 years. The survival after suppression of therapy showed a plateau at 75% for children and at 86% for young adults.

CONCLUSIONS

1) Relapse was seen in 25% of the patients after cessation of therapy. 2) Relapse occurred in the first two years after therapy cessation in 75% of the instances. 3) At this writing, 78.7% of the patients keep up the CR. 4) Adults over 30 years of age comprise the poorest prognosis. 5) The course of young adults in this series after cessation of therapy is as good as that of children.

High Level Expression of Streptokinase in Escherichia Coli

Streptokinase (SK), which activates human plasminogen by promoting its conversion to plasmin, is normally obtained from beta-hemolytic streptococci. Treatment with SK is an effective therapy for improving survival and preserving left ventricular function after coronary thrombosis. We report the cloning, expression in E. coli to levels of 25% of the total cell protein, and characterization of a novel SK (SKC-2) gene, the product of which is functionally equivalent to the naturally-derived protein. The availability of a recombinant streptokinase (rSK) in high yield and purity offers a potentially attractive alternative source of this important therapeutic agent.

Clinical study of the lactational amenorrhoea method for family planning

The effect of breastfeeding on fertility is well known; however, its use as a method of family planning was, until recently, untested. In 1988, the Bellagio Consensus Conference proposed guidelines that became the basis for a method of family planning called the lactational amenorrhoea method (LAM). The principle of LAM is that a woman who continues to fully or nearly fully breastfeed her infant and who remains amenorrhoeic during the first 6 months postpartum is protected from pregnancy during that time. We have assessed this method in the context of a breastfeeding support intervention study of 422 middle-class women in urban Santiago, Chile. The cumulative 6-month life-table pregnancy rate was 0.45% among women who relied on LAM as their only family planning method (1 woman pregnant in month 6). The findings indicate that LAM, with its high acceptance and efficacy, is a viable method of family planning and can safely serve as an introductory method for breastfeeding women.

[Description of 2 patients with cytogenetically abnormal clones]

We present two patients with two cytogenetically unrelated clones. A patient was diagnosed of refractory anaemia and showed an abnormal clone with trisomy 8 and other clone with 5q-; the other patient, diagnosed as chronic lymphocytic leukaemia showed a clone with an inversion of chromosome 2, inv(2) (p23q12) and the other clone with a 47,XX,+5,t(16;17)(p13;q11),+2ac karyotype. The discussion is focused on the presence of unrelated clones in relation to the monoclonal origin of cancer.

[Serologic longitudinal follow-up of surgically treated patients for hydatidosis]

Beginning with the register of human hydatidosis cases, kept by hydatidosis struggle programs of Rio Negro Province, was done the serologic longitudinal follow-up in patients operated on in the period 1980-1987, in the influence area of Ingeniero Jacobacci, Rio Negro, Argentina. The local Supervision Program obtained blood samples of 36 patients during 1990 (59% of them were operated on in the considered period), five patients died corresponding the remaining to persons to whom did not live in Ingeniero Jacobacci or to whom were not possible to evaluate. The blood samples were studied by DD5, confirming the disease immunologically in 18 cases (50%). In this work are evaluated possible causes of reinfection: surgery technic, individual susceptibility, immunological factors.

Fetal outcome among pregnancies in natural family planning acceptors: an international cohort study

This international, multicenter, prospective cohort study examines the outcome of pregnancies associated with aging gametes. Comparing pregnancies conceived at or near the peak mucus phase with those occurring before or after the peak provides a means of evaluating the effect of aging gametes. The outcome criteria are (1) rates of spontaneous abortion, (2) low birth weight, and (3) congenital malformations. Preliminary analysis shows a trend toward increased spontaneous abortion with aging gametes in certain subsets (women with prior pregnancy losses) but no effect on birth weight. Too few method failures have yet been studied to make a definitive statement on congenital malformations.

Santiago Breastfeeding Promotion Program: preliminary results of an intervention study

A prospective intervention study was undertaken in Santiago, Chile, to assess the impact of a breastfeeding promotion program and the acceptance and use of the lactational amenorrhea method for natural child spacing. The intervention study significantly increased the duration of exclusive breastfeeding and amenorrhea. In addition, the use of the lactational amenorrhea method proved highly efficacious, with an unplanned pregnancy rate of less than 0.5% by 6-month cumulative life table. Total family planning coverage at 6 months was increased in the intervention group.

Ovulation method use during breastfeeding: is there increased risk of unplanned pregnancy?

Data from two prospective studies of the ovulation method were used to assess pregnancy rates and users' fertility-related behaviors among breastfeeding women. The rate of unplanned pregnancy was less than 1% during the first 6 months of lactational amenorrhea. However, the unplanned pregnancy rate was elevated among breastfeeders during the months after menses return compared with the pregnancy rate during nonlactating cycles. Rates were also elevated at the time when infant feeding supplementation was started. This increase in unplanned pregnancies was not directly attributable to nonadherence to the ovulation method rules; there was some indication that adherence to the rules actually may be increased during those months. Therefore, special emphasis on both the need for improved breastfeeding support to delay menses return and the increased potential for method failure among new users during this period of time should be incorporated into ovulation method training and support programs.

[Isochromosome 17q as the sole alteration in 2 patients with a myelodysplastic syndrome and its relation to myeloperoxidase activity]

Two patients diagnosed of myelodysplastic syndrome with an isochromosome i (17q) as the only chromosomal alteration are presented. The MAC method (i.e., morphology, antibodies, chromosomes) was applied in the study of one of the patients, it being found that all the myeloperoxidase-positive cells carried the i (17q) anomaly. Such finding might suggest that those patients with i (17q) as the only chromosomal alteration could have specific clinical and cytological features.

[Nutritional support in liver transplantation]

Given the malnutrition present in patients suffering from advanced hepatic illness, as well as the implications of this in the post-hepatic transplant period, a study was made of various biochemical parameters (prealbumin, retinol-bound protein, zinc, magnesium, cholesterol and amino acid pattern) as indicators of the nutritional condition of a series of 15 patients who underwent hepatic transplants and required total parenteral nutrition (TPN) during the first 10 post-transplant days. Before the transplants were carried out, all the patients studied showed a decrease in all evaluated parameters. Ten days after the transplant, and having been fed parenterally during this time, the different parameters corrected themselves, with the exception of cholesterol. TPN, administered with enrichment of branched amino acids by 35%, practically normalized the plasma amino acid pattern.

Gene transfer in common carp () by microinjection into the germinal disc

We report here on the microinjection of the human growth hormone gene (hGH) into the germinal disc of common carp one-cell embryos. For microinjection, a linear 4.1 kb EcoRi-DNA fragment containing the mouse metallothionein-I promoter (mMT-I), fused to a structural gene coding for the hGH, was used. Of the 14 injected embryos, 9 developed to an age of 60 d. Of these nine fish, two were found to be transgenic and had integrated two to four copies per cell of the hGH construct.

[Control of hydatidosis in the Province of Rio Negro, Argentina: epidemiology]

In this paper we attempt to present a general view of the situation of hydatidosis in the Province of Rio Negro, Argentina, considering the magnitude of infection in man and dog. Because of its seriousness a 10 year program for the control of hydatidosis has been carried out, which included veterinary and medical care. The number of human cases with hydatidosis in the period 1981-1988 was determined by a retrospective study of the registers of Public Health. From 1188 cases registered in the period, the annual numbers varied between 152 in 1981 and 104 in 1988. This implies an incidence rate of 40 x 100,000. The most frequent localization observed was in the liver. The average days of hospitalization has decreased to 15.8 per patient. Screening seroepidemiological surveys using DD5 allowed us to determine that the prevalence rate was in some departments of 2330 x 100,000. Also included are the results, up to now, of 10 years of field work done in the program area.

G-banding improvement for the MAC method

Satisfactory identification of the neoplastic cell as well as an optimal G-banding of its chromosomes are routinely obtained in our laboratory using a modification of the method described by Knuutila et al. Mitotic cells are first identified by either cytochemical or immunological staining. For G-banding, the preparations are then destained with methanol:acetic acid, treated with 2 x SSC at 65 degrees C and restained with Wright stain.

Langerhans-like cells in amphibian epidermis

Langerhans cells have been described in epidermis and other stratified epithelia of mammals. In other vertebrates equivalent cells have not been found. Amphibians show skin graft rejection, so it is possible that these animals have epidermal cells homologous to Langerhans cells. In this work we demonstrate the existence of ATPase-positive dendritic cells in frog epidermis that are similar ultrastructurally to mammalian Langerhans cells, except for the absence of Birbeck granules.

[Surgical treatment in tumors of the anterior mediastinum]

Anterior mediastinal tumours (A.M.T.) suppose a diagnostic problem owing to nonspecific clinical signs and symptoms. In the last twenty years, we have seen ten patients with A.M.T., 50 per 100 of which were fortuitous radiologic findings and the remaining 50 per 100 were diagnosed from nonspecific symptoms. Diagnostic imaging techniques were used to classify the anterior location of the tumours. Posterolateral thoracotomy was performed in the first six patients and sternotomy in the remaining four. In conclusion, sternotomy provides a wider surgical field and is to be recommended in A.M.T. surgery. Low morbidity and mortality support an early decision for thoracic surgery.

[Extrahepatic cholestasis of nonatretic origin. New diagnostic and therapeutic possibilities]

Nonatretic cholestatic disorders exhibit differential features in the pediatric age group, at times not too obvious but always discernible. These characteristic differences, with the aid of increasingly more precise exploratory techniques, make a rapid and sound diagnosis possible. At present, echography, transparietohepatic cholangiography and endoscopic retrograde cholangiography allow us, within a short time, to reach a diagnosis of disorders that not long ago were only roughly profiled and on occasion were left undiagnosed. At the Children's Hospital Valle de Hebrón, treatment has been afforded, in the last seven years, to seven patients with a choledochal cyst, four with a long common biliopancreatic duct, one with a choleperitoneum due to spontaneous perforation of a choledochal cyst and one patient with congenital stenosis of the common hepatic duct. In all cases where echography was performed, an intra- or extrahepatic bile duct dilatation could be demonstrated, or otherwise the diagnosis of a choledochal cyst was established. Furthermore, four transhepatic and three retrograde cholangiographic examinations were carried out, via a fiber duodenoscopy, in those cases that failed to show, on echography, the existence of a choledochal cyst.

[Immunohistochemical diagnosis of Mediterranean spotted fever: detection of rickettsial antigens in the initial skin lesions]

In eight patients with Mediterranean spotted fever we evaluated the yield of the direct immunofluorescence technique against rickettsial antigens for the early laboratory diagnosis of the disease. Frozen sections of biopsy specimens of the initial lesion (tache noire) taken on the admission day were processed by a fluorescent conjugate reactive against Rickettsia conorii. In seven cases, coccobacillary formations consistent with rickettsiae were observed in the studied specimens. The results were negative in the controls and in three of six samples of exanthema elements obtained from six simultaneously studied patients with Mediterranean spotted fever. Our data demonstrate the diagnostic value of direct immunofluorescence applied on the tache noire. This technique is particularly useful in the initial stages of the disease, before the clinical and serological features have completely developed.

Postmenopausal androgen secreting ovarian tumour: pathophysiological implications; a case report

Hyperandrogenism in women is usually accompanied by a disruption of the hypothalamic-pituitary-ovarian axis; however, the precise effect of chronically elevated androgens on this axis is poorly understood. We report a postmenopausal woman with a virilizing ovarian tumour in whom the effects of chronic testosterone secretion on the hypothalamic-pituitary axis was investigated. A 56-year-old woman was evaluated for hirsutism and hyperandrogenism of recent onset. Peripheral serum testosterone was high (19.4 nmol/l), while gonadotropins were below normal for a postmenopausal woman, FSH (19.7 IU/l) being higher than LH (10.3 IU/l). Four LH and 1 FSH pulse were detected over 4 h. A left intraovarian testosterone secreting tumour, shown by catheterization of the ovarian veins and containing imperfect crystalloids of Reinke, was excised. Postoperatively, peripheral testosterone became undetectable, while gonadotropins rose to normal postmenopausal values. This patient's LH/FSH ratio was less than 1, in contrast with other situations of chronic hyperandrogenism. This could be explained by the concomitant hypoestrogenic state, and/or the theoretical absence of inhibin. The interest of this case resides in that it constitutes an appropriate model for studying the effects of testosterone on LH and FSH secretion in the absence of the other two classically involved modulators, namely oestrogens and inhibin.

[Neoplasm of the rhinopharynx: our experience]

We present 87 patients with cancer of the nasopharynx treated in the Fundación "Jiménez Díaz" de Madrid, in the last fifteen years. The clinical aspects of the illness, the therapeutic techniques and the results are analyzed. The global survival and the disease free survival at 5 years were 34 and 22% respectively. Survival in patients with squamous cell carcinoma was somewhat better. Distant metastases was presented in 30% of patients. At present 16 patients are alive and free of disease.

Mutagenicity of N-nitrosomorpholine biosynthesized from morpholine in the presence of nitrate and its inhibition by ascorbic acid

N-nitrosomorpholine biosynthesis and inhibition in mice treated with nitrate, morpholine and ascorbic acid, was studied by means of the mutagenic activity in urine samples. The preincubation method was used and Salmonella typhimurium TA 1535 was the test strain. The results suggest that N-nitrosomorpholine biosynthesis was carried out when the animals were fed high doses of nitrate, however ascorbic acid was an inhibitor of this process.