Prenatal Amphetamine-Induced Dopaminergic Alteration in a Gender- and Estrogen-Dependent Manner.

Prenatal exposure to amphetamine induces changes in dopamine receptors in mesolimbic areas and alters locomotor response to amphetamine during adulthood. Sex differences have been reported in amphetamine-induced brain activity and stress sensitivity. We evaluated the effects of prenatal amphetamine exposure on locomotor activity, dopamine receptors and tyrosine hydroxylase mRNA expression in nucleus accumbens and caudate-putamen in response to amphetamine challenge in adult female and male rats. The role of estrogen in the response to restraint stress was analyzed in ovariectomized, prenatally amphetamine-exposed rats. Pregnant rats were treated with D-amphetamine during days 15-21 of gestation. Nucleus accumbens and caudate-putamen were processed for mRNA determination by real-time PCR. In nucleus accumbens, higher mRNA dopamine (D3) receptor expression was found in basal and D-amphetamine-challenge conditions in female than male, and prenatal amphetamine increased the difference. No sex differences were observed in caudate-putamen. Basal saline-treated females showed higher locomotor activity than males. Amphetamine challenge in prenatally amphetamine-exposed rats increased locomotor activity in males and reduced it in females. In nucleus accumbens, estrogen diminished mRNA D1, D2 and D3 receptor expression in basal, and D1 and D3 in ovariectomized stressed rats. Estrogen prevented the increase in tyrosine hydroxylase expression induced by stress in ovariectomized prenatally exposed rats. In conclusion, estrogen modulates mRNA levels of D1, D2 and D3 receptors and tyrosine hydroxylase expression in nucleus accumbens; prenatal amphetamine-exposure effects on D3 receptors and behavioral responses were gender dependent.

Glomerulonefritis con semilunas / Glomerulonephritis with crescents

La glomerulonefritis rápidamente progresiva (GNRP) es una entidad caracterizada por una brusca y progresiva declinación de la función renal y por la presencia en la biopsia renal de proliferación celular extra capilar (semilunas) que ocupan el espacio de Bowmans. Nosotros analizamos en forma retrospectiva 37 niños con diagnóstico de GNRP (50% o más de los glomérulos con semilunas) asistidos en esta institución durante los últimos 20 años. El propósito fue evaluar la presentación clínica e histopatológica, etiología, evolución y factores de mal pronóstico. La edad media al diagnóstico fue de 11 ± 3,5 años. Los síntomas de presentación fueron: hematuria 100% de los casos (hematuria macroscópica 56%); hipertensión arterial 92%; proteinuria 88%; síndrome nefrótico 57%. Fue necesaria diálisis al ingreso en el 64,1% de los casos. Las biopsias renales fueron realizadas a 38 ± 26 días desde el comienzo de los síntomas. El porcentaje de glomérulos que presentaron semilunas fue del 81,4%; las mismas fueron epiteliales en el 28,3% de los casos; fibroepiteliales en el 21,8% y fibrosas en el 31,3%. En el 75,8% de las biopsias se encontró fibrosis intersticial y atrofia tubular moderada y/o severa. La inmunofluorescencia no mostro depósitos de complejos inmunes (GN pauci-inmune) en el 40,6% de las biopsias, mostró depósitos granulares de complejos inmunes en el 48,6% y depósitos lineales de anticuerpos anti membrana basal glomerular (Goodpasture´s) en el 10,8%. El tratamiento fue iniciado a 36 ± 32 días desde el comienzo de los síntomas. Todos los pacientes recibieron tratamiento de sostén; en 29 de ellos se indicaron además esteroides y ciclofosfamida, y en 5 solo esteroides. El tiempo medio de seguimiento fue de 4,6 ± 3,9 años. La sobrevida de los pacientes al final del seguimiento fue del 87% (IC95% 55-97%) y la sobrevida del órgano fue del 17% (IC95% 7-38%). Por análisis multivariado encontramos que la fibrosis intersticial y atrofia tubular moderada y/o severa fue el único factor que se relacionó con pérdida del órgano (OR: 14,6 IC95%2,6-80) p= 0,001. Nuestros resultados muestran que la GNRP en niños es una entidad con pobre pronóstico en relación a la función renal. El factor de peor pronóstico que puede llevar a la pérdida del órgano es el compromiso túbulo-intersticial (AU)

Rapidly progressive glomerulonephritis (RPGN) is characterized by a sudden and progressive decrease of kidney function and extra-capillary cell proliferation (crescents) occupying the Bowman's space on the biopsy. We retrospectively analysed 37 children with RPGN (50% or more of glomeruli with crescents) seen at our institution over the past 20 years. The purpose of the study was to evaluate clinical and histopathological presentation, etiology, outcome, and factors of poor prognosis. Mean age at diagnosis was 11 ± 3.5 years. Presenting symptoms were: hematuria in 100% of the cases (macroscopic hematuria 56%); arterial hypertension in 92%; proteinuria in 88%; and nephrotic syndrome in 57%. Dialysis was necessary on admission in 64.1% of the cases. Kidney biopsies were performed at 38 ± 26 days after symptom onset. The percentage of glomeruli that presented crescents was 81.4%; they were epithelial in 28.3% of the cases, fibroepithelial in 21.8%, and fibrous in 31.3%. In 75.8% of the biopsies interstitial fibrosis and moderate and/or severe tubular atrophy was found. Immunofluorescence techniques did not show immune complex deposits (pauci-immune GN) in 40.6% of the biopsies. Granular deposits of immune complexes were found in 48.6% and linear anti-glomerular basement membrane deposits (Goodpasture´s) in 10.8%. Treatment was started 36 ± 32 days after symptom onset. All patients received support treatment; in 29 steroids and cyclophosphamide were also indicated, and in 5 steroids only. Mean time of follow-up was 4.6 ± 3.9 years. Patient survival at the end of follow-up was 87% (95%CI 55-97%) and organ survival was 17% (95%CI 7-38%). On multivariate analysis we found that interstitial fibrosis and moderate and/or severe tubular atrophy was the only factor related to organ loss (OR: 14.6; 95%CI 2.6-80) p= 0.001). Our results show that RPGN in children has a poor prognosis regarding kidney function. Tubulo-interstitial involvement is the factor of poor prognosis that may lead to organ loss (AU)

Genotoxicidad del nifurtimox en diferentes líneas celulares utilizando el ensayo cometa / Genotoxiciyt from Nifurtimox in comet assay

El nifurtimox es un 5-nitrofurano sintético utilizado en el tratamiento dela enfermedad de Chagas. El objetivo de este estudio fue determinar la toxicidad celular y el daño del ADN causado por el nifurtimox en células Vero, J774, NIH/3T3 y THP-1. Se utilizó la coloración vital con azul tripan y elmétodo colorimétrico MTT para determinar la toxicidad y el ensayo cometa alcalino para determinar el daño al ADN. Los cometas fueron contadosen un microscopio de fluorescencia y el porcentaje de daño total del ADN fue calculado y clasificado de 0 (sin daño) a 4 (daño severo). En el ensayo de toxicidad, las células J774 fueron las líneas celulares más sensibles y las células THP-1 las menos sensibles al nifurtimox con valores de CC50 34,04-138,58 μg/ml y CC90 130,58->300 μg/ml de nifurtimox, respectivamente.En el ensayo cometa, el porcentaje de daño total de ADN a 100 μg/ml de nifurtimox fue 79,75%, 85,30% y 10,25% en células NIH/3T3, J774 y THP-1 respectivamente. En las células Vero el daño del ADN fue del 80% en células tratadas y no tratadas. El nifurtimox presentó toxicidad y genotoxicidad con actividades que dependieron del tipo de célula y de la concentración del medicamento utilizada. Es importante tomar en cuenta estas diferencias al realizar conclusiones finales de resultados obtenidos utilizando estos ensayos, especialmente el ensayo cometa...

[Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment]. / Recomendaciones de prevención y tratamiento de las náuseas y vómitos postoperatorios y/o asociados a las infusiones de opioides.

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Española de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.

[Quality of life and sexual function in postmenopausal women with urinary incontinence]. / Calidad de vida y función sexual en mujeres postmenopáusicas con incontinencia urinaria.

INTRODUCTION: Aging is a natural unavoidable process that is expressed through physical, psychological, emotional, and social changes, and that can produce undesirable events, such as Urinary Incontinence (UI). This condition increases with age, is more frequent in women, and can produce impairments in the quality of life, such as social isolation, fear, embarrassment, and self-postponement, among others. This research aimed at describing the quality of life and sexual function in postmenopausal women according to the UI classification through the application of specific questionnaires. MATERIAL AND METHOD: This is a descriptive and cross-sectional study carried out between June and September, 2006. This study included 46 postmenopausal women over 50 years old with clinical and urodynamic diagnosis of UI, active sexual life in the last 3 months. All the subjects answered the King's Health Questionnaire (KHQ) and Female Sexual Function Index [FSFI). RESULTS: According to the UI classification, 43.5% showed Mixed UI, 37% Stress UI, and 19.6% Urge UI. The most affected domains in the total of the subjects in regards to Quality of Life were "UI impact" (65.2%), "activities performed" (56.5%), and the less affected domain was "personal relations" (15.2%). The most affected UI classification in the KHQ domains was Mixed UI (43.5%), which indicates a greater impairment of the quality of life. The most prevalent disorders of the female sexual function were: decrease of "sexual desire" (45.7%) and "excitation" (30.4%), and the less affected domains were "satisfaction" (8.7%) and "pain" (6.5%). The classification of UI that showed the lower punctuations in FSFI was the Mixed UI. CONCLUSION: UI affects quality of life and sexual function being the mixed UI the classification that showed the greatest influence compared to the other two types. Due to the UI is a highly-treatable condition, a comprehensive assessment of these patients is needed, under a bio-psycho-social model, having as central paradigm the improvement of the quality of life, considering the perception of the patients themselves.

[Reticulocyte response after immediate withdrawal of recombinant human erythropoietin in chronic hemodialysis patients]. / Respuesta reticulocitaria tras cese inmediato de administración de eritropoyetina recombinante humana en enfermos en hemodiálisis crónica. Implicaciones en la terapia de la anemia.

UNLABELLED: The sudden interruption of recombinant human erythropoietin (rHuEPO) in end-stage renal disease (ESRD) patients leads to rapid anemization. The mechanisms of this phenomenon are, however, insufficiently understood. The present study examined the response to immediate rHuEPO withdrawal in dialysis patients. METHODS: 10 chronic hemodialysis (HD) patients regularly receiving rHuEPO were studied. rHuEPO was stopped and reinitiated after 7 days. Reticulocyte profile, haemoglobin and haematocrit were measured at 0, 7 and 15 days. As a complementary study, and with the purpose of analyzying whether uremia was a relevant factor, 10 non-uremic male Wistar rats were treated with rHuEPO. After two weeks, rHuEPO was withdrawn in 5 animals, and continued for 7 additional days in the remainder. The same variables than in the human study were determined. RESULTS: Changes in reticulocyte subtypes from baseline to day 7 were: total 18.2 +/- 0.9 vs 14.3 +/- 1.8% (p < 0.06); high-fluorescence (HFR): 2.6 +/- 0.4 vs 0.75 +/- 0.2 (p < 0.001); medium-fluorescence (MFR): 13.0 +/- 1.1 vs 6.6 +/- 0.9% (p < 0.02); and low-fluorescence (LFR): 84.2 +/- 1.4 vs 92.7 +/- 1% (p NS). The baseline pattern was recovered upon 7 days of rHuEPO reinitiation (p NS). Mean hemoglobin and hematocrit decreased by day 14 (p < 0.02) in spite of rHuEPO reinitiation at day 7. In non-uremic rats, changes were similar to that in the ESRD patients. CONCLUSION: rHuEPO induces changes in the reticulocyte pattern, consisting in a reduction of immature reticulocytes. These changes appear to be independent of the presence of uremia. Accordingly, complete rHuEPO withdrawal in HD patients will cause a rapidly-developing anaemia due to an alteration in the reticulocyte maturation series; therefore, sudden rHuEPO interruption should be avoided whenever is possible. As a collateral application, the specific changes described herein have potential use for detecting illegal administration of rHuEPO.

Manejo paliativo del cancer esofagico con stents autoexpandibles de nitinol cubiertos en pacientes del INC / Treatmetn of Esophageal carcinoma with covered expandable endoprothesis of nitinol

Presentamos los resultados parciales del estudio que actualmente se lleva a cabo en el Instituto Nacional de Cancerología en el manejo paliativo de fístulas traqueoesofágicas y disfagia en pacientes con cáncer esofágico avanzado mediante la colocación de endoprótesis esofágicas autoexpandibles de nitinol cubiertas. Comentamos la técnica, materiales empleados, complicaciones y resultados obtenidos en los pacientes tratados entre junio de 2000y abril de 2001

[Comparative study of intravenous anesthesia with propofol in continuous perfusion and neuroleptanalgesia in traumatology surgery]. / Estudio comparativo entre la anestesia intravenosa con propofol en perfusión continua y la neuroleptoanalgesia en cirugía traumatológica.

OBJECTIVE. To study propofol as the single agent for both anesthetic induction and maintenance with respect to quality of anesthesia, hemodynamic effects, quality of recovery and analgesic requirements in comparison with neuroleptoanesthesia as the technique of reference. PATIENTS AND METHODS. We selected 2 homogeneous groups of 15 ASA I-III patients undergoing traumatological surgery. Patients were premedicated with bromazepam 3 mg p.o. and droperidol 0.03 mg/kg prior to induction. Induction was achieved with propofol 1.5-2.5 mg/kg in group I (GI) and with sodium thiopental 4-5 mg/kg in group II (GII). Maintenance was by continuous infusion of propofol 6-12 mg/kg in GI and with droperidol 0.15 microgram/kg/h and 50% N2O/O2 in GII. Both groups received fentanyl 4 micrograms/kg/h. Neither analgesia nor curarization were antagonized pharmacologically. Variables recorded were time and quality of anesthetic induction, mean duration of anesthesia, anesthetic education time, time until orientation and time of residual analgesia. Hemodynamic parameters were recorded for both groups at baseline, after induction, at intubation, at 2 and 5 min after intubation, at the start of surgical incision, 30 min after start of incision, and at the end of surgery. Results for the two groups were compared, as were results at the various moments of measurement within groups.

[Anesthesia and perioperative complications of correcting transposition of the great arteries using the Jatene technique]. / Anestesia y complicaciones peroperatorias de la transposición de las grandes arterias corregida mediante la técnica de Jatene.

We present a retrospective morbi-mortality study in 12 patients undergoing Jatene's arterial repair for transposition of the great vessels between 1988 and 1992. Half of the patients were boys ranging in age from 4 days to 35 months. In 34% heart failure was grade III, while in 65.6% it was grade IV (NYHA). Anesthetic induction was with ketamine in 11 patients and with halothane in 1. Maintenance was with pancuronium and fentanyl supplemented with N2O in 2 and with isoflurane in 1. The overall intra- and perioperative death rate was 16.6%. Nine cases have undergone surgical repair since 1988 with no mortality. We conclude that Jatene's technique is the best alternative for repair of transposition of the great vessels when there is no hypoplasia of the right cavity.

X-ray studies on phospholipid bilayers. XIV. Interactions with the antiarrhythmic asocainol.

Asocainol (ASOC) belongs to class I of the antiarrhythmic drugs, i.e., those that exert their action at the level of the sodium channels of the myocardial cell membrane. It has been suggested that their molecular mechanism of action might be through nonspecific interactions with phospholipids that surround the channel proteins. In order to test this hypothesis, ASOC was made to interact with two multibilayer systems, one built-up of dimyristoylphosphatidylcholine (DMPC) and the other of dimyristoylphosphatidylethanolamine (DMPE). These are the type of lipids that are respectively found in the outer and inner monolayers of human erythrocytes. The experiments were carried out in a hydrophobic as well as in a hydrophilic medium below the phospholipid main transition temperatures. The perturbing effect of ASOC upon the bilayer structures was determined by X-ray diffraction. It was found that ASOC was able to fluidize DMPC in both media but not to DMPE.

X-ray studies on phospholipid bilayers. XII. Interactions of pentachlorophenol with myelin.

Pentachlorophenol (PCP) is a widely used pesticide, particularly for the preservation of wood. Given its high toxicity and resistance to degradation it has become a dangerous environmental pollulant. Due to its high lipophilicity, PCP is able to partition into the lipid bilayer of cell membranes disrupting several vital functions. The present research was concerned with the effects that the chronic administration of PCP could produce in vivo to the sciatic nerve of rats. X-ray diffraction patterns obtained from freshly dissected and dried sciatic nerves of PCP treated rats did not show significant differences in their reflections with respect to those present in the patterns from untreated animals. However, morphological studies performed by optical and electron microscopy showed degenerative changes in about 10% of the A and B type of nerve fibers.

X-ray studies on phospholipid bilayers. X. Interactions with chlortetracycline hydrochloride.

This study deals with the structural perturbations that the antibiotic chlortetracycline hydrochloride (CTC) can produce on phospholipid bilayers. Two multibilayer systems, one built-up of dimyristoylphosphatidylethanolamine (DMPE) and the other of dimyristoylphosphatidylcholine (DMPC) were allowed to interact with different concentrations of CTC in the absence and presence of water. The study was carried out by X-ray diffraction methods and all experiments were done below the phospholipid main transition temperatures. The results showed that CTC produced significant perturbations on DMPC even in the absence of water, whereas they were much milder in DMPE.

X-ray studies on phospholipid bilayers. VIII. Interactions with chlorpromazine.HCl.

Chlorpromazine is a widely used phenothiazine tranquilizer known to alter the shape of normal erythrocytes and their osmotic fragility. In order to understand the nature of the interactions chlorpromazine.HCl (CPZ.HCl) was made to interact with phospholipid bilayers formed by dimyristoylphosphatidylethanolamine (DMPE) and dimyristoylphosphatidylcholine (DMPC). This study was carried out by X-ray diffraction on crystalline powders of various molar mixtures of CPZ.HCl with DMPE and DMPC, with and without water. It was found that CPZ.HCl significatively affects the bilayer structure of DMPC in the presence of water, but not that of DMPE.

X-ray studies on phospholipid bilayers. V. Interactions with DDT.

The possible interaction of DDT with the lipids dimyristoyl lecithin (DML), dipalmitoylphosphatidylethanolamine (DPPE) and tripalmitin (TP) was studied. The work was carried out on oriented films and crystalline powders of DDT-lipid mixtures at different molar ratios by X-ray diffraction techniques. The diagrams showed only the patterns of pure DDT and that of the corresponding lipid. It is concluded that new phases were not formed and, therefore, no interactions occurred.