[Use of methylphenidate in palliative patients with asthenia: a review]. / Revisión sobre el uso del metilfenidato para el tratamiento de la astenia en pacientes paliativos.

Asthenia (or fatigue) is one of the most common symptoms in palliative patients. Methylphenidate is currently being assessed for treating this condition. A review of related literature published to date was performed, revealing methylphenidate to be a safe drug which could decrease fatigue in palliative patients with a tolerable side-effects profile.

Ultrasound study of the myoendometrial border.

Abnormal thickening of the Endometrial Subendometrial Myometrium Unit (ESEMy Unit, including basal endometrium and inner myometrium) has been detected on imaging and referred to as "diffuse adenomyosis" in infertile patients with proven endometriosis. However, no robust relationship exists between enlargement of the ESEMy Unit and adenomyosis proven on hysterectomy specimen examination; moreover, if any correlation exists, it lacks histological validation in women wishing to preserve fertility. While adenomyosis effects on fertility, if any, remain elusive, thickening of the ESEMy Unit have been consistently linked to fertility impairment in both experimental and clinical models. The hypothesis tested herein is that a novel condition exists, called "ESEMy Unit disruption disease"; it is epidemiologically different from adenomyosis, diagnosable on imaging and bears a clear impact on human fertility through various mechanisms. A new wave of good quality studies may be elicited by a clear distinction between adenomyosis and the "ESEMy Unit disruption disease".

[Treatment for endometriosis]. / Tratamiento de la endometriosis.

Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induced a chronic inflammatory reaction. Endometriosis is associated with severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical, or perimenstrual symptoms, with or without abnormal bleeding, infertility, and chronic fatigue. Therapies can be useful to relieve and sometimes solve the symptoms, encourage fertility, eliminate endometrial lesions, and restore the anatomy of the pelvis. For medical therapy, several different preparations (oral contraceptives, progestogenics, gestrinone, danazol, and GnRHa) and new options (GnRH antagonists, aromatase inhibitors, estrogen receptor beta agoinist, progesterone receptor modulators, angiogenesis inhibitors, and COX-2 selective inhibitors) are available.

Obesity surgery results depending on technique performed: long-term outcome.

BACKGROUND: Many techniques have excellent results at 2 years of follow-up but some matters regarding their long-term efficacy have arisen. This is why bariatric surgery results must be analyzed in long-term follow-up. The aim of this study was to extend the analysis over 5 years, evaluating weight loss, morbidity, and mortality of the surgical procedures performed. METHODS: This was a retrospective cohort study of the different procedures for morbid obesity practiced in our Department of Surgery for morbid obesity. The results have been analyzed in terms of weight loss, morbidity improvement, and postoperative morbidity (Bariatric Analysis And Reporting Outcome System). RESULTS: One hundred twenty-five patients were operated on open vertical banded gastroplasty (VBG), 150 patients of open biliopancreatic diversion (BPD) of Scopinaro, 100 patients of open modified BPD (common limb 75 cm; alimentary limb 225 cm), and 115 patients of laparoscopic Roux-en-Y gastric bypass (LRYGBP). Mean follow-up was: VBG 12 years, BPD 7 years, and LRYGBP 4 years. An excellent initial weight loss was observed at the end of the second year of follow-up in all techniques, but from this time an important regain of weight was observed in VBG group and a discrete weight regain in LRYGBP group. Only BPD groups kept excellent weight results so far in time. Mortality was: VBG 1.6%, BPD 1.2%, and LRYGBP 0%. Early postoperative complications were: VBG 25%, BPD 20.4%, and LRYGBP 20%. Late postoperative morbidity was: protein malnutrition 11% in Scopinaro BPD, 3% in Modified BPD group, and no cases reported either in VBG group or LRYGBP group; iron deficiency 20% VBG, 62% Scopinaro BPD, 40% modified BPD, and 30.5% LRYGBP. A 14.5% of VBG group required revision surgery to gastric bypass or to BPD due to 100% weight regain or vomiting. A 3.2% of Scopinaro BPD with severe protein malnutrition required revision surgery to lengthen common limb to 100 cm. A 0.8% of LRYGBP required revision surgery to distal LRYGBP (common limb 75 cm) due to 100% weight regain. CONCLUSIONS: The most complex bariatric procedures increase the effectiveness but unfortunately they also increase morbidity and mortality. LRYGBP is safe and effective for the treatment of morbid obesity. Modified BPD (75-225 cm) can be considered for the treatment of superobesity (body mass index > 50 kg/m(2)), and restrictive procedures such as VBG should only be performed in well-selected patients due to high rates of failure in long-term follow-up.

[Tunneled catheters. Complications during insertion]. / Catéteres tunelizados. Complicaciones en su inserción.

INTRODUCTION: The creation of vascular accesses for hemodialysis in patients affected with terminal kidney failure affections, is presented periodically as a problem. Because of it, the availability of alternatives to the arteriovein fistula is something necessary; different types of tunnelled dialysis catheters are being developed, among which the Tesio catheter is the most well known and most widely utilized. Often it is implanted by vascular surgeons or radiologists; this creates dependence for the nephrology services that can delay obtaining the new vascular access and initiating or reinitiating the treatment. MATERIAL AND METHODS: A descriptive study with the objective of analyzing the immediate complications during the insertion of tunnelled central catheters for hemodialysis and to evaluate the possibility of its attainment was carried out by nephrologists and personnel specialized in dialysis. Between January of 2003 and December of 2005, 175 Tesio tunnelled central catheters were implanted in our hemodialysis unit. Age and sex of the patient was registered, time in dialysis, diagnosis of hypertension, diabetes mellitus or prior heart disease, previous anticoagulant or platelet antiaggregate treatment, difficulty perceived by the nephrologist for the development of the technique, bleeding, systolic and diastolic arterial pressure, cardiac frequency, oxygen saturation and changes in the monitoring of electrocardiogram, at the beginning of the intervention, during the channelling of the vein, insertion of the dilatators and catheter, and at the end of it. RESULTS: The patients were 88 men and 82 women, with an average of age of 64. 21% of the patients habitually followed a treatment with platelet antiaggregate or anticoagulant, which had been withdrawn in the prior days. The ultrasound size of the vein was greater than one cm in 79% of the cases. Of 175 insertions only three patients (2%) presented signs of hemodynamic instability, two of them due to a descent of arterial tension and one by oxygen saturation descent; none of them required assisted backup, neither hemorrhage nor other complications appeared. CONCLUSIONS: The implant of tunnelled catheters, under local anesthesia, presents minimal complications and incidents during its insertion. It can be carried out by a nephrologist and specialized personnel, in hospitals with backup units that can undertake any possible complications.

Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system.

OBJECTIVES: To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment. METHODS: Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology. RESULTS: One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant. CONCLUSIONS: Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach.

Coupling of impurity modes in one-dimensional periodic systems.

One-dimensional periodic dielectric structures are known to exhibit band gaps because of their symmetry. Defect states can be found in the band gaps if an impurity layer is added to the lattice such that the symmetry of the structure is broken. In this paper, we consider the case where a second impurity layer is added and we discuss the existence of coupling between the two defects. We discuss the possibility of exploiting the coupling of impurity modes in the realization of tunable wavelength emitting devices and dual-wavelength vertical-cavity surface-emitting lasers.

In vitro susceptibility of Mycobacterium kansasii to the difluorinated quinolone sparfloxacin using a broth microdilution and macrodilution MIC system.

OBJECTIVES: To study the minimum inhibitory concentrations (MIC) of the difluorinated quinolone sparfloxacin against 32 clinical isolates of Mycobacterium kansasii from 23 patients, all of whom had clinically significant infections due to M. kansasii, and 11 the acquired immune-deficiency syndrome (AIDS). To study the correlation between the microdilution and macrodilution techniques in M7H9 broth. DESIGN: The MICs were determined by two methods: broth microdilution in microplates and broth macrodilution in tubes. The isolates were inoculated into two-fold drug dilutions (ranging from 0.063 to 8 microg/ml) in Middlebrook 7H9 broth and then incubated at 37 degrees C for 21 days. RESULTS: All 32 strains were susceptible, with identical MIC results in both methods, 96.9% of them showing an MIC of 0.25 microg/ml. CONCLUSION: These MIC studies suggest that sparfloxacin may be useful for drug treatment of slow-growing nontuberculous mycobacteria such as M. kansasii. The microdilution method appears to be a reliable method for routine susceptibility testing of M. kansasii, and is easy to interpret and to carry out.

[Epidemiology of Serratia marcescens between 1987 and 1995 at Vall d'Hebron Hospital]. / Epidemiología de Serratia marcescens entre 1987 y 1995 en el Hospital Vall d'Hebron.

BACKGROUND: Nosocomial infection have a relative high prevalence, which is necessary to reduce in order to improve the quality of patient care. The aims of this work is to study the behaviour of Serratia marcescens in our hospital as between 1987 and 1995. METHODS: Between February 1987 and March 1995 we detected 679 isolates of Serratia marcescens in 504 patients. We used serotype as first marker and phagotype as second, and evaluation of PGFE as a discriminator of doubtful strains was done. RESULTS: 35.8% of the strains were from the respiratory tract, 37.2% from urinary tract; and 11.7% were isolated in blood culture, among them 23.3% came form children younger than 7 years. We noticed a tendency to decrease the number of isolates along the studied period. The most frequent serotypes were O:6, O:3 and O:2; representing the 36.0% of the total. Serotypes O:6;14, O:4, O:5, O:11 and polyagglutinables accounted for 37% of the total. The frequency was variable from year to year, and the predominant serotypes were different in every one of the hospitals in which the center is divided. A 60% of the patients were hospitalized in the General Hospital Vall d'Hebron building, in ICU (20%) and in chirurgical services (25%). Ninety-six patients had more than one isolate, 91 of them (94.8%) can be classified by phenotypic test. The PFGE is discriminatory in three of the five unclassificable isolates. In more than 35% of the patients the strains isolated along the time are different. The 66.7% of the patients acquired Serratia strains in the same admission, and in some cases with few days of difference. We detected 17 cross infections, predominantly in ICUs. With PFGE we could discriminate isolates which produced cross infections between patient who are not in the same hospital. CONCLUSIONS: Although the prevalence of Serratia marcescens is diminishing, it is able to produce crossed infections that, in general, affected few patients. The serotype and phagotype discriminate 94.8% of isolates. The PFGE is high discriminatory and reproducible, only 6.8% of the 44 strains tested by this method can not be typed.

Impairment of long-term memory and sparing of short-term memory in monkeys with medial temporal lobe lesions: a response to Ringo.

During the last decade, an animal model of human amnesia was developed in the monkey. Studies using this model have identified structures in the medial temporal lobe that are essential for forming long-term memory (i.e. the hippocampus and the entorhinal, perirhinal and parahippocampal cortices). Recently, an important aspect of these studies was questioned by Ringo (Behav. Brain Res., 42 (1991) 123-134). He suggested that the data from the delayed non-matching-to-sample task, which has been extensively used in these studies, have been analyzed in a potentially misleading way. He reanalyzed the data from several laboratories by transforming percent correct data to a discriminability (d') measure based on signal detection theory. In monkeys with lesions, performance appeared to be equivalently impaired at short and long retention delays. He concluded that the data do not support the idea that medial temporal lobe damage produces an impairment in long-term memory, but not short-term memory. However, most of the studies he analyzed were not designed to address the distinction between short-term and long-term memory. We show here that, in studies designed to compare short-term and long-term memory directly, medial temporal lobe lesions impair long-term memory while leaving short-term memory intact. This result is obtained whether the data are analyzed using a percent correct measure, the d' measure, or an arcsine transform.

Organization of CA1 projections to the subiculum: a PHA-L analysis in the rat.

The organization of CA1 projections to the rat subiculum was investigated with the anterograde tracer, Phaseolus vulgaris leucoagglutinin (PHA-L). Discrete iontophoretic injections of PHA-L were placed into various transverse positions of the CA1 field at different septotemporal levels of the hippocampus. The distribution of CA1 projections was observed in dissected and extended hippocampal preparations. CA1 cells located proximally in the field, i.e., close to the CA2 field, gave rise to projections that terminated in the distal third of the subiculum, i.e., close to the presubiculum. CA1 cells located distally in the field, i.e., close to the subiculum, gave rise to projections that terminated proximally in the subiculum, i.e., just across the CA1/subiculum border. CA1 cells in the middle of the field projected to a midtransverse portion of the subiculum. The same general pattern of projections was observed at all septotemporal levels of the hippocampus. Varicose fibers from the CA1 neurons terminated among the basal dendrites of the subicular pyramidal cells, within the pyramidal cell layer, and in the deep portion of the molecular layer. In addition to the CA1 to subiculum projections, the discrete PHA-L injections provided the opportunity of examining the extent of local and associational connections within CA1. In general, associational connections in CA1 are far less extensive than in CA3. CA1 is not entirely without local connections, however. CA1 cells located close to the subicular border, for example, originated axons that first innervated the proximal subiculum and then reentered the CA1 field at the interface between stratum radiatum and stratum lacunosum-moleculare. In most of the experimental cases, there were collaterals located in stratum oriens of CA1 that branched from the fibers directed toward the subiculum. Thus, the basal dendrites of CA1 cells may receive associational inputs. The organization of the CA1 projections to the subiculum is discussed in relation to the organization of CA3 projections to CA1 and the differential output of transverse regions of the subiculum. The possibility is raised that information may be "channeled" through the hippocampal formation via the transverse organization of these connections and ultimately distributed to different recipients of hippocampal efferent projections.

Stereotaxic lesions of the hippocampus in monkeys: determination of surgical coordinates and analysis of lesions using magnetic resonance imaging.

A technique is described for producing accurate stereotaxic lesions of the hippocampus in monkeys. This technique overcomes the problem that the size and shape of the brain can vary considerably from monkey to monkey. Magnetic resonance imaging (MRI) is used to create an individual brain atlas for each monkey. The atlas is then used to derive coordinates for making stereotaxic radio frequency lesions of the hippocampus. There are two key features of this procedure. First, a specially-designed, acrylic, stereotaxic headholder was constructed that could be used safely with the MR magnet. Second, small glass beads, anchored to the skull of the monkey, served as common landmarks from which lesion coordinates were determined in the MR images and then again in neurosurgery. MRI techniques are also described for determining the extent of tissue damage postoperatively. This technique could also prove useful in other areas of neuroscience research that depend on accurate stereotaxic placement of electrodes (e.g., electrophysiological studies and neuroanatomic tracing studies).

Independence of memory functions and emotional behavior: separate contributions of the hippocampal formation and the amygdala.

Structures and connections in the medial temporal lobe of humans and nonhuman primates have long been recognized as important for normal memory and emotional behavior. The present study investigated memory and emotional behavior in normal monkeys and six groups of monkeys with lesions of the medial temporal lobe. Two groups had damage to the hippocampal formation (or adjacent perirhinal and parahippocampal cortex) but not the amygdaloid complex; two groups had either partial or complete damage to the amygdaloid complex but not the hippocampal formation; and two groups had damage to both the hippocampal formation and the amygdaloid complex. Memory was evaluated with three tasks sensitive to human amnesia: (1) delayed nonmatching to sample; (2) retention of object discriminations; and (3) concurrent discrimination learning. Emotional behavior was assessed by measuring the responsiveness of monkeys to 12 different stimulus situations. Damage to the hippocampal formation or anatomically related cortex impaired memory but did not affect emotional behavior. Partial or complete damage to the amygdaloid complex affected emotional behavior but not memory. These findings show that memory impairment and abnormal emotional behavior are anatomically dissociable and independent effects of damage to the medial temporal lobe.