Presence of an extra chromosome alters meiotic double-stranded break repair dynamics and MLH1 foci distribution in human oocytes.

Studies performed on human trisomic 21 oocytes have revealed that during meiosis, the three homologues 21 synapse and, in some cases, achieve what looks like a trivalent. This implies that meiotic recombination takes place among the three homologous chromosomes 21, and to some extent, crossovers form between them. To see how meiotic recombination is in the presence of an extra chromosome 21, we analyzed the distribution of three recombination markers (γH2AX, RPA, and MLH1) on trisomic 21 oocytes at pachynema and, in particular, on chromosomes 21. Results clearly show how the presence of an extra chromosome 21 alters meiotic recombination progression, leading to the presence of a higher number of early recombination markers at pachynema. Moreover, the distribution on these chromosomes 21 of some of these markers is different in aneuploid oocytes. Finally, there is a substantial increase in the number of MLH1 foci, a marker of most crossovers in mammals, which is related to the number of synapsed chromosomes in pachynema. Thus, bivalents 21 had fewer MLH1 foci than partial or total trivalents, suggesting a close relationship between synapsis and crossover designation. All of the data presented suggest that the presence of an extra chromosome alters meiotic recombination globally in aneuploid human oocytes.

Interstitial disease associated with connective tissue disease and vasculitis.

Systemic autoimmune diseases comprise a complex, heterogeneous group of entities. Noteworthy among the pulmonary complications of these entities is interstitial involvement, which manifests with the same radiopathologic patterns as in idiopathic interstitial pneumonia. High-resolution computed tomography is the gold-standard imaging technique; it enables us to identify and classify the disease and to determine its extent, providing useful information about the prognosis. In this group of processes, the most common pattern of presentation is nonspecific interstitial pneumonia. It is essential for radiologists to work together in collaboration with other specialists to reach the correct diagnosis and enable appropriate, integrated treatment.

Human meiotic progression and recombination are affected by Bisphenol A exposure during in vitro human oocyte development.

BACKGROUND: Bisphenol A (BPA) is a 'weak' endocrine disruptor. The effect of BPA on human reproduction is controversial but has been related to meiotic anomalies, recurrent miscarriages and abnormal karyotypes. METHODS: To evaluate the effects of BPA on survival, pairing-synapsis and meiotic recombination of human fetal oocytes, 21 510 oocytes from 12 cultured fetal ovaries were analyzed. Ovaries were cultured for 7, 14 or 21 days in control medium, dimethylsulfoxide-medium, BPA-medium and estradiol (E(2))-medium. Meiotic pairing-synapsis and recombination were studied by immunofluorescence against lateral element protein, central element protein of the synaptonemal complex and chromosome axis cohesin REC8. Mismatch repair protein, MLH1, was used as a crossover (CO) marker. Meiotic progression was analyzed following the number of surviving oocytes at different meiotic stages found in each culture time and condition, and the total number of MLH1 foci found in oocytes from cultured ovaries. RESULTS: Oocyte survival in vitro decreased with the addition of BPA to the medium (1 µM or greater). Oocyte degeneration was up to five times higher when BPA was added to culture medium. Moreover, oocytes exposed to BPA concentrations of 10 µM or higher presented approximately two times more MLH1 foci than unexposed cultured oocytes (P = 0.01). This was also observed in chromosome 21 from BPA-exposed oocytes, which had double the average number of MLH1 foci found in control oocytes (P = 0.001). E(2) was used as a positive control of estrogen receptors activity, and E(2) addition to the medium had similar effects on meiotic progression of oocytes from cultured ovaries. CONCLUSIONS: Our findings show that BPA concentrations of 1 µM or higher decrease the survival of human fetal oocytes in vitro, and concentrations of 10 µM or higher increase MLH1 foci number. MLH1 is considered a CO marker, and thus an increase in MLH1 foci could indicate an increase in COs in BPA-exposed oocytes. These data suggest that BPA can act as a toxic substance, which has particular implications for human females and the critical events of meiotic prophase, such as pairing-synapsis and recombination processes, as well as oocyte survival.

Cytogenetic analyses of human oocytes provide new data on non-disjunction mechanisms and the origin of trisomy 16.

BACKGROUND: Nowadays, oocyte donation is an extended practise in IVF programmes. However, to date, little information on aneuploidy frequency in oocytes from donors is available. Aneuploidy is one of the major causes of embryo and fetal wastage as well as of congenital mental and developmental disabilities. It is known that most aneuploidies are due to non-disjunction events occurring in the maternal germ line. Linkage studies have associated abnormal patterns of meiotic recombination to the origin of the non-disjunction event in many aneuploid conditions. METHODS AND RESULTS: In the present study, we analyse the frequency of chromosome imbalances in a series of metaphase I (MI; n = 44) and metaphase II (MII; n = 103) oocytes from 140 young donors (aged from 18 to 35 years, mean age 26.6) after hormone-induced superovulation. The aneuploidy frequency found in MII oocytes was 12.6%, and both whole-chromosome non-disjunction (1.94%) and premature separation of sister chromatids (PSSC) (12.6%) have been found. The chromosomes involved have been identified by multiplex fluorescent in situ hybridization (FISH). Achiasmate chromosomes have been identified in MI oocytes (9.1%), with most of them corresponding to chromosome 16 (6.8%). For this reason, the meiotic recombination pattern of chromosome 16 has been analysed in prophase I oocytes (n = 81) by immunofluorescence staining against MLH1 protein and subsequent FISH with specific probes. Our results show a percentage of oocytes with non-crossover bivalent 16 (2.5%) and a high percentage of bivalents 16 with a single exchange (19.8%). CONCLUSIONS: In the present study, we report the finding of a considerable frequency of aneuploidy in oocytes from young donors, with the frequency of PSSC being higher than the frequency of whole-chromosome non-disjunction. In addition, we report vulnerable patterns of meiotic recombination in chromosome 16 that may be at risk of leading to a non-disjunction event. This gives new data on the susceptibility of the control population to conceive a trisomic 16 embryo.

A new culture technique that allows in vitro meiotic prophase development of fetal human oocytes.

BACKGROUND: Little is known about the mechanisms that regulate meiosis in the human female fetus as a result of the technical difficulties in obtaining samples. Currently, there is no technique for human fetal oocyte culture that permits the maintenance of fetal ovarian tissue in vitro which allows the progression of meiosis in a reproducible and standardized way. METHODS: Meiotic progression was analyzed following pairing-synapsis and recombination progress. A total of 7119 oocytes were studied and analyzed. The proteins used to evaluate meiotic progression were: REC8, SYCP1, SYCP3 and MLH1, studied by immunofluorescence. Four different sample disaggregating methods were used, two enzymatic (trypsin and collagenase + hyaluronidase) and two mechanical (puncture and ovarian fragments). Two different culture media were used, control media and stem cell factor (SCF)-supplemented media. The oocytes were studied at initial time T0, and then at T7, T14 and T21 days after culture. RESULTS: The mechanical methods increased the total number of oocytes found at the different times of culture and decreased the number of degenerated oocytes. Independently of the disaggregation method used, oocytes cultured with SCF-supplemented media showed a higher proportion of viable oocytes and fewer degenerated cells at all culture timepoints. No evidence of abnormal homologous chromosome synapsis was observed. Meiotic recombination was only observed in oocytes mechanically disaggregated and cultured with supplemented media. CONCLUSIONS: The oocytes obtained by mechanical disaggregating methods and cultured with SCF-supplemented media are able to follow pairing-synapsis and recombination, comparable to oocytes in vivo. The culture conditions described herein confirm the methodology as a standardized and reproducible method.

Functional analysis of mTERF5 and mTERF9 contribution to salt tolerance, plastid gene expression and retrograde signalling in Arabidopsis thaliana.

We previously showed that Arabidopsis mda1 and mterf9 mutants, defective in the chloroplast-targeted mitochondrial transcription termination factors mTERF5 and mTERF9, respectively, display altered responses to abiotic stresses and abscisic acid (ABA), as well as perturbed development, likely through abnormal chloroplast biogenesis. To advance the functional analysis of mTERF5 and mTERF9, we obtained and characterized overexpression (OE) lines. Additionally, we studied genetic interactions between sca3-2, affected in the plastid-RNA polymerase RpoTp, and the mda1-1 and mterf9 mutations. We also investigated the role of mTERF5 and mTERF9 in plastid translation and plastid-to-nucleus signalling. We found that mTERF9 OE reduces salt and ABA tolerance, while mTERF5 or mTERF9 OE alter expression of nuclear and plastid genes. We determined that mda1-1 and mterf9 mutations genetically interact with sca3-2. Further, plastid 16S rRNA levels were reduced in mda1-1 and mterf9 mutants, and mterf9 was more sensitive to chemical inhibitors of chloroplast translation. Expression of the photosynthesis gene LHCB1, a retrograde signalling marker, was differentially affected in mda1-1 and/or mterf9 compared to wild-type Col-0, after treatments with inhibitors of carotenoid biosynthesis (norflurazon) or chloroplast translation (lincomycin). Moreover, mterf9, but not mda1-1, synergistically interacts with gun1-1, defective in GUN1, a central integrator of plastid retrograde signals. Our results show that mTERF9, and to a lesser extent mTERF5, are negative regulators of salt tolerance and that both genes are functionally related to RpoTp, and that mTERF9 is likely required for plastid ribosomal stability and/or assembly. Furthermore, our findings support a role for mTERF9 in retrograde signalling.

ATR, BRCA1 and gammaH2AX localize to unsynapsed chromosomes at the pachytene stage in human oocytes.

Asynapsis of homologous chromosomes at the pachytene stage has been associated with gametogenic failure and infertility, but the cellular mechanisms involved are currently unknown in human meiocytes. In mice, the protein encoded by the breast-cancer susceptibility gene Brca1 has been described to direct kinase ATR (ataxia telangiectasia and Rad3 related) to any unpaired DNA at the pachytene stage, where ATR triggers H2AX phosphorylation, resulting in the silencing of those chromosomes. In this study, the distribution of ATR, BRCA1 and the phosphorylated histone gammaH2AX is assessed by immunofluorescence in human oocytes and it is found that they localize at unpaired chromosomes at the pachytene stage. Evidence is shown to propose that BRCA1, ATR and gammaH2AX in the human may be part of a system such as the one previously described in mouse, which signals unsynapsed chromosomes at pachytene and may lead to their silencing.

Analysis of recombination along chromosome 21 during human female pachytene stage.

It is accepted that recombination errors during human female meiotic prophase have some influence on the origin of trisomy 21. A total of 335 oocytes from four euploid fetuses were analysed by immunofluorescence and fluorescence in-situ hybridization in order to assess the recombination nodules along chromosome 21. Results based on the analysis of recombination points on the bivalent 21 during human female meiosis showed that both number [none (3.70%), one (79.01%) and two (17.29%)1 and distribution (always positioned interstitially on the q-arm) are different in males, ensuring that the two homologues more efficiently remain together until anaphase 1.Therefore, the mainly maternal origin of trisomy 21 appears not be linked to the first stages of oocyte development during fetal life, and this leads to the suggestion that the influence of environmental factors on the segregation of chromosome 21 homologues in later meiotic stages could have a significant role in the predominant maternal origin of trisomy 21.

Proporción sexual y hermafroditismo del molusco, Anadara tuberculosa (Bivalvia: Arcidae) en Panamá / Sexual proportion and hermaphroditism of the mollusc, Anadara tuberculosa (Bivalvia: Arcidae) in Panama

Introducción: El bivalvo Anadara tuberculosa es un recurso pesquero y económico importante en el Pacífico Este Tropical. La proporción sexual varia a lo largo de su área de distribución, con casos de aparición de hermafroditismo, ocasional para algunas poblaciones, normal en otras. Estas características podrían ser una respuesta a presiones antropogénicas y ambientales. Objetivo: Evaluar la proporción sexual y el hermafroditismo en la especie en el Pacífico de Panamá. Métodos: Se analizó información reproductiva de A. tuberculosa generada entre 1994 y 2020 para el Golfo de Montijo, así como datos de 2017 para el manglar de David. Se aplicaron procedimientos macroscópicos, contrastados con histológicos y se generó un factor de corrección para ajustar la proporción sexual macroscópica, debido al efecto, sobre la proporción sexual, que ocasiona los organismos indeterminados. Resultados: Para el Golfo de Montijo, la histología indicó una proporción sexual hembra a macho de 1:1 hasta 3.2:1, entre 1994 y 2017, mientras que la macroscopía varió de 1.9:1 a 5.1:1 entre 2004 y 2020. Para el manglar de David, la histología indicó una proporción sexual de 3.7:1, y de 7.9:1 por macroscopía en el 2017. En ambas localidades, especímenes más grandes mostraron mayor variación en la proporción sexual, pese a la técnica implementada, así como hermafroditismo protándrico no casual en el 2017. Conclusiones: La aparición del hermafroditismo protándrico y los cambios en la proporción sexual indican que la población de A. tuberculosa, en ambas localidades, está respondiendo a presiones antropogénicas y ambientales.

Introduction: The bivalve Anadara tuberculosa is an important fishery in the Eastern Tropical Pacific. The sex ratio varies along its geographic range and there are cases of hermaphroditism, occasional in some populations, normal in others. These characteristics may be a response to anthropogenic and environmental pressure. Objective: To evaluate sex ratio and hermaphroditism of the species in the Panamanian Pacific. Methods: Data on reproductive features of A. tuberculosa generated between 1994 and 2020 for Gulf of Montijo, as well as 2017 data from mangroves of David was analyzed. Macroscopic diagnosis of individual sex is sensitive to the problem of indeterminate individuals, which in turn can skew the sex ratio analysis; therefore, the macroscopic method was compared with histological sections to generate a correction factor to adjust the macroscopically determined sex ratio. Results: For Montijo, histology indicated that the female to male sex ratio ranged from 1:1 to 3.2:1 between 1994 and 2017, while macroscopy indicated 1.9:1 to 5.1:1 between 2004 and 2020. For David, histology indicated a ratio of 3.7:1, and macroscopy 7.9:1. At both localities, larger specimens had more sex ratio variation, independently of the technique, and there was non-casual protandric hermaphroditism in 2017. Conclusion: The occurrence of protandric hermaphroditism and sex ratio changes suggest anthropogenic and environmental pressure in all populations.

[Advance directives. Representatives' opinions]. / Los documentos de voluntades anticipadas. La opinión de los representantes.

INTRODUCTION: The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. OBJECTIVE: To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. METHODS: Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. RESULTS: More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. CONCLUSION: The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying.

Estructura de tallas, distribución y abundancia de Anadara tuberculosa (Bivalvia: Arcidae) en dos sistemas de manglar del Pacífico de Panamá / Size structure, distribution, and abundance of Anadara tuberculosa (Bivalvia: Arcidae) in two mangrove systems from the Pacific Coast of Panama

Resumen Introducción: Anadara tuberculosa es un recurso pesquero y económico importante, propio de los ecosistemas de manglar en el Pacífico Orienta Tropical. Objetivo: El objetivo del estudio fue analizar la estructura de tallas, distribución y densidad de A. tuberculosa, en el Golfo de Montijo y Manglares de David, para evaluar el estado del recurso en los dos sistemas de manglar del Pacífico de Panamá. Métodos: Los datos corresponden a información histórica de tallas y densidad levantada entre el 2004 y 2020 para el Golfo de Montijo (GM), así como datos de tallas, densidades y distribución levantados en el 2016 de manera simultánea en 51 cuadrantes en GM y 56 cuadrantes en Manglares de David (MD), muestreados en temporada seca, transición, lluviosa y transición, donde además se registró la temperatura, la salinidad y el pH del agua del canal y del agua retenida en el manglar. En el 2016 se instalaron y muestrearon cuadrantes fijos para seguimiento de densidades, muestreo que se repitió en el 2019. En el 2019 se establecen transectos desde el borde del manglar con el canal principal, hasta límite con tierra firme y en cada transecto se instalaron tres cuadrantes, en los estratos inicial, medio y final. Resultados: Los ejemplares del Golfo de Montijo resultaron más grandes, pero la densidad resultó superior en Manglares de David. La comparación de tallas por periodo de muestreo en el 2016, dentro de cada localidad, resultó significativa solo para el Golfo de Montijo, donde las mayores tallas se presentaron en marzo y junio y las menores en octubre-diciembre. No se encontró asociación entre la temperatura, salinidad y pH, y la distribución del molusco. Para el Golfo de Montijo se encontró un descenso sostenido de las densidades desde 1.82 conchas/m2 en el 2004 hasta 0.6 conchas/m2 en el 2019, contrario a lo observado en la estructura de tallas, donde se observó predominio de las tallas superiores a los 50 mm de longitud total y un aumento de la talla promedio de captura de 52.62 mm en el 2004 a 59.28 mm en el 2020. Atendiendo a la distancia del canal principal, se determinó la presencia del molusco hasta poco más de dos kilómetros dentro del manglar y hasta más de 500 m del canal secundario más cercano, así como una disminución de la densidad y un aumento de la talla conforme nos acercamos a tierra firme. Conclusiones: Para A. tuberculosa, la combinación de una estructura de tallas sobre los 50 mm y de bajas densidades, indican que la población de concha negra en el Golfo de Montijo presenta un grado de deterioro, asociado a estresores pesqueros y ambientales.

Abstract Introduction: Anadara tuberculosa is an economically important fishery resource of mangrove ecosystems in the tropical Eastern Pacific. Objective: The objective of this study was to analyze the size structure, distribution, and density of A. tuberculosa, in the Gulf of Montijo (GM) and Mangroves of David (MD) in the Panamanian Pacific, to assess the state of the resource in Panama's two Pacific mangrove systems. Methods: We analyzed Gulf of Montijo historical clam size records and densities from 2004 and 2020. Hundred and seven 30 m2 permanent plots (51 from GOM and 56 from MOD) were set and sampled in 2016 at four time intervals (dry season, transition into rainy, rainy season and transition into dry season) to obtain clams sizes, densities and distributions. The plots were sampled again in 2019. Physical variables such as temperature (°C), salinity (PSU) and pH from the water retained in the mangrove channels were also recorded. Nine transects were installed and sampled in 2019. Three at the seaward edge of the mangrove fringe, three at the inshore edge, and three half-way between the first two. Three quadrats were sampled at the beginning, middle and end of each transect. Results: Gulf of Montijo A. tuberculosa were found to larger but at lower densities than those from Mangroves of David. At each site, size comparison by sampling period, were statistically significant only for GOM, where larger sizes were found in March and July and smaller sizes in October-December. There was no correlation between the distributions of A. tuberculosa and temperature, salinity and pH. A sustained decrease in A. tuberculosa densities was found for GOM (1.82 ind/m2 in 2004 to 0.6 ind/m2 in 2019). This contrast with the predominantly larger clam sizes above 50 mm in total length and an increase in mean size of collected individuals (52.62 mm in 2004 to 59.28 mm in 2020). Specimens of A. tuberculosa were found up to slightly more than 2 km inshore from the main channel and within slightly more than 500 m from a secondary channel. Clam densities decreased and sizes increased in a seaward-inshore direction. Conclusions: For A. tuberculosa, the combination of size classes larger than 50 mm and low densities of individuals is evidence of population deterioration associated to fishery and environmental stressors.

A mutational analysis of leaf morphogenesis in Arabidopsis thaliana.

As a contribution to a better understanding of the developmental processes that are specific to plants, we have begun a genetic analysis of leaf ontogeny in the model system Arabidopsis thaliana by performing a large-scale screening for mutants with abnormal leaves. After screening 46,159 M2 individuals, arising from 5770 M1 parental seeds exposed to EMS, we isolated 1926 M2 putative leaf mutants, 853 of which yielded viable M3 inbred progeny. Mutant phenotypes were transmitted with complete penetrance and small variations in expressivity in 255 lines. Most of them were inherited as recessive monogenic traits, belonging to 94 complementation groups, which suggests that we did not reach saturation of the genome. We discuss the nature of the processes presumably perturbed in the phenotypic classes defined among our mutants.

Genetic analysis of incurvata mutants reveals three independent genetic operations at work in Arabidopsis leaf morphogenesis.

In an attempt to identify genes involved in the control of leaf morphogenesis, we have studied 13 Arabidopsis thaliana mutants with curled, involute leaves, a phenotype herein referred to as Incurvata (Icu), which were isolated by G. Röbbelen and belong to the Arabidopsis Information Service Form Mutants collection. The Icu phenotype was inherited as a single recessive trait in 10 mutants, with semidominance in 2 mutants and with complete dominance in the remaining 1. Complementation analyses indicated that the studied mutations correspond to five genes, representative alleles of which were mapped relative to polymorphic microsatellites. Although most double-mutant combinations displayed additivity of the Icu phenotypes, those of icu1 icu2 and icu3 icu4 double mutants were interpreted as synergistic, which suggests that the five genes studied represent three independent genetic operations that are at work for the leaf to acquire its final form at full expansion. We have shown that icu1 mutations are alleles of the Polycomb group gene CURLY LEAF (CLF) and that the leaf phenotype of the icu2 mutant is suppressed in an agamous background, as is known for clf mutants. In addition, we have tested by means of multiplex RT-PCR the transcription of several floral genes in Icu leaves. Ectopic expression of AGAMOUS and APETALA3 was observed in clf and icu2, but not in icu3, icu4, and icu5 mutants. Taken together, these results suggest that CLF and ICU2 play related roles, the latter being a candidate to belong to the Polycomb group of regulatory genes. We propose that, as flowers evolved, a new major class of genes, including CLF and ICU2, may have been recruited to prevent the expression of floral homeotic genes in the leaves.

Pleuropulmonary infections caused by Mycobacterium bovis: a re-emerging disease.

Between 1980 and 2003, 13 patients (0.95% of all cases of tuberculosis) at a 600-bed university hospital in Madrid, Spain, were diagnosed with Mycobacterium bovis infection. All 13 cases occurred between 1994 and 1999; the mean age of the patients was 50 years (range 23-83 years), and 77% were males. Four (30%) patients were also positive for human immunodeficiency virus (HIV). The most frequent localisation of the disease was the lung (ten patients; 77%). Seven patients, including four HIV-positive patients who died, had multidrug-resistant M. bovis infection. No other patient died, including two HIV-negative patients with multidrug-resistant disease.

Optical absorption for parallel cylinder arrays.

We study the long-wavelength electromagnetic resonances of interacting cylinder arrays. By using a normal-modes expansion where the effects of geometry and material are separated, it is shown that two parallel cylinders with different radii have electromagnetic modes distributed symmetrically about depolarization factor 1 / 2. Both sets couple to longitudinal and transverse components of the external field, but amplitudes of symmetric depolarization factors become exchanged when considering longitudinal or transverse polarization. We also find that amplitudes satisfy sum rules that depend on the ratio of the cylinders radii. The main effect of the difference in radii is a spectral shift towards the isolated cylinder resonance as this difference increases.

[Prosthetic endocarditis and splenic abscess caused by Clostridium clostridiformis]. / Endocarditis protésica y absceso esplénico causados por Clostridium clostridiformis.

We report the first case of Clostridium clostridiformis endocarditis in a 71 year old man with an aortic prosthetic valve. He was febrile with left upper quadrant pain and left lower lobe infiltrate in chest X ray. The diagnosis was made by gram-positive bacilli grown from three blood cultures. Transthoracic and transesophageal echocardiogram showed a paraaortic abscess. A computed tomographic scan of the abdomen revealed a large splenic abscess. He received penicillin G 4 million units every 4 hours intravenously. A successful percutaneous drainage guided computed tomographic scan was performed. The patient remained febrile and a new computed tomographic scan of the abdomen revealed residual splenic abscess. A splenectomy was performed. The patient defervesced on the second day of surgery and remained afebrile during the remainder of his hospitalization. He has returned for medical follow-up and two years later the patient is asymptomatic.

[Aortic prosthetic endocarditis and periprosthetic abscess caused by Staphylococcus aureus]. / Endocarditis protésica aórtica y absceso periprotesico por Staphylococcus aureus.

Prosthetic endocarditis with annular abscess formation is a severe complication of cardiac valve replacement fortunately uncommon, though highly lethal. Increasing surgical experience and the high mortality with medical management have led to a widespread recommendation for early prosthetic replacement. We report a case of a 49 year old man with infective endocarditis due to Staphylococcus aureus in aortic ascendens prosthetic and aortic valve prosthetic complicated with periaortic abscess which was as successful treatment by drain of abscess without prosthetic replacement.

[Biventricular diverticulosis associated with rheumatic heart disease: apropos of a case]. / Diverticulosis biventricular asociada a cardiopatía reumática: a propósito de un caso.

We report a case of a 58-year-old woman with rheumatic mitral stenosis scheduled for percutaneous valvuloplasty. Prior left and right ventricular angiograms showed multiple diverticula at left ventricular apical and diaphragmatic walls and right ventricular diaphragmatic wall. Chest x-ray and echocardiogram were normal. Magnetic resonance imaging was concordant with catheterization findings and ruled out other cardiac malformations. The risk of ventricular perforation changed our indication of percutaneous valvuloplasty in favor of open heart commissurotomy.

[Information about operative risk: opinions of the physicians and patients involved]. / Información sobre los riesgos operatorios: opinión de los medicos implicados y de los pacientes.

OBJECTIVE: To know the opinion of physicians in charge of informing patients about operative risks, to know how they impart the information and how they think it ought to be explained, and to compare their opinions with those of patients. PATIENTS AND METHODS: Attitude survey. Written questionnaires were given to all surgeons and anesthesiologists at our hospital (143) and to a sample of patients undergoing surgery (90). Results were compared by age, sex, responsibility, and specialty. A chi-squared test was used to compare results if the necessary conditions were met; otherwise, a Fisher exact test was used. RESULTS: Sixty percent of the doctors always inform patients about risks and 51% of the patients report having been so-informed. Information is given out of respect for the patient's desire for information and to prepare the patient for possible complications. Both the patient and the family are considered the recipients of information equally, according to all doctors except gynecologists, for whom the patient is the one who must be informed. There is little agreement among doctors about criteria for giving information about possible complications. Both surgeons and anesthesiologists believe that risks arising from associated diseases are the responsibility of the anesthesiologist. The doctors believe that information should be both oral and written and that a doctor is obliged to inform a patient about risks. More surgeons (71%) than anesthesiologists (29%) always give information about risks, and patients report learning more about surgical risks (51%) than anesthetic risks (46%). Residents give the least information and young male patients declare themselves to be the best informed. CONCLUSION: Information about operative risk is not widespread even though patients know they have a right to be so-informed.

[Validation, adaptation and translation of the MacCAT-T into Spanish: a tool to assess the ability to make health decisions]. / Validación, adaptación y traducción al castellano del MacCAT-T: herramienta para evaluar la capacidad en la toma de decisiones sanitarias.

INTRODUCTION: Capacity assessment is an essential element of the informed consent process and is the duty of the physician. The MacCAT-T instrument explores four skills needed to consent a treatment. There is no Spanish version, and the main objective of this work is to validate, adapt and translate the MacCAT-T into Spanish. MATERIAL AND METHODS: The MacCAT-T was translated into Spanish and then back-translated into English. It was validated as regards its appearance and content (by 15 experts), construct (inter-rater reliability and internal consistency) and criteria (the validity of an instrument by comparing it to some external criterion, in this case the Mini Examen Cognoscitivo de Lobo). Ninety medical and surgical outpatients over 18 years were included with no deficits of expression and/or severe disorders of consciousness that did not allow them to be interviewed. RESULTS: They have been optimal considering different types of validity. The average application time was between 9 and 13minutes. DISCUSSION: Data are consistent with those obtained in other applications of MacCAT-T in the English language and facilitate the provision of a Spanish tool for assessing capacity.