Functional patterns of cytomegalovirus (CMV) pp65 and immediate early-1-specific CD8(+) T cells that are associated with protection from and control of CMV DNAemia after allogeneic stem cell transplantation.

BACKGROUND: The functional profile of cytomegalovirus (CMV)-specific CD8(+) T cells that associate with protection from and control of CMV DNAemia in allogeneic stem cell transplant (allo-SCT) recipients remains incompletely characterized. METHODS: We enumerated pp65 and immediate early (IE)-1-specific CD8(+) T cells expressing interferon-gamma, tumor necrosis factor-alpha, and CD107a, by flow cytometry in 94 patients at days +30 and +60 after allo-SCT. RESULTS: Fifty of 94 patients had CMV DNAemia within the first 100 days after transplant. CMV-specific CD8(+) T-cell responses (of any functional type) were more likely to be detected in patients who did not display CMV DNAemia than in those who did (P = 0.04). Qualitatively, no major differences in the functional signature of CMV-specific CD8(+) T cells were noted between patients who had or did not have CMV DNAemia. Patients displaying levels of polyfunctional CD8(+) T cells at day +30 >0.30 cell/µL had a lower risk of CMV DNAemia (positive predictive value 76%, and negative predictive value 43%). CONCLUSION: The presence of polyfunctional CD8(+) T cells (either expressing CD107a or not) was associated with lower levels of CMV replication, and higher frequency of self-resolved episodes. The data reported further clarify the role of polyfunctional CD8(+) T cells in control of CMV DNAemia in allo-SCT recipients.

Optical coherence tomography predictive factors for macular hole surgery outcome.

AIM: To evaluate the use of preoperative optical coherence tomography (OCT) findings as predictive factors for macular hole (MH) surgery outcomes. METHODS: 46 eyes from 46 patients with a diagnosis of MH were included in this study. In all cases, a pars plana 25-gauge vitrectomy with peeling of the internal limiting membrane was performed. Before and after surgery, a complete clinical examination and a detailed macular analysis, which included the MH minimum and base diameter, the MH height, the Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI), were performed. Predictive factors for visual prognosis after surgery were obtained by receiver operating characteristic curve analysis. RESULTS: Minimum and base diameter as well as THI and MHI correlated significantly (p<0.01, p = 0.01, p = 0.04, p = 0.03, respectively) with postoperative best spectacle corrected visual acuity at 3 months, but DHI and MH height did not. Cut-off values of 311 microm and 1.41 were obtained for the minimum diameter and THI, respectively, from receiver operating characteristic curve analysis, providing an acceptable sensitivity and specificity. CONCLUSION: An MH minimum diameter of <311 microm or a THI >1.41 are predictive factors for a good visual prognosis after MH surgery.

Microinjection of urocortin 2 into the dorsal raphe nucleus activates serotonergic neurons and increases extracellular serotonin in the basolateral amygdala.

The intra dorsal raphe nucleus (DRN) administration of corticotropin releasing hormone (CRF) inhibits serotonergic (5-HT) activity in this structure, an effect blocked by antagonists selective for the type 1 CRF receptor (CRF1). The DRN has a high density of the type 2 receptor (CRF2), and so the present experiments explored the impact of CRF2 activation within the DRN on 5-HT function. The intra-DRN administration of the selective CRF2 agonist urocortin 2 (Ucn 2) dose dependently increased 5-HT efflux in the basolateral amygdala, a projection region of the DRN. Intra-DRN Ucn 2 also increased c-fos expression in labeled 5-HT neurons. Both of these effects of Ucn 2 were completely blocked by intra-DRN antisauvagine-30 (ASV-30), a relatively selective CRF2 antagonist. These data suggest that CRF1 and CRF2 activation within the DRN affect 5-HT neurons in opponent fashion. Implications of these results for understanding the behavioral effects of CRF and other CRF-like ligands are discussed.

A second look at the barriers of the medial basal hypothalamus.

The cell bodies of hypothalamic secretory neurons are localized in areas protected by the blood-brain barrier (BBB), whereas their axon terminals are localized in the median eminence, which lacks a BBB. This implies a complex barrier system, allowing neurons of the central nervous system to secrete into the blood stream without making the BBB leaky. In the present study, three experimental protocols were applied to clarify certain relevant aspects of the barriers operating in the medial basal hypothalamus of the rat. We established that the milieu of the arcuate nucleus is exposed to both the ventricular and the subarachnoidal cerebrospinal fluid (CSF). The median eminence milieu, the perivascular space of the portal vessels, and the subarachnoid space appear to be in open communication; also, beta2-tanycytes establish an efficient barrier between the median eminence milieu and the ventricular CSF. Similarly, beta1-tanycytes establish a lateral barrier, separating the intercellular space of the median eminence from that of the arcuate nucleus. We also found that the glucose transporter I (GLUT I), a BBB marker, is localized throughout the whole plasma membrane of beta1-tanycytes, but is missing from beta2-tanycytes. Expression of GLUT I by tanycytes progressively develops during the first postnatal weeks; while the degree of damage of the arcuate nucleus by administration of monosodium glutamate, at different postnatal intervals, parallels that of the GLUT I immunoreactivity of beta1-tanycytes. An explanation is offered for the selective destruction of the arcuate neurons by the parenteral administration of monosodium glutamate to infant rats.

Colecistectomía laparoscópica en pacientes con cirugía del abdomen superior / Laparoscopic cholecystectomy in patients with upper abdominal surgery

Hasta hace poco tiempo, la existencia de cirugía previa en el abdomen superior era una contraindicación para practicar la colecistectomía laparoscópica. Presentamos nuestros 12 primeros pacientes operados, 10 mujeres y 2 hombres. La cirugía previa más frecuente practicada fue la gástrica por úlcera duodenal. En el 83,4 por ciento se completó el procedimiento, con un índice de conversión del 16,6 por ciento. No hubo morbilidad ni mortalidad. Como conclusión, la existencia de cirugía previa en el abdomen superior no contraindica la CL. Se requiere eso sí, una mayor experiencia en la técnica laparoscópica y un instrumental más completo.

Tratamiento paliativo del cáncer de esófago irresecable / Palliative treatment of the irresecable esophageal cancer

En nuestro medio el cáncer esofágico sigue diagnosticándose tardíamente, por lo cual el tratamiento quirúrgico con intención resectiva no excede el 30 por ciento. Al resto de los pacientes sólo se les puede ofrecer tratamientos paliativos. De un total de 224 enfermos portadores de esta localización de cáncer, 170 accedieron a esta última alternativa de tratamiento. Dilataciones periódicas, gastrostomías, prótesis endoluminales o puentes con ascenso de estómago o de un segmento de intestino grueso fueron los procedimientos terapéuticos utilizados en esta serie, motivo de este estudio. De ellos, la dilatación periódica es el que presenta menor morbimortalidad, y los procedimientos de puente están indicados cuando los pacientes en buenas condiciones generales presentan intensa disfagia, y la operación les permite una mejor calidad de vida en el corto o mediano plazo de sobrevida

[Bronchial asthma caused by occupational sulfite exposure]. / Asma bronquial por exposición laboral a sulfitos.

A case is reported of a patient with episodes of bronchospasm requiring hospital admission after handling sodium bisulfite on the job. The patient had a 15-year history of bronchial asthma and concomitant rhinoconjunctivitis and a 6-year history of asthma induced by moderate exercise. His family history included a father with sensitization to mites. Skin tests, measurement of specific IgI, and nasal provocation were positive for domestic dust mites and grass pollen. Skin tests for sodium metasulfite at a concentration of 10 mg/ml were negative. A simple blind oral provocation test of sodium metasulfite (1, 5, 20, and 50 mg) in acid medium was positive at the 50-mg dose, eliciting bronchial and nasal symptoms, and a decrease in CVF, FEV1, and PEF of more than 20% over baseline values. The episode of bronchospasm has not recurred in the workplace since exposure to sodium bisulfite was eliminated. Oral provocation with metasulfite in acid medium is considered a good technique for confirming the diagnosis of these cases.

Sustratos morfológicos de la vía ventricular de secreción y transporte de sustancias en la región tuberoinfundibular del hipotálamo: estudio ultraestructural / Morphologic substrates of the ventricular route of secretion and transport of substances in the tubero-infundibular region of the hypothalamus: ultrastructural study

Ultrastructural studies of the ependyma of the tuberoinfundibular region of the rat hypothalamus have revealed the existence of intraventricular axonal endings and of cytoplasmic blebs and bulbs that project from the apical surface of the ependymal cells to the ventricular lumen. All these structures account for the processes of ependymal apocrine secretion and the neuroventriculocrinia, and hence the release of biologically active substances into the cerebrospinal fluid (CSF). These substances contained in the CSF must act on the nervous nuclei of the tuberoinfundibular region, such as the arcuate nucleus, which is very important in the neuroendocrine regulation of the anterior pituitary gland. Dilated intercellular spaces among neighbouring ependymocytes of this region, small intraependymal cisternae and, in particular, a lateral prolongation of the infundibular recess, which courses through the nervous tissue between the arcuate nucleus and the median eminence from the vertex of the lateral angle of the infundibular recess, may be the route followed by the CSF from the third ventricle to the tissue compartment of the tuberoinfundibular region. Also studied are the cisternae of the region and the relationships of these with the lateral prolongation of the infundibular recess. Some of these cisternae may be filled by the CSF through the prolongation. In this way, the tissue compartment of CSF would be enlarged, and hence the ventricular route for the secretion and transport of biologically active substances would be potentiated

Obstrucción mecánica de intestino delgado: análisis de parámetros pronósticos / Mechanical obstruction of low intestine: analysis of prognostic parameters

Se analizan retrospectivamente 147 casos de obstrucción mecánica de Intestino delgado, entre los años 1986-1988. De ellos, un 54% son mujeres y 46% hombres. Se analizan diversos parámetros clínicos y de laboratorio para establecer la probabilidad de necrosis intestinal. De ellos, el único que demuestra utilidad es la desviación izquierda mayor de 20%. Las etiologías principales fueron bridas (63%) y hernias (23%). La morbilidad general fue de 39% y la mortalidad de 7,5%

[Post-pneumonectomy bronchial fistula. Treatment by resection of the carina]. / Fistules bronchiques post-pneumonectomie. Traitement par résection de carène.

A technique for the surgical treatment of bronchial fistulae developed after pneumonectomy is presented. This technique, which resembles that of Abruzzini, consists of resection of the carina followed by tracheo-bronchial suture in a healthy area away from any purulent focus of infection. It is easy to perform and facilitates the treatment of thoracic empyema which is no longer maintained by the fistula.

Changes in surface area and number of Leydig cells in relation to the 6 stages of the cycle of the human seminiferous epithelium.

In order to evaluate the occurrence of a Leydig cell cycle related to the cycle of the seminiferous epithelium in man, the numbers of peritubular Leydig cells and surface area of these cells along 1 mm of tubular basement membrane at each stage of the cycle were calculated on histological sections of young adult testes. The Leydig cells that were located separated from the tubules (perivascular Leydig cells) were also classified according to the stage of the cycle shown by the nearest seminiferous tubule; the surface area and number of these cells were also calculated. The total surface area and numbers of Leydig cells (peritubular plus perivascular) along 1 mm of tubular basement membrane did not change during the cycle of the seminiferous epithelium. Both the surface area and the numbers of peritubular Leydig cells were greater in stages I and II of the cycle, when spermatozoa are released; they decreased in stages III and IV and increased again in stages V and VI, whereas the contrary occurred in perivascular Leydig cells. The average surface area of each Leydig cell type remained constant throughout the stages of the cycle.

Testicular involution in elderly men: comparison of histologic quantitative studies with hormone patterns.

An endocrinologic and quantitative histologic study was carried out in 64 elderly men who underwent orchidectomy owing to prostatic carcinoma. The men were classified into age groups (decade of life), and each group was subdivided into group A (testes with complete spermatogenesis in most tubules) and group B (testes showing maturation arrest of spermatogenesis in most tubules). Up to 80 years of age, men of group A showed hormone levels and testicular parameters similar to those of young control men. From 50 to 60 years of age, men of group B showed a significant decrease in testicular volume, tubular volume, tubular length, number of germ cells, Sertoli cells and Leydig cells per testis, and plasma testosterone levels, whereas the tunica propria thickness and plasma levels of both follicle-stimulating hormone and luteinizing hormone were increased.

Gonadotropins and gonadal steroids in androgen insensitivity (testicular feminization) syndrome: effects of castration and sex steroid administration.

Gonadotropin control mechanisms were examined in 12 subjects with the complete syndrome of androgen insensitivity (testicular feminization). This study confirmed the presence of elevated luteinizing hormone (LH) and normal follicle-stimulating hormone (FSH) values in these subjects and suggests an intact feedback mechanism for FSH but not LH. This gives further credence to the opinion that estrogens and a nonsteroidal inhibin are important in FSH control. Because of an exaggerated pulsatile pattern of gonadotropins in intact and gonadectomized subjects, there were dramatic variations in gonadotropin levels. After gonadectomy, there was a marked rise in FSH and a further rise in LH. Administered estradiol benzoate and, to a lesser degree, testosterone propionate were capable of lowering LH levels. The effect of testosterone could be via conversion to estrogen(s) in the testes or elsewhere.

[Action of repeated doses of a beta-adrenergic in the response of plasma cyclic AMP in asthmatic patients]. / Acción de dosis repetitivas de un beta-adrenérgico en la respuesta del AMP cíclico plasmático en asmáticos.

The present work studies the behaviour of plasma cAMP after repeated doses of a beta mimetic currently used as a broncodilator in asthmatics. A group of patients repeatedly treated with Phenoterol showed increased cAMP values, particularly evident when compared with those obtained throughout the day. It is notable that this increase does not continue with treatment, but levels off and even shows some tendency to diminish. After the final dose of beta mimetic there is an abrupt fall of cAMP to initial (pre-treatment) values. It is suggested that the increase in nucleotide values is not maintained after repeated doses of beta-stimulants because asthmatics show a diminished response as a result of exhaustion or "tolerance" to the response. It is probable that, as in the case of some hormones, the receptors in the effector organs are exhausted.

Maternal plasma estrogens after dehydroepiandrosterone-sulfate injection into the fetus.

To study the biogenesis of estrogens by the fetoplacental unit in late pregnancy, dehydroepiandrosterone sulfate was injected directly into the fetus and maternal blood sampled at intervals for 2 hours thereafter. There was no increase of estrone, estradiol, or estriol concentration in the maternal circulation.