EACVI survey on radiation exposure in interventional echocardiography.

AIMS: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey on radiation exposure in interventional echocardiography. The survey aimed to collect data on local practices for radioprotection in interventional echocardiography and to assess the awareness of echocardiography operators about radiation-related risks. METHODS AND RESULTS: A total of 258 interventional echocardiographers from 52 different countries (48% European) responded to the survey. One hundred twenty-two (47%) participants were women. Two-thirds (76%) of interventional echocardiographers worked in tertiary care/university hospitals. Interventional echocardiography was the main clinical activity for 34% of the survey participants. The median time spent in the cath-lab for the echocardiographic monitoring of structural heart procedures was 10 (5-20) hours/month. Despite this, only 28% of interventional echocardiographers received periodic training and certification in radioprotection and 72% of them did not know their annual radiation dose. The main adopted personal protection devices were lead aprons and thyroid collars (95% and 92% of use, respectively). Dedicated architectural protective shielding was not available for 33% of interventional echocardiographers. Nearly two-thirds of responders thought that the radiation exposure of interventional echocardiographers was higher than that of interventional cardiologists and 72% claimed for an improvement in the radioprotection measures. CONCLUSION: Radioprotection measures for interventional echocardiographers are widely variable across centres. Radioprotection devices are often underused by interventional echocardiographers, portending an increased radiation-related risk. International scientific societies working in the field should collaborate to endorse radioprotection training, promote reliable radiation dose assessment, and support the adoption of radioprotection shielding dedicated to interventional echocardiographers.

Environmental risk assessment of the anionic surfactant sodium lauryl ether sulphate in site-specific conditions arising from mechanized tunnelling.

Sodium lauryl ether sulphate (SLES) is the anionic surfactant commonly utilized as the main synthetic chemical component in most foaming agents used in mechanized tunnelling. This produces huge amounts of soil debris which can contain residual concentrations of SLES. The absence of environmental quality standards for soil and water and the limited information about SLES persistence in real excavated soils do not facilitate any re-use of soil debris as by-products. The environmental risk assessment (ERA) of foaming agents containing SLES can be a valid tool for this purpose. In this study, an ERA analysis of SLES in 12 commercial formulations (cf) used for tunnelling excavation was performed. Various soils from different tunnel excavation sites were conditioned with the selected foaming agents containing SLES. Predicted or measured environmental concentrations (PECs, MECs) were determined and then compared with the Predicted No Effect Concentrations (PNECs) for both the terrestrial and aquatic compartments. The results indicate a reduction of the potential risk over time for these ecosystems, with differences depending on both the commercial foaming formulation and the spoil material characteristics. However, because potential threats to the natural environment cannot be excluded, some risk management and mitigation actions are discussed.

Cirugía ortognática para el tratamiento de las anomalías dentoesqueletales / Orthognathic surgery for the treatment of dentoskeletal abnormalities

Las anomalías dentoesqueletales se presentan en el 2-3% de la población. Las mismas afectan el complejo maxilomandibular como también la relación entre las arcadas dentarias. Estas alteraciones producen problemas fonéticos, deglutorios, respiratorios y estéticos. Existe una tendencia en corregir las alteraciones dentarias sin tratar las discrepancias esqueletales, dificultando la corrección quirúrgica, si esta fuera necesaria. Actualmente, la cirugía ortognática ha tenido mayor aceptación como el tratamiento ideal para pacientes con estas anomalías. Se presentará una revisión de la literatura sobre las características que esta alteración presenta, junto a la resolución de casos clínicos (AU)

Role of two sequence motifs of mesencephalic astrocyte-derived neurotrophic factor in its survival-promoting activity.

Mesencephalic astrocyte-derived neurotrophic factor (MANF) is a prosurvival protein that protects the cells when applied intracellularly in vitro or extracellularly in vivo. Its protective mechanisms are poorly known. Here we studied the role of two short sequence motifs within the carboxy-(C) terminal domain of MANF in its neuroprotective activity: the CKGC sequence (a CXXC motif) that could be involved in redox reactions, and the C-terminal RTDL sequence, an endoplasmic reticulum (ER) retention signal. We mutated these motifs and analyzed the antiapoptotic effect and intracellular localization of these mutants of MANF when overexpressed in cultured sympathetic or sensory neurons. As an in vivo model for studying the effect of these mutants after their extracellular application, we used the rat model of cerebral ischemia. Even though we found no evidence for oxidoreductase activity of MANF, the mutation of CXXC motif completely abolished its protective effect, showing that this motif is crucial for both MANF's intracellular and extracellular activity. The RTDL motif was not needed for the neuroprotective activity of MANF after its extracellular application in the stroke model in vivo. However, in vitro the deletion of RTDL motif inactivated MANF in the sympathetic neurons where the mutant protein localized to Golgi, but not in the sensory neurons where the mutant localized to the ER, showing that intracellular MANF protects these peripheral neurons in vitro only when localized to the ER.

Recurrent infections in children with nickel allergic contact dermatitis.

Some patients with nickel (Ni) allergic contact dermatitis (ACD) suffer from systemic symptoms after ingestion of Ni-rich foods, a condition termed Systemic Nickel Allergy Syndrome (SNAS). The aim of this study is to investigate in children the relationship between Ni ACD and lymphocyte subsets or susceptibility to infections. Nineteen children with Ni ACD and 18 controls matched for sex and age were enrolled. All participants underwent patch test, skin prick test and clinical assessment. Serum immunoglobulins and flow cytometry for lymphocyte subset study were also evaluated. In children with Ni ACD a higher incidence of recurrent upper respiratory tract infections and recurrent otitis media were detected. Serum levels of immunoglobulins and lymphocyte subsets did not show significant changes (p>0.05) between the two groups studied. We can hypothesize that in children with Ni ACD the risk of recurrent infections is increased. Although the clinical manifestations of SNAS are still controversial, we can suppose that recurrent infections may be considered a clinical symptom of this syndrome.

Herida transfixiante cérvicotoracica en un paciente pediátrico / Transfixiante wound cervicoracic in a patient pediatric

Se presenta un niño de 8 años que sufrió una herida por arma de fuego con puerta de entrada a nivel cervical y sin orificio de salida. El proyectil se alojó en posición intraarticular en hombro izquierdo recorriendo en forma transfixiante el mediastino superior. Las lesiones produjeron un pseudoaneurisma de la arteria subclavia izquierda que fue tratado mediante la colocación de un dispositivo de clausura intraarterial con buena evolución. Comentamos su evaluación durante la urgencia, metodología diagnóstica y tratamientos realizados. Evaluamos como satisfactoria su evolución y ponemos a consideración un novedoso tratamiento que nos ha permitido un manejo selectivo de una grave lesión arterial.(AU)

Fungal bioremediation of creosote-treated wood: a laboratory scale study on creosote components degradation by Pleurotus ostreatus mycelium.

A bioremediation system for creosote-treated wood is proposed, based on the detoxifying capability of Pleurotus ostreatus, a ligninolythic fungus. Non-sterilized chipped contaminated wood was mixed at various ratios with wheat straw on which Pleurotus mycelia was grown. At 1:2 initial ratio contaminated wood:wheat straw, chemical analyses demonstrated an almost complete degradation of creosote oil components after 44 days, also confirmed by a significant reduction of ecotoxicity. Lower ratios, i.e. higher amount of contaminated wood, lower system efficiency, although a better creosote degradation was obtained by a stepped up wood addition.

Nuclear factor kappaB activity is increased in peripheral blood mononuclear cells of children affected by atopic and non-atopic eczema.

Atopic and non-atopic eczema is an inflammatory cutaneous disease which is common in childhood and is associated with a dysregulation of the immune system. Many genes encoding immune receptors, cytokines, chemokines, chemokine receptors, and adhesion molecules involved in the development of the disease are under the control of transcription factors belonging to the nuclear factor (NF)-kappaB family. To investigate the role of NF-kappaB in the development of eczema, 20 children, affected by relapsing chronic eczema, were enrolled in this study. Eleven of the 20 children showed IgE immunoreactivity and had a positive prick test. The DNA binding activity of NF-kappaB in nuclear extracts of the patients' peripheral blood mononuclear cells (PBMC) was examined by electrophoretic mobility shift assay. We found that basal NF-kappaB-DNA binding activity in PBMC was significantly higher in the eczema patient group in comparison with the same parameter in the healthy age-matched control group. Moreover, we observed a significant correlation between NF-kappaB-DNA binding activity and patients clinical score (SCORAD). Based on these observations we speculate that NF-kappaB can play an important role in the immunopathogenesis of eczema and therefore could be considered as a potential therapeutic target.

Las psicosis endógenas / Endogenous psychoses

Desde su introducción a fines del siglo XIX, el concepto de endogeneidad ha ocupado un lugar central en la investigación y la práctica clínica de la psiquiatria latinoamericana. El neuropsiquiatria alemán MOBIUS, manteniendo la tradición de la teoria degenerativa, define como endógenas a "aquellas alteraciones psíquicas que no constituyen reacción a condiciones desfavorables al desarrollo o estressores actuales, ni son consecuencia directa de alteraciones corporales". A partir de MOBIUS el concepto de endogeneidad es fundamental en las concepciones nosológicas esgimidas posteriormente por KRAPELIN, KRETSCHMER, SCHNEIDER, TELLENBACH y DELGADO entre otros, manteniendo asi validez innegable durante decenios. La endoneneidad corresponde a uno de esos conceptos psiquiátricos que despiertan fuertes emociones tanto en las discusiones de especialistas como también en la legos en la material

Demencia: Psicopatologia y Perfusión Cerebral / Dementia: Psychopathology and Brain Perfusion

El desarrollo primigenio del cerebro empieza del ectodermo con la histogenesis del palio (corteza),cuya pared en los primeros dos meses de gestacion permanece sumamente delgada y esta compuesta por solo 3 capas, pero hacia el termino del segundo mes se inicia una migracion de celulas de la capa del manto hacia la zona marginal formando la substancia gris: la corteza cerebral. Las células se van organizando en varias capas horizontales las cuales llegan al número de 6 en el sexto mes de gestación. Desde estas circunstancias el cerebro estructura se convierte en cerebro función a lo largo de toda la vida. Las áreas estructurales descritas por Brodman (47 áreas) y las descritas por Von Economo (109 áreas 5-tipos), se intentan correlacionar con la fución cerebral en los trastornos neuropsiquiátricos a la luz de los conocimientos actuales y de nuestra experiencia. Proponemos una teoría estructuro-funcional en la psicopatología de la demencia

Biological markers in suicide: one apply to medical practice

Can suicide be predicted? If we know that more than 50 per cent of suicide persons have visit a doctor before and we know probable clinic markers of suicide intent, we should look for biochemical suicide markers that have use in the medical praxis. Suicide behavior is associated mainly to alterations of the serotoninergic system. The most consistent indicator of suicide risk in the history in course is the metabolism of the serotonine, 5HIAA, mainly in the CSF, also can be use like helpers in the increase of the urinal 17 hidrocortizone, the increase of plasmatic cortisol higher than 20mcg per cent, positivity of the dexametazone suppression test, the answer of TSH to TRH, the latency of REM increase in the electroencephalogram of sleep and seric cholesterol decrease. Perhaps all this investigations in the biochemical of suicide have a little application in medicine. That's why we make a revision in the principal and probable suicide biologic markers and we intent to help in the search of one that have application in the medical praxis, like cholesterol. We are doing a investigation work between cholesterol association, suicide behavior and depression, based in the serotoninergic hypothesis of suicide etiopathogeny.

Tratamiento farmacológico de la depressión refractaria / Pharmacologic treatment in refractory depression

La Depresión Refractaria, según Schatzberg y colaboradores (1983), es la insuficiencia de respuesta a un antidepresivo probado, en dósis, tiempo y concentración en el plasma, adecuados; aunque ha sido definida por múltiples autores clínicos, entre ellos: Frayhan (l974), Feighner (l980), Akiskal (l983), Fawcett y Kravitz (l985), Feinberg y Halbreich (l986), Paykel (l989) y Nierenberg y Amsterdam (l990). La rcfractariedad puede variar según la dimensionalidad clínica, socio cultural, temporal, cronológica y patogénica. La alternativa básica para todo tratamiento antidepresivo es el uso de los ISRS o los tricíclicos, como fármacos de primera línea. La primera alternativa es la adición de un tricíclico a los ISRS o viceversa; la segunda alternativa consiste en la adición de litio a los antidepresivos de primera línea, cuya exhaustiva revisión la hace Johnson (l991); la tercera alternativa es el uso de los IMAO, pero el único que ha demostrado ser suficientemente eficaz en la depresión refractaria, es la tranilcilpromina según la revisión de Nolen (l994), quien agrega que en un futuro cercano los IMAO tipo A podrían ser considerados fármacos de primera elección conjuntamente con los ISRS y los tricíclicos. Entre las alternativas de segundo orden se encuentran: El rol de la hormona tiroidea, revisado por Gorman y Hatterer (l994), nos dan cada vez más evidencia que la adición de litio a los antidepresivos ha eclipsado la adición del T3 a los mismos. La combinación con antidepresivos de acción serotoninérgica, como lo es la asociación de fluoxetina, buspirona y trazadone, resulta ser una asociación efectiva en las depresiones refractarias, según Lader (l991) y Bakish (l994). El rol de los psicoestimulantes (PS), los cuales están indicados en la depresión refractaria, solamente en los pacientes que por alguna razón no toleran los ISRS y los tricíclicos. El rol de los estrógenos, aunque no es concluyente, por el perfil bajo de efectos colaterales, puede permitirnos tenerlo como una alternativa secundaria para la depresión refractaria en las mujeres. El tratamiento de la depresión refractaria envuelve varios grados de desequilibrio, entre los que se encuentran la actividad serotoninérgica y adrenérgica central, la hiperactividad del eje HPA, los defectos estructurales y metabólicos cerebrales.

Neurobiologia del suicidio: neuroquímica del suicidio: en busca de un predictor / Neurobiology of suicide: neurochemistry of suicide: looking for a predictor

Cuántos suicidios tendremos a cuestas nosotros los Psiquiatras? La Neuroquímica puede predecir un suicidio? Si nosotros conocemos que en el mundo se suicidan cada día alrededor de 2,000 personas, lo que representa más de 80 personas por hora. Si nosotros conocemos que más del 50 por ciento de los suicidas han visitado a un profesional de la salud mental, con unas semanas de anterioridad. Si nosotros conocemos los predictores clínicos del intento suicida. Entonces nosotros, podemos y debemos buscar predictores bioquímicos del suicidio, que tengan aplicación en la práctica médica. Más aún, que con la modernidad, los facilitadores indirectos de la autoagresión se incrementan exponencialmente a través de los medios de comunicación. Por lo tanto, hacemos uma revisión de los principales marcadores bioquímicos de la gesta suicida e intentamos recomendar algunos, como los que tienen que ver con el eje HPA.

[Continuous 24-hour intragastric pH monitoring. A new model of interpretation]. / La pHmetria endogastrica continua sulle 24 ore. Nuovo modello d'interpretazione.

Using the study as a basis for a novel interpretation of the pH-metric curve, the paper reports the results of a study carried out in a sample group of 11 normo-secretory subjects (students from the Faculty of Medicine and Surgery). The pH-metric curve was assessed over 24 hours using a portable pH measuring device.

1,25-Dihydroxyvitamin D3 and phorbol esters (TPA) may induce select in vitro differentiation pathways in the HL60 promyelocytic cell line.

Monocytic features can be induced in the myeloid cell line HL60 in order to provide a suitable in vitro model for the investigation of in vitro activity in mononuclear phagocytes. 1,25-Dihydroxyvitamin D3 (calcitriol) induced the HL60 cell line to express the monocytic differentiation antigen Leu M3 in about 30-50% of the cells along with an increase (up to 20%) in the expression of HLA-DR but not HLA-DQ class II antigen. Functional investigation showed that calcitriol-treated cells formed rosettes with sheep erythrocytes coated with an anti-sheep erythrocyte-specific IgG2a mouse MoAb and readily ingested them. In addition, these same sensitized erythrocytes were lysed in an 18-hr antibody-dependent cellular cytotoxicity (ADCC) assay. All together these data indicate the presence of functionally active Fc-IgG receptors (FcR). Sorting experiments demonstrated that only Leu M3+ HLA-DR+ cells contained the effector cell population; such was also the case for blood monocytes. This phenotypic profile was, however, not predictive per se of FcR presence and function, as 12,O-tetradecanoylphorbol-13-acetate (TPA)-induced HL60 cells neither formed rosettes nor phagocytosed nor exhibited ADCC activity, although they express Leu M3 and HLA-DR (as well as HLA-DQ) antigens. These results suggest that calcitriol and TPA cause the differentiation of HL60 cells along distinct pathways. On the other hand, different subpopulations with given predetermined differentiation capabilities may coexist in HL60 cell line. This hypothesis gains support by the observation that when TPA and calcitriol were added together to the undifferentiated cells, the resulting phenotypic pattern was representative of the different activities of both of the inducers as they were used separately.

Immunological studies in patients with central nervous system tumors.

Impairment of cell-mediated immunity in patients with primary central nervous system (CNS) tumors has repeatedly been reported but data to demonstrate the underlying immunological defect are not univocal. This report concerns a series of 31 patients harboring a glioma in which we studied: peripheral blood T-lymphocyte subpopulations by monoclonal antibody analysis; cellular responsiveness to mitogens; serum immunoglobulin values. The same parameters were also evaluated in 7 cases of intracranial meningioma and in 8 patients affected by non-proliferative, non-inflammatory CNS diseases. Thirty age-matched healthy volunteers formed the control group. Neither impairment of T-cells as regard to number, responsiveness and subsets, nor abnormal Ig values were found in these groups. However two patients, harboring respectively a third ventricle low grade astrocytoma and an anterior callosal glioblastoma, presented a striking T-cells impairment. These findings might suggest a correlation between hypothalamus and immune system, as already postulated by several previous experimental and clinical studies.

Results in two infants with the DiGeorge syndrome--effects of long-term TP5.

We treated two patients affected by DiGeorge syndrome with long-term administration of the synthetic thymic hormone thymopoietin (TP5). In both cases we obtained durable immunological reconstitution, starting as early as 2 weeks after beginning of TP5 treatment. High levels of circulating immature thymocytes and precursor T cells (defined by monoclonal antibodies OKT6, OKT9, and OKT10) were present prior to therapy, and they steadily decreased during the first few weeks of study. During the same time, phenotypically mature T lymphocytes (OKT3+ and OKT4+/OKT8+) markedly increased, thereafter remaining at near normal levels. OKT10+ cells appeared to rise again after 3 months of TP5 treatment. In vitro function of T cells, assessed by PHA stimulation, and in vivo cell-mediated immunity (skin tests with Candida) were normal at 3 and at 2 months, respectively, after initiation of therapy. No severe infection episodes were recorded and normal development was achieved. No side effect or adverse reaction occurred. In these two patients the other features of the DiGeorge syndrome were successfully treated by early cardiac surgery and vitamin D therapy. The immunological reconstitution, in absence of functioning thymus observed in these two cases, provides further evidence of the effectiveness of long-term treatment with thymic hormones--with maintenance of the improvement of cell-mediated immunity.

Ecotoxicological profile of xylenes. Working Party on Ecotoxicological Profiles of Chemicals.

The xylenes (o, m, p), which are produced in large amounts and widely used, must be considered as environmental contaminants, as they have been identified in the atmosphere of many countries. Their acute and chronic toxicity in mammals is moderate. Mutagenic and teratogenic properties can be excluded. Carcinogenic potential has been at present inadequately studied. In man some disturbances are evident at the concentration of 45 ppm. Hepatic metabolism is a valid process of detoxification and its high rate limits the risk of accumulation of the xylenes in adipose tissue. Ecotoxicological data refer almost exclusively to water. No long-term tests have been made. However, the high volatility, elevated elimination, and the low factor of accumulation suggest the impact on aquatic environment should be limited. Xylenes are easily biodegraded by many microorganisms. Photoxydation is one of the main degradation processes, responsible for the disappearance of the xylenes from the atmosphere.