Effects of choline on the phenotype of the cultured bovine preimplantation embryo.

Choline is a precursor of acetylcholine, phosphatidylcholine, and the methyl-donor betaine. Reports indicate that supplementation with rumen-protected choline improves postpartum reproductive function of dairy cows. The objective was to determine whether addition of choline to culture medium of in vitro-produced embryos alters the phenotype of the resultant blastocysts. Treatments were choline chloride (ChCl; 0.004, 1.3, 1.8, and 6.37 mM) and phosphatidylcholine (1.3 mM). Treatment with 0.004 mM ChCl improved development to the blastocyst stage, increased blastocyst cell number, and increased the percentage of blastocysts that were hatching or hatched. Development was not affected by higher concentrations of ChCl but was reduced by 1.3 mM phosphatidylcholine. Treatment of embryos with 1.3 mM ChCl (but not other concentrations) increased expression in blastocysts of 11 of 165 genes examined (AMOT, NANOG, HDAC8, HNF4A, STAT1, MBNL3, SOX2, STAT3, KDM2B, SAV1, and GPAM) and decreased expression of one gene (ASS1). Treatment with 1.3 mM ChCl decreased global DNA methylation at d 3.5 of development and increased DNA methylation at d 7.5 in blastocysts. Treatment with 1.8 mM ChCl also increased methylation in blastocysts. In conclusion, addition of choline to the culture medium alters the phenotype of preimplantation bovine embryos produced in vitro. Choline chloride can act in a concentration-dependent manner to alter development, expression of specific genes, and DNA methylation.

Índice elevado de ácidos grasos omega 6/omega 3 en niños con neuropatías causa o efecto / High ratio of omega 6/omega 3 ratio children with neuropathies cause or effect

Introducción: Los ácidos grasos n-3 y n-6 compiten por las mismas elongasas y desaturasas, siendo muy deficiente la síntesis de ácidos grasos poliinsaturados n-3 a partir de ácido linolénico. Los poliinsaturados n-3 previenen enfermedades y son importantes en el desarrollo y mantenimiento de las actividades neuronales, siendo necesaria una relación adecuada con sus antagonistas n-6. En este trabajo se estudia la proporción de estos ácidos grasos. Material y métodos: Se han analizado los ácidos grasos n-3 y n-6 en sueros y fosfolípidos de membrana de 374 niños con neuropatías y de 34 niños sanos, mediante cromatografía de gases con detector de masas. Se ha realizado el estudio estadístico pertinente. Resultados: Los ácidos grasos n-3 (EPA y DHA) en suero y su correspondientes fosfolípidos de membrana correlacionan mejor que los de la familia n-6. Los mayoritarios n-6 (LA y ARA) están en igual proporción en sueros, siendo más elevados significativamente en los fosfolípidos de los niños sanos. Los n-3 (EPA y DHA) tienen valores más altos en los niños sanos, tanto en suero como en fosfolípidos, su suma se iguala en los fosfolípidos de membrana. El índice n-6/n-3 es mayor en los niños con trastorno neurológico en ambas muestras. Conclusión: No siendo la causa de la neuropatía el alto índice n-6/n-3, sin embargo es aconsejable incrementar la ingesta de n-3, sobre todo DHA en toda la población y en especial en los niños con trastornos neurológicos (AU)

Introduction: The n-3 and n-6 fatty acids compete for the same elongases and desaturases, still highly deficient synthesis of polyunsaturated fatty acids from n-3 linolenic acid. The n-3 polyunsaturated prevent disease and are important in the development and maintenance of neuronal activities, necessitating a proper relationship with their antagonists n-6. This paper studies the proportion of these fatty acids. Material and methods: We analyzed the fatty acids of n-3 and n-6 in sera and membrane phospholipid with 374 children neuropathies and 34 healthy children, using gas chromatography with mass detector. It has made the relevant statistical study. Results: The n-3 (EPA and DHA) in serum and their corresponding membrane phospholipids correlate better than the n-6 family. The major n-6 (LA and ARA) are equally in serum, being significantly higher in phospholipids of healthy children. The n-3 (EPA and DHA) have higher values in healthy children, both in serum and phospholipids, their sum is equal to the membrane phospholipids. The n-6/n-3 ratio is higher in children with neurological disorder in both samples. Conclusion: Not being the cause of the high rate n-6/n-3 neuropathy, however it is advisable to increase the intake of n-3, DHA particularly across the population, especially in children with neurological disorders (AU)

[High ratio of omega 6/omega 3 ratio children with neuropathies; cause or effect]. / Índice elevado de ácidos grasos omega 6/omega3 en niños con neuropatía; causa o efecto.

INTRODUCTION: The n-3 and n-6 fatty acids compete for the same elongases and desaturases, still highly deficient synthesis of polyunsaturated fatty acids from n-3 linolenic acid. The n-3 polyunsaturated prevent disease and are important in the development and maintenance of neuronal activities, necessitating a proper relationship with their antagonists n-6. This paper studies the proportion of these fatty acids. MATERIAL AND METHODS: We analyzed the fatty acids of n- 3 and n-6 in sera and membrane phospholipid with 374 children neuropathies and 34 healthy children, using gas chromatography with mass detector. It has made the relevant statistical study. RESULTS: The n-3 (EPA and DHA) in serum and their corresponding membrane phospholipids correlate better than the n-6 family. The major n-6 (LA and ARA) are equally in serum, being significantly higher in phospholipids of healthy children. The n-3 (EPA and DHA) have higher values in healthy children, both in serum and phospholipids, their sum is equal to the membrane phospholipids. The n-6/n-3 ratio is higher in children with neurological disorder in both samples. CONCLUSION: Not being the cause of the high rate n-6/n- 3 neuropathy, however it is advisable to increase the intake of n-3, DHA particularly across the population, especially in children with neurological disorders.

Introducción: Los ácidos grasos n-3 y n-6 compiten por las mismas elongasas y desaturasas, siendo muy deficiente la síntesis de ácidos grasos poliinsaturados n-3 a partir de ácido linolénico. Los poliinsaturados n-3 previenen enfermedades y son importantes en el desarrollo y mantenimiento de las actividades neuronales, siendo necesaria una relación adecuada con sus antagonistas n- 6. En este trabajo se estudia la proporción de estos ácidos grasos. Material y métodos: Se han analizado los ácidos grasos n-3 y n-6 en sueros y fosfolípidos de membrana de 374 niños con neuropatías y de 34 niños sanos, mediante cromatografía de gases con detector de masas. Se ha realizado el estudio estadístico pertinente. Resultados: Los ácidos grasos n-3 (EPA y DHA) en suero y su correspondientes fosfolípidos de membrana correlacionan mejor que los de la familia n-6. Los mayoritarios n-6 (LA y ARA) están en igual proporción en sueros, siendo más elevados significativamente en los fosfolípidos de los niños sanos. Los n-3 (EPA y DHA) tienen valores más altos en los niños sanos, tanto en suero como en fosfolípidos, su suma se iguala en los fosfolípidos de membrana. El índice n-6/n-3 es mayor en los niños con trastorno neurológico en ambas muestras. Conclusión: No siendo la causa de la neuropatía el alto índice n-6/n-3, sin embargo es aconsejable incrementar la ingesta de n-3, sobre todo DHA en toda la población y en especial en los niños con trastornos neurológicos.

Influencia del ácido docosahexaenoico y la hipoxia perinatal moderada en la resolución de un laberinto en T en ratas Wistar de un mes de edad / The influence of docosahexaenoic acid and moderate perinatal hypoxia on the performance of one-month-old Wistar rats in a T-maze test

Introducción. El ácido docosahexaenoico (DHA) tiene una influencia favorable en el neurodesarrollo tanto de niños como de modelos animales. Las lesiones inducidas por la asfixia perinatal constituyen una causa importante de trastornos del neurodesarrollo. Objetivo. Se plantea si el efecto positivo en el desarrollo del sistema nervioso central se puede inducir en animales sometidos a condiciones de hipoxia moderada. Materiales y métodos. Se dividió un total de 140 crías de rata Wistar en dos grupos principales de 70 cada uno. Un grupose crió con dieta suplementada con DHA, mientras que el otro lo fue con dieta normal. La mitad de cada grupo fue sometida a una situación de hipoxia neonatal inmediata (FiO2 = 0,05; 1 h). Todas las ratas fueron sometidas individualmente a un test de laberinto en T para valorar su evitación pasiva, entre otras habilidades, los días P25 (pruebas 1, 2 y 3) y P30 (prueba 4). Todos los ensayos fueron registrados en vídeo y revisados para tomar nota del tiempo de resolución del test (TRT), del número de choques eléctricos recibidos (NCE) y del porcentaje de resoluciones correctas del test (RCT). Resultados. Los animales del grupo control mejoraron significativamente el TRT (p < 0,01). El grupo de dieta suplementada con DHA sólo mejoró la RCT (p < 0,001). El grupo de hipoxia mejoró el TRT (p < 0,014) y el NCE (p < 0,004). El grupo de hipoxia y con dieta con DHA mejoró el NCE (p < 0,0000) y la RCT (p < 0,0001). Conclusiones. Los grupos sometidos a hipoxia moderada o a dieta suplementada con DHA de forma independiente mejoraron los resultados del laberinto en T en relación con el grupo de control. Las ratas sometidas a las dos condiciones experimentales a la vez mejoraron su perfil de resolución del laberinto en T con respecto al grupo de control y a los animales sometidos a una de las dos condiciones experimentales por separado (AU)

Introduction. Docosahexaenoic acid (DHA) has been shown to improve neurodevelopment in both human observations and animal models. Perinatal hypoxic insults have been recognized as a major cause of neurodevelopmental disturbances. Aim. To find out if the CNS-improving effect of DHA could be induced in animals subjected to mild perinatal hypoxic conditions. Materials and methods. A total of 140 Wistar rat pups were separated into two main groups of 70 each, and one group was reared on a DHA-supplemented diet while the other was not. One half of each group was subjected to immediate post-natal hypoxia (FiO2 = 0.05, 1 h). All the rats were individually subjected to a T-maze to test their passive-avoidance performance, among other skills, on days P25 (three trials) and P30 (one trial). All the trials were videotaped and reviewed to record the maze-solving time (MST), the number of electrical hazards (NEH) and the correct maze-solution percentage (CMS). Results. The animals in the control group significantly improved their MST (p < 0.01). The group on the DHA-supplemented diet improved only the CMS (p < 0.001). The hypoxic group improved the MST (p < 0.014) and the NEH (p < 0.004). The hypoxic group on the DHA-supplemented diet improved the NEH (p < 0.0000) and the CMS (p < 0.0001). Conclusions. The subgroups subjected to one experimental condition or the other (DHA-supplemented diet or perinatal hypoxia) independently improved their T-maze-test performance more than the absolute control group. The rats subjectedto both conditions appeared to improve their T-maze-test solution performance more effectively than the control groups and the groups subjected to only one of the two conditions (AU)

[The influence of docosahexaenoic acid and moderate perinatal hypoxia on the performance of one-month-old Wistar rats in a T-maze test]. / Influencia del acido docosahexaenoico y la hipoxia perinatal moderada en la resolucion de un laberinto en T en ratas Wistar de un mes de edad.

INTRODUCTION: Docosahexaenoic acid (DHA) has been shown to improve neurodevelopment in both human observations and animal models. Perinatal hypoxic insults have been recognized as a major cause of neurodevelopmental disturbances. AIM: To find out if the CNS-improving effect of DHA could be induced in animals subjected to mild perinatal hypoxic conditions. MATERIALS AND METHODS: A total of 140 Wistar rat pups were separated into two main groups of 70 each, and one group was reared on a DHA-supplemented diet while the other was not. One half of each group was subjected to immediate post-natal hypoxia (FiO2 = 0.05, 1 h). All the rats were individually subjected to a T-maze to test their passive-avoidance performance, among other skills, on days P25 (three trials) and P30 (one trial). All the trials were videotaped and reviewed to record the maze-solving time (MST), the number of electrical hazards (NEH) and the correct maze-solution percentage (CMS). RESULTS: The animals in the control group significantly improved their MST (p < 0.01). The group on the DHA-supplemented diet improved only the CMS (p < 0.001). The hypoxic group improved the MST (p < 0.014) and the NEH (p < 0.004). The hypoxic group on the DHA-supplemented diet improved the NEH (p < 0.0000) and the CMS (p < 0.0001). CONCLUSIONS: The subgroups subjected to one experimental condition or the other (DHA-supplemented diet or perinatal hypoxia) independently improved their T-maze-test performance more than the absolute control group. The rats subjected to both conditions appeared to improve their T-maze-test solution performance more effectively than the control groups and the groups subjected to only one of the two conditions.

Efectos de diferentes estrategias de entrenamiento al ejercicio sobre parámetros antropométricos según el fenotipo del paciente con EPOC / Effects of different exercise training strategies on anthropometric parameters according to the prenotype of the patient with EPOC

OBJETIVO: Analizar el efecto sobre dos parámetros antropométricos de la aplicación de distintas modalidades de entrenamiento al ejercicio en un grupo de pacientes con enfermedad pulmonar obstructiva crónica (EPOC), categorizados según su fenotipo (con o sin predominio de enfisema). METODOLOGIA: 64 pacientes con EPOC estable (edad media de 64,1 ± 6,8 años) que presentan obstrucción moderada severa al flujo aéreo, realizaron un programa de entrenamiento al ejercicio, aleatoriamente distribuidos en tres grupos: resistencia (n=21; entrenamiento aeróbico en bicicleta al 70% de su VO2 máximo inicial), fuerza (n=22; cinco ejercicios de levantamiento de pesas al 70-85% del test 1 RM inicial, incluyendo grupos musculares de MMSS y MMII) y mixto (n=21; combinación de los anteriores).Se subdividieron en pacientes EPOC con predominio de enfisema(n=32) o sin enfisema (n=32) según criterios clínicos, funcionales y radiológicos. Inicialmente y tras 12 semanas de entrenamiento se midieron los cambios en el peso y en el índice de masa corporal (IMC) como parámetros antropométricos. RESULTADOS: Los pacientes EPOC sin enfisema cuyo entrenamiento incluía ejercicios de tipo aeróbico (grupos resistencia y mixto) experimentaron una disminución del IMC (-0,43 ± 1,45 y -0,82 ± 1,04; p<0,05) y del peso (-0,96 ± 4,15 y -2,44 ± 2,96 kg). Los EPOC tipo enfisema cuyo entrenamiento incluía ejercicios de fuerza (fuerza y mixto) presentaron un aumento del IMC (0,42 ± 0,50 y 0,35± 1,04; p<0,05) y del peso (0,91 ± 1,08 y 1,25 ± 2,83 kg; p<0,05). CONCLUSIONES: Distintas estrategias de entrenamiento alejercicio producen efectos diferentes sobre índices antropométricos en pacientes con EPOC, dependiendo del fenotipo que presenten (AU)

OBJECTIVE: To analyse the effect of the application of different modes of exercise training on two anthropometric parameters in a group of patients with chronic obstructive pulmonary disease (COPD), categorised according to their phenotype (with or without predominance of emphysema). METHODOLOGY: Sixty-four patients with stable COPD (average age of 64.1 ± 6.8 years) that presented moderate-severe air flow obstruction, undertook an exercise training programme, randomly distributed in three groups: resistance (n=21; aerobicbicycle training to 70% of their initial maximum VO2), strength(n=22; five weight raising exercises to 70-85% of the initial 1-RMtest, including arm and leg muscle groups) and mixed (n=21; combination of the previous). They were subdivided into COPD patients with predominance of emphysema (n=32) or without emphysema (n=32) according to clinical, functional and radiological criteria. The changes in weight and body mass index (BMI) were measured as anthropometric parameters initially, and after12 weeks of training. RESULTS: COPD patients without emphysema whose training included aerobic type exercises (resistance and mixed groups) experienced a reduction of BMI (-0.43 ± 1.45 and -0.82 ± 1.04;p<0.05) and weight (-0.96 ± 4.15 and – 2.44 ± 2.96 kg). The COPD patients with emphysema whose training included strength exercises (strength and mixed) displayed an increase in BMI (0.42 ± 0.50and 0.35 ± 1.04; p<0.05) and weight (0.91 ± 1.08 and 1.25 ± 2.83 kg; p<0.05). CONCLUSIONS: Different exercise training strategies produce different effects on anthropometric indices in patients with COPD, depending on the phenotype they present (AU)

Concentrations of potentially toxic metals in urban soils of seville: relationship with different land uses.

Fifty-two samples of surface soils were taken in the urban area of Seville, to assess the possible influence of different land uses on their metal contents and their relationship with several soil properties. The samples corresponded to five categories or land uses: agricultural, parks, ornamental gardens, riverbanks, and roadsides. Sequential extraction of metal according to the procedure proposed by the former Community Bureau of Reference (BCR) was carried out, and pseudo-total (aqua regia soluble) metal contents were determined. Lower organic C, total N and available P and K contents were found in riverbank samples, probably due to the lack of manuring of those sites, left in a natural status. In contrast, significantly higher electrical conductivity was found in those sites, due to the tidal influence of the nearby Atlantic Ocean. Other land uses did not show significant differences in the general properties. Concentrations of Cu, Pb and Zn, both aqua-regia soluble and sequentially extracted, were clearly higher in soils from ornamental gardens, whereas the concentrations in the riverbank samples were slightly lower than the other categories. In contrast, other metals (Cd, Cr, Fe, Mn, Ni) were uniformly distributed throughout all land uses. A strong statistical association is found among the concentrations of Cu, Pb, Zn and organic C, suggesting that the larger contents of these metals in ornamental gardens are partly due to organic amendments added to those sites more frequently than to other kinds of sites. Considering the conclusions of previous studies, heavy traffic can also contribute to those ;urban' metals in urban soils. Periodic monitoring of the concentrations of urban metals in busy city centres and of the quality of amendments added to soils of recreational areas are recommended.

Fatty acid absorption in preterms on formulas with and without long-chain polyunsaturated fatty acids and in terms on formulas without these added.

BACKGROUND/OBJECTIVE: Long chain polyunsaturated fatty acids have beneficial effects in preterm neurophysiological development and are semi-essential. Their levels and variation in plasma and red cells in term and preterms are better known than their intestinal absorption. In this paper the absorption of supplemented arachidonic acid (AA) and docosahexaenoic acid (DHA) is evaluated in a preterm group. DESIGN: Four newborn randomized groups were studied. Group T comprised 11 terms on regular formula. Preterms: group P (n=9) was on a classic preterm formula. INTERVENTION: groups PA (n=9) and PB (n=13) were on the same formula but PB contained AA and DHA in similar proportion to breast milk. At 20 days a 3 day metabolic balance was taken for Ca, P(i), Mg, total fat and individual fatty acids (C8-C24, saturated unsaturated). RESULTS: Calcium absorption was (mean+/-s.d.) 51+/-13% in terms. In preterms it was respectively 45+/-18, 38+/-11 and 37+/-21%. Total fat absorption was 92.0+/-8.0% in terms, and from 95.0+/-2.0 to 91.0+/-8.0% in preterms. Absorption of 8:0, 10:0 and 12:0 showed a very high and constant rate despite significant intake differences (715-33 mg/kg/day). Linoleic acid and alpha-linolenic acid were absorbed in the three groups at around 94% regardless of a greater LA intake in group P. Details of absorption (mg/kg/day) were: for AA, intake 17+/-7, fecal excretion 5+/-4, net retention 12+/-5 (75.0+/-18%); for DHA, intake 10+/-3, fecal excretion 3+/-2, net retention 6+/-4 (62.3+/-30%). CONCLUSION: Intestinal absorption of fatty acids is high and is comparable in terms and preterms as regards the studied acids. Longer acids were less well absorbed. The supplemented amounts of AA and DHA were less well absorbed and probably not impairing calcium absorption. SPONSORSHIP: University of Alicante, University of Miguel Hernández.

[Multiple type I pseudohypoaldosteronism: neonatal management and outcome]. / Seudohipoaldosteronismo tipo I múltiple: presentación y seguimiento.

UNLABELLED: Multiple type I pseudohypoaldosteronism (PHA-I) is an autosomal recessive condition with multiple target-organ unresponsiveness to aldosterone, manifested early after birth with severe salt-wasting and hyperkalemia. Case 1. Female infant born at term after an uneventful pregnancy. One female sibling died in the first week of life with hyperkalemia. The diagnosis of multiple PHA-I resulted from a picture of dehydratation, hyperkalemia and hyponatremia with increased plasma renin activity (PRA), plasma aldosterone and sweat electrolytes. The treatment consisted of salt and sodium bicarbonate supplements, restricted potassium intake, cation exchange resins and high fluid intake. During first year she was hospitalized for severe salt-losing crises. At 7 years of age, she needs salt and sodium bicarbonate supplements and cation exchange resins. She has a normal growth and neurodevelopment. Case 2. Seven-day female newborn with consanguinity in maternal family. Pregnancy and delivery were uncomplicated. On admission she was severely dehydrated with hyponatremia, hyperkalemia, metabolic acidosis and elevated PRA, plasma aldosterone and sweat electrolytes. She remained hospitalized for six months and she was dependent on high amounts of salt and sodium bicarbonate supplements, fluid intake and cation exchange resins. Growth and neurodevelopment are normal. CONCLUSIONS: Multiple PHA-I may be suspected in a newborn with salt-loss and hyperkalemia without glucocorticoid defect. The frequent episodes of dehydratation during the first year of life require long hospitalization. The improvement with age make possible an ambulatory control after the first year of life.

[Absorptive pattern of individual fatty acids and total fat in full term babies. Its stability in the absence of lactose]. / Patrón absortivo de ácidos grasos individuales y grasa total en el recién nacido a término. Estabilidad del mismo en ausencia de lactosa.

OBJECTIVE: Lactose absence implies a decrease in calcium absorption. If not absorbed, calcium soaps can be produced with the intestinal fatty acids. Absorption and retention of total fat, individual fatty acids, calcium, magnesium and phosphate have been compared between two groups of children, one fed with lactose free formula and higher levels of calcium (FSL) and the other with standard starting formula (FI). None of them had additional arachidonic or docosahexaenoic acids. PATIENTS AND METHODS: A randomized prospective study was made on 19 term newborn babies by means of metabolic balance measurement during an 8 day period (four days of a stabilization period on the formula, 3 days of the balance period and the final day for feces collection). Both groups were selected following the same criteria for gestational age, balance age, and weight and length at both time periods. Aliquos from the formula were collected daily, as well as all feces and urine during the balance period. Calcium and magnesium quantification of the corresponding ashed products was performed by means of atomic absorption, while Pi was with a colorimetric assay. Total fat was extracted by organic solvents and quantified by gravimetry. Lipid phase fatty acids were methylated, extracted and quantified by means of gas chromatography with a detector of flame ionization. RESULTS: Total fat content and the percentages of each fatty acid did not differ, only calcium concentration in FSL was slightly higher (64.9 +/- 6.9 vs 58.9 +/- 7.0 mg/100 g). No differences were found between groups in relation to ingestion, excretion and retention. The percentages of calcium and total fat retention, however, were slightly superior in the FI in relation to the FSL group. Ca: 68 +/- 22 mg/kg/d, 49 +/- 14% vs 56 +/- 23 mg/kg/d, 48 +/- 17% and total fat: 6.6 +/- 1.2 g/kg/d, 92 +/- 8% vs 6.8 +/- 1.5 g/kg/d, 90 +/- 9%. Absorption of MC fatty acids was 99% for C8. Linoleic and alfalinolenic acid showed an absorption of around 90% despite the big differences in their intake (10/1). Net retention of linoleic acid was 933 +/- 168 mg/kg/d (FI) and 963 +/- 190 mg/kg/d (FSL) and the amount of alpha-linolenic acid was 95 +/- 16 (FI) and 100 +/- 22 mg/kg/d (FSL). No correlation could be found between the amount of excreted calcium and the total amount of fat in feces or with any of the fatty acids studied. This was true for each group studied separately or when considered as a single group. CONCLUSIONS: The absorptive pattern of fatty acids in full term babies, when quantified did not show any conspicous alterations in relation to the accepted values of other ages. The absence of lactose (FSL) in a formula does not make any change in the absorption of total fat and the individual fatty acids when compared to lactose containing formula (FI), when these are present in the same proportions. Supplemented calcium in the formula without lactose could compensate for its lower absorbtion. The absorptive pattern of fatty acid in full term babies did not show any conspicuos alterations in relationship to the accepted values of other ages.

[Treatment and outcome of pneumococcal meningitis in adults. Study of a recent series of 70 episodes]. / Terapéutica y evolución de la meningitis neumocócica en el adulto. Estudio de una serie reciente de 70 episodios.

BACKGROUND: Pneumococcal meningitis (PM) is an infection with high morbidity and mortality. The aim of this study was to evaluate the most relevant clinical, epidemiologic and evolutive characteristics of a recent series of adult patients with this disease. METHODS: Over a period of 10 years all the patients with PM diagnosed by isolation of this microorganism in the cerebrospinal fluid (CSF) were evaluated from a clinical, therapeutic and evolutive points of view. The impact of the new therapies in the disease and the variables associated with mortality were analyzed. RESULTS: Seventy episodes of PM were diagnosed, 60% being found in patients over the age of 50 years. The male/female relationship was 2/1. Fifty-three percent of the patients had other underlying diseases. Acute otitis media (AOM) was the source in 34% of the cases, in 11% the patients had a fistula of CSF and in 9% a pneumonia. At the time of diagnosis 74% of the patients had some degree of reduction in the level of consciousness and in 40% of the episodes the presence of neurologic local manifestations were observed. A decrease in sensitivity to penicillin was observed in 33% of the microorganisms isolated. Third generation cephalosporins were used as initial treatment in 57 episodes and penicillin in other 11 episodes. Adjuvant treatment with dexamethasone, mannitol and/or diphenylhydantoin was administered in 54% of the patients. Overall mortality was 23%: the factors associated with an unfavourable evolution were the existence of underlying disease, deep alteration in the level of consciousness at the time of diagnosis, the coexistence of pneumonia and the absence of adjuvant therapy. CONCLUSIONS: Mortality in pneumococcal meningitis is high. The most relevant risk factor is the initial degree of consciousness. Adjuvant therapies probably determine a reduction in the rate of mortality.

Recurrent Salmonella arizona infection after treatment for metastatic carcinoma.

Serious Salmonella arizona infection may be acquired through the ingestion of rattlesnake meat used as a folk medicine remedy. We report a patient with metastatic carcinoma and a remote history of rattlesnake meat ingestion who developed recurrent S. arizona bacteremia and reactivation of tuberculosis after receiving corticosteroid and radiation therapy. Physicians should be aware of the potential for rattlesnake-associated S. arizona infection to occur as either the presenting manifestation or as a complication in immunosuppressed patients who may take folk remedies, especially Hispanics who live along the United States-Mexico border.

Chemotherapy for head and neck cancer relapsing after radiotherapy.

Thirty-nine patients (28 men and 11 women, ages 43 to 83 years) with advanced head and neck epidermoid carcinoma (33 had relapsed from previous radiotherapy) were treated with a three-day bleomycin administration (30 by continuous intravenous infusion and nine by subcutaneous route) followed on the fifth day by intravenous administration of cyclophosphamide + methotrexate + 5-fluorouracil (Bleo-CMF). This drug schedule was based on the cell cycle synchrony principle. Twenty-one of 39 patients (54%) responded (seven complete, 14 partial remission) lasting from 4 to 20 months. The median duration of survival for complete remission, partial remission, and disease progression was 15, ten, and four months, respectively. The Bleo-CMF was well tolerated with minimal toxicity. The effectiveness of this regimen in previously irradiated patients compels us to pursue its application in a randomized study as an adjuvant for Stages III and IV head and neck cancer following maximum eradication of the local disease by surgery and/or radiotherapy.