[Evaluation of the management of erectile and ejaculatory dysfunction in a series of 90 patients with spinal cord injuries]. / Évaluation du traitement des dysfonctions érectiles et éjaculatoires dans une série de 90 blessés médullaires.

OBJECTIVE: To evaluate the erectile dysfunction and ejaculatory on patients injured in conus medullaris (CMI) and the efficacy of treatment. METHODS: Ninety patients with injured conus medullaris underwent a retrospective and monocentric study. They have all an assessment of erectile dysfunction and ejaculatory by the International Index of Erectile Function (IIEF-15) and a clinic scenario. We evaluated the erection by a clinical scoring scale (Shrameck). Seventy-seven out of 90 (85.55%) had therapeutic tests to restore erection: prostaglandin (PGE1), phosphodiesterase type 5 inhibitors (PDE5) and Papaverine. Seventy-four out of 90 (82.22%) underwent a penile stimulation tests (VM) more or less associated with Midodrine(®) (alpha mimetic) to cause ejaculation with a systematic search of spermatozoa in urine. Data were entered and analyzed using Microsoft Office Excel. RESULTS: Ninety patients with a complete lesion of the sacral metameres (S2S3S4) were included. They were responding to PGE1, PDE5, respectively 81.63% and 30.76%. The association VM/Midodrine(®) improves ejaculation in 52.63% of cases. Orgasm is absent in all our CMI. CONCLUSION: In this series of BCM patients, we observed a good efficacy of PGE1 and PDE 5 on erection. We also observed positive results of vibromassage and alpha-agonists on ejaculation.

Host-parasite relationship between colonial terns and bacteria is modified by a mutualism with a plant with antibacterial defenses.

Predator-prey and host-parasite interactions and mutualisms are common and may have profound effects on ecosystems. Here we analyze the parasitic and mutualistic associations between three groups of organisms: the plant Artemisia maritima, bacteria, and a colonial seabird (the sandwich tern Sterna sandvicensis) that breeds in dense colonies covered in feces produced by both adults and chicks. A disproportionately large fraction of colonies of the sandwich tern in Denmark were located in patches covered by A. maritima. This association was specific for the densely colonial sandwich tern, but was not present for four other sympatric species of terns that breed in much less dense colonies. A. maritima reduced the abundance of pathogenic Staphylococcus on chicken eggshells in a field experiment. Recruitment by sandwich terns breeding in patches of A. maritima was 18 % higher than for sandwich terns breeding in the absence of A. maritima. A. maritima benefitted from the association with sandwich terns due to the supply of nutrients from feces and uneaten food lost by young. These findings are consistent with sandwich terns exploiting the association with A. maritima and its antimicrobial properties to improve their reproductive success, while sandwich terns and A. maritima are involved in a mutualistic interaction.

Psychometric properties of the Spanish validation of the Five Facets of Mindfulness Questionnaire (FFMQ)

Background and Objectives: Mindfulness-based therapies have demonstrated effectiveness in many clinical contexts. Various therapies that train mindfulness skills have proliferated in recent years. There is increasing interest in mindfulness-based therapies and in incorporating instruments that measure mindfulness in order to understand its role in clinical and basic research. The Five Facets of Mindfulness Questionnaire (FFMQ) is a questionnaire for measuring mindfulness; it was derived from a factor analysis of five different questionnaires that measure a trait-like general tendency to be mindful in daily life. The objective of this study is to validate the FFMQ in a Spanish sample. Methods: The FFMQ was administered to a sample of 462 subjects ranging from 18 to63 years (X = 27.9; SD = 9.75). The sample was composed by clinical (n = 146) and nonclinical (n = 226) subsamples. Results: The internal reliability of the scales ranged from acceptable to very good. Convergent analysis was conducted by computing Pearson’s correlations, showing high correlations. The factorial structure is the same as that proposed by Baer et al. Conclusions: The FFMQ proved to be an effective instrument for measuring mindfulness in clinical and non-clinical Spanish samples (AU)

Distribution of uranium isotopes in surface water of the Llobregat river basin (Northeast Spain).

A study is presented on the distribution of (234)U, (238)U, (235)U isotopes in surface water of the Llobregat river basin (Northeast Spain), from 2001 to 2006. Sixty-six superficial water samples were collected at 16 points distributed throughout the Llobregat river basin. Uranium isotopes were measured by alpha spectrometry (PIPS detectors). The test procedure was validated according to the quality requirements of the ISO17025 standard. The activity concentration for the total dissolved uranium ranges from 20 to 261mBqL(-1). The highest concentrations of uranium were detected in an area with formations of sedimentary rock, limestone and lignite. A high degree of radioactive disequilibrium was noted among the uranium isotopes. The (234)U/(238)U activity ratio varied between 1.1 and 1.9 and the waters with the lowest uranium activity registered the highest level of (234)U/(238)U activity ratio. Correlations between uranium activity in the tested water and chemical and physical characteristics of the aquifer were found.

[Sensitization to Castanea sativa pollen and pollinosis in northern Extremadura (Spain)]. / Sensibilización a polen de castaño y polinosis en el norte de Extremadura.

BACKGROUND: Castanea sativa pollen allergy has generally been considered to be uncommon and clinically insignificant. In our geographical area (Plasencia, Cáceres, Spain) Castanea sativa pollen is a major pollen. OBJECTIVE: To determine the atmospheric fluctuations and prevalence of patients sensitized to Castanea pollen in our region and to compare this sensitization with sensitizations to other pollens. METHODS: Patients with respiratory symptoms attending our outpatient clinic for the first time in 2003 were studied. The patients underwent skin prick tests with commercial extracts of a battery of inhalants including Castanea sativa pollen. Serologic specific IgE to Castanea sativa pollen was determined using the CAP system (Pharmacia and Upjohn, Uppsala, Sweden). Airborne pollen counts in our city were obtained using Cour collection apparatus over a 4-year period (2000 to 2003). RESULTS: The most predominant pollens detected were (mean of the maximal weekly concentrations over 4 years in pollen grains/m3): Quercus 968, Poacea 660, Olea 325, Platanus 229, Pinus 126, Cupresaceae 117, Plantago 109, Alnus 41, Populus 40, Castanea 32. We studied 346 patients (mean age: 24.1 years). In 210 patients with a diagnosis of pollinosis, the percentages of sensitization were: Dactylis glomerata 80.4%, Olea europea 71.9%, Fraxinus excelsior 68%, Plantago lanceolata 62.8%, Chenopodium album 60.9%, Robinia pseudoacacia 49%, Artemisia vulgaris 43.8%, Platanus acerifolia 36.6%, Parietaria judaica 36.1%, Populus nigra 32.3%, Betula alba 27.6%, Quercus ilex 21.4%, Alnus glutinosa 20.9%, Cupressus arizonica 7.6% and Castanea sativa 7.1%. Fifteen patients were sensitized to Castanea sativa and 14 had seasonal rhinoconjunctivitis and asthma. Ten patients had serum specific IgE to Castanea pollen (maximum value: 17.4 Ku/l). Castanea pollen is present in our area in large amounts from the 23rd to the 28th weeks of the year, with a peak pollen count in the 25th week. CONCLUSIONS: The most important allergenic pollens in northern Extremadura were Poaceae, Olea europaea and Plantago sp. The prevalence of sensitization to Castanea sativa pollen was very low (7.1%). Most sensitized patients had asthma and polysensitization. Castanea sativa pollen is not a major cause of pollinosis in our area.

Sensibilización a polen de castaño y polinosis en el norte de Extremadura / Sensitization to Castanea sativa pollen and pollinosis in northern Extremadura (Spain)

Introducción: La alergia al polen de castaño (Castanea sativa) ha sido considerada rara y clínicamente insignificante. En nuestra área geográfica (Plasencia, Cáceres, España) es un polen predominante. Objetivo: Este trabajo pretende determinar las fluctuaciones atmosféricas y la existencia de individuos sensibilizados al polen de castaño y su comparación con otras especies. Métodos: Pacientes que acudieron en el año 2003 por primera vez a nuestra consulta por síntomas respiratorios. Se les realizó prueba del prick con extractos comerciales de una batería de aeroalérgenos que incluía polen de castaño. Se determinó la IgE específica a polen de Castanea sativa por CAP system (Pharmacia & Upjohn, Uppsala, Suecia). El estudio aerobiológico se realizó con un captador Cour, durante los años 2000-2003. Resultados: Los taxones más abundantes fueron (media de la concentración semanal máxima de los 4 años, en granos de polen/m 3 de aire): Quercus 968, gramíneas 660, olivo 325, plátano de sombra 229, pino 126, cupresáceas 117, llantén 109, aliso 41, chopo 40, castaño 32... Se estudiaron 346 pacientes. En los 210 diagnosticados de polinosis, los porcentajes de sensibilización fueron: Dactylis glomerata 80,4 %, Olea europea 71,9 %, Fraxinus excelsior 68 %, Plantago lanceolata 62,8 %, Chenopodium album 60,9 %, Robinia pseudoacacia 49 %, Artemisia vulgaris 43,8 %, Platanus acerifolia 36,6 %, Parietaria judaica 36,1 %, Populus nigra 32,3 %, Betula alba 27,6 %, Quercus ilex 21,4 %, Alnus glutinosa 20,9 %, Cupressus arizonica 7,6 % y Castanea sativa 7,1 %. Hubo quince pacientes sensibilizados al polen de castaño, catorce con rinoconjuntivitis y asma. Diez tuvieron IgE específica sérica a polen de castaño, aunque el valor mayor encontrado fue de 17,4 ku/L. El castaño polinizó en las semanas 23 a 28, con pico en la 25. Conclusiones: Los pólenes alergénicos más importantes en el norte de Extremadura fueron gramíneas, Olea europea y Plantago sp. La prevalencia de sensibilización al polen de Castanea sativa fue del 7,1 %, cifra muy baja. La mayoría de los pacientes eran asmáticos y estuvieron polisensibilizados. El polen de castaño no es un alérgeno importante en nuestra zona como causa de polinosis

Background: Castanea sativa pollen allergy has generally been considered to be uncommon and clinically insignificant. In our geographical area (Plasencia, Cáceres, Spain) Castanea sativa pollen is a major pollen. Objective: To determine the atmospheric fluctuations and prevalence of patients sensitized to Castanea pollen in our region and to compare this sensitization with sensitizations to other pollens. Methods: Patients with respiratory symptoms attending our outpatient clinic for the first time in 2003 were studied. The patients underwent skin prick tests with commercial extracts of a battery of inhalants including Castanea sativa pollen. Serologic specific IgE to Castanea sativa pollen was determined using the CAP system (Pharmacia & Upjohn, Uppsala, Sweden). Airborne pollen counts in our city were obtained using Cour collection apparatus over a 4-year period (2000 to 2003). Results: The most predominant pollens detected were (mean of the maximal weekly concentrations over 4 years in pollen grains/m 3): Quercus 968, Poacea 660, Olea 325, Platanus 229, Pinus 126, Cupresaceae 117, Plantago 109, Alnus 41, Populus 40, Castanea 32. We studied 346 patients (mean age: 24.1 years). In 210 patients with a diagnosis of pollinosis, the percentages of sensitization were: Dactylis glomerata 80.4 %, Olea europea 71.9 %, Fraxinus excelsior 68 %, Plantago lanceolata 62.8 %, Chenopodium album 60.9 %, Robinia pseudoacacia 49 %, Artemisia vulgaris 43.8 %, Platanus acerifolia 36.6 %, Parietaria judaica 36.1 %, Populus nigra 32.3 %, Betula alba 27.6 %, Quercus ilex 21.4 %, Alnus glutinosa 20.9 %, Cupressus arizonica 7.6 % and Castanea sativa 7.1 %. Fifteen patients were sensitized to Castanea sativa and 14 had seasonal rhinoconjunctivitis and asthma. Ten patients had serum specific IgE to Castanea pollen (maximum value: 17.4 Ku/l). Castanea pollen is present in our area in large amounts from the 23rd to the 28th weeks of the year, with a peak pollen count in the 25th week. Conclusions: The most important allergenic pollens in northern Extremadura were Poaceae, Olea europaea and Plantago sp. The prevalence of sensitization to Castanea sativa pollen was very low (7.1 %). Most sensitized patients had asthma and polysensitization. Castanea sativa pollen is not a major cause of pollinosis in our area

Plasma urea-cycle-related amino acids, ammonium levels, and urinary orotic acid excretion in short-bowel patients managed with an oral diet.

BACKGROUND AND AIMS: The small intestine contains several enzymes involved in arginine synthesis and converts glutamine to citrulline, the major compound for endogenous arginine synthesis. This study was conducted to assess the plasma status of urea-cycle intermediates and orotic urinary excretion in short-bowel patients. METHODS: Thirteen stable short-bowel syndrome patients (7 men; 60.2+/-15.2 years) were studied. Patients were divided into moderately resected (Group A; n=6) and severely resected (Group B; n=7) according to their remnant bowel length (Group A: 61-150 cm; Group B: < or =60 cm). All subjects were consuming an oral diet plus dietetic supplements. Plasma urea-cycle amino acids, ammonium and urinary orotic acid were determined. RESULTS: Plasma glutamine levels were significantly higher in both patient groups than in the control group (P<0.001). Regarding citrulline, Group B levels were significantly lower vs. controls (P<0.001). Comparisons between patient groups showed higher arginine in Group A (P<0.05) and non-statistically lower citrulline in Group B. Blood ammonium and orotic urinary excretion were normal. CONCLUSIONS: Although plasma citrulline and glutamine alterations were found, patients showed no hyperammonemia or orotic aciduria, which suggests a certain degree of adaptation in arginine and related amino acid metabolism, when an adequate dietary supply of arginine is provided.

Variations in diagnostic yield of head-up tilt test and electrophysiology in groups of patients with syncope of unknown origin.

AIMS: To assess the diagnostic yield of the head-up tilt test and electrophysiology in different groups of patients with syncope of unknown origin established according to simple clinical criteria. METHODS AND RESULTS: Six hundred consecutive patients with syncope of unknown origin submitted to a tilt test. Two hundred and forty seven of them also underwent electrophysiology. Patients were divided into groups according to age at the time of first syncope, ECG findings and the presence of organic heart disease. Positive responses to the tilt test were more common in patients who had suffered their first syncope at an age equal to or below 65 years (group I) than in older patients (group II) (47% vs 33%, P<0.05, OR 1.8, CI 1.2-2.78), and in patients with a normal ECG and without organic heart disease than in the other subgroups of patients (47% vs 37%, P<0.008, OR 1.6). The lowest rate of positive response was observed in older patients with an abnormal ECG and organic heart disease. Electrophysiology disclosed abnormal findings in group II more often than in group I (23% vs 7%, P<0.001, OR 3.7, CI 1.7-9.2). The diagnostic yield from electrophysiology was higher in patients with an abnormal ECG than in those with a normal ECG (22% vs 3.7%, P<0.0005, OR 7.1), and it was especially low in patients with a normal ECG and without organic heart disease (2.6%). CONCLUSION: The diagnostic yield of the tilt test and electrophysiology differs in groups of patients with syncope of unknown origin, established according to simple clinical criteria. These findings have a bearing on selecting the most appropriate test in a particular patient.

L-Arginine administration prevents reperfusion-induced cardiomyocyte hypercontracture and reduces infarct size in the pig.

OBJECTIVE: Stimulation of cGMP synthesis protects cardiomyocytes against reoxygenation-induced hypercontracture. The purpose of this study was to determine whether L-arginine supplementation has a protective effect against reperfusion-induced hypercontracture and necrosis in the intact animal. METHODS: Twenty-four Large-White pigs were randomized to receive either 100 mg/kg of L-arginine i.v. or vehicle 10 min before 48 min of coronary occlusion and 2 h of reperfusion. Hemodynamic variables, coronary blood flow and myocardial segment length changes (piezoelectric crystals) were monitored. Postmortem studies included quantification of myocardium at risk (in vivo fluorescein), infarct size (triphenyltetrazolium reaction), myocardial myeloperoxidase activity and histological analysis. Systemic, coronary vein, and myocardial cGMP concentration were measured in additional animals. RESULTS: Administration of L-arginine had no significant effect in hemodynamics or coronary blood flow. During reperfusion, myocardial cGMP content was reduced in the LAD as compared to control myocardium (P=0.02). L-Arginine increased myocardial cGMP content and caused a transient increase in plasma cGMP concentration during the initial minutes of reperfusion (P=0.02). The reduction in end-diastolic segment length induced by reperfusion, reflecting hypercontracture, was less pronounced in the L-arginine group (P=0.02). Infarct size was smaller in pigs receiving L-arginine (47.9+/-7.2% of the area at risk) than in controls (62.9+/-4.9%, P=0.047). There were no differences between groups in leukocyte accumulation in reperfused myocardium (P=0.80). CONCLUSION: L-Arginine supplementation reduces myocardial necrosis secondary to in situ ischemia-reperfusion by a direct protective effect against myocyte hypercontracture.

[Bacterial content of the enucleated prostate gland]. / Contenido bacteriano de la glándula prostática enucleada.

OBJECTIVE: To determine the prevalence of prostatic colonization or infection in patients undergoing prostatic surgery for obstructive symptoms due to benign hyperplasia of the prostate (BPH), to identify and quantitate the microorganisms isolated in quantitative bacterial tissue cultures, and to determine the influence of open surgery vs endoscopy on the microbiological findings. METHODS: A prospective study was conducted on 175 patients undergoing surgery for BPH. All patients were entered into a study protocol that included quantitative bacterial cultures of prostatic tissue. Data of previously defined variables were entered into a data base for subsequent analysis comprised of redefinition of the variables and descriptive and analytical studies. RESULTS: 44 of the 175 patients (25.1%) had a positive bacterial culture of prostatic tissue. Histological lesions indicating prostatitis associated with BPH were found in 68 of the 175 patients (38.9%), regardless of the presence or absence of bacteria. Of these 68 patients with histologically demonstrated prostatic inflammation, only 19 (27.9%) had a positive prostatic tissue culture. The incidence of granulomatous prostatitis was 1.1%. CONCLUSIONS: The presence of bacteria was demonstrated in prostates of a significant number of patients (25.1%) undergoing prostatectomy for BPH. The microorganisms most frequently isolated in the quantitative bacterial cultures were, by order of frequency, coagulase negative Staphylococci, Escherichia coli and Enterococcus faecalis, which were present in concentrations of at least 10(4) CFU/Gm in prostatic tissue of 79.6% of the cases. No differences were found between the type of procedure the patient underwent and the presence or absence of prostatic infection.

L-arginine limits myocardial cell death secondary to hypoxia-reoxygenation by a cGMP-dependent mechanism.

The objective of this study was to investigate the effect of L-arginine supplementation on myocardial cell death secondary to hypoxia-reoxygenation. Isolated rat hearts (n = 51) subjected to 40 min of hypoxia and 90 min of reoxygenation received 3 mM L-arginine and/or 1 microM 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; a selective inhibitor of soluble guanylyl cyclase) throughout the experiment or during the equilibration, hypoxia, or reoxygenation periods. The incorporation of L-[3H]arginine into myocytes during energy deprivation was investigated in isolated adult rat myocytes. The addition of L-arginine to the perfusate throughout the experiment resulted in higher cGMP release (P < 0.05), reduced lactate dehydrogenase release (P < 0.05), and increased pressure-rate product (P < 0.05) during reoxygenation. These effects were reproduced when L-arginine was added only during equilibration, but addition of L-arginine during hypoxia or reoxygenation had no effect. Addition of ODQ either throughout the experiment or only during reoxygenation reversed the beneficial effects of L-arginine. L-[3H]arginine was not significantly incorporated into isolated myocytes subjected to energy deprivation. We conclude that L-arginine supplementation protects the myocardium against reoxygenation injury by cGMP-mediated actions. To be effective during reoxygenation, L-arginine must be added before anoxia.

[Assessment of an interventional study on iodine deficiency in Burkina Faso, 1990-1993. Direction de la Santé de la Famille (Burkina Faso)]. / Valoración de un estudio de intervención sobre el déficit de yodo en Burkina Faso, 1990-1993. Direction de la Santé de la Famille (Burkina Faso).

OBJECTIVES: To find how the urinary parameters of iodine excretion evolved in a community with deficiencies, after administering iodine orally and IM in two provinces in Burkina Faso; to recommend a national strategy to tackle iodine deficits. Design. A longitudinal survey before and after the iodine was given (12 months). Descriptive analysis of the data. SETTING: Provinces of Namentenga and Passoré in Burkina Faso. PARTICIPANTS: The general population of the two provinces who satisfied age-sex criteria: males from 0 to 25, females from 0-45. Randomised two-stage sampling. 423 people in all took part (210 in Namentenga and 213 in Passoré). INTERVENTIONS: The administration of 1 ml of iodised oil (Lipiodol) orally in Namentenga and IM in Passoré. MEASUREMENTS AND MAIN RESULTS: The urinary parameters of micrograms of iodine per gr. of Creatinine, and micrograms of iodine per dl of urine, were used. Figures for normalisation of the urinary parameters 12 months after iodisation was significantly higher in Passoré province, where iodine was administered IM. CONCLUSIONS: The intramuscular pathway has more longlasting effects, but the characteristics of Burkina Faso's health system and the feasibility of a medium or long-term intervention make it advisable that iodine supplements be administered orally.

Is there a place for pudendal nerve maximal electrical stimulation for the treatment of detrusor hyperreflexia in spinal cord injury patients?

The aim of the study is to determine whether pudendal nerve maximal electrical stimulation (MES) could represent an alternative treatment for detrusor hyperreflexia in spinal cord injury (SCI) patients. Six suprasacral SCI patients participated in the study. The treatment consisted of daily stimulation periods of 20 min, repeated five times a week, during 4 weeks, with continuous electrical stimulation of the penis or of the clitoris via bipolar surface electrodes (rectangular stimuli of 0.5 ms pulse duration, 5 Hz frequency), with the maximum tolerable stimulation strength (under the level of pain). In two patients, additional stimulation was administrated by means of an anal plug during the last 2 weeks. The stimulus strengths ranged from 35 to 99 mA (mean 54 mA). One patient stopped MES after 2 weeks. At the end of the treatment, neither the cystometric bladder capacities (153 ml vs 157 ml) nor the micturition charts had significantly improved for the five remaining patients. Only two patients experienced non lasting improvement of nocturia at some time of the treatment. In conclusion, we were not able to demonstrate the efficacy of MES in inhibiting detrusor hyperreflexia in SCI patients. To reach therapeutic effects, other parameters may be needed, such as higher stimulation strengths (currents above or equal to 99 mA) or other currents (such as interferential therapy). Chronic stimulation with external or implanted electrodes using lower currents may represent an alternative.

Nitrendipine and enalapril in the treatment of diabetic hypertensive patients with microalbuminuria.

A trial to study the efficacy, safety and tolerability of nitrendipine and enalapril in the treatment of diabetic hypertensive patients with microalbuminuria (MA) was performed to compare the effects of both drugs in the prevention of the renal impairment. Twenty-eight valid patients [13 with nitrendipine (N) and 15 with enalapril (E) with NIDDM, hypertension (diastolic blood pressure between 90 to 114 mm Hg) and MA (urinary albumin between 30 to 300 mg/24 hr) were recruited in a double blind, randomized trial. Following a placebo run-in period of two to four weeks, all eligible patients were randomly allocated to either N or E treatment. Treatment lasted six months, with two different visits at three and six months in which blood pressure (BP), heart rate (HR), renal function and MA were measured. No statistically significant differences on BP and metabolic parameters were found between both treatment groups. The geometric mean of final glomerular filtration rate (GFR) in the N group was 34.5% higher than in the E group, while the reduction on MA was most important in the E group. Eleven patients reported adverse events (AEs) and there were four dropouts, three of them due to AEs. We conclude that both treatments are a good choice for treating diabetic hypertensive patients with early altered renal function, as they reduce BP without altering metabolic parameters, increase GFR and reduce MA with a low frequency of AEs.

Short-term effect of pudendal nerve electrical stimulation on detrusor hyperreflexia in spinal cord injury patients: importance of current strength.

Twenty patients with chronic suprasacral spinal cord injury presenting with detrusor hyperreflexia were examined. In a preliminary study in ten patients we investigated the reproducibility of bladder capacity through the repetition of three cystometries. The effect of electrical stimulation (ES) on detrusor hyperreflexia was then investigated in ten patients during three consecutive cystometries, the first one without ES (baseline) and the other two with continuous ES of the dorsal penile or clitoris nerve via surface electrodes. Parameters of stimulation were 5 Hz frequency, 0.50 msec pulse duration, and stimulation strength of 1 and 2 times the bulbocavernosus reflex threshold. No significant differences in bladder capacity were found between the three consecutive cystometries without ES (respectively 97.0 ml, 101.5 ml and 105.6 ml). A current at the bulbocavernosus threshold (mean 24.4 mA) failed to induce a significant increase in bladder capacity compared to baseline (173.0 ml vs 155.5 ml, P = 0.17) whereas a current of twice the bulbocavernosus threshold (mean 48.9 mA) was highly significant (318.5 ml vs 155.5 ml, P < 0.007). ES of twice the threshold resulted in perineal contraction in all of the patients, the threshold ES never did. Our results emphasise the decisive roles of perineal contraction and of current strength for achieving short-term bladder inhibition in spinal cord injury patients. The carry-over effect may also be dependent on the current strength. If so, maximal pudendal ES could represent an alternative procedure in the treatment of detrusor hyperreflexia in these patients.

[Perfusion tomographic scintigraphy and coronary angiography as complementary studies for the therapy decision for patients with ischemic cardiopathy]. / La tomogammagrafía de perfusión y la coronariografía como exploraciones complementarias en la decisión terapéutica de pacientes con cardiopatía isquémica.

BACKGROUND: The aim of the present study was to assess the value of tomographic perfusion scintigraphy as a complement to coronary arteriography in the therapeutic management of patients admitted to the hospital for treatment of unstable ischaemic heart disease. METHODS: A review was carried out of the discharge report of 100 consecutive patients (mean age 58 years, 19 females) in which there was a mention of having taken a therapeutic decision on the basis of coronary angiography and tomographic perfusion scintigraphy with 99m-technetium isonitriles under exercise and/or dipyridamole. In 90% of instances the study was performed during drug therapy after the patient had remained stable for at least 3 days. The indication of the studies and the type of therapy was made by the attending physician. Concordance between both studies was said to exist when both pointed to the same type of therapeutic approach, either medical treatment (nonsevere stenosis on coronary arteriography with mild ischaemia on scintigraphy) or revascularization (severe stenosis with moderate or severe ischaemia in tomographic scintigraphy). Discordance was said to be present when ischaemia was mild with severe stenosis on coronary angiography. RESULTS: In 80 patients there was concordance between both studies regarding the subsequent therapeutic approach (medical treatment in 32 and revascularization in 48 [25 coronary angioplasty and 23 bypass surgery]). In the patients with discordance (n:20) medical treatment was decided in 14 patients on the basis of mild ischaemia with significant angiographic stenosis, and in only 6 patients revascularization (angioplasty in 5 and bypass surgery in 1) was indicated, based on the severity of coronary stenosis even if the ischaemia apparent on the scintigraphy was mild. CONCLUSIONS: Therefore, in 80% of patients admitted for unstable coronary artery disease there was a concordance between the results of tomographic scintigraphy and coronary angiography, when both studies were indicated to select the most appropriate therapeutic modality. In the 20% of discordant cases the attending physician decided on a conservative strategy in most cases, as no significant enough perfusion defect was shown on scintigraphy in spite of severe coronary artery stenosis.

[Prophylaxis with ciprofloxacin in postchemotherapy neutropenia in acute myeloid leukemia]. / Profilaxis con ciprofloxacino en la neutropenia posquimioterápica de la leucemia mieloide aguda.

BACKGROUND: Infection is the most frequent complication in patients with acute myeloid leukemia (AML) following chemotherapy. The new quinolones, among which ciprofloxacin may be found, seem to be effective in the prophylaxis of this complication. METHODS: Fifty consecutive episodes of neutropenia were studied in patients with AML who received prophylaxis with ciprofloxacin and these were compared with a historic control group of another 50 consecutive episodes of neutropenia in AML patients who did not receive antibiotic prophylaxis. The difference with regard to the prevalence of infection and the characteristics of the same were studied. RESULTS: Ciprofloxacin significantly decreased the number of febrile episodes following chemotherapy of induction or consolidation with respect to those who did not receive prophylaxis (68% versus 94%; p = 0.002). Likewise, the patients who received ciprofloxacin presented fewer bacteriologically documented infections (26% versus 50%; p = 0.023), bacteremias (10 versus 25, p = 0.03) and infections produced by Gram negative microorganisms (2 versus 13, p = 0.009). Ciprofloxacin led to disappearance of the infections produced by Pseudomonas aeruginosa. Delay in the development of infection was observed in patients who received ciprofloxacin (mean: 11 days, CI: 7-15 days) with respect to those who did not receive prophylaxis (mean: 6 days, CI: 4-6 days) (p = 0.0001). CONCLUSIONS: Ciprofloxacin is an effective antibiotic in the prevention of infection in episodes of neutropenia after induction or consolidation chemotherapy in patients with acute myeloid leukemia. Not only does it decrease the number of febrile episodes, bacteriologically documented infections, bacteremias and infections produced by Gram negative microorganisms, but it also delays the appearance of the febrile episodes.

[Clinical effectiveness and tolerance of acarbose in the treatment of insulin-dependent diabetic patients (type I)]. / Eficacia clínica y tolerancia de la acarbosa en el tratamiento de pacientes diabéticos dependientes de la insulina (tipo I).

BACKGROUND: Acarbose is a reversible inhibitor of the intestinal alpha-glucosidases, the oral administration of which delays or diminishes the postprandial increase of glucose and insulin. METHODS: A multicentric double-blind clinical trial (11 centers), controlled versus placebo, crossed and randomized, was carried out with 137 insulin-dependent diabetic type I patients treated with diet and insulin. During the first 3 months of the trial the patients received placebo or acarbose randomly. Following one month of wash out with placebo the patients received the inverse medication for 3 more months. During the first month of each phase the patients were given 50 mg three times per day of acarbose or placebo and the two following moths received 100 mg x 3/day. RESULTS: Upon comparison of the two treatments significant statistical differences were found in HbA1 (p = 0.0005) and in postprandial glycemia (p = 0.007). There were differences, although not statistically significant, in the amounts of triglycerides, cholesterol and fasting glycemia. One hundred and two patients referred adverse events, most being gastrointestinal (flatulence, meteorism). CONCLUSIONS: Acarbose may be useful in the treatment of insulin-dependent diabetic type I patients treated with insulin and diet since it reduces the levels significantly of HbA1 and postprandial glucose.

[Clinical efficacy and tolerance to acarbose in the treatment of non-insulin-dependent diabetic patients]. / Eficacia clínica y tolerancia de la acarbosa en el tratamiento de pacientes diabéticos no dependientes de la insulina (tipo II).

BACKGROUND: Acarbose is a pseudotetrasacaride which reversibly and competitively inhibits the intestinal alpha-glycosidases leading to a decrease in the increase of postprandial glycemia. METHODS: A multicentric double-blind clinical trial (8 centers), controlled versus placebo, crossover and randomized was carried out in 90 non insulin dependent diabetic patients under treatment with diet or with diet and sulphonilureas. During the first three months of the trial the patients received placebo or acarbose randomly. Following one months of wash-out with placebo the patients received the inverse medication for 3 more months. During the first month of each phase the patients received 3 x 50 mg/day of acarbose or placebo and the following 2 months 3 x 100 mg/day. RESULTS: Upon comparison of the two treatments significant statistical differences were observed in HbA1 (p = 0.0115) and in postprandial glycemia (p = 0.0001). There were differences, although not significant, in the levels of triglycerides, cholesterol, fasting glycemia, and postprandial insulinemia. Episodes of hypoglycemia appeared in 12 patients and 57 patients referred undesirable gastrointestinal effects. CONCLUSIONS: The results of this trial indicate that acarbose may be useful in the treatment of non insulindependent diabetic patients since it significantly reduces the amount of postprandial glycemia and HbA1.

An outbreak of Salmonella enteritidis infection at a fast-food restaurant: implications for foodhandler-associated transmission.

An outbreak of Salmonella enteritidis infection occurred in patrons and employees of a fast-food restaurant. Transmission took place over a 9-day period. A single employee (employee A) was identified who had onset of gastrointestinal illness 1 day before the first reported patron exposures and had S. enteritidis isolated from stool. A case-control study of 37 ill and 20 healthy patrons who ate during shifts worked by employee A demonstrated that curly-fried potatoes and ice (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.5-33.7; P = .007), both food items handled bare-handed by employee A, were associated with illness. Employees who worked two or more shifts with employee A were more likely to be infected than those who did not work with employee A (OR, 4.4; CI, 1.0-19.5; P = .03). Foodhandlers who subsequently became infected apparently contaminated multiple food items with additional transmission to patrons. This outbreak illustrates the potential for foodhandlers in a fast-food restaurant setting who are infected with Salmonella to be a source of transmission.