Radiologic evidence that hypothalamic gliosis is associated with obesity and insulin resistance in humans.

OBJECTIVE: To use quantitative magnetic resonance imaging (MRI) to test whether mediobasal hypothalamic (MBH) gliosis is associated with obesity and insulin resistance in humans. METHODS: Sixty-seven participants underwent a fasting blood draw and MRI. Cases with radiologic evidence of MBH gliosis (N = 22) were identified as the upper tertile of left MBH T2 relaxation time and were compared to controls (N = 23) from the lowest tertile. In a separate postmortem study, brain slices (N = 10) through the MBH were imaged by MRI and stained for glial fibrillary acidic protein (GFAP). RESULTS: In all participants, longer T2 relaxation time in the left MBH was associated with higher BMI (P = 0.01). Compared with controls, cases had longer T2 relaxation times in the right MBH (P < 0.05), as well as higher BMI (P < 0.05), fasting insulin concentrations (P < 0.01), and HOMA-IR values (P < 0.01), adjusted for sex and age. Elevations in insulin and HOMA-IR were also independent of BMI. In the postmortem study, GFAP staining intensity was positively associated with MBH T2 relaxation time (P < 0.05), validating an MRI-based method for the detection of MBH gliosis in humans. CONCLUSIONS: These findings link hypothalamic gliosis to insulin resistance in humans and suggest that the link is independent of the level of adiposity.

Cranioplasty with bandaging. New forms of limitation of life support and organ donation.

Most of transplanted organs are obtained from brain death (BD) donors. In neurocritical patients with catastrophic injuries and decompressive craniectomy (DC), which show a dreadful development in spite of this treatment, DC could be a futile tool to avoid natural progress to BD. We propose if cranial compressive bandage (cranioplasty with bandage) could be an ethically correct practice, similar to other life-sustaining treatment limitation (LSTL) common methods. Based on a clinical case, we contacted with the Assistance Ethics Committee and some bioethics professionals asking them two questions: 1) Is ethically correct to perform a cranioplasty with bandage in those patients with LSTL indication? 2) Thinking in organ donation possibility, is this option preferable? Conclusions 1) Cranioplasty with bandage could be considered an ethically acceptable LSTL practice, similar to other procedures. 2) It facilitates organ donation for transplant, which provides value-added because of its own social good. 3) In these cases, it is necessary to know previous patient's will or, in absentia, to obtain family consent after a detailed procedure report.

Calibration of a TLD-100 powder dosimetric system to verify the absorbed dose to water imparted by 137Cs sources in low dose rate brachytherapy at the oncology unit in the Hospital General de Mexico.

A thermoluminescence dosimetry (TLD) system was characterised at SSDL-ININ to verify the air-kerma strength (S(K)) and dose-to-water (D(W)) values for (137)Cs sources used in low dose rate (LDR) brachytherapy treatments at the Hospital General de Mexico (HGM). It consists of a Harshaw 3500 reader and a set of TLD-100 powder capsules. The samples of TLD-100 powder were calibrated in terms of D(W) vs. nC or nC mg(-1), and their dose response curves were corrected for supralinearity. The D(W) was calculated using the AAPM TG-43 formalism using S(K) for a CDCSM4 (137)Cs reference source. The S(K) value was obtained by using a NE 2611 chamber, and with two well chambers. The angular anisotropy factor was measured with the NE 2611 chamber for this source. The HGM irradiated TLD-100 powder capsules to a reference dose D(W) of 2 Gy with their (137)Cs sources. The percent deviations between the imparted and reference doses were 1.2% < or = Delta < or = 6.5%, which are consistent with the combined uncertainties: 5.6% < or = u(c) < or = 9.8% for D(W).

Derrame pleural en joven de 16 años / Pleural effusion in a 16-year old patient

No disponible

Anaplastic carcinoma of the fimbriated end of the fallopian tube as an incidental finding.

Carcinoma of the fallopian tube is an uncommon gynecologic tumor that is usually diagnosed in an advanced stage. The majority are tubal in origin, and rarely arise in the fimbriae. It appears that the latter may have a worse prognosis than the equivalent stage of tubal tumors that do not arise from fimbriae. We present a case of a 53-year-old white woman with FIGO stage 1 primary anaplastic carcinoma of the fimbriated end of the fallopian tube that was incidentally found in a specimen resected during a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The patient underwent surgery because of findings of severe cervical dysplasia, atypia and dyskaryosis on a routine Papanicolau smear. Postoperative recovery was uneventful, and follow-up abdominal and pelvic CT scans showed no evidence of disease. However, because of the poor degree of differentiation, focal serosal infiltration and fimbrial end tube site of the carcinoma she was considered to have a high risk of recurrence. Thus, it was recommended that she undergo adjuvant chemotherapy with cyclophosphamide and carboplatin. Eighteen months after diagnosis, the patient is alive and well with no evidence of disease.

[Giant mesenchymal tumor of the vulva with atypical clinical evolution]. / Tumor mesenquinmatoso gigante de la vulva con comportamiento clínico atípico.

Mixed mesenchymal tumors of the vulva are rare lesions. On other hand, aggressive angiomyxoma is a recently characterized neoplasm occurring principally in the pelvic soft-tissues and showing propensity for local recurrence. The benign soft-tissue tumors are small than malign neoplasm, mimicking and often are misdiagnosed as cysts of Bartholin's gland. In this report we describe one case of a benign, giant and atypical mixed mesenchymal tumor of the vulva and its particular clinical characteristics.

Urinary prostaglandins (PGE2 and PGI2) in hyporeninaemic hypoaldosteronism in diabetic patients with chronic renal failure.

The present work studies the urinary excretion of PGE2 and PGI2 (6-keto PGF 1 alpha) in 11 insulin-dependent diabetic patients with chronic renal failure with a glomerular filtration rate of 33.9 +/- 9.03 ml/min who had hyporeninaemic hypoaldosteronism to evaluate the influence of these prostaglandins on the appearance of this latter process. The results obtained in this group of patients were compared with those of a control group of healthy individuals, another group of nine non-diabetic patients with CRF, and a last group of eight insulin-dependent diabetic patients with normal renal function to evaluate to what extent the possible variations in prostaglandin excretion could be related to the diabetes, CRF, or a conjunction of both processes. The results of the groups of diabetic patients with CRF were Ccr 33.9 +/- 9.03 ml/min, decreased (P < 0.0001) with respect to the control group and with no difference with the CRF group without diabetes; plasma potassium (4.7 +/- 0.4 mEq/l), increased (P < 0.005) with respect to the values found in the control group; plasma bicarbonate (17.8 +/- 1.8 mEq/l), decreased (P < 0.005) with respect to the control group and also, though not significantly, with respect to the group of non-diabetic patients with CRF. Plasma aldosterone (pg/ml): resting 44.3 +/- 14.9; standing 65.7 +/- 63.5 and post-frusemide 65.5 +/- 58.6, decreased (P < 0.01) with respect to the other three groups. Plasma renin activity (PRA) (ng/ml/h): resting 0.34 +/- 0.3; standing 0.6 +/- 0.4, post-frusemide 0.9 +/- 0.5, decreased significantly with respect to the other three groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal atresia and tracheoesophageal fistula in two infants born to hyperthyroid women receiving methimazole (Tapazol) during pregnancy.

We report on 2 newborn infants with esophageal atresia and tracheoesophageal fistula (EA + TEF) born to hyperthyroid mothers receiving methimazole (Tapazol) before and during their entire pregnancies. Both mothers were euthyroid during gestation and developed hydramnios diagnosed during weeks 34 and 33 of gestation. Premature delivery (36.2 weeks of gestation) occurred in one case, and both newborn infants were small for date with palpable goiter; one of them had other associated malformations. Hypothyroidism was diagnosed by laboratory tests in both cases. Corrective surgery was undertaken, but both newborn infants developed septicemia and renal insufficiency and died in the first week of life. The EA + TEF and a normally placed enlarged thyroid gland were confirmed at necropsy. These cases represent a previously unreported example of the association of maternal ingestion of methimazole during pregnancy and EA + TEF.

Snowballing movement. Legislators are now active advocates regarding population and development.

PIP: Newly industrializing economies (NIEs) in East Asia have demonstrated that the population programs were part of their economic success, such as in Thailand and Indonesia where family planning (FP) was made a way of life. The population growth in the Philippines has put pressure on the environment by migration to uplands where slash-and-burn agriculture adds to deforestation. The Global Committee of Parliamentarians of Population and Development headquartered in New York serves as a liaison for 56 legislative groups sponsoring meetings and seminars. In October 1981 the Asian Conference on Parliamentarians on Population and Development was held in Beijing with the participation of legislators from 19 countries. It set up the Asian Forum for Parliamentarians on Population and Development to contribute and promote activities that facilitate population and development, and to improve the living standards and welfare of people in Asia. The Secretariat is located in Bangkok, Thailand. In October 1987 in Beijing and in October 1990 follow-up regional conferences were organized. The latter was attended by 21 Asian parliamentarians who endorsed the stabilization of population growth to achieve a 1% growth rate for Asia by 2000. The Philippine population numbered 63.9 million in mid-1992 with an annual growth rate of 2.3%. The Philippine House of Representatives started an inquiry about the disturbing demographic trends with implications on economic growth. In 1987 a movement commenced that hosted the Philippine Parliamentarians Conference on Human Survival, Population and Development (PARLCON '88) in Manila. It focused on sustainable development, the conditions of women and children, the environment, and the promotion of FP which was adopted by the House and involved a major segment of legislators.^ieng

[Cicatricial, antibacterial and antimycotic effects of tepescohuite in experimental animals]. / Efectos cicatrizante, antibacteriano y antimicótico del tepescohuite en animales de experimentación.

The cicatricial and antibacterial effects of the sterile powder of the barks of tepescohuite (Mimosa tenuiflora), 2% mupirocin ointment, and 0.9% saline were compared. The experiment was performed in rabbits with chemically induced burns clinically, histopathologically, bacteriologically, and mycologically controlled. No statistically significant difference was found among the three treatment modalities. Due to the potentially hepatotoxic effects and low therapeutic efficacy of tepescohuite it should not be used in human beings.

[Primary amebic meningoencephalitis caused by Naegleria fowleri in an adolescent from Huetamo, Michoacan, Mexico]. / Meningoencefalitis amibiana primaria por Naegleria fowleri en un adolescente de Huetamo, Michoacán, México.

A 13 year old boy died after a three day illness with severe headache, explosive vomiting, fever and progressive loss of consciousness. The autopsy revealed purulent and necrotizing meningoencephalitis mainly involving the basal regions and posterior fossa and on microscopic examination numerous trophozoites of Naegleria were seen in the meninges and necrotic brain tissue. The trophozoites were identified as Naegleria fowleri by immunoperoxidase staining. This case as well as others previously reported in Mexico and the documented presence of Naegleria species from several sources indicate that primary amebic meningoencephalitis should be considered in the differential diagnosis of cases with neurological symptoms of sudden onset.

Population program doing fine.

PIP: In appraising the current status, problems and approaches of the Philippines population program, initial focus is on providing a brief account of the program's development. A national family planning program that respected the religions beliefs and values of individuals was the 1st step. These early family planning efforts were physician oriented, clinic-based, and female-oriented, and the acceptance rates continued to be low. In response to this, population and family planning was made an integral part of the socioeconomic development of the country. This new orientation paved the way for the birth of the national population and family planning project which is currently the program's core project. The outreach project was intended to stregthen the programs' capability to reach out to the remote areas through its Full-Time Outreach Workers (FTOW) and Barangay supply points. This program is being implemented throughout the Philippines. About 2596 full-time outreach workers, 31,592 barangay supply points, and 3612 family planning clinics are making family planning information and services available to the population. Based on outreach reports, current users increased from 780,183 to 815,061 by March 1979. These accomplishments contributed greatly to the decline in the population growth rate from 3.01 in 1960-1970 to 2.78% in 1970-1975. Greater concerted efforts still need to be exerted to achieve target populations by the year 2000. The special committee to review the Philippine population program has recommended that the concept of family planning be redefined to include family welfare. The program continues to implement complementary and supplementary sets of projects which are termed phase 1 project, population planning 2 projects, and population loan 1 and 2.^ieng

Popcom brass report on China: simplicity, IEC methods impress no. 2 official.

PIP: In the People's Republic of China, the national family planning goals of deferred marriage, increased birth intervals, and smaller family size are communicated to the citizens of the country primarily through small group activities, and conformity to these goals is achieved by bringing peer and community pressure to bear on the individual. The State Council and the Office of Family Planning formulate national population policy which is then implemented by the Ministry of Health. Ministry officials organize local family planning committees in schools, factories, villages, and other institutions. These local committees are charged with the responsibility of motivating their co-workers, neighbors, and colleagues toward compliance with national goals. Women are expected to discuss their own family planning goals with their assigned committee and each committee must submit a plan for their group designating the number of births that will occur in the future, who will give birth, and when these births will occur. In the schools, sex education is not given until the secondary level and at that time a member from each class is selected and made responsible for the family planning education of his fellow classmates. This grass-roots approach to family planning is unique and may have applicability in other developing countries.^ieng

Direct evidence of luteal insufficiency in women with habitual abortion.

Plasma levels of progesterone were measured during the luteal phase in 10 of 15 women with clinical histories of at least three spontaneous abortions in the last three gestations, and in 15 healthy nonpregnant women during the same phase of the ovarian cycle. Progesterone values found in the women with habitual abortion were lower (P less than 0.05-0.005) than in the nonpregnant group almost throughout the period of observation. The habitually aborting women who became pregnant again aborted between the seventh and 12th weeks. Their progesterone concentrations were less than 6 ng/ml, 48-72 hours before vaginal bleeding or abortion. These values were compared with those found during the first 12 weeks in normal pregnancy (P less than 0.001). The results suggest a useful method of evaluating the treatment of habitual abortion.

[Subcutaneous cysticercosis. 8 cases in children]. / Cisticercosis subcutánea. Informe de ocho casos en niños

Observations in eight patients with subcutaneous or submucous cysticercosis studied at the "Hospital del Nino, IMAN", between November 1970 and June 1975 are reported; the age of the patients varied between 4 and 14 years; six of them were females and 2 were males. One of the patients was found to have C. cellulosae in the central nervous system as well. In the presence of subcutaneous and submucous nodules, cysticercosis should be considered in the differential diagnosis, and anatomic and histopathological documentation should be sought; in cases in which cysticercosis is verified, the patient should be carefully studied, to rule out the presence of C. cellulosae in other locations, mainly the central nervous system.