Pulmonary Hemorrhage Secondary to Disseminated Strongyloidiasis in a Patient with Systemic Lupus Erythematosus.

Introduction. Pulmonary hemorrhage secondary to disseminated strongyloidiasis is an unusual, well-recognized entity in immunocompromised patients with autoimmune disease, which is associated with the hyperinfection syndrome, sepsis, and a high mortality rate. Case Presentation. We present a case of a 44-year-old Mexican woman with systemic lupus erythematosus and acute bacterial meningitis who developed pulmonary hemorrhage with acute respiratory failure requiring mechanical ventilation, treated with broad spectrum systemic antibiotics and high dose methylprednisolone, who subsequently developed a characteristic purpuric skin eruption and septic shock and died two days later of refractory hypoxemia caused by massive pulmonary bleeding. The postmortem examination reports filariform larvae of S. stercolaris in lung, skin, and other organs. Conclusion. This case highlights the importance of considering disseminated strongyloidiasis in the differential diagnosis of diffuse alveolar hemorrhage in systemic lupus erythematosus, and screening for S. stercolaris infection before initiation of immunosuppressive therapy should be considered, especially in endemic areas. Disseminated strongyloidiasis has a high mortality rate, explained in part by absence of clinical suspicion.

Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias.

Induction of preoperative progressive pneumoperitoneum is an elective procedure in patients with hernias with loss of domain. A prospective study was carried out from June 2003 to May 2005 at the Hospital de Especialidades, Instituto Mexicano del Seguro Social, Leon, Mexico. Preoperative progressive pneumoperitoneum was induced using a double-lumen intraabdominal catheter inserted through a Veress needle and daily insufflation of ambient air. Variables analyzed were age, sex, body mass index, type, location and size of defective hernia, number of previous repairs, number of days pneumoperitoneum was maintained, type of hernioplasty, and incidence of complications. Of 12 patients, 2 were excluded because it was technically impossible to induce pneumoperitoneum. Of the remaining 10 patients, 60% were female and 40% were male. The patients' average age was 51.5 years, average body mass index was 34.7, and evolution time of their hernias ranged from 8 months to 23 years. Nine patients had ventral hernias and one had an inguinal hernia. Pneumoperitoneum was maintained for an average of 9.3 days and there were no serious complications relating to the puncture or the maintenance of the pneumoperitoneum. One patient who previously had undergone a mastectomy experienced minor complications. We were able to perform hernioplasty on all patients, eight with the Rives technique, one with supra-aponeurotic mesh, and one using the Lichtenstein method for inguinal hernia repair. One patient's wound became infected postoperatively. Preoperative progressive pneumoperitoneum is a safe procedure that is easy to perform and that facilitates surgical hernia repair in patients with hernia with loss of domain. Complications are infrequent, patient tolerability is adequate, and the proposed modification to the puncture technique makes the procedure even safer.

El alma, razón o no de un ejercicio médico / The soul, reason or not of an exercise physician

La medicina tiene como propósito principal lograr una mejor calidad de vida en los pacientes. Para que esto sea posible no es suficiente conformarse con estudiar y tratar el aspecto físico de estos, también es igualmente importante tener la posibilidad de curar su alma. Luego de explicar y analizar diferentes conceptos y realidades de lo que son el alma y el espíritu, notamos que es perfectamente posible para el médico mejorar la calidad de vida espiritual de su paciente una vez que acepte que, aunque no es algo científicamente comprobable, el alma y el espíritu existen y son esenciales para la óptima sanidad y cura de todo ser humano

Neutron polarizabilities investigated by quasifree Compton scattering from the deuteron.

Measuring Compton scattered photons and recoil neutrons in coincidence, quasifree Compton scattering by the neutron has been investigated at MAMI (Mainz) at theta(lab)(gamma) = 136 degrees in an energy range from 200 to 400 MeV. From the data a polarizability difference of alpha(n)-beta(n) = 9.8+/-3.6(stat)+2.1-1.1(syst)+/-2.2(model) in units of 10(-4) fm(3) has been determined. In combination with the polarizability sum alpha(n)+beta(n) = 15.2+/-0.5 deduced from photoabsorption data, the first precise results for the neutron electric and magnetic polarizabilities, alpha(n) = 12.5+/-1.8(stat)+1.1-0.6(syst)+/-1.1(model) and beta(n) = 2.7-/+1.8(stat)+0.6-1.1(syst)-/+1.1(model), are obtained.

Test of low-energy theorems for 1H(--> gamma, pi(0))(H)in the threshold hegion.

The photon asymmetry in the reaction 1H(--> gamma,pi(0))(1)H close to threshold has been measured for the first time with the photon spectrometer TAPS using linearly polarized photons from the tagged-photon facility at the Mainz Microtron MAMI. The total and differential cross sections were also measured simultaneously with the photon asymmetry. This allowed determination of the S-wave and all three P-wave amplitudes. The values obtained at threshold are E(0+) = [-1.33+/-0.08(stat)+/-0.03(syst)] x 10(-3)/m(pi(+)), P(1) = [9.47 +/- 0.08(stat) +/- 0.29(syst)] x 10(-3)q/m(2)(pi(+)), P(2) = [-9.46 +/- 0.1(stat) +/- 0.29(syst)] x 10(-3)q/m(2)(pi(+)), and P(3) = [11.48 +/- 0.06(stat) +/- 0.35(syst)] x 10(-3)q/m(2)(pi(+)).

Direct observation of a rho decay of the D13(1520) baryon resonance.

The reaction gammap-->pi(+)pi(0)n has been measured at MAMI for photon energies up to 820 MeV. Invariant mass spectra of the particles in the final state (pi(+)n), (pi(0)n), (pi(+)pi(0)) have been determined for several bins of incident photon energy. Differences in pi(+)pi(0) and simultaneously measured pi(0)pi(0) invariant mass distributions are assigned to a rho branch of the D13(1520) nucleon resonance.

Cyclophosphamide pulse therapy in optic neuritis due to systemic lupus erythematosus: an open trial.

OBJECTIVE: To evaluate the efficacy of intravenous cyclophosphamide pulse therapy in patients with optic neuritis associated with systemic lupus erythematosus (SLE). PATIENTS AND METHODS: Ten consecutive patients with optic neuritis due to SLE whose condition was refractory to corticosteroids and oral immunosuppressants were treated with intravenous cyclophosphamide (0.5 to 1.0 g/m2) monthly for 6 months. RESULTS: All patients had bilateral eye involvement. One eye was legally blind, and 13 eyes could see only hand movements or count fingers. Six patients had evidence of the secondary antiphospholipid antibody syndrome. Complete recovery in visual acuity occurred in 10 eyes (50%), and a partial response occurred in six eyes (30%); four eyes (20%) had no response. Complete response in the field tests occurred in eight eyes (40%), with a partial response in nine eyes (45%); no improvement occurred in three eyes (15%). CONCLUSIONS: Intravenous cyclophosphamide pulse therapy seems to be an effective treatment for optic neuritis refractory to corticosteroids, oral immunosuppressants, or both. A randomized controlled trial will be necessary to confirm our results.

Apoptosis in mouse embryos: elevated levels in pregastrulae and in the distal anterior region of gastrulae of normal and mutant mice.

The pattern of apoptotic cell death has been surveyed in prestreak and primitive streak embryos of four strains of mice and in three mutants affecting gastrulation. In C57BL/6 embryos, a high level of cell death occurs in the early egg cylinder stage at embryonic day 5 (E5) to E5.5. In all strains, cell death is elevated shortly before gastrulation, but the level varies four- to fivefold among strains. During gastrulation, cell death declines but is relatively more abundant in the distal and distal anterior regions. Early streak embryos cultured in media with reduced levels of growth factors show increased cell death mainly in the distal region. In three mutants with disturbed function of the proximal visceral endoderm and/or primitive streak, cell death is increased, and the regional pattern seen in normal embryos is intensified. The results strongly suggest that the proximal visceral endoderm and primitive streak region are the principal sites of synthesis of growth factors promoting cell survival. We conclude that localized growth factor supply has an important role in regulating the size of the embryo and of embryonic regions.

mRNAs for activin receptors II and IIB are expressed in mouse oocytes and in the epiblast of pregastrula and gastrula stage mouse embryos.

Activin is a potent inducer of mesoderm in frog embryos. We showed previously that in the mouse, activin beta A is expressed in the uterine decidua near the embryo before and during the first appearance of mesoderm (E4.5-E6.5). Here, using Northern blotting and in situ hybridization, we show that mouse oocytes, E6.5 and E7.5 embryos, and E6.5 and E7.5 decidua contain mRNAs for both activin receptors type II and IIB. The expression of activin receptor type IIB is particularly strong in embryonic ectoderm apparent at E5.5 and continuing through E8.5. These results support the hypothesis that activin derived from the decidua promotes development of mesoderm in the period E5.5-E6.5.

The expression pattern of the c-kit ligand in gonads of mice supports a role for the c-kit receptor in oocyte growth and in proliferation of spermatogonia.

The tyrosine kinase receptor c-kit and its ligand KL are required for postnatal development of germ cells, in addition to their role in primordial germ cells. To clarify their function, a detailed examination of the pattern of expression of KL in postnatal gonads was undertaken. In ovaries, the expression of KL as seen by RNA blot analysis and by RNase protection assays is relatively high at birth (P0), low from P5 to P8, and high from P12 onward. KL expression is relatively high in testes of all ages. The forms of KL RNA present in the testes suggest that from P5 onward the membrane-bound form of KL predominates, while in the ovary significant amounts of both forms are present. As observed by in situ hybridization and immunohistochemistry, in the newborn ovary KL is highly expressed in central cords whose cells contribute to the formation of central growing follicles. Expression is low in follicle cells of small growing follicles and increases to high levels in three-layered follicles during late oocyte growth. Large amounts of the ligand are found within growing oocytes. After oocyte growth ceases, expression continues only in the outer layers of multilayered follicles. In the testis, from P0 through P9, KL expression is distinct in Sertoli cells, but not in germ cells. Thereafter, the intensity of KL expression declines as the number of spermatogenic cells increases within the tubules. KL in Sertoli cells appears to be concentrated basally at the stage of the cycle of the seminiferous epithelium when it is known to interact with differentiating type A spermatogonia. These data are consistent with a role for KL in oocyte growth and in facilitating proliferation and/or differentiation of type A spermatogonia.

La medición del ajuste emocional del diabético / Measure of the emotional adjustment of diabetic patient

Se describe el desarrollo de una escala auto-administrada de 18 ítems para medir el ajuste emocional de pacientes diabéticos. El coeficiente de consistencia interna, de acuerdo a la fórmula de Spearman-Brown, fue de 0.769; las correlaciones entre ambas mitades del instrumento fueron altas, y la fiabilidad de la prueba, cuatro años después de su administración inicial, fue significativa. La validez concurrente fue establecida comparando los resultados de la escala con el rendimiento, obtenido el mismo día, de una batería de pruebas auto-administradas, fiables y válidas, cuyas versiones en español tenían buena equivalencia transcultural. Los resultados arrojaron correlaciones significativas entre la escala índice y las medidas de depresión, ansiedad rasgo, ajuste familiar y foco de control de la conducta. El análisis de componentes principales con rotación varimax identificó 6 factores que explicaron el 50.4 por ciento de la varianza. Los resultados indicaron que la escala es útil para detectar los casos que presentan desajuste emocional, pero su estabilidad estructural, así como su correlación con los indicadores de control metabólico, requieren más investigación.

Otoesclerosis, experiencia quirúrgica 1982-1991 / Otosclerosis, surgical experience 1982-1991

Se presenta la casuística de 157 pacientes con otoesclerosis intervenidos quirúrgicamente por el primer autor; en un lapso de diez años 1982-1991, en el Servicio de Otorrinolaringología del Hospital General de México S.S. bajo la técnica de estapedectomía, utilizando prótesis de House y de Schuknecht. Se practicó estudios clínicos, audiológicos y de imagen, se analizan los resultados y se dan conclusiones.

[Evaluation of the cold chain during the national antipoliomyelitis vaccination days. Mexico, 1987-1988]. / Evaluación de la cadena de frío en los días nacionales de vacunación antipoliomielítica México, 1987-1988.

An evaluation of the cold chain used during the "National Vaccination Days Against Poliomyelitis" in January and March of 1987 and 1988 was performed in 32 states of Mexico, both the potency of the trivalent Sabin vaccine and completion of requirements for the maintenance of the cold chain were evaluated at each level in the Ministry of Health's structure. Only 56 percent of the refrigeration units exclusively stored vaccines, more than 10 percent of refrigerators were broken, and 44 percent of the persons responsible for the cold chain system considered the storage capacity inadequate. A correlation was found between non-fulfillment of maintenance requirements for cold chain and a decreased in vaccine potency.

Amounts and modulation of actin mRNAs in mouse oocytes and embryos.

In order to measure the content of beta- and gamma-actin mRNA in mouse oocytes and ovulated eggs, Northern and slot blots were hybridized to complementary RNA probes transcribed from mouse isotype-specific cDNA sequences. The blots included samples of isotype-specific sense strand RNA standards prepared from the same cDNA sequences. Total actin mRNA content was estimated to be 40 fg per preovulatory full-grown oocyte or egg, consisting of one-third beta-actin mRNA and two-thirds gamma-actin mRNA. Ninety per cent of the actin mRNA is on polysomes in full-grown oocytes. The per cent of actin mRNA in polysomal mRNA is similar to the per cent of actin in newly synthesized proteins. Measurements on other developmental stages showed that, in mid-growth-phase oocytes, each actin mRNA reaches a level twofold higher than in full-grown oocytes. Thereafter, all modulations of the two isotypic mRNAs occur in parallel; that is, they are maintained at constant levels during the late growth phase (oocytes from females 8-14 days old); gradually degraded in oocytes that have completed their rapid growth phase (oocytes from females 15-18 days old), in maturing oocytes, and in 1- and 2-cell embryos; and deadenylated after about 7 h of progression into meiotic maturation.

Changes in total RNA, polyadenylated RNA, and actin mRNA during meiotic maturation of mouse oocytes.

The total RNA content of mouse oocytes, as measured by ethidium bromide fluorescence, was found to decrease by 19% during meiotic maturation (ovulated eggs contain 19% less RNA than full-grown oocytes). Consistent with these results, prelabeled stable RNA of full-grown oocytes decreased by about 20% during in vitro maturation. Polyadenylated RNA represented 19% of total prelabeled RNA in full-grown oocytes and 10% in oocytes matured in vitro, confirming previous results on in vivo prepared material. To distinguish between deadenylation and degradation for one mRNA, the amount and state of adenylation of actin mRNA was examined using Northern blots of oocyte RNA probed with a nick-translated beta-actin cloned chicken cDNA. The results showed that the amount of actin mRNA remained similar during maturation, but its molecular weight decreased slightly. Experiments in which RNA was treated with oligo(dT) and RNase H demonstrated that the actin mRNA was deadenylated during maturation, when actin synthesis is known to decline. These results indicate that the previously defined loss of bulk RNA and changes in the state of adenylation of mRNA during the first 11/2 days of embryogenesis actually begin during the 12 hr of meiotic maturation preceding fertilization.

Half-lives and relative amounts of stored and polysomal ribosomes and poly(A) + RNA in mouse oocytes.

Growing mouse oocytes were labeled in vitro with [3H]uridine and chased for 2 or for 7 days to estimate the relative amounts of RNA appearing in different fractions and to follow their turnover. Oocytes were lysed and thoroughly dispersed in the presence of 1% DOC, and centrifuged on sucrose gradients to separate polysomes from smaller components not engaged in translation. After the short chase, one-third of the labeled ribosomes appeared in EDTA-sensitive polysomes. The proportion of ribosomes in both fractions remained stable during the long chase, demonstrating no net flow from one fraction to the other. When gradient fractions were analyzed by poly(U) Sepharose chromatography, it was found that about 20% of the labeled poly(A)+ RNA appeared in polysomes after the short chase. The half-lives of stored and translated mRNA were followed relative to stable rRNA during the long chase. Stored mRNA was completely stable, but translated mRNA turned over with a t1/2 of about 6 days. Other methods for separating stored from translated components were not successful, including sedimentation of putative large complexes (fibrillar lattices) containing stored components, or chromatography of lysates on oligo(dT)-cellulose. Results presented here combined with our previous results demonstrate that, during meiotic maturation, the percent of labeled stable RNA which is polyadenylated declines from 19 to 10%, suggesting deadenylation or degradation of half of the accumulated maternal mRNA.

Mouse egg ribosomes: evidence for storage in lattices.

The ribosomes of mouse ova were labeled by exposure of growing ovarian oocytes to [3H]uridine. The ribosomes of ova lysed and dispersed in hypotonic medium were contained in particles with an unusually low buoyant density in CsCl density gradients. These particles sedimented at 9000g or less, and electron microscopy of the pellet revealed ribosome-like particles embedded in a fibrillar network. These results indicate that the ribosomes are present in a proteinaceous superstructure, probably the lattices seen in situ by transmission electron microscopy.

Mouse histidyl-tRNAs during pregnancy. Differentiation of activity profiles within and between organs.

Optimal conditions for in vitro formation of His-tRNA were established. Transfer RNA of maternal mouse organs and total embryo at 13 and 17 days of pregnancy was acylated in vitro with [3H] or [14C] histidine and examined by reversed-phase plaskon chromatography. Most tissues show different radioactive profiles reflecting a varying activity of six to eight isoaccepting His-tRNA species. Quantitative differences in profile were observed for liver tRNA during pregnancy. Profiles of embryo and uterus, kidney, heart and muscle changes less, and that of brain did not change during pregnancy. The significance of these observations with respect to molecular differentiation of His-tRNAs during pregnancy is discussed.