[Encephalopathy due to human herpesvirus 6 in a western immunocompetent patient]. / Encefalopatia por virus herpes humano de tipo 6 en una paciente inmunocompetente occidental.

TITLE: Encefalopatia por virus herpes humano de tipo 6 en una paciente inmunocompetente occidental.

El cambio en la sensibilidad a la insulina no altera el perfil de lípidos en mujeres con posmenopausia temprana / No association between insulin sensitivity and serum lipid levels in postmenopausal women

Background: It is not clear if changes in serum lipid profile during menopause are related to changes in the distribution of fat or to insulin resistance. Aim: To look for an association between insulin resistance and changes in serum lipid levels in post menopausal women. Patients and methods: Cross-sectional study of 66 early postmenopausal women aged 45 to 55years. Body mass index (BMI), waist-to hip ratio (WHR), total body adiposity, systolic blood pressure (SBP), diastolic blood pressure (DBF), mean blood pressure (MBP) and pulse pressure (PP) were measured. Total cholesterol, low-density íipoproteins, high-density íipoproteins, triglycerides, glucose and insulin were determined in a fasting blood sample. Insulin sensitivity was calculated using the homeostasis model assessment method (HOMA) and patients were stratified in quartiles according to this parameter. Results: Patients stratified in the different quartiles of insulin sensitivity were comparable in age and postmenopausal period, but had no differences in serum lipid levels. Compared to women in the lower quartile of insulin resistance, women in the upper quartile had higher BMI (23 and 27 kg/m² respectively, p =0.02), SBP (110 and 125 mmHg respectively, p <0.01) and MBP (83 and 93 mmHg respectively, p <0.01). Differences in total body adiposity were observed between the lower, third, and the upper quartile (30 percent, 35 percent and 36 percent respectively, p <0.01). Conclusions: In this group of early postmenopausal women, no association was observed between the level of insulin sensitivity and serum lipid levels.

Listeriosis materno-fetal: reporte de tres casos / Maternal-fetal Listeriosis: Report of three cases

Los reportes de listeriosis en mujeres embarazadas en Estados Unidos indican 12 a 17 por ciento de casos, mientras que en Europa se reporta una incidencia de 0.5 a 3 por ciento. En México no existen estadísticas confiables, sólo hay reportes aislados como los realizados en 1989 por el Hospital Infantil de México (HIM) en forma conjunta con el Instituto Nacional de Perinatología; en siete casos se identificaron como factores de riesgo antecedentes de procesos infecciosos de vías urinarias, así como datos de corioamnionitis al inicio de trabajo de parto. Posteriormente, el HIM realizó otro reporte aislado de tres casos de listeria neonatal por exámenes de laboratorio, y en estudio retrospectivo se concluyó que los factores de riesgo para la madre y el producto eran de estrato socioeconómico bajo, antecedentes de infección vaginal en el último trimestre del embarazo y convivencia con perros. A diferencia de lo publicado, los caos que presentamos provienen de estratos socioeconómicos altos y con buenos hábitos higiénico-dietéticos; el cuadro clínico materno no corresponde con lo descrito en otras series, ya que las manifestaciones clínicas se presentaron al inicio de trabajo de parto y la mayoría de estas pacientes comparten el antecedente de la presencia de abortos de repetición

Isolation of the Aspergillus nidulans sudD gene and its human homologue.

We have been studying the heat-sensitive bimD6 mutation of Aspergillus nidulans. At a restrictive temperature, the chromosomes of bimD6 mutant strains fail to attach properly to the spindle microtubules, and the mutant also displays a high rate of chromosome loss. We previously cloned the sudA gene, an extragenic suppressor of the heat-sensitive bimD6 mutation and showed that it coded for a DA-box or SMC protein. SMC proteins have been demonstrated to function in chromosome condensation, segregation and global gene regulation. We have now cloned the sudD gene, another of the extragenic suppressor genes of the bimD6 mutation. The predicted SUDD protein is the founding member of a widely expressed protein family. Similar proteins are found in sequence databases for Saccharomyces cerevisiae, Caenorhabditis elegans, mammals and four species of archaebacteria. We have also cloned and sequenced a human cDNA that encodes the human homologue of SUDD and mapped the gene to 18q11.2. The predicted SUDD proteins from A. nidulans, Homo sapiens and S. cerevisiae all share a variety of features. The predicted proteins are approximately 60000Da in mass and have a serine-plus-threonine content of about 11%. The evolutionary conservation of the proteins suggests an ancient origin and conserved function for these proteins.

Sentinel lymph node uptake of two different technetium-labeled radiocolloids,.

BACKGROUND: The study was designed to compare the uptake of technetium-99m-labeled human serum albumin ([99mTc]HSA) and 99mtechnetium-labeled sulfur colloid ([99mTc]SC) in the sentinel lymph nodes (SLNs). METHODS: Radiocolloid levels in the SLN, femoral lymph node (FLN), ischial lymph node (ILN), spleen (SP), and right rear footpad (RRF) were quantitated over a period of 240 min after injection of [99mTc]SC or [99mTc]HSA into the rear footpad of C57 BL/6 mice. RESULTS: There was a significantly greater (p < 0.001) radioactive count in SLNs after [99mTc]SC (mean cpm 211,084.8) compared to [99mTc]HSA (mean cpm 115,640.8). In contrast, the counts in the FLNs were higher after [99mTc]HSA (mean cpm 11,333.4) than after [99mTc]SC injection (mean cpm 5,065.5). The percent uptake in the SP was higher after [99mTc]HSA than after [99mTc]SC injection. CONCLUSIONS: [99mTc]SC is rapidly and efficiently taken up by lymphatics at the primary injection site, is significantly retained in the SLN, and flows slowly to the next echelon node (FLN or ILN) and to the systemic circulation (SP). [99mTc]HSA tends to accumulate less efficiently in the SLN and to disperse more rapidly to the next echelon nodes and to the systemic circulation. By extrapolation, [99mTc]SC is likely to be a better radiocolloid for the intraoperative detection of SLNs.

Sentinel lymph node metastasis in experimental melanoma: relationships among primary tumor size, lymphatic vessel diameter and 99mTc-labeled human serum albumin clearance.

BACKGROUND: This study was designed to investigate the relationships among primary tumor size, lymphatic vessel diameters, the incidence of sentinel lymph node (SLN) metastasis and lymphatic clearance from murine footpad melanomas. METHODS: Lymphatic clearance (LC) of [99mTc]HSA from the middle of the footpad of syngeneic C57BL/6 mice, with or without primary melanomas (sizes varying from 1 to 5 mm in anteroposterior diameter), was quantitated using a gamma scintillation detection system. Lymphatic vessel diameters (LD) were measured after injection of aniline blue dye into footpad tumors. The incidence of SLN, femoral lymph node (FLN), and lung metastases was recorded. RESULTS: Metastasis to SLNs increased as tumor growth progressed (r = 0.976, p = 0.001), and there was a correlation between tumor size and both FLN (p = 0.041) and lung (p = 0.055) metastases. There was also a correlation between lymph node metastasis and LC (r = 0.83, p = 0.04) and LD (r = 0.84, p = 0.04). CONCLUSIONS: These studies support the hypothesis that lymph flow and LD is increased in experimental murine melanomas and this relates to both primary tumor size and to lymphatic and hematogenous metastasis.

Lymphatic diameters and radionuclide clearance in a murine melanoma model.

OBJECTIVES: To determine the clearance of a radionuclide from various sizes of footpad melanomas via lymphatics and to measure the diameters of these vessels. DESIGN: Nonrandomized animal study. SETTING: A hospital research laboratory. SUBJECTS: C57BL/6 mice. INTERVENTIONS: Female mice were injected in the right rear footpad with B16 F10 cells that were allowed to grow to either 1, 2, 3, 4, or 5 mm in anteroposterior diameter. Clearance from feet with or without tumors of injected technetium Tc 99m human serum albumin (99mTcHSA) was assessed for 200 minutes. Calf lymphatic diameters were measured using aniline blue dye. RESULTS: The clearance of the injected 99mTcHSA from mouse footpads without tumors was 1.26 +/- 0.18 x 10(-4) mL/min x cm3 of tissue. Clearance increased 2.24-fold to 2.82 +/- 0.12 x 10(-4) mL/min x cm3 of tissue from 1-mm tumors and to 6.20 +/- 0.08, 6.11 +/- 0.13, 6.91 +/- 0.58, and 7.23 +/- 0.48 x 10(-4) mL/min x cm3 of tissue from 2-, 3-, 4-, and 5-mm tumors, respectively (P < .05). Calf lymphatic diameters increased from 75.41 +/- 9.72 microns in naive nontumor-bearing mice to 93.51 +/- 7.12, 111.61 +/- 27.07, 126.69 +/- 25.20, 124.43 +/- 24.75, and 127.44 +/- 25.35 microns in mice bearing 1-, 2-, 3-, 4-, and 5-mm tumors, respectively (P < .01). CONCLUSIONS: There was a size-dependent, direct correlation between increasing tumor size in the footpad and increasing diameter of lymphatics draining the footpad. Clearance of injected 99mTcHSA from these tumors also exhibited a similar positive correlation with tumor size.

A prolactin-inducible T cell gene product is structurally similar to the Aspergillus nidulans nuclear movement protein NUDC.

Clone 15 (c15) was originally identified as a PRL-inducible gene in activated T cells. Sequence analysis of c15 revealed that the last 94 amino acids of c15 are 68% identical and 78% similar to the filamentous fungus Aspergillus nidulans nuclear movement protein NUDC. The identification of the mammalian (rat) c15 protein suggests that the carboxy-terminal NUDC-like region has been conserved over evolution for an important structure and/or function. To determine whether c15 is functionally analogous to NUDC, complementation studies were performed using the inducible/repressible pAL5 vector system. The results of the complementation experiments show that the full-length mammalian c15 protein is not only capable of rescuing the nuclear movement defect of the nudC3 mutants, but is also able to restore the expression of the downstream endogenous NUDF protein to near wild type levels. These results indicate that rat c15 and fungal NUDC not only share similar structures, but also serve similar functions. Taken together, the structural and functional conservation between c15 and NUDC is consistent with the notion that c15 is the rat homolog of nudC and has therefore been given the name RnudC.

[The detection of factors predictive of the abandonment of disabled patients in a basic health area]. / Detección de factores predictores de abandono de pacientes incapacitados de una zona básica de salud.

MAIN OBJECTIVE: to elaborate a Persons at Risk Index (PRI) for the abandonment of elderly handicapped. SECONDARY OBJECTIVES: to discover the profile of these invalids and their carers within our Health District. DESIGN: A case-control study. A uni- and multi-variant analysis (multiple logistic regression). SETTING: An urban Health Centre. Programme for the Care of the handicapped Patient. PATIENTS AND OTHER PARTICIPANTS: 1. Handicapped patients (those unable to attend the Health Centre for care) who were included in the Programme in December 1991 (Total = 177). 2. Carers (those with direct responsibility in caring for the sick). 106 handicapped patients were interviewed (33 took part in the pilot study, 13 died, 1 entered hospital, 16 refused to answer and 8 were not located). 20 patients (19%) were identified as being abandoned invalids, with abandon being defined as not having their need for help in their daily activities covered. The other 86 (81%) were considered as controls. MEASUREMENTS AND MAIN RESULTS: Profile of the handicapped patient: woman > 76 years old, illiterate, housewife, widow. Profile of career: woman, daughter or wife of the invalid, between 50 and 65, house-wife, uneducated. The variables selected by the multiple model as being linked to abandonment show greater risk for invalid patients living in zones of high social risk, who lack a specific career or have only been looked after by their present career for a brief period. CONCLUSIONS: The PRI is an instrument which serves for predicting those invalids most likely to be abandoned, an undesirable situation to be avoided by prioritizing health service interventions.

Ethics and research in nursing.

Considering the importance of research in the development of nursing, we examine the ethical principles governing nurses' investigative activity, as well as the different codes regulating biomedical investigation with human beings, amongst which are the Nuremberg Code, the Declaration of Human Rights, and the Declaration of Helsinki. From the perspective of the central points of the article reference is made to different codes proposed by international nursing associations, as well as reviewing the Deontological Code of Spanish Nursing. The ethical principles a nurse has to bear in mind in research are analysed, with respect to patients, society and the profession. Finally, we refer to certain ethical aspects to be considered in the elaboration and development of a research project, as well as publication of the results.

Development of lymph node and pulmonary metastases after local irradiation and hyperthermia of footpad melanomas.

C57BL/6 mice with syngeneic B16-F10 melanomas were treated 7 days after tumor inoculation into the footpad with local hyperthermia (HT) of 43.5 degrees C for 90 min. A combination of local 30 Gy X-irradiation (XRT) given 2, 4 or 12 h after HT cured the primary tumor in 34/35 mice, with irreversible damage to normal foot tissues in most of the animals. When 7.5, 10 or 15 Gy XRT were delivered 4, 18 or 24 h after HT, there were only a small number of cures and also a much smaller incidence of irreversible normal tissue damage. HT alone resulted in a significant (P less than 0.001) increase in metastases to regional lymph nodes (RLN) and the lungs. The 'curative' doses of combined XRT and HT resulted in a significant (P less than 0.001) decrease in metastasis to RLN and to the lungs. Conversely, subcurative doses of combined therapy resulted in an increase in RLN and lung metastasis (P less than 0.001). Abdominal lymph node metastasis, not usually seen in control mice, is markedly increased after HT alone or in combination with subcurative XRT (P less than 0.001). The overall survival of mice treated with HT alone is decreased (P less than 0.0028). The survival of mice treated with HT followed 4, 18 or 24 h later with 10 Gy XRT is further decreased (P less than 0.0025). These data show that subcurative HT, or XRT plus HT, increases the incidence of spontaneous metastasis in this syngeneic mouse melanoma model. Curative doses prevent this effect on metastasis, but there is an unacceptable incidence of irreversible damage to the tumor-bearing foot. The cause(s) of this phenomenon are not known.

El colera / Cholera

Se presenta la etiologia, epidemiologia, diagnostico y patogenesis y terapeutica. El colera es una enfermedad aguda y grave transmitida principalmente por consumo de alimentos contaminados, de predominio intestinal de presentacion epidemica y endemica productora de diarrea profusa producida por un micro-organismo perteneciente al genero Vibrio cholerae; con una morfologia caracteristica: bacilo curvado, de gran motilidad gracias al flagelo que posee, gramnegativo y de una dimension relativamente grande; 1 a 3 micrones de longitud por 0,5 de diametro.

Inhibition of the promotional phase of azoxymethane-induced colon carcinogenesis in the F344 rat by calcium lactate: effect of simulating two human nutrient density levels.

The effects of 2 levels of dietary calcium and 2 types of dietary fat on the promotional phase phase of azoxymethane-induced colon cancer in the F344 rat were investigated. During the initiation phase of carcinogenesis all animals were fed a 5% corn oil AIN-76A diet containing 0.32% Ca in the form of calcium lactate. Rats were then injected with azoxymethane (AOM) weekly for 8 weeks. Thereafter, the rats were fed 1 of 3 diet formulations: a 5% corn oil diet or a 20% corn oil or 20% American Blend oil fat diet, with the level of Ca set at either 0.32% of the diet, a nutrient density simulating a daily human intake of approximately 1700 mg Ca/day, or at 0.04% of the diet, reflecting a human daily intake of approximately 200-250 mg of Ca/day, thus modeling 2 human nutrient density levels for calcium. Measurements of fecal pH during the experiment indicated an acidic adaptation of the large bowel to the lactate anion. Analysis of collected fecal samples showed more total fatty acids to be present in the colon when higher amounts of calcium were consumed. However, results of the tumorigenesis study indicated that calcium lactate fed at the 0.32% level significantly inhibited the development of colonic adenocarcinoma in all dietary groups. Taken together, this investigation supports the hypothesis that calcium supplementation can inhibit colon neoplasia in rats fed a high fat diet; however, under the conditions of this study, the 20% fat level did not significantly promote colon cancer as compared to a 5% fat level.

[Development and application of 2 scales of attitude to the promotion of health in primary care]. / Elaboración y aplicación de dos escalas de actitudes hacia la promoción de la salud en atención primaria.

The paper which follows is an attempt to delve into the field of Health Promotion, proposing a questionnaire which would study the attitudes towards the subject held by various professionals in Primary Care Teams, in this case in the province of Malaga. In the introduction, we evaluate the importance of these attitudes as a variable which is involved in specific programs, and therefore, the need to keep them in mind when elaborating strategies of Health Promotion at the Primary Care level. After describing the process followed for obtaining the final results, we show the results of one of the possible specific applications of the questionnaire, applying it to various professionals at Health Care Centers.

Changes associated with metastasis in B16-F1 melanoma cells surviving heat.

Metastasis to distant sites is mediated by various receptors on the surface of tumor cells. B16-F1 melanomas surviving 43.5 degrees C heat in vitro for 15 minutes and cultured for 10 days bind significantly increased amounts of the basement membrane protein laminin. Motility of heat-resistant B16-F1 cells in vitro toward the chemoattractant laminin is significantly increased. The increased expression of putative laminin receptors may be associated with increased metastasis of melanomas after subcurative hyperthermia.

Relationship of spontaneous regional lymph node metastases to dose of local irradiation of primary B16 melanomas.

We evaluated the effects of local X-irradiation on microscopic or small macroscopic primary melanomas in the feet of C57BL/6 mice and the subsequent development of spontaneous femoral lymph node (LN) metastases. Doses of 30, 40, 55, 62.5, or 72.5 Gy often cured the foot tumor and metastases to regional femoral lymph nodes were relatively uncommon. Doses of 3.75, 7.5, 10, 15, and 20 Gy were associated with a dose-dependent regrowth delay of the foot tumor treated at microscopic size. Foot melanomas that were not cured spread to regional femoral LNs more frequently (P less than 0.001). The relative risk of developing femoral LN metastasis increased 2.55 times for each 1-mm increase in the anteroposterior diameter of the primary foot tumor in mice with 20 days of primary tumor exposure and increased 4.87 times for each 1-mm increase in mice with 100 days of primary tumor exposure. Although tumors treated with subcurative doses of irradiation had a longer period of time to metastasize to regional LNs for each 1-mm increase in primary tumor size, this variable alone did not account for the increased incidence of metastasis seen with irradiation.

Lung metastases after curative or noncurative irradiation of microscopic primary melanomas.

Melanomas growing in the feet of syngeneic C57BL/6 mice were treated with a single dose of X-irradiation. After doses of 0, 3.75, 7.5, 10, 20, or 30 Gy the tumor-bearing limb was amputated at tumor sizes 1, 2, 3, 4, or 5 mm. After doses of 40, 50, 62.5, or 72.5 Gy, progressive tumor growth did not occur, and amputation of tumor-bearing limbs was done when controls were 1, 2, 3, 4, or 5 mm in size. Eighteen days after amputation the mice were killed, and pulmonary metastases were documented at autopsy. None of the mice developed pulmonary metastases after curative irradiation of the primary foot tumor. After subcurative irradiation there was a significant increase (P less than .003) in pulmonary metastases. The size of the primary melanoma is important in the prediction of these metastases. In this model melanomas can be cured by an adequate dose of irradiation, but in those not cured the incidence of lung metastases is increased. The impact of this biologic phenomenon on survival is unclear.