Diffuse vascular hamartoma with malignant behavior.

Pulmonary hamartomas are benign lesions, usually asymptomatic and incidentally discovered on a routine chest radiograph; occasionally, however, this benign lesion may cause life threatening symptoms due to it's location and diffuse vascular involvement. We report the case of a 27 year-old male, non-smoker, who presented with dyspnea, cough, hemoptysis and weight loss. He was found to have a mass in the right hilar region which also involved the right main bronchus, pulmonary artery and esophagus. Surgical biopsy of the lesion led to the diagnosis of diffuse vascular hamartoma. Although it was a benign lesion, due to the size and location, surgical removal was not possible and patient died 10 years after being diagnosed with the condition.

La objeción de conciencia en el ámbito clínico. Propuesta para un uso apropiado (II) / Conscientious objection in the clinical setting. A proposal for its appropriate use (II)

Los cambios sociales y el uso de nuevas tecnologías han generado nuevos conflictos en la relación clínica. En muchas de estas situaciones se hace un uso improcedente de la objeción de conciencia, con las repercusiones que ello conlleva para los profesionales, los pacientes y las instituciones sanitarias. En este artículo se intenta clarificar el problema desde el punto de vista clínico, valorando el incremento de los riesgos en la praxis clínica a causa de las elecciones de los pacientes, la complejidad de la praxis clínica actual y el uso adecuado de los medios de soporte vital. Asimismo se analizan los valores éticos socialmente controvertidos y prácticas profesionales sin un fin curativo y sin indicación clínica en sentido fisiológico(AU)

Social changes and new technologies have brought new problems in doctor-patient relationship. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. In this article an attempt will be made to clarify the problem from a clinical point of view, assessing the increase in risks in clinical praxis due to patient choice, the complexity of current clinical praxis, and the appropriate use of life support measures. Likewise, it analyses socially controversial ethical values and professional practices with no curative value and with no clinical indication in the physiological sense(AU)

La objeción de conciencia en el ámbito clínico. Propuesta para un uso apropiado (I) / Conscientious objection in the clinical setting. A proposal for its appropriate use

Los cambios sociales y el uso de nuevas tecnologías han generado nuevos conflictos en la relación clínica. En muchas de estas situaciones se hace un uso improcedente de la objeción de conciencia, con las repercusiones que ello conlleva para los profesionales, los pacientes y las instituciones sanitarias. En este artículo se trata de clarificar el problema que supone la objeción de conciencia en una sociedad plural, basada en una democracia deliberativa, y cuáles son los modelos que puede adoptar dicha sociedad para respetar, al mismo tiempo, las «razones éticas» de cada individuo y el marco normativo del Estado de Derecho que obliga a todos sus ciudadanos. Asimismo se identifican diversos escenarios clínicos en los que, con frecuencia, los profesionales aluden a la figura de la objeción. También se señalan y se analizan los argumentos que explican por qué en muchos de esos escenarios no es procedente ni correcta dicha apelación. Por último, se aporta el fundamento jurídico, la jurisprudencia española y la bibliografía clínica y ética de relevancia en nuestro entorno respecto de la objeción(AU)

Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic(AU)

[Conscientious objection in the clinical setting. A proposal for its appropriate use (II)]. / La objeción de conciencia en el ámbito clínico. Propuesta para un uso apropiado (II).

Social changes and new technologies have brought new problems in doctor-patient relationship. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. In this article an attempt will be made to clarify the problem from a clinical point of view, assessing the increase in risks in clinical praxis due to patient choice, the complexity of current clinical praxis, and the appropriate use of life support measures. Likewise, it analyses socially controversial ethical values and professional practices with no curative value and with no clinical indication in the physiological sense.

[Conscientious objection in the clinical setting. A proposal for its appropriate use]. / La objeción de conciencia en el ámbito clínico. Propuesta para un uso apropiado. I.

Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic.

Ants' role (Hymenoptera: Formicidae) as potential vectors of mycobacteria dispersion / Comportamento de formigas (Hymenoptera: Formicidae) como vetores potenciais de dispersão de micobactérias

Ants are found worldwide playing an important environmental role. Some species are considered as agricultural pests and potential risk to human life and public health acting as pathogens carriers. Ants as Paratrechina longicornis and Camponotus spp. have been found inside hospitals. The aim of this study was the research of mycobacteria in 138 samples of ants (137 Paratrechina longicornis and only one Camponotus spp.) which got into the laboratories of tuberculosis diagnosis. These ants were suspended in sterile saline solution and inoculated into Petragnani and Stonebrink media, incubated at 37° C until 90 days and the isolates were identified as environmental mycobacteria (1 Mycobacterium fortuitum peregrinum, 1 Mycobacterium smegmatis) and 1 Mycobacterium tuberculosis complex. These results showed that ants should also act as mechanical vectors of mycobacteria dissemination in risk environments, reinforcing their significance in public health.

As formigas têm uma distribuição mundial e representam importante papel no ecossistema. Algumas espécies são consideradas pragas para a agricultura e um risco potencial à vida humana e à saúde pública veiculando mecanicamente agentes patogênicos. Formigas como Paratrechina longicornis e Camponotus spp. têm sido encontradas em ambientes hospitalares. O foco do presente estudo foi a identificação de micobactérias em 138 amostras de formigas (137 Paratrechina longicornis e apenas uma Camponotus sp.), que tiveram acesso a áreas de laboratórios de diagnóstico de tuberculose. Essas formigas foram suspensas em solução salina estéril que foi semeada em meios de Petragnani e Stonebrink, incubadas a 37º C por até 90 dias e as estirpes de micobactérias isoladas foram identificadas pelas técnicas clássicas como micobactérias ambientais (sendo 1 Mycobacterium smegmatis, 2 Mycobacterium fortuitum peregrinum e 1 Mycobacterium tuberculosis). Esses resultados mostram que as formigas podem também se constituir vetores de dispersão de micobactérias em ambientes de risco, reforçando sua importância em saúde pública.

Los niveles de la justicia sanitaria y la distribución de los recursos / The levels of health justice and the distribution of resources

El derecho a la asistencia sanitaria es una conquista social de los Estados democráticos de derecho. Para que esto se haga efectivo de una manera justa se requiere el concurso de muchos elementos que se analizan en este artículo en sus diversos momentos: el Estado como garante de este derecho y limitador de las prestaciones; las instituciones sanitarias, gestoras directas de la asistencia, que deben combinar la eficiencia y la equidad; y por último los profesionales de la salud verdaderos distribuidores finales de los recursos. La medicina tradicional siempre dejó fuera de su ámbito la evaluación de los factores socioeconómicos. Incluso llegó a considerar que estas cuestiones eran opuestas al buen ejercicio de la medicina. En la actualidad tal afirmación es insostenible. Para un profesional sanitario el camino hacia la eficiencia pasa por asegurar la efectividad clínica, garantizando de esta manera tanto el bien del paciente como la adecuada distribución de los recursos

The right to health care is a social achievement of democratic states based on law. In order for this to become effective in a just way, it is necessary for many elements to come together. This article analyses these elements in their different moments: the state as a guarantor of this right and to limit assistance; the health institutions, direct managers of care, which must combine efficiency and equity; and, finally, the health professionals, who are in the final instance the real distributors of resources. Traditionally medicine always omitted evaluation of the socio-economic factors from its sphere. It even came to consider that these questions were opposed to good medical practice. Today such an assertion is unsustainable. For a health professional the path to efficiency passes by way of assuring clinical effectiveness, in this way guaranteeing both the patient’s interest and the suitable distribution of resources

[The levels of health justice and the distribution of resources]. / Los niveles de la justicia sanitaria y la distribución de los recursos.

The right to health care is a social achievement of democratic states based on law. In order for this to become effective in a just way, it is necessary for many elements to come together. This article analyses these elements in their different moments: the state as a guarantor of this right and to limit assistance; the health institutions, direct managers of care, which must combine efficiency and equity; and, finally, the health professionals, who are in the final instance the real distributors of resources. Traditionally medicine always omitted evaluation of the socio-economic factors from its sphere. It even came to consider that these questions were opposed to good medical practice. Today such an assertion is unsustainable. For a health professional the path to efficiency passes by way of assuring clinical effectiveness, in this way guaranteeing both the patient's interest and the suitable distribution of resources.

Influence of pro- and anti-inflammatory cytokines in Th1 polarization after allogeneic stimulation.

The exogenous cytokine milieu can influence Th1/Th2 polarization. Besides the differential functional properties, T lymphocytes also acquire distinct profiles of chemokine receptors. Human Th1 lymphocytes preferentially express CCR5 and CXCR3 while Th2 lymphocytes express CCR3, CCR4 and CCR8. After their polarization into Th1 cells, grafted T lymphocytes mediate the development of graft-vs-host-disease, the major complication after bone marrow transplantation. We performed mixed lymphocyte cultures for ten days, with and without addition of IL-2, IL-4, IL-10, IL-12 and IL-18 at the third and sixth day of cultures. The expression of CXCR3 and CCR5, in CD4(+) and CD8(+) T lymphocytes was evaluated by flow cytometry, before and after ten days of culture. The exogenous addition of IL-2 or IL-12 favoured the Th1/Tc1 phenotype and IL-4 was also capable of inducing Th1 polarization. In opposition to IL-12, IL-18 didn't induce a significant polarization into Th1 phenotype, an effect more similar to that induced by IL-10. This action could explain, at least in part, its possible protective effect in the incidence of acute and chronic graft-versus-host disease after allogeneic stem cell transplantation.

[Transient erythroblastopenia in the context of Epstein-Barr virus infection]. / Eritroblastopenia transitoria en el contexto de infección por el virus de Epstein-Barr.

The authors report the case of a previously healthy 5-year-old boy who, 1 month after tonsillitis, presented severe aregenerative anemia, macrocytosis, and increased hemoglobin F associated with mild thrombocytopenia. Peripheral blood smear showed no significant alterations and bone marrow aspirate revealed markedly decreased red blood cell precursors. Etiological investigation showed elevated titers of Epstein-Barr virus antibodies (IgM anti-viral capsid antigen). Bone marrow biopsy showed no criteria for red cell aplasia and in situ hybridization revealed intracellular Epstein-Barr virus. Reticulocytosis emerged from days 10-17 of follow-up, together with rising hemoglobin. Mean corpuscular volume and hemoglobin F returned to normal 2 months later. Immunological study revealed partial IgG3 deficit that persisted after 1 year of follow-up.

Eritroblastopenia transitoria en el contexto de infección por el virus de Epstein-Barr / Transient erythroblastopenia in the context of Epstein-Barr virus infection

Los autores describen el caso clínico de un niño varón de 5 años de edad, previamente sano que, 1 mes después de una amigdalitis, presentó una anemia arregenerativa grave con macrocitosis y hemoglobina F aumentada, asociada a una trombocitopenia ligera. El frotis de la sangre periférica no presentaba alteraciones significativas y el aspirado de medula ósea revelaba una hipoplasia eritroide marcada. La investigación etiológica reveló la presencia de un título elevado de anticuerpos anti-viral capsid antigen IgM para el virus Epstein-Barr. En la biopsia ósea, sin criterios de aplasia medular, se comprobó la presencia intracelular del virus por hibridación in situ. El día 17 de seguimiento fue posible documentar la aparición de reticulocitosis y el incremento del valor de hemoglobina. El volumen globular medio y el porcentaje de hemoglobina F se normalizaron a los 2 meses. El estudio inmunológico reveló un déficit parcial de IgG3, que mantiene después de 1 año de seguimiento (AU)

Functional aspects of cord blood lymphocytes response to polyclonal and allogeneic activation.

With the purpose of contributing to a better knowledge of the phenotypic characteristics and functional activity of umbilical cord blood (UCB) lymphocytes, we have carried out extensive immunophenotyping of these cells, evaluated their immune response to polyclonal and allogeneic activation and then compared these results with those obtained with peripheral blood lymphocytes of healthy donors (PBHD). Our results showed, in CD4+ UCB lymphocytes, an increase of CD38 and CD45RA and a decrease of CD11a (S6F1), CD54 and HLA-DR double positive cells. An increase of CD38, CD45RA and CD56, and a decrease of CD28, CD57 and HLA-DR were observed in CD8+ UCB lymphocytes. Most natural killer UCB cells are CD16+, CD56+, CD57-, and among the UCB cells there is a lower number of CD8+ and TCRgammadelta+ (either CD8- or CD8+), and higher number of CD4+ lymphocytes. After allogeneic stimulus the majority of these phenotypic differences disappeared, which seems to be in agreement with the normal allogeneic response (assessed through MLR, frequency of CTL and helper T lymphocytes precursors) presented by UCB lymphocytes. Regarding the response to polyclonal activation, among the mitogens used, only PHA induced a different result: a lower IFNgamma production by UCB cells.

Isolated teratozoospermia and in vitro fertilization.

PURPOSE: To show whether increased amounts of spermatozoa used in insemination of preovulatory oocytes in isolated teratozoospermia according to Kruger's strict criteria gives good fertilization rates. METHODS: This study was carried out from September 1993 to November 1994 for a total of 77 cycles, with sperm samples classified according to Kruger's strict classification. Group 1 (C; control) included 37 couples with normal sperm morphology (> 14% normal; SC). Group 2 (GP; good prognosis) included 18 couples (morphology, > or = 4 and < or = 14% normal) and group 3 (T; teratozoospermic) included 11 couples, with isolated teratozoospermia in the male partner (morphology, < 4% normal). RESULTS: No statistically significant difference was seen in the three groups regarding age, duration of infertility, aspirated follicles, oocytes collected, and embryos transferred. There is a statistically significantly difference (P < 0.001) in the number of spermatozoa used in insemination in group 3. CONCLUSIONS: In conclusion, a morphological classification using strict criteria in the assessment of sperm morphology is still very important, as increasing the sperm number of spermatozoa inseminated per oocyte may improve zona pellucida binding and give better IVF results.

[A peripheral neuroectodermal tumor of the vulva]. / Tumor neuroectodérmico periférico da vulva.

A case of malignant peripheral neuroectodermal tumor occurring in the vulva of a 29-year-old woman is reported. It is a rare malignant tumor with aggressive biological behavior belonging to a wide group, the so-called small round-cell tumors. The patient is well and free of disease 8 months after surgery, chemotherapy and radiation therapy.