Toxicidad pulmonar por gemcitabina / No disponible

Describimos el caso clínico de un paciente que presentó una insuficiencia respiratoria aguda en muy probable relación a toxicidad por gemcitabina. El aumento de incidencia de enfermedades neoplásicas conlleva un mayor uso de este fármaco en el tratamiento de las mismas, y esto a su vez provoca una mayor incidencia de efectos secundarios. La toxicidad pulmonar es especialmente relevante por el posible desenlace fatal que puede conllevar. Detectado y tratado a tiempo, el pronóstico es favorable. Con la intención de aumentar la casuística en este campo de la neumología exponemos el siguiente caso (AU)

We present a case of pulmonary toxicity associated with gemcitabina that caused respiratory insufficiency. The rise in incidences of neoplasms has led to an increase in the use of this drug. This, in turn, has led to a greater probability of side effects. Lung toxicity is particularly relevant as it can be fatal, but with rapid diagnosis and treatment the prognosis can be positive. This description of pulmonary toxicity induced by gemcitabine should provide additional information to what is already known in this field

Cómo calcular el ratio enfermera-paciente / How to calculate the nursing-patient ratio

No disponible

Reflecting profiles that produce a given phase distribution of light.

We give a method to construct, for a given surface and a point source, a one-parametric family of reflecting profiles, each of them with the characteristic property of producing a predetermined phase distribution of light that from the point source is incident on that surface after reflection at the profile. The profiles are constructed as the envelopes of specific families of ellipsoids of revolution. We also study the singularities of these profiles.

Nephrotic syndrome complicating chronic visceral leishmaniasis: re-emergence in patients with AIDS.

Leishmania infection may be associated with immunecomplex-mediated glomerular injury. Contrary to immune-competent individuals, leishmaniasis in HIV patients is a chronic, relapsing disease. Despite the increasing frequency of the Leishmania/ HIV co-infection, there is a paucity of information on the effects of such co-infection in the kidney. We present a patient with AIDS and refractory, relapsing visceral leishmaniasis who developed nephrotic syndrome associated with renal involvement by Leishmania in the absence of immunecomplex glomerular deposition. For the first time, the relapsing nature of renal injury in this context is documented.

[Fluid therapy in surgical patients: composition and influences on the internal milieu]. / Sueros empleados en enfermos quirúrgicos: composición y efectos sobre el medio interno.

UNLABELLED: Intravenous fluids administration is the usual practice in the postoperative period. Nonetheless, consensus about the more appropriate fluid reposition recipe is still insufficient. OBJECTIVE: To study the type of intravenous reposition used in Surgical Units and its impact on the internal milieu. DESIGN: prospective study of 112 patients with scheduled surgery, receiving only intravenous fluids. METHODS: biochemical study on postoperative fluids management in uncomplicated surgery. Principal variables: 1. Water and electrolytes administrated. 2. Differences in sodium/water balances before surgery vs first day after surgery. 3. Symptoms related to hyponatremia. RESULTS: Median P[Na] before and after surgery was 139.9+/-2.9 and 137.7+/-3.7, respectively (p<0.01). Fourteen patients (12.5%) had P[Na]<135, and 12 of them had a reduction of more than 6 mmol/L; accordingly, twenty-six patients (23.2%) had an increased free-water retention (p<0.05). Relevantly, they did not receive a higher amount of free-water and the proportion of isotonic saline/free water varied from <1 to >3. As possible mechanism of free-water accumulation: the postoperative P[Na] was lower in the patients who had a negative free-water clearance >or= -1 L (136.7+/-4.1 vs 138.5+/-3.2 mmol/L, p 0.015). CONCLUSION: The present study provides new information about the intravenous fluids prescribed in postoperative patients, ie, different proportions saline/water are basically equivalent with respect to inducing symptomatic hyponatremia. The mean value of the relation saline/water is 2:1. Hypotonic fluids input is not clearly related to more intense hyponatremia; the latter appears to depend more on a reduced capacity of the kidney to generate sufficient free water output.

Sueros empleados en enfermos quirúrgicos: composición y efectos sobre el medio interno / Fluid therapy in surgical patients: composition and influences on the internal milieu

La prescripción de sueros en el postoperatorio es una práctica rutinaria, pero sobre la que no existe un consenso basado en la evidencia. Objetivo: Examinar sistemáticamente el tipo de reposición hidroelectrolítica empleado por los Servicios Quirúrgicos y sus consecuencias sobre el medio interno. Pacientes y métodos: Diseño: estudio prospectivo en 112 pacientes con cirugías programadas. Método: estudio bioquímico del manejo hidroelectrolítico en postoperatorios no complicados tratados solo con sueros intravenosos. Variables principales: 1. agua y electrolitos administrados; 2. Diferencias de equilibrio hidrosalino entre pre- y post-operatorio;3. alteraciones clínicas atribuíbles a hiponatremia. Resultados: La [Na]P media pre y postoperatoria fue 139,9± 2,9 y 137,7 ± 3,7, respectivamente (p < 0,01) Catorce pacientes(12,5%) alcanzaron [Na]P < 135 mmol/L, y 12 presentaron un descenso de [Na]P ≥ 6 mmol/L, vg, 26 sujetos(23,2%) tuvieron un incremento significativo de agua libre(p < 0,05) Estos pacientes no habían recibido mayor cantidad de agua libre que el resto, siendo la proporción sueros isotónicos/agua libre desde < 1 a > 3. Como posible mecanismo de la retención hídrica, la [Na]P postoperatoria en los pacientes con aclaramiento de agua libre negativo ≥ -1litro/24 h fue más baja (136,7 ± 4,1 vs 138,5 ± 3,2 mmol/L,p 0,015). Conclusiones: Se aporta información previamente no disponible: a) diversas proporciones de suero isotónico: agua libre resultaron equivalentes frente al desarrollo de hiponatremia sintomática; b) la relación media suero isotónico: agua libre es 2:1, y c) las soluciones de reposición más hipotónicas no aparecen relacionadas con más hiponatremias. Éstas en cambio dependen de la respuesta renal de retención de agua (AU)

Intravenous fluids administration is the usual practice in the post operative period. Nonetheless, consensus about the more appropriate fluid reposition recipe is still insufficient. Objective: To study the type of intravenous reposition used in Surgical Units and its impacton the internal milieu. Patients and methods: Design: prospective study of 112 patients with scheduled surgery, receiving only intravenous fluids. Methods: biochemical study on postoperative fluids management in uncomplicated surgery. Principal variables: 1. Water and electrolytes administrated. 2. Differences in sodium/water balances before surgery vs first day after surgery. 3. Symptoms related to hyponatremia. Results: Median P[Na] before and after surgery was 139.9 ± 2.9 and 137.7 ± 3.7, respectively (p< 0.01). Fourteen patients (12.5%) had P[Na] < 135, and 12 ofthem had a reduction of more than 6 mmol/L; accordingly, twentysix patients (23.2%) had an increased free-water retention (p <0.05). Relevantly, they did not receive a higher amount of freewater and the proportion of isotonic saline/free water varied from< 1 to > 3. As possible mechanism of free-water accumulation: the postoperative P[Na] was lower in the patients who had a negative free-water clearance ≥ -1 L (136,7 ± 4,1 vs 138,5 ± 3,2 mmol/L, p0,015). Conclusion: The present study provides new information about the intravenous fluids prescribed in postoperative patients, ie, different proportions saline/water are basically equivalent with respect to inducing symptomatic hyponatremia. The mean value of the relation saline/water is 2:1. Hypotonic fluids input is not clearly related to more intense hyponatremia; the latter appears to depend more on a reduced capacity of the kidney to generate sufficient free water output (AU)

Monitoring of leachate at a test road using treated fly ash from municipal solid waste incinerator.

A treatment process for municipal solid waste incinerator fly ash has been jointly developed by the Université Libre in Brussels and the Solvay company. This experimental process has led to an experimental project with a multi-disciplinary team from Solvay along with several companies and organisations, plus support from the ADEME agency. After a laboratory assessment of the treated fly ash (TFA), its environmental properties and the optimal fields of application in road construction, as part of the Revasol project, a full-scale analysis was organised for both environmental and mechanical purposes. A test section using TFA was designed in order to collect percolation water; TFA was used as a road base component (a cement-bound graded aggregate containing 12% TFA). A reference section with the same structure was also built using natural materials. After a description of the treatment process and the test road design, the main TFA characteristics are presented. Then, the environmental behaviour of both sections over a 1-year period following construction is detailed: infiltration, leachate quality, cumulative release. This monitoring effort highlights not only the evolution in TFA behaviour, but also the general permeability of the road structure to various external influences.

The fate of chondrocyte in osteoarthritic cartilage of transgenic mice expressing bovine GH.

OBJECTIVE: The aim of the present study was to demonstrate whether bGH transgenic mice develop OA. We therefore studied in this animal model the structural features of cartilage and the subchondral bone changes of the knee joints that may be associated with osteoarthritic lesion. METHOD: Degenerative changes in the knee joints of bGH transgenic female mice (N = 11) and control mice (N = 11) were histologically analyzed at the age of 7 months. Histochemical and stereological studies were conducted. Immunohistochemistry on cell cyclin activity (assessed by anti-PCNA labeling) and cell viability (assessed by bcl-2 expression), as well as ribosomal activity (AgNOR), TNF-alpha expression and apoptosis (TUNEL technique) were performed. In ten 7-month-old female mice (Tg+ N = 5; control N = 5) the knee articular cartilages were studied with electron microscopy techniques. RESULTS: Disruption of the articular surface (18.2%), cleft (63.7%), cloning (81.8%), hypocellularity of chondrocytes (18.2%), moderate (54.6%) to severe (45.4%) loss of safranin-O staining, and duplication and rupture of the tidemark (54.5%) were some of the main features observed in articular cartilage chondrocytes of bGH transgenic mice. Furthermore, cell cyclin activity and cell viability decreased, while TNF-alpha expression and TUNEL+ cells increased. These chondrocytes also showed an increase in the number of black dots per cell, as revealed by the AgNOR technique. CONCLUSION: Our results show that bGH transgenic mice develop a lesion of the articular cartilage consistent with that described in osteoarthritis.

Estudio de variables relacionadas con el abandono de pacientes de un Servicio de Salud Mental / Study of some variables related to the drop-out patients attended in a Mental Health Service

El estudio describe variables relacionadas con el abandono de pacientes que acuden a un Centro de Salud Mental Comunitario de Madrid (Equipo de Salud Mental de Vallecas. Centro de Salud Rafael Alberti), durante el periodo de un año (octubre de 1996-octubre de 1997). Se seleccionan 41 variables que describen características psico-sociales de los pacientes, del proceso psicoterapéutico y de los terapeutas. Por último se consideran una serie de medidas con el objetivo de implementar la adherencia de los pacientes a los tratamientos en los Equipos de Salud Mental. (AU)

Levofloxacino frente a betalactámicos en el tratamiento de la neumonía adquirida en la comunidad con ingreso hospitalario / Levofloxacin versus betalactamic therapy in commu nity-acquired pneumonia that requires hospitaliza tion

Objetivo: Comparar la eficacia y seguridad de levofloxacino frente al tratamiento estándar con betalactámicos en pacientes con Neumonía Adquirida en la Comunidad que cumplen criterios de ingreso hospitalario (NACH). Pacientes y métodos: Estudio prospectivo de un año de duración de 49 pacientes (ptes.) ingresados en el Servicio de Medicina Interna, diagnosticados de NACH con asignación aleatoria a recibir.- I: cefotaxima o ceftriaxona, II: amoxicilina-clavulánico, (las dos previas asociadas o no a un macrólido) o, III: levofloxacino. Se realizó Rx. tórax a los 7 -10 días, al mes y, posteriormente si era necesario. Resultados: 29 ptes. recibieron pauta estándar (I o II) y 20 ptes. levofloxacino. Eran varones el 84%, con edad media de 70,9 años, 57% con enfermedad de base moderada o grave, y 55% con criterios de gravedad inicial. En el 47% de los casos se llegó a diagnóstico etiológico, siendo en un tercio de los casos bacilos gramnegativos. Se produjo la curación en el 94% de los pacientes y éxitus en 2 pacientes (5%). No se observaron diferencias entre los dos grupos en las características demográficas, enfermedad de base ni gravedad inicial. No se detectaron diferencias en los efectos secundarios, complicaciones, estancia hospitalaria o porcentaje de curaciones. La necesidad de prolongar el tratamiento fue mayor en el grupo estándar que en el tratado con levofloxacino (52 vs 15%, p: 0,02). Conclusiones: En población mayor y con gravedad inicial el tratamiento con levofloxacino puede ser una alternativa válida al tratamiento estándar (AU)

Objective: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). Patient and methods: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.- I: cefotaxime or ceftriaxone, II: amoxicillin/ clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7 -10 days, to the month and, other reviews if was necessary. Results: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84 %, half age 70,9 years old, 57 % with moderate or severe underlying disease, and 55 % with approaches of initial severity criteria. In 47 % of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94 % of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52 % vs. 15 %, p:0.02). Conclusions: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy (AU)

[Levofloxacin versus beta-lactamic therapy in community acquired pneumonia that requires hospitalization]. / Levofloxacino frente a betalactámicos en el tratamiento de la neumonía adquirida en la comunidad con ingreso hospitalario.

OBJECTIVE: To compare the effectiveness and security of levofloxacin treatment in front betalactamic therapy in patient with community-acquired pneumonia that require hospitalization (CAPH). PATIENT AND METHODS: A prospective and randomized study along a year from 49 patients diagnosed of (CAPH) that were admitted in the Internal Medicine Service. The patients were assigned randomly to receive.-I: cefotaxime or ceftriaxone, II: amoxicillin/clavulanate (both could be associated or not with a macrolide) or III: levofloxacin. It was accomplished Rx. thorax to 7-10 days, to the month and, other reviews if was necessary. RESULTS: 29 cases were in standard therapy (I or II) and 20 cases received levofloxacin therapy. Male 84%, half age 70.9 years old, 57% with moderate or severe underlying disease, and 55% with approaches of initial severity criteria. In 47% of the cases we arrived to etiologic diagnosis, in the third of the cases were BGN. The cure took place in 94% of the patients and 2 patients died (5%). No differences were observed regarding demographic characteristics, underlying disease and severity. No differences were detected in: the secondary effects, complications, hospital stay or, mean stay or percentage of cures. The necessity to prolong the therapy was bigger in the standard group in front of the group tried with levofloxacin (52% vs. 15%, p:0.02). CONCLUSIONS: In bigger population and with initial severity the treatment with levofloxacin can be a valid alternative to the standard therapy.

Regulation of beta-adrenoceptor-mediated relaxation of the rat aorta is modulated by endogenous ovarian hormones.

The aim of this study was to assess the influence of the endogenous status of ovarian hormones on the relaxation induced by the beta-adrenoceptor agonists isoprenaline (isoproterenol) and dobutamine in thoracic aorta segments, precontracted with noradrenaline, from age-matched (13-week-old) virgin (oestrus) and ovariectomized (OVX) prepubertal female Wistar rats. Isoprenaline-induced relaxation was decreased in intact aortic segments from OVX rats compared with that in segments from oestrus rats. Relaxation was significantly reduced by endothelium removal, 1 micromol/l propranolol or 100 micromol/l N(G)-nitro-L-arginine methyl ester (L-NAME). The beta(1)-adrenoceptor agonist dobutamine induced less relaxation in intact arteries from oestrus rats than did isoprenaline, and dobutamine-induced relaxation was markedly less in intact segments from OVX compared with oestrus rats. This dobutamine-induced relaxation was abolished by endothelium removal, and reduced by 1 micromol/l propranolol, 100 micromol/l L-NAME or 1 micromol/l yohimbine. Cholera toxin (an activator of the stimulatory G-protein G(s)) caused relaxation in intact arteries from oestrus rats; this relaxation was decreased by both deprivation of ovarian hormones and endothelium removal. Forskolin (a direct activator of the catalytic subunit of adenylate cyclase) and sodium nitroprusside (a nitric oxide donor and cGMP-dependent vasodilator agonist) induced similar endothelium-independent relaxation in arteries from both oestrus and OVX rats. These results suggest that the relaxation elicited by endothelial beta-adrenoceptor activation in the rat thoracic aorta is impaired by deprivation of female ovarian hormones; this impairment is caused, at least in part, by decreases in both the endothelial release of NO and G(s) function.

Algorithm for normal random numbers.

We propose a simple algorithm for generating normally distributed pseudorandom numbers. The algorithm simulates N molecules that exchange energy among themselves following a simple stochastic rule. We prove that the system is ergodic, and that a Maxwell-like distribution that may be used as a source of normally distributed random deviates follows in the N-->infinity limit. The algorithm passes various performance tests, including Monte Carlo simulation of a finite two-dimensional Ising model using Wolff's algorithm. It only requires four simple lines of computer code, and is approximately ten times faster than the Box-Muller algorithm.

A replica plating technique for in vitro study of susceptibility of Candida albicans to miconazole, econazole and ketoconazole: some data for standardization.

We report our studies in vitro on the activity of ketoconazole (KZ), econazole and miconazole on 115 isolates of Candida albicans of clinical origin tested by an agar dilution method with three different culture media: yeast morphology agar, Sabouraud maltose agar and Casitone agar (CA). The antifungal effects of the imidazole compounds (IC) were strongest in CA. Eighty percent of the strains were inhibited by 0.1 micrograms/ml of KZ, the most active drug. The frequent appearance of "veil growth" at higher concentrations of the IC made the exact determination of the minimal inhibitory concentration (MIC) difficult. Microscopic examination of the growth on plates at the highest drug dilutions was performed and the results compared with a replica plating technique of IC plates on other plates with antibiotic-free media. The following were observed: a) a residual capacity of cell division of Candida strains even in the presence of high antifungal concentrations to which they are considered sensitive; and b) a certain viability (7% of the cases) of some fungal cells in the residual growth, particularly in those strains with higher conventional MIC. A standardized methodology is needed for the clinical evaluation of the susceptibility tests of Candida to the imidazolic compounds.

Susceptibility of Candida spp. of clinical origin to lucknomycin, a new polyenic antibiotic.

Lucknomycin is a new polyenic derivative antifungal agent obtained from a Streptomyces diastatochromogenes culture. The in vitro activity of the compound was tested against 403 strains of different Candida species of clinical origin by the Sabouraud Agar dilution method. The mean geometrical value of the minimal inhibitory concentrations (MIC) for Candida albicans was 0.85 microgram/ml, 6 times lower than the corresponding value of nystatin (5.29 micrograms/ml) and very close to that of amphotericin B (0.56 microgram/ml). Lucknomycin was also 4-10 times more active than nystatin on other Candida species, with an MIC similar to those obtained with amphotericin B.

[Selective autotransplant of the spleen. An experimental study]. / Autotrasplante selectivo de bazo. Estudio experimental.

A study was carried out on 40 dogs. Four groups of ten dogs each were established. A laparotomy group, a simple splenectomy group and two groups which underwent a selective autotransplant of the medium an deep layers of a centrifugated solution of splenic medulla respectively. Immunisation with BSA showed that humoral immune response with formation of anti-BSA antibodies is more intense in the control group which underwent laparotomy than in the splenectomised group. The response obtained in dogs subjected to autotransplant of deep layer is almost identical to that of the control group while that of the medium layer showed a slightly lower response. Cellular immune response is more accentuated in the group which underwent autotransplant from the deep layer, while those from the medium layer showed a higher response than that of the splenectomised group.