Direct and bystander radiation effects: a biophysical model and clinical perspectives.

In planning treatment for each new patient, radiation oncologists pay attention to the aspects that they control. Thus their attention is usually focused on volume and dose. The dilemma for the physician is how to protract the treatment in a way that maximizes control of the tumor and minimizes normal tissue injury. The initial radiation-induced damage to DNA may be a biological indicator of the quantity of energy transferred to the DNA. However, until now the biophysical models proposed cannot explain either the early or the late adverse effects of radiation, and a more general theory appears to be required. The bystander component of tumor cell death after radiotherapy measured in many experimental works highlights the importance of confirming these observations in a clinical situation.

Incidence of hypercalcemia, hypercalciuria and related factors in patients treated with recombinant human parathyroid hormone (1-84).

AIM: The aim of this paper was to determine the incidence of hypercalcemia and hypercalciuria (and related factors) in 22 postmenopausal women with osteoporosis treated with PTH (1-84) in daily practice. METHODS: Osteoporosis was defined as history of osteoporotic fracture or a T score less than -3 SD on bone densitometry. Patients were treated with PTH (1-84), 100 mcg/daily, for 12 months. Clinical and laboratory data at baseline and after 6 months of treatment were assessed. RESULTS: The mean age was 71.9 years. The incidence of hypercalcemia and the hypercalciuria were 6 events. Increase in serum calcium levels showed a statistically significant correlation with 24-hour urinary calcium (rho [ρ]=0.83, P<0.001), serum alkaline phosphatase (ρ=0.76, P=0.001), total proteins (ρ=0.77, P=0.005), and ß-CTx (ρ=0.82, P=0.002). On the other hand, 24-hour urinary calcium excretion correlated significantly with ß-CTx (ρ=0.83, P=0.002), alkaline phosphatase (ρ=0.73, P=0.005), total proteins (ρ=0.73, P=0.02), and serum phosphate (ρ=0.58, P=0.04). When the group of patients with and without hypercalcemia were compared, there were statistically significant differences in increases of ß-CTx and baseline ß-CTx values, whereas the group of patients with and without hypercalciuria showed significant differences in serum calcium increases and baseline values of T score at the femoral neck. CONCLUSION: The incidence of hypercalcemia and hypercalciuria after treatment with PTH (1-84) is similar to that expected according to the product's technical specifications. There was a significant correlation between increases of serum calcium, urinary calcium excretion, serum alkaline phosphatase, and ß-CTx after treatment with PTH (1-84). Baseline ß-CTx values were significantly lower in patients who developed hypercalcemia than in those with normal serum calcium levels.

Arte y Psiquiatría en el vacío de la postmodernidad / No disponible

En el vacío de la postmodernidad descubrimos unarte caracterizado por la transgresión y la provocación.El análisis de los síntomas y defensas de este arte tieneorígenes y consecuencias psicopatológicos. En estasinteracciones la locura y el arte buscan la esencia de laverdad

In the postmodernity’s empty space we discover anart characterized by the transgression and the provocation.The analysis of the symptoms and defenses of thisart have psychopathological origins and consequences.In these interactions madness and art look for the essence of the truth (AU)

Estudio psicopatológico sobre la creatividad y la perversión (la extraña inquietud en el cine de Greenaway) / Psychopathological study about creativity and perversion (the uncanny in the Greenaway´s cinema)

Podrían calificarse de artistas perversos desde la psicopatologíaa Buñuel, Bergman, Hitchcock o Greenawayporque en sus películas conviven lo imaginario y larealidad provocando en los espectadores esa extrañainquietud (Das Unheimliche) de la que nos hablanFreud y Heidegger. Estas perversiones sadomasoquistasy exhibicionistas son sólo el escaparate en que asomanlos cadáveres descuartizados por forenses obstinados ylos libros del saber condenados a contar las historias dela humanidad olvidando la inocencia de las víctimas.Para el inconsciente el asesinato no requiere un cuerpofísico y un acto criminal concreto. El pensamiento ordenaen el vacío los hechos, las secuencias numéricas–rituales y mágicas– y en el diccionario babélico losalfabetos pierden el sentido literal por el significadomítico. Dejando de un lado la perversión, pero sin exterminarlade nuestra mirada, dirigimos la atención a lacreatividad de Greenaway analizando los contenidos dealgunas de sus películas y exposiciones desde el psicoanálisisy/o el esquizoanálisis deleuziano. El deseo y lamuerte, la omnipotencia y el miedo sugieren la necesidady las defensas de la creación. La fragmentación delos cuerpos, el renacimiento y la resurrección en lasmaquinarias del tiempo son imágenes prisioneras ennuestro inconsciente y la realidad es un sueño desconcertantedel cual no podemos despertar

They could be described as perverse artists from the ;;Psychopathology Buñuel, Bergman, Hitchcock or ;;Greenaway because in their movies the imaginary and ;;the reality cohabit causing in the spectators that stranger ;;experience of the Uncanny/Das Unheimliche (Freud ;;and Heidegger). These sadomasochist and exhibitionist ;;perversions are only the cabinet in wich they appear the ;;cadavers quartered by obstinate forensic surgeons and ;;the books of the knowledge condemned to count the ;;Humanity’s histories, forgetting the innocence of the ;;victims. For the unconscious the murder doesn’t require ;;a physical body and a concrete criminal act. The ;;thought orders in the empty space the facts, the numerical, ;;ritual and magic sequences and in the Babel dictionary ;;the alphabets lose the literal sense for mythical ;;meaning. Leaving aside the perversion, but without ;;exterminating it of our look, we direct the attention to ;;the creativity of Greeenaway analyzing the contents of ;;some of his movies and exhibitions from the psychoanalysis ;;and/or schizoanalysis (Freud and Deleuze). ;;The desire and the death, the omnipotence and the fear ;;suggest the need and the defences of the creation. The ;;fragmentation of the bodies, the rebirth and the resurrection ;;in the machineries of the time are images prisoners ;;in our unconscious and the reality is a disconcerting ;;dream from which we cannot wake up

[Heart failure as the initial cardiac manifestation of Steinert's myotonic dystrophy]. / Insuficiencia cardíaca como manifestación cardiológica inicial de la distrofia miotónica de Steinert.

The relationship between neuromuscular diseases and the heart has been well known for many years. Cardiac lesions tend to involve the specialized conducting system. We report the case of a 36-year-old male diagnosed with Steinert's myotonic dystrophy whose initial cardiovascular symptom was heart failure and not symptoms related to alterations of the specialized conducting system.

[Creatine kinase increases after coronary interventions]. / Elevaciones de la creatincinasa tras intervencionismo coronario.

INTRODUCTION AND OBJECTIVES: Percutaneous revascularization has led to an important change in the treatment of patients with symptomatic ischemic heart disease in recent years. There is controversy concerning the incidence and prognostic significance of postprocedural increases in creatine kinase. The aim of this study was to assess the incidence of these elevations and the related factors and to observe the prognosis of patients with and without creatin kinase elevations. METHODS: We reviewed 447 patients in whom an angioplasty was done in our department from January 1997 to June 1998, excluding 138 patients with myocardial infarction in the previous four days or unsuccessful angioplasty. Creatine kinase was measured in all patients at 0, 4, 8 and 24 hours after angioplasty. We analyzed the incidence of elevated levels of creatine kinase following coronary surgery and the characteristics of the patients in comparison with a control group made up of patients who, at a similar time had undergone a similar angioplasty procedure including, a similar vessel and type of lesion, and equivalent left ventricular function but without elevated serum levels of creatine kinase. Major adverse coronary events were defined as: cardiac death, nonfatal myocardial infarction, new revascularization and unstable angina in which hospitalization was required. RESULTS: Out of 309 patients studied, an elevation in creatine kinase was observed in 24 patients (7.7%). Complications related to the procedure were found in 50% of these elevations, most of which involved side branch occlusion. There were no differences with respect to the demographical or anatomical characteristics of the lesions in the groups studied. During the follow-up of 9.5 months, complications were observed in 37.5% of the group of patients with elevated creatine kinase levels and in 20% of the control group, but this difference did not achieve statistical significance. CONCLUSIONS: Creatine kinase elevations are produced in 7.7% of the patients after coronary angioplasty. Complications related to the procedure were observed in 50% of the cases, most being side branch occlusion and no complications were seen in the remaining patients. Continuous measurement of creatine kinase after angioplasty shows a low sensitivity for detecting complications during follow-up. New, more sensitive and specific cardiac markers, such as troponin, could define this group of patients.

La personalidad del médico (reflexiones entre la Medicina y la Filosofía) / The doctor´s personality (reflexions between Medicine and Philosophy)

No disponible

[Quality control and improvement of the care provided to the patient with acute myocardial infarction. Implementation of a quality assurance program]. / Garantía y mejora de calidad de la atención al paciente con infarto agudo de miocardio. Implantación de un programa de calidad.

INTRODUCTION AND OBJECTIVES: Hospital care of patients with acute myocardial infarction involves a series of therapeutic measures and risk stratification which are a must since their efficacy has been clearly demonstrated. The aim of this study was to develop an internal program to guarantee and improve the quality of hospital care to acute myocardial infarction patients. METHODS: A medical audit was carried out for evaluation. Seven evaluation criteria considered as class I by the guidelines on the management of acute myocardial infarction patients were analyzed in the discharge report of 163 consecutive patients. Following analysis of the results corrective measures were implemented. In the second phase reevaluation of 40 patients was performed to determine the efficacy of the adopted measures. RESULTS: Following the first evaluation the use of AAS, IECAS and the beta-blockers was found to be correctly indicated in 95, 80 and 72% of the patients, respectively. A strategy of the adequate stratification of risk was carried out and ventricular function was evaluated in 93 and 96% of the cases. Correct hypolipemia treatment was indicated in 54% of the cases with an adequate diet being prescribed in 100%. Three months after the intervention, 40 new patients were evaluated with all the criteria analyzed being fulfilled in 100% of the cases. CONCLUSIONS: The use of evaluation techniques and improvement in the quality of health care provided to cases of acute myocardial infarction allows the determination of the care undertaken and its correction if necessary in order to follow the guidelines recommended for the care of these patients.

Psicopatobiografía de strindberg. psicopatología y teatro de la verdad (III): vida y muerte / Psychopathobiography of Strindber. Psychopatology and theatre of the truth (III): life and death

En el Teatro de Cámara podemos analizar algunas de las preocupaciones de Strindberg: demostrar su paternidad, el "asesinato del alma" perpetrado por la mujer, la presentación de los seres humanos bajo máscaras, la responsabilidad sobre un hijo no deseado, la carga de culpabilidad desde el nacimiento y el lenguaje secreto de la familia (AU)

Psicopatobiografía de strindberg. psicopatología y teatro de la verdad (IV): historia y memoria / Psychopathobiography of Strindber. Psychopatology and theatre of the truth (IV): history and memory

Los dramas y tragedias históricas han sido desconsideradas en los estudios psicopatológicos sobre el teatro de Strindberg. En esta investigación analizamos la etapa final de la vida del dramaturgo relacionando psicopatología y teatro histórico para integrarlos en la picopatobiografía. La verdad es un descubrimiento de la historia de su país a partir de su propia vida. La memoria recupera o altera personajes y circunstancias en función de su propia biografía (AU)

Psicopatobiografía de strindberg. psicopatología y teatro de "la verdad", I: sueño y realidad / Strindberg's psychopathobiography: psychopathology and theatre of "the truth", I: punishment and salvation

En estudios previos hemos investigado la psicopatobiografía de Strindberg mediante el estudio de la relación entre personalidad, psicosis y factores históricos. Esta investigación se centra en su drama "El sueño" para descifrar algunas claves psicopatológicas. El estudio de la psicopatología y el teatro no es el objetivo del presente trabajo, pertenece a anteriores investigaciones (Ruiz Ruiz, Ruiz-Ruiz y Fernández-Baca, 1998). En este caso estudiamos el momento crítico de cambio experimentado por el dramaturgo desde el Teatro Naturalista al Teatro del Alma, el cual ha sido provocado por los acontecimientos psicológicos de la vida de Strindberg, especialmente por su estado psicopatológico. Sería importante distinguir y analizar los sueños, fantasías y delirios en la representación escenográfica (AU)

Psicopatobiografía de strindberg. psicopatología y teatro de "la verdad", II: castigo y salvación / Strindberg's psychopathobiography: psychopathology and theatre of "the truth", II: punishment and salvation

Strindberg camina con sus dobles buscando el niño original, perseguido por sus tres sombras: la mujer, la locura y la muerte. La culpabilidad mueve a los fantasmas de la infancia y el tejido del drama es el del delirio puesto en movimiento mediante los personajes desdoblados y fragmentarios. El eterno Retorno y la Repetición se reflejan en el espejo del sueño y la ficción nos ofrece la realidad deseada en el escenario. Alguien que camina con el "alma asesinada" no teme dejar su cadáver en cualquier carretera (AU)

Estudio psicopatobiográfico de Strindberg. Autobiografía y Psicopatología. VII: Soledad y existencia / A study of Strindberg's psychopathobiography. Autobiography and psychopathology. VII: solitude and existence

Basándonos en su correspondencia, el "Diario Oculto" y sus últimos escritos investigamos psicopatológicamente, en continuidad con trabajos anteriores, la etapa final de la vida de Strindberg. Insistimos en la investidura del objeto libidinal (perspectiva psicoanalítica) y la conciencia culposa (perspectiva fenomenológica) para dar sentido a la tristeza, las ideas de suicidio y la memoria delirante. La psicopatobiografía pone en evidencia el proceso esquizofrénico con un claro deterioro psíquico. (AU)

Estudio psicopatobiográfico de Strindberg Autobiografía y Psicopatología. VI: el exorcista poseído y huída hacia la abadía / A study of Strindberg's psychopathobiography. Autobiography and psychopathology. VI: the possessed exorcist and escape to the abbey

Continúan las experiencias alucinatorias y delirantes en esta etapa de la vida descrita en "Leyendas" donde la trama de la persecución se hace más manifiesta. La convicción delirante, el significado de revelación y la memoria de los sucesos vividos en Infierno estructuran el delirio sobre la omnipotencia narcisística y el dolor de la individuación/separación. (AU)

Effect of DT-TX 30, a combined thromboxane synthase inhibitor and thromboxane receptor antagonist, on retinal vascularity in experimental diabetes mellitus.

Combined thromboxane synthase inhibitors and thromboxane receptors antagonists have been shown to have a beneficial effect on different models of thrombosis in vivo. We studied the action of one of these compounds (DT-TX 30) compared with dazoxiben (a thromboxane synthase inhibitor) on retinal vascularity in streptozotocin-diabetic rats. Ten nondiabetic animals were treated with isotonic saline, 30 (10 animals per group) were given 0.4, 4, and 8 mg kg(-1) per day of DT-TX 30 (p.o.) and 30 (10 animals per group) were given 10, 50, and 100 mg kg(-1) per day of dazoxiben (p.o.) over a 90-day study period. DT-TX 30 caused a dose-dependent decrease of platelet aggregation and thromboxane B2 synthesis. There was an increase of 9, 65, and 166% in the synthesis of prostacyclin after treatment with 0.4, 4, and 8 mg kg(-1) per day, respectively. Retinal vascularity increased in 51, 72, and 182% of animals in response to the three doses used. Synthesis of prostacyclin and the degree of retinal vascularity showed a linear correlation (r2=0.6528,p<0.00001). Dazoxiben, at doses that inhibited thromboxane synthesis as much as DT-TX 30, increased prostacyclin production and retinal vascularity with less potency than DT-TX 30. In conclusion, the antagonism of thromboxane receptors may be an important additional effect to the inhibition of thromboxane synthase in the prevention of ischemic retinal lesions in experimental diabetes.

Estudio psicopatobiográfico de Strindberg. Autobiografía y psicopatología, V: Infierno / A study of Strindberg's psychopathobiography. Autobiography and psychopathology, V: Inferno

Analizamos desde las perspectivas fenomenológica y psicoanalítica la crisis psicopatológica más importante sufrida por Strindberg en "Infierno". Comparamos los diversos estudios patográficos, destacando los de Jaspers y Lidz, para criticar las conclusiones obtenidas, aportando nuevos datos desde las fuentes biográficas y literarias. Se confirma el diagnóstico de esquizofrenia y resaltamos los orígenes de las ideas delirantes e interpretaciones delirantes, desde la omnipotencia narcisística, la ruptura del vínculo y la personalidad susceptible del dramaturgo (AU)

[Pneumopericardium in an asthmatic patient. A case report and review of the bibliography]. / Neumopericardio en un paciente asmático. Descripción de un caso y revisión de la bibliografía.

Pneumopericardium is an uncommon but potentially serious condition of which leading cause is mechanical ventilation in infants suffering respiratory distress syndrome. In adults, however, the most common causes are iatrogenic in diagnostic and therapeutic procedures, as well as traumatic lesions. We describe a case of pneumopericardium in a teenager suffering an asthma crisis. A review of the literature is presented, stressing the most relevant findings of the physical examination and habitual laboratory tests.

p53-mediated up-regulation of CD95 is not involved in genotoxic drug-induced apoptosis of human breast tumor cells.

Induction of CD95 (Fas/APO-1) and CD95 ligand during chemotherapeutic treatment may contribute to the death by apoptosis of some tumor cells. In this study, we have analyzed the role of the CD95 system in genotoxic drug-induced death of human breast tumor cells. Incubation of the breast tumor cell lines MCF-7 and EVSA-T with doxorubicin or methotrexate caused apoptosis after 48 h of treatment. These drugs induced a marked increase in the level of CD95 mRNA and protein in wild-type p53-expressing MCF-7 cells. On the contrary, the breast cancer cell line EVSA-T that expresses high levels of an inactive form of p53, did not up-regulate CD95 upon drug treatment. Elevation of CD95 expression by DNA-damaging drugs was notably blocked in MCF-7 cells expressing the human papillomavirus type 16 E6 protein (E6 cells) which prevented p53 accumulation upon DNA damage. However, E6 cells were still killed by the drugs. Furthermore, the genotoxic drugs did not induce the expression of CD95 ligand in MCF-7 cells at doses that caused apoptosis in these breast tumor cells. Moreover, drug-induced apoptosis of breast tumor cells was not prevented in the presence of either a CD95 antagonistic antibody or a CD95 ligand blocking antibody. We also observed a strong synergism between lower doses of DNA-damaging drugs and CD95 agonistic antibody in the induction of apoptosis in MCF-7 cells. In summary, our data indicate that drug-induced apoptosis of breast tumor cells occurs by a CD95/CD95L-independent mechanism although by elevating the tumor suppressor proteins p53 and CD95, genotoxic drugs may sensitize breast tumor cells to CD95-mediated apoptosis.

Importance of poly(ADP-ribose) polymerase and its cleavage in apoptosis. Lesson from an uncleavable mutant.

We have studied the apoptotic response of poly(ADP-ribose) polymerase (PARP)-/- cells to different inducers and the consequences of the expression of an uncleavable mutant of PARP on the apoptotic process. The absence of PARP drastically increases the sensitivity of primary bone marrow PARP-/- cells to apoptosis induced by an alkylating agent but not by a topoisomerase I inhibitor CPT-11 or by interleukin-3 removal. cDNA of wild type or of an uncleavable PARP mutant (D214A-PARP) has been introduced into PARP-/- fibroblasts, which were exposed to anti-CD95 or an alkylating agent to induce apoptosis. The expression of D214A-PARP results in a significant delay of cell death upon CD95 stimulation. Morphological analysis shows a retarded cell shrinkage and nuclear condensation. Upon treatment with an alkylating agent, expression of wild-type PARP cDNA into PARP-deficient mouse embryonic fibroblasts results in the restoration of the cell viability, and the D214A-PARP mutant had no further effect on cell recovery. In conclusion, PARP-/- cells are extremely sensitive to apoptosis induced by triggers (like alkylating agents), which activates the base excision repair pathway of DNA, and the cleavage of PARP during apoptosis facilitates cellular disassembly and ensures the completion and irreversibility of the process.