Rediseño del proceso de alta hospitalaria / Redesigning the hospital discharge process

Objetivo. Mostrar que el rediseño y la planificación del proceso de alta hospitalaria adelantan la hora de salida del paciente del medio hospitalario. Material y método. Estudio cuasiexperimental, realizado entre enero de 2011 y abril de 2013, en un hospital comarcal. Los casos analizados fueron de las unidades de enfermería médicas y quirúrgicas. El proceso fue rediseñado para coordinar a todos los profesionales que intervienen en el proceso. La mejora del proceso de alta hospitalaria se realizó a través de la creación de un grupo de trabajo, el análisis de los datos retrospectivos y la identificación de las áreas de mejora y rediseño. La variable dependiente fue la hora de alta administrativa del paciente. La muestra fue clasificada en preintervención, intraintervención y postintervención en función del momento temporal del estudio. Resultados. La muestra, tras aplicar los criterios de inclusión y exclusión, fue de 14.788 pacientes. El tiempo medio de salida de alta disminuyó de forma significativa en 50 min entre los periodos preintervención y postintervención. La salida en pacientes con alta planificada fue una hora y 25 min menor que en los pacientes no planificados. Conclusiones. El rediseño de procesos es una estrategia útil para mejorar el proceso de alta hospitalaria. Además, la planificación del alta se muestra como un elemento clave para que el paciente abandone el centro sanitario antes de las 12 de la mañana (AU)

Objective. The aim of this article is to show that the redesign and planning process of hospital discharge advances the departure time of the patient from a hospital environment. Material and method. Quasi-experimental study conducted from January 2011 to April 2013, in a local hospital. The cases analysed were from medical and surgical nursing units. The process was redesigned to coordinate all the professionals involved in the process. The hospital discharge improvement process improvement was carried out by forming a working group, the analysis of retrospective data, identifying areas for improvement, and its redesign. The dependent variable was the time of patient administrative discharge. The sample was classified as pre-intervention, inter-intervention, and post-intervention, depending on the time point of the study. Results. The final sample included 14,788 patients after applying the inclusion and exclusion criteria. The mean discharge release time decreased significantly by 50 min between pre-intervention and post-intervention periods. The release time in patients with planned discharge was one hour and 25 min less than in patients with unplanned discharge. Conclusions. Process redesign is a useful strategy to improve the process of hospital discharge. Besides planning the discharge, it is shown that the patient leaving the hospital before 12 midday is a key factor (AU)

Deep-UV nitride-on-silicon microdisk lasers.

Deep ultra-violet semiconductor lasers have numerous applications for optical storage and biochemistry. Many strategies based on nitride heterostructures and adapted substrates have been investigated to develop efficient active layers in this spectral range, starting with AlGaN quantum wells on AlN substrates and more recently sapphire and SiC substrates. Here we report an efficient and simple solution relying on binary GaN/AlN quantum wells grown on a thin AlN buffer layer on a silicon substrate. This active region is embedded in microdisk photonic resonators of high quality factors and allows the demonstration of a deep ultra-violet microlaser operating at 275 nm at room temperature under optical pumping, with a spontaneous emission coupling factor ß = (4 ± 2) 10(-4). The ability of the active layer to be released from the silicon substrate and to be grown on silicon-on-insulator substrates opens the way to future developments of nitride nanophotonic platforms on silicon.

[Redesigning the hospital discharge process]. / Rediseño del proceso de alta hospitalaria.

OBJECTIVE: The aim of this article is to show that the redesign and planning process of hospital discharge advances the departure time of the patient from a hospital environment. MATERIAL AND METHOD: Quasi-experimental study conducted from January 2011 to April 2013, in a local hospital. The cases analysed were from medical and surgical nursing units. The process was redesigned to coordinate all the professionals involved in the process. The hospital discharge improvement process improvement was carried out by forming a working group, the analysis of retrospective data, identifying areas for improvement, and its redesign. The dependent variable was the time of patient administrative discharge. The sample was classified as pre-intervention, inter-intervention, and post-intervention, depending on the time point of the study. RESULTS: The final sample included 14,788 patients after applying the inclusion and exclusion criteria. The mean discharge release time decreased significantly by 50 min between pre-intervention and post-intervention periods. The release time in patients with planned discharge was one hour and 25 min less than in patients with unplanned discharge. CONCLUSIONS: Process redesign is a useful strategy to improve the process of hospital discharge. Besides planning the discharge, it is shown that the patient leaving the hospital before 12 midday is a key factor.

Sal k 5, a member of the widespread Ole e 1-like protein family, is a new allergen of Russian thistle (Salsola kali) pollen.

BACKGROUND: Salsola kali is an Amaranthaceae weed with important repercussions for pollinosis in temperate areas. Ole e 1-like members are relevant allergens in pollen from different species. We aimed to characterize and produce as recombinant allergen S. kali Ole e 1-like protein. METHODS: The natural allergen was purified at homogeneity after three chromatographic steps. Specific cDNA was sequenced and expressed in Pichia pastoris yeast. Structural relationships of natural and recombinant forms were carried out by 2D electrophoresis and spectroscopic analyses. Its immunological relevance was analyzed by ELISA and immunoblotting using an IgG antiserum and monoclonal antibodies specific to Ole e 1, as well as sera from 57 allergic patients recruited from two Spanish regions where this pollinosis is frequent. RESULTS: The purified allergen, Sal k 5, is an acidic glycoprotein of 151 amino acid residues and 17,628 Da of molecular mass. Its amino acid sequence exhibits 68 and 32% identity with the allergens of Che a 1 and Ole e 1, respectively. The recombinant protein was correctly processed and its structural and immunologic equivalence to the natural form was proven. A sensitization frequency between 30 and 40% was observed in pollinic patients from the center and east coast of Spain. CONCLUSIONS: Sal k 5 is a member of the Ole e 1-like protein family which can be considered an important allergen from S. kali. Its inclusion in diagnosis protocols would allow the accurate defining of patients allergic to this pollen.

Detection of a biexciton in semiconducting carbon nanotubes using nonlinear optical spectroscopy.

We report the observation of the biexciton in semiconducting single-wall carbon nanotubes by means of nonlinear optical spectroscopy. Our measurements reveal the universal asymmetric line shape of the Fano resonance intrinsic to the biexciton transition. For nanotubes of the (9,7) chirality, we find a biexciton binding energy of 106 meV. From the calculation of the χ((3)) nonlinear response, we provide a quantitative interpretation of our measurements, leading to an estimation of the characteristic Fano factor q of 7 ± 3. This value allows us to extract the first experimental information on the biexciton stability and we obtain a biexciton annihilation rate comparable to the exciton-exciton annihilation one.

A pectin methylesterase as an allergenic marker for the sensitization to Russian thistle (Salsola kali) pollen.

BACKGROUND: Chenopodiaceae pollen is considered the main cause of pollen allergy in desert countries and its incidence is world-wide increasing by the desertization of extensive zones. Although the correlation between the sensitization to Chenopodium album and Salsola kali pollens of patients suffering from allergy to Chenopodiaceae pollens is high, a significant number of patients exhibited IgE sensitivity exclusively towards S. kali. OBJECTIVE: To analyse this differential reactivity and to purify, clone and characterize the putative responsible allergen. METHODS: Immunoblotting was used to analyse the IgE binding to pollen extract for S. kali and C. album. The protein was isolated by two chromatographic steps and characterized by Edman degradation, mass spectrometry, finger print analysis and Concanavalin A lectin staining. Specific cDNA was amplified by polymerase chain reaction, cloned in Escherichia coli and sequenced. Immunologic characterization was performed by immunoblotting, enzyme-linked immunoassay detection and inhibition experiments using sera from 11 patients allergic to S. kali pollen. RESULTS: cDNA codifies for a mature protein of 339 amino acids plus a putative signal peptide of 23 residues and it belongs to the plant pectin methylesterase (PME) family. It is a mildly basic and polymorphic protein and was recognized by the IgE from all the patients allergic to S. kali included in the study, and was called Sal k 1. The protein was not recognized in the C. album pollen extract using the sera of these patients. CONCLUSION: Sal k 1 is a protein from the PME family with a high allergenic relevance. Considering this allergen as responsible for the different sensitization between S. kali and C. album pollen, it may be a useful marker to classify patients allergic to Chenopodiaceae allowing a safer and more specific immunotherapy.

[Clinical and neuroimaging findings in a family with CADASIL associated to C475T mutation]. / Hallazgos clínicos y de neuroimagen en una familia con CADASIL asociada a la mutación C475T.

INTRODUCTION: The term CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) refers to an autosomal dominant hereditary arteriopathy of the brain that is characterised by headache, recurring strokes and progressive cognitive deterioration. We report the case of another family with CADASIL and emphasise the importance of a genetic study in its diagnosis. CASE REPORT: A 62-year-old female patient with repeating lacunar strokes, subcortical dementia and a family history of dementia and strokes. Neuroimaging studies conducted on the patient and her siblings showed signs of leukoencephalopathy and lacunar infarctions. The ultrastructural study of the biopsy performed on a sample of the patient's skin, which included five dermal vessels, did not show any electron-dense deposits. The genetic study revealed the presence of mutation C475T in exon 4 of NOTCH3. CONCLUSIONS: The possible presence of CADASIL must be suspected in patients with symptoms of cerebrovascular disease or dementia who present characteristic alterations in the magnetic resonance brain scan, especially when there is a compatible family history. The first choice diagnostic procedure must be a genetic study.

Clinical efficacy and safety of a depigmented and glutaraldehyde polymerized therapeutic vaccine of Parietaria judaica.

BACKGROUND: The inhalation of Parietaria judaica pollen is a common cause of allergic respiratory diseases in the Mediterranean area. The objective of this study was to investigate the safety and clinical efficacy of a chemically modified (depigmented and glutaraldehyde-polymerized) vaccine of Parietaria judaica. METHODS AND RESULTS: Thirty patients with a well-documented clinical history of seasonal rhinitis and clinical sensitivity to Parietaria judaica pollen were included in a randomized trial during 12 months. The study was conducted following good clinical practices and appropriate consent forms were signed. Patients were divided into 2 groups of 15 individuals; group A received the modified extract and group C did not receive specific immunotherapy. Any adverse event was recorded to assess safety. Symptom scores, symptomatic medication use and the results of specific nasal challenges (before and after 12 months of treatment) were recorded to evaluate clinical efficacy. The treatment schedule consisted of an incremental phase of 5 injections and a maintenance dosage of 0.5 ml per month. Each patient received 14 injections during this period. All the patients completed the trial and no adverse reactions related to immunotherapy were recorded. A significant difference (p < 0.001) in symptom scores and overall use of symptomatic medication was observed between the two groups, being both scores lower in group A. No significant differences in nasal sensitivity existed before treatment among the 2 groups. However, after 12 months, a significant difference (p < 0.05) was observed only in group A patients, who showed a significant improvement in specific nasal challenges. CONCLUSIONS: Immunotherapy with depigmented and glutaraldehyde-polymerized extract of Parietaria judaica pollen is safe and effective to treat patients with allergic rhinitis and clinical sensitivity to this pollen.

Clinical efficacy and safety of a depigmented and glutaraldehyde polymerized therapeutic vaccine of Parietaria judaica

Background: The inhalation of Parietaria judaica pollen is a common cause of allergic respiratory diseases in the Mediterranean area. The objective of this study was to investigate the safety and clinical efficacy of a chemically modified (depigmented and glutaraldehyde-polymerized) vaccine of Parietaria judaica. Methods and results: Thirty patients with a well-documented clinical history of seasonal rhinitis and clinical sensitivity to Parietaria judaica pollen were included in a randomized trial during 12 months. The study was conducted following good clinical practices and appropriate consent forms were signed. Patients were divided into 2 groups of 15 individuals; group A received the modified extract and group C did not receive specific immunotherapy. Any adverse event was recorded to assess safety. Symptom scores, symptomatic medication use and the results of specific nasal challenges (before and after 12 months of treatment) were recorded to evaluate clinical efficacy. The treatment schedule consisted of an incremental phase of 5 injections and a maintenance dosage of 0.5 ml per month. Each patient received 14 injections during this period. All the patients completed the trial and no adverse reactions related to immunotherapy were recorded. A significant difference (p < 0.001) in symptom scores and overall use of symptomatic medication was observed between the two groups, being both scores lower in group A. No significant differences in nasal sensitivity existed before treatment among the 2 groups. However, after 12 months, a significant difference (p < 0.05) was observed only in group A patients, who showed a significant improvement in specific nasal challenges. Conclusions: Immunotherapy with depigmented and glutaraldehyde-polymerized extract of Parietaria judaica pollen is safe and effective to treat patients with allergic rhinitis and clinical sensitivity to this pollen (AU)

Antecedentes: La inhalación del polen de Parietaria judaica es una causa frecuente de enfermedades respiratorias alérgicas en la región mediterránea. El objetivo de este estudio era investigar la seguridad y la eficacia clínica de una vacuna químicamente modificada (despigmentada y polimerizada con glutaraldehído) de Parietaria judaica. Métodos y resultados: Se incluyó en un estudio aleatorizado de 12 meses de duración a 30 pacientes con historia clínica bien documentada de rinitis estacional y sensibilidad clínica al polen de Parietaria judaica. El estudio se llevó a cabo conforme a las buenas prácticas clínicas y se firmaron los formularios de consentimiento apropiados. Se distribuyó a los pacientes en dos grupos de 15 sujetos; el grupo A recibió el extracto modificaco y el grupo C no recibió inmunoterapia específica. Para evaluar la inocuidad se registraron las reacciones adversas. Para evaluar la eficacia clínica se registraron las puntuaciones de los síntomas, el uso de medicación sintomática y los resultados de pruebas de provocación nasales específicas (antes y después de 12 meses de tratamiento).El régimen de tratamiento consistió en una fase de incremento de 5 inyecciones y una posología de mantenimiento de 0,5 ml al mes. Cada paciente recibió 14 inyecciones durante ese período. Todos los pacientes se sometieron al ensayo completo y no se registraron reacciones adversas relacionadas con la inmunoterapia. Se observó una diferencia significativa (p < 0,001) en las puntuaciones de los síntomas y el uso global de medicación sintomática entre los dos grupos; ambas puntuaciones fueron menores en el grupo A. Antes del tratamiento no se observaron diferencias significativas en la sensibilidad nasal de los dos grupos. Sin embargo, al cabo de 12 meses, se observó una diferencia considerable (p < 0,05) sólo en los pacientes del grupo A, los cuales experimentaron una mejoría significativa en pruebas de provocación nasales específicas. Conclusiones: La inmunoterapia con extracto despigmentado y polimerizado con glutaral de hído de polen de Parietaria judaica es segura y eficaz para tratar a los pacientes con rinitis alérgica y sensibilidad clínica a este polen (AU)

Significant improvement in symptoms, skin test, and specific bronchial reactivity after 6 months of treatment with a depigmented, polymerized extract of Dermatophagoides pteronyssinus and D. farinae.

BACKGROUND: The efficacy of allergen immunotherapy using depigmented and polymerized extracts has been previously shown for Olea europaea, Phleum pratense, and Parietaria judaica. The objective of this study was to evaluate the efficacy after 3 and 6 months of treatment of a depigmented, polymerized extract of a mixture of Dermatophagoides pteronyssinus and D. farinae. METHODS: A group of 22 patients suffering from asthma and monosensitized to mites was treated with the mixture of modified allergen extract. A group of 11 mite-sensitive, asthmatic patients receiving only pharmacological treatment was used as control. The study was open, parallel, controlled, and random-allocated. Objective and subjective criteria, such as changes in D. pteronyssinus-specific bronchial hyperreactivity, visual scale, and medication/symptom scores were used to evaluate efficacy. Each patient received a built-up phase of 6 injections in 5 weeks, followed by 5 injections of the maintenance dose, which consisted of 42.5 micrograms of depigmented, polymerized extract of D. pteronyssinus and 32.5 of D. farinae. The Friedman test was used to compare the results of the specific bronchial challenges at baseline and after 3 and 6 months of treatment. RESULTS: A significant difference in the amount of native extract of D. pteronyssinus needed to produce a drop of 20% in the FEV1 (p = 0.0029) in the immunotherapy-treated group was found. In this group, the median allergen potency needed at baseline was 0.6 HEP (35 micrograms) vs. 3.96 HEP (232 micrograms) at the end of the study, whereas no difference (median 0.6 vs. 0.57 HEP) was found in the control group. At the end of the study, 10 patients in the immunotherapy treated group vs. 1 in the control group needed more than twice the amount of allergen than at baseline to experience a 20% drop in FEV1 (p = 0.03). Symptom and medication scores and visual scale evaluation did also show a significant improvement after 3 and 6 months of treatment only in active group. A significant decrease in skin test reactivity was also detected in the active group after 6 months, which needed a median of 3 times more allergen to elicit the same reaction as histamine (10 HEP) (p = 0.028), whereas no changes were found in control group. No serious side effects were registered. CONCLUSIONS: Depigmented polymerized extracts of D. pteronyssinus and D. farinae are safe and effective in the treatment of mite allergic asthmatic patients, and provide clinical benefit in the shock organ after 6 months of treatment. Skin test reactivity, symptom and medication scores were also improved. Depigmented polymerized extracts of D. pteronyssinus and D. farinae induce clinical protection against a native extract as verified by specific bronchial challenges.

Tele-affiliation in medical education: experience from the international program at Yale Office of Telemedicine.

OBJECTIVES: Telemedicine is developed in response to the needs of users that results in a more viable model. Yale has developed a process called tele-affiliation to combine services that are customized to the international client's needs. METHODS: Several defined steps compose the tele-affiliation process. The Yale-Greece telemedicine program is used as an illustration of this process. Some of the programs developed in response to Greek needs include breast cancer clinics, women's health clinics and tele-homecare monitoring for post-operative and chronically ill patients. RESULTS: Tele-affiliation creates on infrastructure that has the potential to change the method of health care delivery. By using the infrastructure created by the tele-affiliation process, templates for disease management, as well as health promotion and education can be delivered to a global audience. CONCLUSIONS: A tele-affiliation education environment has been developed and tested between Yale University School of Medicine and Greece resulting in an improved infrastructure for health education and management.

Progesterone and 17 beta-estradiol acutely stimulate nitric oxide synthase activity in rat aorta and inhibit platelet aggregation.

The rapid non-genomic stimulatory action of progesterone (Pg) and estradiol (E2) on nitric oxide synthase (NOS) activity of endothelium intact aortic rings and its effect on platelet aggregation was investigated. First we measured the effect of the hormones on platelet aggregation when added to rat aortic strips (RAS) incubated in a PRP. RAS induced an antiaggregatory activity, which was enhanced by the presence of the hormones. The inhibitory action induced by the hormones was evoked in a dose dependent manner (10 pM-100 nM). These effects are specific for progesterone and 17-beta-estradiol, since either testosterone and 17-alpha-estradiol were devoid of activity. The hormones induced rapid responses, producing significant inhibition within 1 to 5 minutes of hormonal exposure. The addition of 10(-5) M L-NAME suppressed the antiaggregatory effect of 1 nM E2 or 10 nM Pg. Furthermore, we specifically quantified the NO generation by the 3H-citrulline technique. 10(-8) M E2 induced 2-fold increase of RAS citrulline production, while the increment induced by 10(-7) M Pg was 55% over control. Preincubation with 10(-5) M L-NAME completely suppressed the stimulatory action of 10(-9) M E2 or 10(-8) M Pg, confirming that the antiaggregatory factor released from the aortic tissue was NO. Preincubation with cycloheximide did not block the increment in NO induced by the hormones. In conclusion the present study provides for the first time evidence of acute, non-genomic effects of Pg on rat aorta NOS activity and platelet aggregation in coincidence with the results obtained with estradiol treatment.

Vertebral hemangioma mimicking a metastatic bone lesion in well-differentiated thyroid carcinoma.

The authors report a case of abnormal accumulation of I-131 in a thoracic vertebra in a patient with a well-differentiated thyroid carcinoma. The presumptive diagnosis was metastatic bone disease. Further diagnostic work-up confirmed a benign bone lesion. Bone metastasis, when shown on I-131 whole-body scintigraphy, usually supports a change in the staging and therapeutic approach to a patient with thyroid carcinoma. The authors believe that, although an infrequent lesion, the differential diagnosis of abnormal accumulation of I-131 in the body of a vertebra in patients with well-differentiated thyroid carcinoma should raise the possibility of a benign hemangioma. Complete work-up of the suggested bone metastatic lesion should be performed before tumor restaging and I-131 therapy is recommended.

Formación en metodología para la mejora de los servicios sanitarios / Training in methodology for the improvement of the health services

El proceso docente en la formación para la mejora de los servicios de salud exige coherencia entre el contenido de la acción formativa y la calidad de la propia actividad docente. Son características específicas de la misma las que a continuación describimos: - Los "clientes" (alumnos) son, por un lado, los responsables de la institución y, por otro, los profesionales de la organización. - La iniciativa para la formación en métodos para la mejora de la calidad debe partir de la propia dirección de la organización. - Los contenidos del programa docente deben incluir aspectos cientificotécnicos y de relación en la organización. - Es útil la integración de diferentes subgrupos profesionales en la actividad formativa y generar estrategias docentes que estimulen la participación activa de los alumnos. Son eficaces las metodologías grupales, los estudios de casos, el aprendizaje por problemas, por proyectos y por tareas en situaciones reales. Todas estas estrategias docentes son más efectivas si están centradas en las necesidades del propio alumno (aprendizaje significativo). - El alumno en la formación en esta área temática es considerado como el protagonista indispensable y "un verdadero experto" de la actividad que realiza. El profesor es más un facilitador que controla la relación docente y que favorece su aplicación al contexto real y cotidiano. Estas características dan a la formación en la mejora de la calidad de los servicios sanitarios un matiz diferenciador, no exclusivo, que debe tenerse en cuenta para incrementar su efectividad (AU)

Aerobiology of Artemisia airborne pollen in Murcia (SE Spain) and its relationship with weather variables: annual and intradiurnal variations for three different species. Wind vectors as a tool in determining pollen origin.

Detailed results from a 2-year survey of airborne pollen concentrations of Artemisia in Murcia are presented. Three consecutive pollen seasons of Artemisia occurring each year, related to three different species (A. campestris, A. herba-alba and A. barrelieri), were observed. A winter blooming of Artemisia could explain the incidence of subsequent pollinosis in the Murcia area. With regard to meteorological parameters, mathematical analyses showed relationships between daily pollen concentrations of Artemisia in summer-autumn and precipitations that occurred 6-8 weeks before. The cumulative percentage of insolation from 1 March seemed to be related to blooming onsets. Once pollination has begun, meteorological factors do not seem to influence pollen concentrations significantly. Intradiurnal patterns of pollen concentrations were similar for late summer and winter species (A. campestris and A. barrelieri). During autumn blooming (A. herba-alba), the intradiurnal pattern was particularly erratic. Theoretical values of wind run were obtained for each pollen season by the graphical sum of hourly wind vectors. When theoretical wind run was mapped onto the vegetation pattern, supposed pollen source locations were obtained for each hour. By comparing supposed hourly pollen origins with the intradiurnal patterns of pollen concentrations, it can be seen that this simple model explains variations in mean pollen concentrations throughout the day.

Rapid actions of calcitriol and its side chain analogues CB1093 and GS1500 on intracellular calcium levels in skeletal muscle cells: a comparative study.

1. The ability of synthetic analogues of the secosteroid hormone 1alpha,25-dihydroxy-vitamin-D3 [calcitriol, CT; 1,25(OH)2D3] to exert non-genomic (rapid) effects on target cells has been scarcely studied. To evaluate the pharmacological potential of the CT side-chain analogues CB1093 and GS1500, we compared their fast effects on intracellular calcium concentration ([Ca2+]i) in chick skeletal muscle cells with those elicited by the natural hormone. 2. Both analogues, similarly to CT, specifically induced rapid (30-60 s) and sustained rises in [Ca2+]i levels. CB1093 and GS1500 were more potent than the natural hormone at concentrations as low as 10(-13) M (4.5 fold stimulation) and 10(-12) M (2.5 fold), respectively, whereas higher concentrations (10(-9)- 10(-8) M) of CT were more effective than the analogues in elevating [Ca2+]i. Cyclic AMP was markedly increased by both analogues pointing for a role of this messenger in the fast actions of the synthetic compounds. 3. In Ca2+ free medium CT and analogues elicited a transient elevation in [Ca2+]i. The PLC inhibitors U73122 (2 microM) and neomycin (0.5 mM), as well as depletion of intracellular stores with thapsigargin (1 microM), completely prevented CB1093/GS1500-dependent changes in [Ca2+]i suggesting that, similarly to CT, these analogues mobilized Ca2+ from an IP3/thapsigargin-sensitive store. 4. The voltage-dependent calcium channel (VDCC) blocker nifedipine (2 microM) reduced by 50-60% the influx phase of the [Ca2+]i response to CB1093 and GS1500, indicating that VDCC contributed partially to Ca2+ entry. The Ca2+ readdition protocol suggested that analogue-dependent activation of a SOC entry pathway accounted, to the same extent as for CT, for the remaining non-VDCC mediated Ca2+ influx.

Recurrent ectopic adrenocorticotropic hormone producing thymic carcinoid detected with octreotide imaging.

Primary thymic carcinoids are rare tumors in which the tumor cells retain functional somatostatin receptors. In-111-labeled octreotide imaging has been used to diagnose abdominal carcinoids with a sensitivity rate of approximately 87%. The authors describe a case of a recurrent, ectopic cortisol-releasing hormone that produced thymic carcinoid localized as a focal area of increased activity in the upper mediastinum when planar and tomographic octreotide scintigraphy was used. Chest CT and MRI failed to localize the tumor. This may be the first reported case of In-111-labeled octreotide used to identify Cushing's syndrome caused by a cortisol-releasing hormone that produced thymic carcinoid.

Incidence of Alternaria spores in the atmosphere of Murcia (SE Spain). Seasonal, monthly and intradiurnal variations.

Variation in Alternaria spores in the atmosphere of Murcia (SE Spain) were studied for 2 years. Using a Burkard volumetric sampler located about 19 m above ground level, spores were collected and counted hourly by light microscopy. The results suggest that species of Alternaria are present in the atmosphere of Murcia every day throughout the year. Mean daily concentration of Alternaria was 25 spores/m3. Seasonal variations showed the lowest concentrations during winter and the highest in autumn. In the monthly pattern two peaks were observed every year: the first in about May-June and the second occurring in October. In the intradiurnal variations, maximum concentrations were observed between 5:00-6:00 p.m. (Spanish official time). The variation of Alternaria spores in the atmosphere in Murcia seems to be related to different factors throughout the year.