Expression of prostate specific membrane antigen (PSMA) in prostatic adenocarcinoma and prostatic intraepithelial neoplasia

The prostatic membrane antigen (PSMA) is a protein that is expressed in the prostatic epithelium. We studied the expression of PSMA in a series of 55 patients with different stages of prostate cancer and we compared the PSMA staining in prostate cancer cells, in high-grade prostatic intraepithelial neoplasia (PIN) and in histologically benign prostatic epithelium for the same specimen. For this purpose archival paraffin-embedded specimens were studied by immunohistochemistry with a monoclonal antibody 7E11-C5.3 against PSMA using the streptavidin-biotin method. The mean percentage of PSMA immunoreactivity was 56.67% in prostate cancer (CaP) cells, and 48.6% in PIN cells, which was significantly higher than benign-appearing prostatic epithelium (5.72%) (for each pair, p<0.001). PSMA expression was greater in CaP with a higher Gleason score (p=0.01), but no relationship was found with serum PSA value. We conclude that PSMA overexpression is detected in high-grade PIN and is associated with a higher Gleason score of prostate cancer. It is a potential marker for studying carcinogenesis and progression of prostate cancer.

[Venlafaxine extended release for the treatment of chronic pain. A series of 50 cases]

INTRODUCTION

The objective of this study is to investigate analgesic effectiveness and safety of venlafaxine extended release in chronic pain of any etiology.

METHODS

Six month, observational, open study, carried out in two pain units. Initially, a daily dose of 75 mg of venlafaxine extended release was administered, increasing it to 150 mg, following clinical criteria. Treatment response was measured using the Visual Analogue Scale (VAS), rest and mobilization, Hospital Anxiety and Depression Scale (HAD) and Eastern Cooperative Oncology Group (ECOG) and an adverse event sheet to record adverse events occurring during the study.

RESULTS

The study was carried out in a 50 patient sample with a mean age of 57.1 +/- 1.8 years, with chronic pain. A total of 85-90 % of the patients was maintained with a daily dose of 75 mg of venlafaxine extended release. This produced a gradual reduction of the VAS scores at rest (significant reduction of 5.2 +/- 1.1 to 2.7 +/- 1.5 points; (p<0.0005) and mobilization (significant reduction of 5.5 +/- 0.8 to 3.1 +- 1.6 points; p<0.0005). Pain relief increased progressively. Regarding physical activity measured by the ECOG scale, there was a reduction of the percentage of patients and increase of outpatients. Tolerability to venlafaxine was "excellent", "very good" or "good" for 72% of the patients.

CONCLUSIONS

Extended release venlafaxine can be an effective and well-tolerated treatment in patients with chronic pain of any etiology, although it must be investigated in depth.

Atomoxetine hydrochloride for the treatment of attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) occurs in approximately 3% to 10% of the pediatric population. Most of the drugs typically used to treat ADHD are stimulants, which, because of their addictive properties and potential for abuse, are controlled substances. Although these drugs are the mainstay of treatment for ADHD, nearly one third of patients may not respond to or be able to tolerate them. Atomoxetine hydrochloride, a nonstimulant approved by the US Food and Drug Administration for the treatment of ADHD, may provide an alternative to the use of stimulants.

OBJECTIVE

The goal of this review was to describe the chemistry, mechanism of action, pharmacokinetics, drug interactions, and efficacy and safety profiles of atomoxetine in pediatric and adult patients with ADHD, as well as relevant pharmacoeconomic considerations.

METHODS

Relevant publications were identified through a search of the English-language literature indexed on PreMEDLINE and MEDLINE (1966-May 2003) using the search terms atomoxetine, tomoxetine, and LY139603. These terms were also applied to the Google search engine. All articles were reviewed for suitability for inclusion. The manufacturer of atomoxetine provided both published and unpublished data.

RESULTS

In the data reviewed, atomoxetine was more efficacious than placebo in patients with ADHD (P<0.05 to P<0.01). Therapeutic doses ranged from 45 mg or placebo (P<0.05). These results add support to the hypothesis that atomoxetine may not cause the increase in dopamine concentrations in the nucleus accumbens that is associated with pleasurable effects and abuse potential.

Ethnobotany and antibacterial activity of some plants used in traditional medicine of Zapotitlán de las Salinas, Puebla (México)

The village of Zapotitlán de las Salinas is situated in the Valley of Tehuacán-Cuicatlán, Puebla, Mexico. Plant species used by the local inhabitants to treat gastrointestinal diseases were identified using ethnobotanical, ethnographic and taxonomic methods. Out of 119 interviews, 44 plant species were registered, of which the following are the most frequently used (listed in descending order): Lippia graveolens H.B. et K. (Verbenaceae), Lantana achyranthifolia Desf. (Verbenaceae), Turnera diffusa (Willd.) ex Schult. (Turneraceae), Lippia oaxacana Rob. et Greenm. (Verbenaceae), Gymnolaena oaxacana (Greenm.) Rydb. (Asteraceae), Cordia curassavica (Jacq.) Roem. et Schult. (Boraginaceae), Lantana camara L. (Verbenaceae) and Acalypha hederacea Torrey (Euphorbiaceae). From these plants, hexane, chloroform and ethanol extracts were prepared in order to assess their antibacterial activity against 14 bacterial strains causing the most common gastrointestinal diseases in Mexican population. All hexane extracts showed antibacterial activity against Gram-positive and Gram-negative bacteria. There is a correlation between the frequency of mention (of plant use) and the antibacterial activity. In conclusion, the knowledge of plants most frequently used for gastrointestinal infections in Zapotitlán de las Salinas is supported by scientific rationale.

Traditional knowledge about mushrooms in a Nahua community in the state of Tlaxcala, Mexico

This paper describes the traditional mycological knowledge of the Nahua of San Isidro Buensuceso, on the slopes of La Malinche Volcano National Park, in the state of Tlaxcala, México. The results described in this paper were obtained through interviews with villagers selected at random; a free-listing technique was used to determine the cultural significance of the mushrooms of the region. A total of 48 species, which had 65 Náhuatl names and 40 in Spanish, were identified. Although San Isidro villagers consider mushrooms to be a natural resource mainly used for food, they also use them for medicine, insecticides and trade. This paper presents traditional information on the morphology, ecology, fenology and consistency of the mushrooms found around San Isidro. It proposes that, from a cultural perspective, Gomphus flocossus, Ramaria spp. and Boletus spp. are the most important species of the region.

The value of the determination of anti-Aspergillus IgG in the serodiagnosis of canine aspergillosis: comparison with galactomannan detection

Diagnosis of canine aspergillosis is difficult using currently available methods. It often passes unnoticed or is diagnosed in the later phases of the disease. We developed an ELISA technique to detect anti-Aspergillus antibodies in canine serum using an Aspergillus antigenic mycelial extract, which could then be used for the diagnosis of canine aspergillosis. We used a cut-off of X + 3SD obtained from 20 control sera. The test was performed on 46 dogs with lesions indicating possible aspergillosis and gave nine positive results: one systemic mycosis, two discospondylitis, one uveitis, two bronchopulmonary processes and three rhinitis. We compared this methodology with the PLATELIA technique in the follow-up of the affected dogs, obtaining the same limitations as in the diagnosis of human aspergillosis. We consider our ELISA technique using sera samples a speedy, safe and reliable method which enables us to follow up the evolution of the disease and the efficacy of the therapy chosen. A definitive diagnosis must still take into account the results of other tests such as clinical examination, radiographic studies, endoscopy and biopsy.

Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study

OBJECTIVE

To determine how frequently life support is withheld or withdrawn from adult critically ill patients, and how physicians and patients families agree on the decision regarding the limitation of life support.

DESIGN

Prospective multi-centre cohort study.

SETTING

Six adult medical-surgical Spanish intensive care units (ICUs).

PATIENTS AND PARTICIPANTS

Three thousand four hundred ninety-eight consecutive patients admitted to six ICUs were enrolled.

MEASUREMENTS AND RESULTS

Data collected included age, sex, SAPS II score on admission and within 24 h of the decision to limit treatment, length of ICU stay, outcome at ICU discharge, cause and mode of death, time to death after the decision to withhold or withdraw life support, consultation and agreement with patient's family regarding withholding or withdrawal, and the modalities of therapies withdrawn or withheld. Two hundred twenty-six (6.6%) of 3,498 patients had therapy withheld or withdrawn and 221 of them died in the ICU. Age, SAPS II and length of ICU stay were significantly higher in patients dying patients who had therapy withheld or withdrawn than in patients dying despite active treatment. The proposal to withhold or withdraw life support was initiated by physicians in 210 (92.9%) of 226 patients and by the family in the remaining cases. The patient's family was not involved in the decision to withhold or withdraw life support therapy in 64 (28.3%) of 226 cases. Only 21 (9%) patients had expressed their wish to decline life-prolonging therapy prior to ICU admission.

CONCLUSIONS

The withholding and withdrawing of treatment was frequent in critically ill patients and was initiated primarily by physicians.

[Transdermal nitroglycerin versus corticosteroid infiltration for rotator cuff tendinitis]

AIMS

To compare transdermal nitroglycerin (NTG) and corticosteroid infiltration in patients with rotator cuff tendinitis (RCT).

DESIGN

Experimental, randomized controlled study.

SETTING

Semirural basic health area in the Garraf region of Barcelona province, Spain, with a population of public health service users of 12000.

PATIENTS AND METHODS

Patients diagnosed as having RCT of less than 6 weeks' evolution who had not responded to treatment with oral nonsteroid antiinflammatory drugs. The patients were distributed randomly into two groups: a) group A, local infiltration via a posterior approach with a depot corticosteroid and local anesthesia, and b) group B, treated for 3 days with a 5-mg NTC patch.

MAIN MEASURES

Age, sex, pain (measured with an analog visual scale) and adverse events. In patients who showed a partial response, treatment was repeated up to 3 times at 15-day intervals. Pain was tested after 7-10 days of treatment. Complete improvement was considered a reduction in pain of more than 5 points on the analog visual scale; partial improvement was considered a reduction of 3-5 points, and treatment failure was recorded when there was no improvement in pain or when there was a decrease of less than 3 points.

RESULTS

A total of 48 patients were included; 33 (69%) were women and 15 (31%) were men. Mean age was 61 years. In group A, complete improvement was seen in 19 patients and partial improvement in 3; treatment failed in 2 patients. In group B complete improvement was seen in 5 patients, partial improvement in 5, and failure of treatment in 14. The difference between groups was statistically significant. Adverse events were mild pain at the injection site in 4 patients from group A, and headache in 15 patients from group B, 8 of whom abandoned treatment for this reason.

CONCLUSION

Treatment with NTG is not a clear alternative to infiltration of corticosteroids in patients with RCT, because of its lack of effectiveness and because of the greater number of patients who had adverse events that lead them to abandon treatment.

Activities of sordarins in experimental models of candidiasis, aspergillosis, and pneumocystosis

Sordarin derivatives represent a new class of antifungal agents that act as potent inhibitors of fungal protein synthesis and possess a broad spectrum of activity. The in vivo activity of GM193663 and GM237354 was studied in mouse models of disseminated candidiasis and aspergillosis and in a rat model of pneumocystosis. The pharmacokinetic behavior of both sordarin derivatives was studied in mice and rats. In all studies, compounds were administered by the subcutaneous route. After a subcutaneous dose of 50 mg/kg of body weight to mice, the maximum level in serum, area under the concentration-time curve, half-life, and clearance for GM193663 and GM237354 were 51.8 and 23 microg/ml, 79.5 and 46 microg. h/ml, 0.8 and 0.85 h, and 21 and 25 ml/h, respectively. Systemic candidiasis and aspergillosis were established in CD-1 male mice infected with Candida albicans or Aspergillus fumigatus. For systemic candidiasis, compounds were given three times per day for seven consecutive days at 15, 30, 60, or 120 mg/kg/day. GM193663 and GM237354 showed dose-related efficacy against C. albicans, with 50% effective doses, 1 month after infection, of 25.2 and 10.7 mg/kg/dose, respectively. In experimental infections with A. fumigatus, GM237354 was given three times per day at 30, 60, or 120 mg/kg/day for five consecutive days. Animals treated with GM237354 demonstrated irregular responses. The survival of animals treated with GM237354 was 0, 30, and 0% at 30, 60, and 120 mg/kg/day, respectively. The therapeutic efficacy of GM193663 and GM237354 against Pneumocystis carinii was studied in an experimental P. carinii pneumonia (PCP) rat model. After a subcutaneous dose of 10 mg/kg given to rats, the maximum level in serum, area under the concentration-time curve, half-life, and clearance for GM193663 and GM237354 were 6.6 and 7.2 microg/ml, 8.5 and 11.8 microg. h/ml, 0.7 and 0.8 h, and 230 and 133 ml/h, respectively. To induce spontaneous PCP, rats were chronically immunosuppressed with dexamethasone. Infected animals were treated twice daily for 10 days at 0.2, 2, or 10 mg/kg/day. The therapeutic effect was estimated by the reduction in the number of cysts in the lungs of treated versus untreated animals. GM193663 and GM237354 significantly reduced the mean (+/- standard deviation) log number of cysts from 7.6 +/- 0.2 in the untreated group to 4.7 +/- 0.2 and 4.6 +/- 0.1, respectively, when the drugs were administered at a dose of 2 mg/kg/day. The log number of cysts was also reduced in infected animals given lower doses of the compounds (0.2 mg/kg/day). In summary, GM193663 and GM237354 are new sordarin derivatives that may potentially play a major role in the treatment of candidiasis and PCP. Further testing with Aspergillus in other animal models is warranted.

Genomic variability of Haemophilus influenzae isolated from Mexican children determined by using enterobacterial repetitive intergenic consensus sequences and PCR

Genomic fingerprints from 92 capsulated and noncapsulated strains of Haemophilus influenzae from Mexican children with different diseases and healthy carriers were generated by PCR using the enterobacterial repetitive intergenic consensus (ERIC) sequences. A cluster analysis by the unweighted pair-group method with arithmetic averages based on the overall similarity as estimated from the characteristics of the genomic fingerprints, was conducted to group the strains. A total of 69 fingerprint patterns were detected in the H. influenzae strains. Isolates from patients with different diseases were represented by a variety of patterns, which clustered into two major groups. Of the 37 strains isolated from cases of meningitis, 24 shared patterns and were clustered into five groups within a similarity level of 1.0. One fragment of 1.25 kb was common to all meningitis strains. H. influenzae strains from healthy carriers presented fingerprint patterns different from those found in strains from sick children. Isolates from healthy individuals were more variable and were distributed differently from those from patients. The results show that ERIC-PCR provides a powerful tool for the determination of the distinctive pathogenicity potentials of H. influenzae strains and encourage its use for molecular epidemiology investigations.

Disseminated mycoses in a dog by Paecilomyces sp

We describe a case of canine mycoses initially diagnosed by clinical signs and enzyme-linked immunosorbent assay anti-fungal test, and later confirmed by the isolation of Paecilomyces sp. during the post-mortem examination. The fungus was isolated from lesions in the kidneys, mitral valve, abdominal aorta and vertebral discs. In this kind of process, it is important to identify the responsible agent early in order to make a study of anti-fungal susceptibility and establish effective treatment.

[Acyclovir may modulate clonal expansion of cd8+ lymphocytes induced by the Cytomegalovirus antigen]

BACKGROUND

Although the potent antiviral effect of acyclovir on the Herpes-simplex (HSV) and Varicela-zoster (VZV) virus and the scarce effectiveness versus Cytomegalovirus (CMV) is known, some data suggest that it may have an immunodulator implicated in the control of these viral disease. The aim of this study was to characterize this possible effect of acyclovir versus the CMV antigen.

METHODS

We stimulated cultures of mononuclear cells obtained in 7 healthy patients who were seropositive for CMV and HSV with CMV antigen, HSV and with phitohemaglutinine (PHA). The proliferation index and culture cell phenotype were later determined in the absence and presence of acyclovir (2 micrograms/ml). In another group the proliferation index and cell phenotype following stimulation with the CMV antigen were studied prior to and after treating the same volunteers with acyclovir for one week (800 mg/6h).

RESULTS

The CMV antigen and HSV induced T cell proliferation predominantly involving the CD8+ subpopulation leading to an inversion of the CD4/CD8 quotient. On addition of acyclovir to the cell culture a moderate reduction was produced in lymphoproliferative response versus the CMV antigen and HVS, characteristically modulating CD8+ cell proliferation, thereby leading to reestablishment of the CD4/CD8 quotient. However, the proliferation induced by PHA was not inhibited. These results were produced on oral administration of acyclovir.

CONCLUSIONS

Acyclovir modulates the lymphoproliferative response induced by CMV antigen. Based on this observation, the authors hypothesize that this immunomodulation may be related to its preventive effect on CMV disease in transplanted patients.

[Churg-Strauss syndrome with pericardial and myocardial involvement]

We report the case of a 63-year-old female diagnosed with Churg-Strauss syndrome with both pericardial tamponade and myocardial involvement with congestive heart failure. Allergic granulomatosis and angiitis (Churg-Strauss syndrome) is classically characterized by hypereosinophilia and systemic necrotizing vasculitis of medium and small arteries in patients with previous allergic rhinitis or bronchial asthma. Subsequently the disease has been shown to be associated with cardiac involvement and is responsible for higher morbidity and mortality. The literature for Churg-Strauss syndrome of the heart is reviewed and recent advances in the clinical management of the disease according to appropriate therapeutic strategies are recommended.

[Congenital aneurysm of the sinus of Valsalva ruptured to right ventricle with a ventricular septal defect and aortic regurgitation]

We report the case of a patient with a congenital aneurysm of the sinus of Valsalva ruptured in the right ventricle, aortic valvular regurgitation and ventricular septal defect that remained asymptomatic for many years and presented clinically with severe volume overload of the heart and congestive heart failure. We describe the anatomic, echocardiographic and angiographic findings of this unusual entity with a review of the literature.

Attitudes regarding tuberculosis in immigrants from the Philippines to the United States

BACKGROUND AND OBJECTIVES

More than two thirds of the cases of tuberculosis (TB) in the United States occur in non-white minorities and immigrants. The Philippines is the Asian country of origin with the greatest numbers of TB cases among the foreign-born. This paper explores Filipino knowledge, attitudes, and practices concerning TB.

METHODS

Four focus groups of Filipino immigrants were convened to discuss the participants' explanatory models regarding TB. The results of these groups were reviewed by a panel of Filipino health workers.

RESULTS

The focus group participants expressed a belief in the extreme contagiousness of TB. This leads to social stigma and isolation. The desire to avoid such consequences lead some to deny their illness, not seek attention, or attempt to hide their illness. While all agree that biomedical treatment is necessary, many believe in the effectiveness of traditional and popular treatments.

CONCLUSIONS

If explanatory models of illness are elicited from individual patients, an understanding of the shared beliefs regarding tuberculosis in Filipinos may contribute to treatment of these patients.

[A hydatid cyst in the vena cava inferior and right atrium with venous flow obstruction and pulmonary dissemination]

We report the case of a 62-year-old female patient operated for a hepatic hydatid cyst that years later was found to have a hydatid cyst in the inferior vena cava and right atrium that was the source of disseminated pulmonary spread of the disease and occlusion of the inferior vena cava blood flow. Cardiac hydatid disease is very uncommon and is frequently associated with a poor prognosis. The literature for hydatid disease of the heart is reviewed and the clinical and echocardiographic relevant findings of this patient are discussed.

Morphological variation and the process of domestication of Stenocereus stellatus (Cactaceae) in Central Mexico

Morphological variation was analyzed in wild, managed in situ, and cultivated populations of the columnar cactus Stenocereus stellatus in central Mexico. The purpose was to evaluate whether morphological divergence between manipulated and wild populations has resulted from domestication processes. Variation of 23 morphological characters was analyzed among 324 individuals from 19 populations of the Tehuacán Valley and La Mixteca Baja. Multivariate statistical analyses were used to group individuals and populations according to their morphological similarity. Individuals grouped according to the way of management and fruit characteristics were the most relevant for grouping. Within each region, sweet fruits with pulp colors other than red were more frequent in cultivated populations, where fruits were also larger, contained more and bigger seeds, and had thinner peel and fewer spines than fruits from wild individuals. Phenotypes common in managed in situ and cultivated populations generally occur in the wild but in lower frequencies. Artificial selection has thus operated by enhancing and maintaining desirable rare phenotypes in managed in situ and cultivated populations, causing divergent patterns of morphological variation from wild populations. Cultivation has caused the strongest level of divergence, but divergence has also been significant with management of wild populations in situ.

[Rett's syndrome in the Spanish population]

INTRODUCTION AND OBJECTIVE

Rett syndrome was described in 1966 and became known through the English medical literature in 1983. There are typical and atypical forms. The objective of this study was to record the cases diagnosed in Spain and discover their clinical characteristics in order to describe its phenotype and geographical distribution.

PATIENTS AND METHODS

We know of 207 cases and have obtained the records of 168 of these patients. A protocol and data collection programme has been developed giving the criteria for inclusion, and data which support or exclude this. Data collection was by post and the data for identification were the date of birth and the initials of the name and two surnames. With these variables, double-registering of patients was almost impossible. A statistical study with descriptive analysis and a study of continuous and alternating variables was immediately done.

RESULTS AND CONCLUSION

The results gave the main characteristics, the differences between typical and atypical cases and a comparative study of variables. It has given clinical data which may be useful for prognosis of the condition in the future.

[Aspergillosis: Mechanisms of pathogenicity implicated and approach to laboratory diagnosis.]

Aspergillosis comprises a wide range of clinical conditions, of which the most serious is invasive aspergillosis, which particularly affects immunodeficient individuals. In the present work we present a review centred on three main aspects of this disease: 1) Possibility of differentiation of strains of Aspergillus fumigatus by phenotyphic and genotypic methods, 2) Mechanisms of pathogenicity of this species and especially the relationships of elastase activity, and 3) Laboratory diagnosis of aspergillosis, principaly in terms of determination of circulating antigens and DNA sequences in the blood and urine of patients.

[Cardiac papillary fibroelastoma. Different forms of the clinical presentation]

Papillary fibroelastoma is an uncommon cardiac tumor rarely diagnosed during life. Although most fibroelastomas are incidental findings at autopsy, a few cases have been associated with cardiac symptoms that include angina, arterial embolism and sudden death. We report the case of two patients, a 35-year-old male with an acute myocardial infarction and ventricular fibrillation and a 53-year-old asymptomatic female, with cardiac masses first detected by transthoracic echocardiography. A more detailed morphological study was provided by transesophageal echocardiography. After cardiac surgery, the anatomical study demonstrated that both tumors were papillary fibroelastomas. The literature concerning papillary fibroelastoma is reviewed.

Distortion product otoacoustic emissions in healthy newborns: normative data

Distortion product otoacoustic emissions (DPOAE) offer an alternative to transiently evoked otoacoustic emissions (TEOAE) as an audiological test. The former can be used as a screening technique, and may also provide frequency-specific information about the functional state of the cochlea. We recorded DPOAE in a group of healthy newborns to establish the characteristics of a DPOAE "audiogram" (DP-gram) in this population. The DP-gram can be obtained with characteristics quite similar to those observed in adults, with two sharp peaks of maximum amplitude at F2 frequencies of 2 kHz and 5-6 kHz, and a decline in DPOAE amplitude in midfrequencies. The results confirm the limitations of DPOAE recording for testing parts of the basilar membrane where lower frequencies are coded.

[Cerebral metastasis as first manifestation++ of a bladder carcinoma]

The infiltrant vesical carcinoma shows a tendency to become metastatic in a high percentage of cases, so that the preferred sites are usually the retroperitoneal lymph nodes, liver and bone. CNS metastasis is an uncommon fact, but it is even less common to find CNS affectation symptoms even before the appearance of any signs and symptoms related to the vesical affectation itself. Contribution of one case of infiltrant vesical carcinoma which presented with focal neurological symptomatology as its first manifestation.

[Granulomatous prostatitis. An infrequent diagnosis. Review of our series]

Granulomatous prostatitis is an inflammatory condition of the prostate which presents rarely in the urological practice. It is caused by several specific and unspecific infectious agents, and can also be secondary to prostate surgery or a local reflection of a systemic granulomatous disease. With regard to clinical manifestations and treatment, it is an unspecific entity which has a characteristic histopathology. Its major interest consists on the possibility of it being mistaken for a prostate cancer during physical examination. This paper reviews a series of 7 granulomatous prostatitis, with special emphasis on their histology and ultrasound findings.

[Complications of varicocele embolization: adhesion of the intravascular catheter during infusion of bucrylate]

The introduction of percutaneous occlusion techniques to manage a varicocele has made possible the control of the process with success rates similar to those obtained with conventional surgery. Its efficacy and minimal invasive nature, although not entirely risk-free, are responsible for its expansion. Contribution of one case of adhesion of the intravascular catheter to the underlying spermatic vein wall during infusion with isobutyl cyanoacrylate (bucrylate) as embolization material, an event which forced immediate surgical removal.

[Extrinsic stenosis of the ureter. Our caseload and review of the literature]

Obstructive uropathy is the common presentation course for various processes with an origin either intraluminar, parietal or extraluminar. A retrospective analysis of 41 cases of extrinsically originated obstructive uropathy seen in our Urology Unit from 1976 to 1991 was carried out. The cases were divided in three groups following an exclusively etiological criterion: 21.9% (9 patients) corresponded to primary retroperitoneal fibrosis; 51.2% (21 patients) to tumoral ureteral obstruction; and 26.8% (11 patients) to non-tumoral processes. For each division established, the features of clinical presentation, performance of the various diagnostic procedures used, and different therapy approaches are described also including a review on the current literature.

[Therapeutic options in metastatic renal carcinoma]

Within the scope of urogenital tract tumoral diseases, renal adenocarcinoma is the third most frequent neoplasia diagnosed in the adult population. The limited clinical presentations in early analysis and their anarchical behaviour are the cause for 50% to 60% of patients having already developed distant disease at the time of diagnosis. The only curative procedure so far is radical surgery, which is possible when there is a single metastatic site and sometimes even, depending on various factors which will be analyzed, several sites. In these occasions, the traditional therapeutic choices (Hormonotherapy, Chemotherapy, Radiotherapy) have proven to have limited or no efficacy in managing the disease. This fact, together with the successful results obtained in other tumoral processes, have allowed the clinical development of different modalities of Immunotherapy for the management of metastatic renal carcinoma, with results clearly hopeful. This work is a review of the results reported for each of the mentioned therapeutic choices, basically analyzing the role currently played by surgery and immunotherapy in the management of advanced renal carcinoma.

Effects of Ringer's lactate and fibrin glue on postsurgical adhesions

The intraabdominal instillation of Ringer's lactate decreased adhesion formation and reformation in the rat. Fibrin glue also reduced adhesion formation but was not superior to Ringer's lactate.

[Multiple paragangliomas. The problem of its localization. Report of the first case studied with 131I meta-iodobenzylguanidine in our milieu and review of the literature]

We report the case of a young woman, with an 8 year history of paroxysmal episodes of dyspnea, palpitations, blurred vision, tremors, precordial oppression and hypertension; the diagnosis of a chromaffin tumor was established, with an increase in serum and urine catecholamines level. She had three surgical interventions and also the following studies: abdominal and pelvic ultrasound, computed tomography, cavography; selective arteriography, and infusion of the meta iodobenzyl-guanidine 131, which localizes tissues hypersecretors rich in catecholamines.

Psychological evaluation of intensive care nurses

To understand the possible psychological repercussions of working in an ICU, we report on 18 nurses in our unit, who took the Minnesota Multiphasic Personality Inventory (MMPI), the Rorschach test, and two prints from the Phillipson test. Each nurse took these tests during her 1st month of work and again at 12 months; 9 repeated the tests once more 24 months after entering the ICU. The results demonstrated the absence of clinical evidence in all cases. Findings of the Rorschach indicate that the larger part of the group use defense mechanisms to confront the numerous harmful stimuli and the high level of anxiety. In spite of this, the Phillipson test shows approximately one-half of them to manage depressive situations correctly and formulate solutions and mechanisms of reparation.