[A description and consensus on the role of the professional in the integral management of the haematology patient: Results of a national multicentre Delphi study]. / Descripción y consenso del rol del profesional de enfermería en la gestión integral del paciente hematológico: resultados de un estudio Delphi multicéntrico nacional.

BACKGROUND AND OBJECTIVE: The Haematology Service has undergone significant advances in recent years. Given the vital part played by the nurse in the care of the haematology patient, ensuring optimal management by adapting their role to meet the current healthcare needs is a priority. The aim of this study was to evaluate the level of agreement among professionals of the Haematology Service regarding the role of the nursing professional and their importance in the comprehensive management of these patients in a multidisciplinary work setting. PATIENTS AND METHOD: A national multicentre Delphi study with haematology specialists and nursing professionals. A two-round questionnaire was used, and consensus was reached when > 75% of the panellists scored on the same tertile (1-3: disagreement, 7-9: agreement), and the interquartile range of the median of the responses was ≤4. RESULTS: A total of 33 professionals from the Haematology Department were invited to participate, of whom 19 were haematology specialists and 14 were nursing professionals. In the first round, 25 panellists responded (14 haematology specialists and 11 nursing professionals), and in the second round, 22 panellists responded (12 haematology specialists and 10 nursing professionals). The panel of experts agreed that haematology nurses should have specific training in haematology (96%) and on the definition of the role of nursing in the care process of the haematology patient, except in the possible participation in decision-making with regard to the most appropriate oncological treatment for a patient (58%). The role of the nursing professional as a reference for the patient throughout the healthcare process and their involvement in the process at the time of diagnosis were agreed upon in the second round (72.7% and 68.2%). Their role in the control of nutritional status (100%), visit compliance (96%), and health education for the patient and the family (96%) were included in the highly agreed upon aspects. The panel considered the improvement of adherence to treatment (96%), and the role as consultant for specific care of the haematology patient within the hospital (96%) as important aspects. Together with health education and patient follow-up, a total of 88% of the panellists considered that the haematology nurse reduces patient visits to the emergency department as well as physical visits to the outpatient clinics of the health centre. CONCLUSIONS: The current profile of the haematology nursing professional implies a high level of specialisation. The competencies of the haematology nursing professional are aimed at guaranteeing an integral management of these patients; with important healthcare functions, as well as a key element in the flow of information, and are framed within a multidisciplinary work setting.

Gender differences in ancestral contribution and admixture in Venezuelan populations.

The origin of the contribution of uniparental heritage were analyzed in 615 samples of individuals proceeding from 13 towns classified according to historic differences in their emergence and development as African-derived, European-derived, and admixed/urban. Mitochondrial and Y-chromosome haplogroups were identified by PCR-restriction fragment length polymorphism. The results were compared with previous estimates of admixture made with autosomal markers and with historic aspects. The results show a predominantly indigenous genetic contribution through the female, being more prevalent in urban populations; the African contribution, although dispersed, presents a larger concentration in the African-derived towns, whereas the European contribution is limited to populations with this origin, reflecting isolation and the conservation of the distribution pattern of genes of the Colonial era. With regard to admixture through males, it is almost exclusively of European origin, whereas the African contribution is basically concentrated in the African-derived towns, and the Amerindian lineages are almost nonexistent. The genome of paternal heredity, as opposed to the autosomal and the mitochondrial, shows a homogeneous pattern of admixture that is independent of the origin of the population studied, suggesting that European genes have been introduced into the Venezuelan population through male immigrations, whereas the indigenous contribution has been preserved in the Venezuelan genetic pool through the women. These results provide evidence of the heterogeneity in the genetic origin of the Venezuelan population, which should be taken into account in forensic and epidemiologic genetic studies.

[Analysis of surgical treatment for nonmelanoma skin cancer performed by dermatologists in a public hospital: clinical-pathological correlation, use of hospital resources, and waiting list time from diagnosis]. / Análisis del tratamiento quirúrgico del cáncer cutáneo no melanoma cuando es realizado por dermatólogos en un hospital público: correlación anatomoclínica, empleo de recursos hospitalarios y tiempo de espera desde el diagnóstico.

BACKGROUND: Nonmelanoma skin cancer is the most common form of cancer in humans. It can be treated by a variety of specialists and using different techniques, surgical excision being the procedure associated with the lowest rates of recurrence. No studies have been published addressing differences in the management of surgical treatment for nonmelanoma skin cancer according to the specialties involved. OBJECTIVES: To assess the preoperative diagnostic accuracy and the use of health care resources when surgical treatment of nonmelanoma skin cancer is done by dermatologists belonging to the Spanish national health service. METHODS: A prospective observational study was carried out over a period of 36 months using data corresponding to all patients diagnosed with nonmelanoma skin cancer and treated surgically in the Dermatology Department of Complejo Hospitalario de Burgos, Spain. Data were analyzed for clinical-pathological correlation, complexity of the intervention, use of health care resources, and time elapsed between clinical diagnosis and surgery. RESULTS: The study included 448 patients and 521 skin lesions suspected to be nonmelanoma skin cancer (basal cell carcinoma or squamous cell carcinoma). Diagnosis was exclusively clinical in 487 tumors and a clinical-pathological correlation of 84.39% was observed. Surgery was performed with local anesthesia in 96.42% of patients, although 111 (21.29%) required complex surgical repair. In 349 patients (77.90%) the procedure was performed on an outpatient basis, 73 (16.29%) required a short stay in the surgical day care unit, and 26 (5.80%) required hospital admission. The mean (SD) delay from clinical diagnosis to surgery was 68.44 (42.22) days, with a median delay of 60 days. CONCLUSIONS: Dermatology specialists are highly qualified to diagnose malignant skin tumors and accurately identify those patients requiring surgery. Dermatological surgeons use minimal health care resources, shorten the overall length of the process, and help to control overall health care costs for cancer.

A simple methodology for the evaluation of groundwater pollution risks.

Groundwater represents a very significant source of fresh water for irrigation and drinking purposes and therefore preserving the availability and quality of this resource is extremely important. A first assessment of the amount of pollutants that can be exported to groundwater via soil drainage can be made by a) measuring the amount of contaminants present in the soil solution at the bottom of the soil after a prolonged simulated rainfall event, and b) estimating the amount of drainage water passing the soil bottom during a period of time long enough to include sufficient instances of both, wet and dry episodes inherent to the local climate. Drainage water was estimated by means of a simple infiltration model ("bucket model") which computes on a daily basis the inputs and outputs of soil water through rainfall and evapotranspiration generated by a stochastic model of the local climate along a period of 50-100 years. The methodology was applied in the Guadiamar valley after the toxic spill of a pyrite mine in Aznalcóllar (Spain). The results show that Zn is the dominant contaminant at the site with a 1.2 g m(-2)year(-1) contribution to groundwater. The presence of a gravel rich horizon below 50 cm depth reveals an increase in drainage and the threat to groundwater.

Guidelines for improving organic carbon recovery by the wet oxidation method.

The study of soil degradation processes as well as the monitoring of environmental quality often yields large sample batches in which organic carbon is the key property to be determined. A description is given for a rapid method to analyse organic carbon by wet oxidation; the reaction is carried out with 3ml K(2)Cr(2)O(7) and 6ml H(2)SO(4) in small vials, and Cr(3+) resulting from organic C oxidation is determined by spectrophotometry. No special equipment is needed and handling is reduced to a minimum, enabling over 100 samples per day to be analysed. There is one important detail in the operation protocol: the vials are placed inside an insulator block during oxidation. Heat insulation retards the cooling of vials, which results in a high organic C recovery (over 0.90). The improved method is feasible, simple, and easy to perform. Reproducibility was lower than 10% and recoveries from certified reference materials were about 90%. The simplified method is recommended for widespread organic C content sampling.

Growth status of children 6-12 years from two different geographic regions of Mexico.

PRIMARY OBJECTIVES: The purposes of the study are to assess the growth status of urban Mexican children living in different geographic areas of the country, to estimate the prevalence of overweight and obesity, and to explore secular trends in body size. DESIGN: Cross-sectional surveys of 293 children 6-11 years from Sonora in the north-west of the country (155 boys, 138 girls), and 356 children 7-12 years from Veracruz on the Gulf Coast (194 boys, 162 girls) were undertaken in 1992 and 1993, respectively. PROCEDURES: Height and weight were measured; the body mass index (BMI, kg m(-2)) was calculated. Growth status was compared to USA reference data and to samples of Mexican children in 1926 and 1975. The prevalence of overweight (BMI > or = 85th and < 95th percentiles) and obesity (BMI > or = 95th percentile) was estimated. RESULTS: Girls and boys from Sonora and Veracruz do not differ in height, weight and the BMI. Mean heights are at (girls) or below (boys) the medians of USA growth charts, while mean weights are at (boys) or just below (girls) the 75th percentiles at most ages. As a result, mean BMIs are above (boys) and below (girls) the 75th percentiles over the age range studied. The prevalence of overweight and obesity is 40% in boys and 35% in girls, whereas the prevalence of obesity per se is 23% in boys and 17% in girls. Compared to urban Mexican children in the Federal District surveyed in 1926, children in the present sample are taller and heavier, but the secular trend in body weight is more pronounced since the mid-1960s. Heights of the current samples are similar to those of well-off children in Mexico City in the early 1970s, but weights are heavier. CONCLUSIONS: The gap in height between well-off and lower socioeconomic status children in different regions of Mexico has been reduced, but there is an increase in the prevalence of overweight and obesity.

An overview of the present state of standardization of soil sampling in Spain.

There are no national standard soil sampling guidelines at present in Spain, although a strong need for standardization of sampling activities is evident. Some relevant publications dealing with sampling subjects are cited, and common practices in sampling and sample pre-treatment carried out in Spain for basic soil maps, soil fertility and soil contamination are briefly described. The need to standardize sampling protocols and guidelines in Spain and to harmonize them with those of the EU countries is emphasized.

Application of a modified BCR sequential extraction (three-step) procedure for the determination of extractable trace metal contents in a sewage sludge amended soil reference material (CRM 483), complemented by a three-year stability study of acetic acid and EDTA extractable metal content.

This paper provides additional data on a sewage sludge amended soil certified reference material, CRM 483, which was certified in 1997 for its EDTA and acetic acid extractable contents of some trace metals, following standardised extraction procedures. The additional work aimed to test the long-term stability of the material and the applicability of an improved version of the BCR three-step sequential extraction procedure on the sewage sludge amended soil (CRM 483). The paper demonstrates the CRM 483 long-term stability for EDTA and acetic acid extractable contents of Cd, Cr, Cu, Ni, Pb and Zn and gives the results (obtained in the framework of an interlaboratory study) for the extractable contents of the same elements in the CRM 483, following the BCR three-step sequential extraction scheme. The aqua regia extractable contents following the ISO 11466 Standard are also given. The data are given as indicative (not certified) values.

[Uterine leiomyomatosis in the female in late menopause]. / Miomatosis uterina en la mujer en la posmenopausia tardía.

Leiomyomatosis is less frequent in old woman, and its clinical and histological characteristic in late postmenopause are unknown. Uterine leiomyomas were confirmed histologically in 14 out of 69 patients (20.2%) who were 65 or older and in whom a vaginal hysterectomy was performed. Another group without myomas was paired by age to the study group. In both groups, the uterine volume and the minor diameter of the uterus were compared, as well as age at menarche, menopause and duration of the menstrual life. Statistical analysis was done with ANOVA. It was observed, as expected, that uterine volumes of women with leiomyomatosis were significantly greater (p < 0.01) than those of women that did not have myomas; however, the smaller uterine diameters were not significantly different between the two groups, which is an important finding for surgical treatment of these patients. In addition, the menstrual life of patients with myomas was significantly greater (p < 0.04) than that of women without leiomyomatosis. In conclusion, one fifth women 65 years old or older can present myomas and consequently an increase in uterine volume, but without increase in minor diameters. Furthermore, the greater menstrual life span must be recognized as possible risk factor for the presence of leiomyomatosis.

Effect of antibiotic therapy in asthenozoospermic men associated with increased agglutination and minimal leukospermia.

Thirteen patients with asthenozoospermia and semen analysis suggestive of infection were studied and divided at random into 2 groups according to the antibiotic treatment they received: (I) ciprofloxacine 250 mg every 12 hours by 14 days per os (n = 7) and (II) trimethoprim 160 mg and sulfamethoxazole 800 mg every 12 hours by 14 days per os (n = 6). Their couples received the same treatment. Changes in sperm density, morphology, viability, motility, agglutination, pH, and presence of leukocytes were analyzed before and after treatment. The average of morphologically normal sperms significantly decreased after treatment in the ciprofloxacine group; sperm with grade III motility increased in the trimethoprim-sulfamethoxazole group, but without statistical significance. With these preliminary results, it can be concluded that antibiotic administration modifies some of the spermatic parameters, particularly motility and morphology, in patients whose semen analysis parameters suggested infection.

Effects of pentoxifylline on sperm motility in normogonadotropic asthenozoospermic men.

Forty-seven normogonadotropic men with idiopatic asthenozoospermic were divided at random: group I (N = 22) received placebo and group II (N = 25) received 1200 mg of pentoxifylline/day during 6 months. Semen analysis was performed basal and at 3 and 6 months of the study period. No statistical changes in serum hormone concentration were found, nor in volume, sperm counts, viability, and morphology before and after treatment. Sperm motility increased following pentoxifylline treatment after 3 and 6 months from 25.5 (21.0-30.0) to 35.5 (31.5-39.0) (p < .00001) and to 42.0 (38.0-46.0) (p < .00001), respectively. Although in the placebo control cases some changes were observed in the sperm motility, they were less significant. Furthermore, progressive motility only in grade A increased with pentoxifylline from 2.5 (0.0-6.0) to 12.0 (6.0-19.5) (p < .001) at 3 months and to 22.5 (17.0-26.0) at 6 months (p < .00001). In conclusion, pentoxifylline had an additional effect rather than placebo and was useful treatment in these cases of male factor infertility.

Hyperprolactinemia in men with asthenozoospermia, oligozoospermia, or azoospermia.

The role of serum prolactin (PRL) in male infertility is still unclear. To assess the clinical significance of PRL determination during infertility studies, serum hormones and semen samples from 167 men attending the Andrology Clinic were analyzed, and PRL seric values were correlated with volume, sperm count, motility, viability, and morphology. The range of PRL levels (ng/mL) was 7.3 +/- 2.1 in the control group (n = 46), 13.9 +/- 6.6 in asthenozoospermic (n = 51), 12.6 +/- 7.8 in oligozoospermic (n = 42), and 10.9 +/- 4.8 in azoospermic patients (n = 28). Significantly higher (p < .0001) levels of PRL were found in the men with asthenozoospermia, oligozoospermia, and azoospermia. In the 121 infertile patients with abnormal semen analysis, serum PRL levels were below 14.0 ng/mL (normal mean + 3 SD) in 81 (66.9%) and above this level in 40 (33.1%) cases. Serum FSH and LH concentrations in azoospermic men were significantly higher (p < .0001) when compared with those of the control group, which indicates some disturbance of the spermatogenic process, and estradiol was significantly higher (p < .02) in oligozoospermic patients. No significant differences were found in serum testosterone. Twenty-one patients with idiopathic oligoasthenozoospermia and hyperprolactinemia were treated with 2.5 mg of bromocriptine daily for 6 months, resulting in a nonmeasurable effect on their sperm analysis. In conclusion, two-thirds of patients with oligozoospermia, asthenozoospermia, and azoospermia have normal PRL levels. Infertility in men due to moderate hyperprolactinemia could be associated with these sperm disturbances, but bromocriptine was of no therapeutic utility.

[Apparent heterogeneous distribution of progesterone receptors in certain cases of endometrial carcinoma]. / Aparente distribución heterogénea de receptores de progesterona en ciertos casos de carcinoma endometrial.

The progesterone receptor contents in the cytosol of two of three samples of same tumor was measured in 19 cases of endometrial cancer. The receptor concentration in one sample of each tumor was calculated by Scatchard analysis of specific binding data; in the other, one or two samples of each tumor, the receptor concentration was calculated by using a single point. All tumors did have receptors at least in one of the two or three samples. Ten tumors showed certain consistency in the receptor content in the two or three samples. On the other hand, a striking variability in the receptor content between the two or three samples of each of the remaining tumors was found, ranging from zero to several hundred femtomoles/mg of protein. In seven cases, follow-up was possible during 66 months, and the response to progestagen treatment was independent from the progesterone-receptor content. Our results suggest that the analysis of a single site of a tumor would reveal values that might not be representative of the tumor and, furthermore, it would explain, at least partially, the uncertain response to progestagen therapy that has been frequently described.

Sperm characteristics and hormonal profile before and after treatment with follicle-stimulating hormone in infertile patients.

Fourteen asthenoteratozoospermic (ATZS) patients were treated with 75-IU follicle-stimulating hormone (FSH) injections 3 times a week for 3 months. In the group as a whole, sperm motility, viability, and morphology were improved, but not significantly. Only 3 patients impregnated their wives following treatment. Semen characteristics of the 3 patients whose wives were pregnant showed significant improvement in sperm morphology (p = .001). Only FSH levels were statistically higher (p = .022) than controls. The administration of FSH in weekly doses can improve the fertilization potential of sperm.

Determination of the steroidogenic capacity in premature ovarian failure.

OBJECTIVE: To determine the secretion of precursors, intermediate and final products of androgen biosynthesis in women with premature ovarian failure (POF). PATIENTS: Seven patients 20 to 34 years of age with idiopathic POF and a control group of six women 27 to 29 years of age with normal ovarian function studied during the early follicular phase were included. DESIGN, INTERVENTIONS: In all patients an adrenal stimulation test was performed as follows: a short dexamethasone (DEX) inhibition was carried out the night before the corticotropin (ACTH, 0.25 mg, Cortrosyn; Organon, Orangeburg, NY) stimulation test, obtaining blood samples in basal conditions, post-DEX inhibition as well as at 60, 120, and 180 minutes after the ACTH bolus. MAIN OUTCOME MEASURES: Using specific RIA serum concentrations of delta 5 precursors (pregnenolone, 17-hydroxypregnenolone, DHEA), delta 4 intermediates (P, 17-hydroxyprogesterone, androstenedione) and the final products T and cortisol (F) were measured. RESULTS: Adrenal inhibition and stimulation responses in both groups of patients showed no differences for delta 5 precursors and F. On the other hand, delta 4 intermediates and androgens exhibited significant differences at the level of response to ACTH stimulation. Patients with POF had significantly lower values than those of control group. CONCLUSION: An important decrement in the steroidogenesis was noticed in POF, particularly in androgen synthesis, revealing the selective participation of the adrenal gland in steroid production.

Androgen-binding proteins from human hyperplastic prostate as evaluated by electrophoresis.

Until 1972 it was shown that the androgen action in the prostatic tissue was through receptor proteins. In 1975 the synthesis of methyltrienolone (MT) opened a new field in searching receptor proteins. This synthetic androgen discriminates between receptors and other proteins such as TeBG and albumin. The main purpose in this investigation was to obtain the electrophoretic patterns of human prostatic androgen-binding proteins and compare them with those of other tissues from male genital tract (e.g., testes and epididymis), using as a reference the already described pattern in blood serum. The experimentation was carried out with cytosol (105,000 g) and nuclear fractions from the homogenized tissue. Both fractions were incubated with the tritiated steroids and then treated with dextran-coated charcoal. Polyacrylamide gel electrophoresis (PAGE) was then performed at pH 8.3 with acrylamide (T) 7.7%. The prostatic cytosol incubated with 3H-dihydrotestosterone (3H-DHT) revealed radioactive areas with the following average electrophoretic mobilities relative to Bromophenol Blue (Rf): 0.195, 0.285, 0.815, 0.910. When cytosol was incubated with 3H-MT the pattern showed radioactive peaks with Rf 0.280, 0.570, and 0.969. The nuclear fraction bound 3H-DHT in 0.190, 0.455, 0.570, 0.660, and 1.055 and bound 3H-MT in Rf 1.01. We concluded from these results that the electrophoretic patterns in the prostate gland shared some radioactive areas resembling TeBG and albumin, although they present low binding capacity. The other peaks with different electrophoretic mobilities are in the process of further identification.

Preliminary characterization of a new androgen-binding protein in human seminal plasma.

In order to obtain comparative analysis between the steroid binding proteins from blood serum and seminal plasma, fresh samples were incubated and assayed in parallel with the following tritiated steroids: dihydrotestosterone, testosterone, cortisol, progesterone and estradiol. Thereafter, and using techniques such as (1) polyacrilamide disk gel electrophoresis with elution of proteins from the gel slices, (2) ammonium sulphate precipitation, (3) enzymatic hydrolysis, and (4) gel filtration on Sephadex G-100, there was a resemblance in the electrophoretic patterns confirming the presence in both fluids of proteins like TeBG, CBG, and Albumin, previously described in blood serum. In seminal fluid, but not in blood serum, another small protein with androgen binding capacity was found and its preliminary characterization demonstrated: disappearance with enzymatic treatment, low molecular weight, negative charge, and precipitation range with ammonium sulphate from 30 to 35%. Its elution profile on Sephadex G-100 was contaminated with albumin.

Primary structure of rat liver apoferritin. The amino end.

Rat liver apoferritin is known to have a blocked amino end. From a pronase digest of rat liver apoferritin we have isolated and purified by ion-exchange chromatography the blocked N-terminal tripeptide. Its sequence and the nature of the blocking group were shown to be Ser-Ser-Gln and an acetyl moiety, respectively. The N-terminal sequence of rat liver apoferritin is thus N-acetyl-Ser-Ser-Gln, which coincides with the N-terminal sequence of horse-spleen apoferritin, the only other apoferritin studied structurally at present.