Respuesta al autor: Triaje y urgenciólogo: dos palabras que llaman a la puerta de la Real Academia Española / No disponible

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Toxicity of metal-ethylenediaminetetraacetic acid solution as a function of chemical speciation: an approach for toxicity assessment.

The influence of complexation by ethylenediaminetetraacetic acid (EDTA) on the toxicity of Cd(II), Cu(II), Cd(II), and Ni(II) was investigated. Result of the Microtox test, which is based on measuring the decrease of light emitted by Vibrio fischeri bacterium when exposed to a toxicant, was used as an indication of toxicity. The effect of pH and EDTA molar ratio that might potentially modify the percentage of chemical species in solution on toxicity was evaluated. In general, results indicate that toxicity decreases when increasing the pH value as well as the EDTA molar ratio. Chemical modeling was used to predict metal speciation and correlation analysis to relate chemical species with the obtained toxicity results. The species that most contribute to toxicity resulted to be MeCl(+) (Me = metal), which is formed as a consequence of the presence of the bioassay medium (2 % NaCl). A model that predicts metal-solution toxicity by using the chemical species, which most contribute to toxicity is proposed as a useful tool for toxicity assessment in waters containing metal ions and EDTA.

Increased eutrophication and nutrient imbalances in the agricultural soil of NE Catalonia, Spain.

The soil C, N, P and K content of agricultural soil were measured over the last 4 decades in NE Catalonia (NE Spain). Plant-available P and K increased by ca 109 and 105% respectively and total N decreased by 30%. The increases in plant-available P content are in accordance with the increasingly used pig slurry being very rich in P, and with P tendency to be retained in soils, since it is less mobile than N. The total soil N (N(tot)) decrease occurred in the first decade (by 41%). The uptake and withdrawal of mineral N by crops and the leaching of mineral N into groundwater and rivers after torrential rainfalls were the two likely major pathways of N-loss from the soil. After the first decade, there has been no further decrease of N(tot) as a result of the increasing fertilization of these fields, including the increasing applications of pig slurry. These results show an increasing P eutrophication in Mediterranean agricultural soils and will have several consequences for the next decades with (i) an increasing unbalance between N and P (and K) in soils that might affect crop productivity (ii) an increasing leaching of N as nitrate to continental waters, both ground and surface waters, and (iii) a consequent need for the establishment of another fertilization strategy based on lowering the use of pig slurry and on increasing the use of fertilizers of slow mineralization that increase soil organic matter, and stabilise the soil N and P contents.

Efecto de la estimulación auditiva a una frecuencia de 5 Hz en la memoria verbal / Impact of auditory stimulation at a frequency of 5 Hz in verbal memory

Introducción. El objetivo de este estudio es establecer si la estimulación a 5 Hz favorece el recuerdo inmediato de palabras. Método. Veinte participantes recibieron estimulación auditiva a frecuencias de 5 Hz-theta, 13 Hz-beta, ruido blanco (RB) y palabras. Resultados. Los resultados indican diferencias significativas en número de palabras recordadas por día entre las frecuencias. A partir del día 3 hasta el día 5 se observó una asociación significativa entre un mayor número de palabras recordadas con 5 Hz comparadas con las demás frecuencias. Si tenemos en cuenta el número de palabras recordadas durante el registro en la magnetoencefalogrofia, en la segunda medida se encontró diferencias significativas con mayor número de palabras entre 5 Hz y 13 Hz y entre 5 Hz y RB. En la frecuencia mediana sólo se presentaron diferencias significativas en estimulación a una frecuencia de 5 Hz. Conclusión. La estimulación auditiva durante largo tiempo a una frecuencia de 5 Hz genera un acoplamiento de la actividad cerebral a dicho ritmo que aumenta la capacidad de memoria verbal inmediata (AU)

Introduction. The objective of this study was to establish whether stimulation at 5 Hz enables immediate words recall. Method. A total of 20 participants received auditory stimulation at 5 Hz-theta, beta-13 Hz frequencies, white noise (WN) and words. Results. The results indicate significant differences in the number of recalled words per day depending on the stimulation frequencies. From the third to the fifth day a significant association was shown between increasing numbers of recalled words at 5 Hz compared with the rest of the frequencies. If we take the number of words recorded during the recording of the magnetoencephalography into account, significant differences with greater numbers of words between 5 Hz and between13 Hz and 5 Hz and WN were found in the second measure. The median frequency only showed significant differences in stimulation at a frequency of 5 Hz. Conclusion. Auditory stimulation over a long time at a frequency of 5 Hz generates a coupling of brain activity that increases the capacity of immediate verbal memory (AU)

Impact of auditory stimulation at a frequency of 5 Hz in verbal memory.

INTRODUCTION: The objective of this study was to establish whether stimulation at 5 Hz enables immediate words recall. METHOD: A total of 20 participants received auditory stimulation at 5 Hz-theta, beta-13 Hz frequencies, white noise (WN) and words. RESULTS: The results indicate significant differences in the number of recalled words per day depending on the stimulation frequencies. From the third to the fifth day a significant association was shown between increasing numbers of recalled words at 5 Hz compared with the rest of the frequencies. If we take the number of words recorded during the recording of the magnetoencephalography into account, significant differences with greater numbers of words between 5 Hz and between 13 Hz and 5 Hz and WN were found in the second measure. The median frequency only showed significant differences in stimulation at a frequency of 5 Hz. CONCLUSION: Auditory stimulation over a long time at a frequency of 5 Hz generates a coupling of brain activity that increases the capacity of immediate verbal memory.

[Assessment of the immigrant child]. / Valoración del niño inmigrante.

In the last twenty years Spain has turned into one of the principal countries recipients of foreign population. As consequence of this massive entry of people, our country is among the first ones of Europe for interannual increase of population. The concept of immigrant child is very wide and includes minors of very diverse characteristics, as the proceeding from international adoptions, the children coming from developing countries or those that come from other developed countries. The immigrant children do not represent health risk for the autochthonous population, on the contrary, they are in situation of defenselessness for their scanty vaccination coverages, their situation of marginality and the precarious sanitary systems of the countries of origin. At the moment of offering medical paediatric attention to foreign children, we must individualize our actions in conformity with the characteristics of each patient. It is not possible to simplify in one unique protocol the best studies to resolve a problem of health in an immigrant child. The attention of these children implies an overstrain for the pediatrician and the sanitary personnel that receives them, because it is necessary to conquer idiomatic, cultural and social barriers to optimize the level of health of these patients. The syndromic initial description can help to prioritize the studies in each case (according to the most probable diagnoses). The children who return to the native land of their parents meet in a special situation of risk, for not being prepared to resist the attack of pathogen that do not exist or are rare in Spain.

Valoración del niño inmigrante / Assessment of the immigrant child

En los últimos veinte años España se ha convertido en uno de los principales países receptores de población extranjera. Como consecuencia de esa entrada masiva de personas, nuestro país se encuentra entre los primeros de Europa en cuanto a incremento interanual de población. El concepto de niño inmigrante es muy amplio y engloba a menores de características muy diversas, como los procedentes de adopciones internacionales, los hijos de familias provenientes de países en vías de desarrollo o aquellos que vienen de otros países desarrollados. Los niños inmigrantes no representan un riesgo de salud para la población autóctona, muy al contrario, suelen estar en situación de desprotección por sus escasas coberturas vacunales, su situación de marginalidad y los precarios sistemas sanitarios de los países de los que proceden.A la hora de brindar atención médica pediátrica a niños extranjeros, debemos individualizar nuestras actuaciones conforme a las características de cada paciente. No se puede simplificar en un protocolo único los estudios a realizar ante un problema de salud en un niño inmigrante. La atención de estos niños implica un sobreesfuerzo para el pediatra y el personal sanitario que los recibe, pues hay que vencer barreras idiomáticas, culturales y sociales para conseguir optimizar el estado de salud de estos pacientes. La descripción sindrómica inicial puede ayudar a priorizar los estudios a realizar en cada caso (según los diagnósticos más probables).Los niños que regresan al país de origen de sus padres se ven en una especial situación de riesgo, por no estar preparados para defenderse de patógenos que no existen o son raros en España

In the last twenty years Spain has turned into one of the principal countries recipients of foreign population. As consequence of this massive entry of people, our country is among the first ones of Europe for interannual increase of population. ;;The concept of immigrant child is very wide and includes minors of very diverse characteristics, as the proceeding from international adoptions, the children coming from developing countries or those that come from other developed countries. ;;The immigrant children do not represent health risk for the autochthonous population, on the contrary, they are in situation of defenselessness for their scanty vaccination coverages, their situation of marginality and the precarious sanitary systems of the countries of origin. ;;At the moment of offering medical paediatric attention to foreign children, we must individualize our actions in conformity with the characteristics of each patient. It is not possible to simplify in one unique protocol the best studies to resolve a problem of health in an immigrant child. The attention of these children implies an overstrain for the pediatrician and the sanitary personnel that receives them, because it is necessary to conquer idiomatic, cultural and social barriers to optimize the level of health of these patients. ;;The syndromic initial description can help to prioritize the studies in each case (according to the most probable diagnoses). ;;The children who return to the native land of their parents meet in a special situation of risk, for not being prepared to resist the attack of pathogen that do not exist or are rare in Spain

3p21, 5q21, 9p21 and 17p13 allelic deletions accumulate in the dysplastic spectrum of laryngeal carcinogenesis and precede malignant transformation.

A tissue field of somatic genetic alterations precede the histopathological phenotypic changes of carcinoma. Loss of Heterozygosity (LOH) at the sites of known or putative tumor suppressor genes is a common genetic abnormality detected in precancerous conditions. These genomic changes could be of potential use in the diagnosis and prognosis of pre-malignant laryngeal lesions. Recently the concept of laryngeal intraepithelial neoplasia (LIN) was introduced. To evaluate patients with an increased risk of developing invasive laryngeal carcinoma via a dysplasia-carcinoma progression we investigated 102 microdissected cell populations. Cell populations were procured from 15 laryngectomy specimens with different peritumoral histological changes adjacent to the squamous cell carcinoma cells and 15 laryngeal endoscopic biopsies with no evidence of malignant transformation in a 6-10-year follow-up period. Histological diagnoses were subdivided into keratosis without dysplasia (KWD), with mild dysplasia (LIN 1), with moderate dysplasia (LIN 2), and with severe dysplasia or carcinoma in situ (LIN 3). Microsatellite analysis was performed with the aim of studying LOH of 5q21 (APC), 9p21 (p16), 3p21 and 17p13 (p53) chromosomal regions. Frequent allelic losses were found in carcinoma cells at p53 (54%), p16 (66%), 3p21(87%) and 5q21(58%). Identical LOH patterns were determined in 100% of the LIN3 peritumoral cells, 60% of LIN2, 50% of LIN 1 and 25% of KWD. In contrast, histologically normal mucosae, KWD and LIN1 lesions without malignant progression showed no allelic loss. These results show that dysplasia correlates with LOH at 3p21, 5q21, 9p21 and 17p13 in early laryngeal carcinogenesis. These genomic changes in pre-malignant laryngeal lesions could be of potential use as markers for cancer risk assessment.

[Vitrectomy for asteroid hyalosis]. / Vitrectomía en hialosis asteroidea.

PURPOSE: To evaluate the role of pars plana vitrectomy for asteroid hyalosis and synchisys scintillans with decrease of visual acuity. METHODS: Retrospective study of 15 patients on whom pars plana vitrectomy was performed. We studied the visual acuity before the surgery, the best and the final vision. Risk vascular factors, intraocular pressure, complications during the surgery or in the follow up were determined. RESULTS: We operated on 17 eyes of 15 patients (10 male, 5 female). In 2 cases we added peeling of macular pucker and in two cases a cataract surgery. Average age was 73.8 (standard deviation 8.6); risk vascular factors were found in 66.6%. There weren't any complications during the surgery. Later, 4 cataracts, 3 macular pucker and 1 macular hole (stage IV) developed. The average vision before the surgery was 20/60, the best 20/40 and the final vision 20/50. Average follow up time was 22.8 (s.d. 17.3) months. CONCLUSIONS: Asteroid hialosis was more frequent in elderly males (2/3) and in patients with risk vascular factors (66.6%). Cataract surgery was necessary in 50% of eyes during or after the pars plana vitrectomy. Seventeen percent of eyes presented macular pucker in the follow up. Recovery of vision was less than expected.

Functionally active duplications of the CYP2D6 gene are more prevalent among larynx and lung cancer patients.

The cytochrome P450 CYP2D6 is a polymorphic drug-metabolizing enzyme that is involved in the metabolism of several drugs and xenobiotics. Several independent studies indicate that the CYP2D6 metabolic status is a secondary factor in the risk of developing lung cancer, with individuals with high activity being at increased risk. The occurrence of functionally active duplications of the CYP2D6 gene is a phenomenon that affects 3-8% of Caucasians and up to 30% in some ethnic groups. These duplications cause ultrarapid metabolism of CYP2D6 substrates. In order to establish whether the highest CYP2D6 enzyme activity is associated with an increased risk of cancer, we analyzed the frequency of CYP2D6 gene duplications and enzyme-inactivating mutations in 199 Caucasian patients with lung or larynx cancer and in 335 healthy controls. A significantly increased frequency of carriers of the CYP2D6 gene duplication were found among lung and larynx cancer patients (13%), as compared with healthy controls (6.9%; p < 0.02). The frequency of the mutated active CYP2D6*9 allele was increased in lung cancer patients (p < 0.01) but not in larynx cancer patients. Global findings indicate that over 20% patients with lung or larynx cancer show CYP2D6 genotypes leading to ultrarapid metabolism or to the expression of an enzyme with altered kinetics (p < 0.01 vs. healthy controls). This may influence the metabolism of CYP2D6 substrates, including antineoplastic drugs and opioid derivatives used for pain relief in cancer patients. These patients would require higher doses than those considered as standard. We conclude that dosages for CYP2D6 substrates should be adapted to lung and larynx cancer patients.

Age effects on long-term neuropsychological outcome in paediatric traumatic brain injury.

In order to investigate the relationship between age at injury and long-term neuropsychological impairment, 29 children and adolescents who sustained traumatic brain injury (TBI) were studied at least 6 years post-trauma. Tests of intellectual, memory, visuospatial and frontal lobe functions were administered to patients and 29 normal matched control subjects. Correlations between performance on neuropsychological tests and age showed the following direction: the younger the child when TBI was sustained, the worse the cognitive outcome. After controlling for injury severity, visuospatial functions remained related to age. Patients' performance differed significantly from that of controls in half of the neuropsychological variables analysed. To further investigate the effects of age at injury, the sample was divided in two groups (TBI before and after age of 8) and then compared with their respective controls. Patients damaged earlier presented impaired intellectual and visuospatial functions. The results suggest that neuropsychological sequelae remain after at least 6 years of evolution, and that there is an age at injury effect.

Improving survival of medulloblastoma: results in two groups of patients.

This retrospective study compares the results obtained in 56 children with medulloblastoma treated with two different protocols at our center between 1975 and 1990. Since 1985 we have been enrolled in the medulloblastoma SIOP II protocol in which we have entered 27 patients. These patients from the SIOP group (SG) and the 29 children treated before 1985, the historical group (HG). When the two groups were compared for age and sex distribution, no differences were found; however, prognostic factors were worse in the HG than in SG: 21 versus 15 T3-T4 and 13 versus 8 high-risk, respectively. The relapse rate was 63% for the HG and 39% for the SG. Five-year disease-free survival was 31% for the HG and 56% for the SG (p = 0.037). Five-year survival was 52 and 70%, respectively (p = 0.055). When SG and HG were compared by stratifying for tumor size, surgical resection and the risk variable, better disease-free survival was obtained in SG than in HG. In a multivariate analysis, the HG and the high-risk proved to be variable independent predictors of poor survival. We observe an increase in survival in our patients with medulloblastoma.

[Intraventricular meningiomas]. / Meningiomas intraventriculares.

Eight cases of surgically intervened intraventricular meningiomas are presented. The patients were six males and 2 females with a mean age of 41.7 years (11-70). The length of symptoms was of several months in 6 (75%) of the cases. The most frequent symptoms observed were cephalea and alterations of the upper functions which were presented in six and four cases, respectively. Papilloedema and involvement of long pathways were the most usual findings observed in neurological examination. Diagnosis was made by computerized tomography and angiography in all the cases. Surgery using a transtemporal approach was carried out in six patients and in the other two a parietal-occipital route was used. Two patients were dead and other two presented bilateral amaurosis. The other patients had good postsurgery.

[First results of a study for the standardization of the electroglottogram of the normal subject]. / Primeros resultados de un estudio para la estandarización del electroglotograma del sujeto normal.

"Primary results of a study for the standardization of the electroglottogram in normal subjects". Using one sample of waveforms from 151 normal subjects, 79 females form 17 to 80 years of age and 72 males from 12 to 85, the waves were normalized in accordance with frequency and amplitude. Two Kinds of parameters were measured, a) morphological, consisting in the three temporal phases determined by the three main inflexions of the waveform, and b) global, obtained when the glottal cycle is divide through the horizontal line of the electrical "O" into a negative and a positive semi-wave. Statistical analysis shows significant variations in the morphological parameters according to sex, age and fundamental frequency of voice Fo, confirming their close correlation with the vibratory events in the glottis. No significant relations have been found between global parameters and sex, age and Fo, indicating a lack of correlation between the electrical "O" line of the electroglottogram and the vibratory events of the glottal cycle.

[Problems with indications for extracorporeal lithotripsy in urolithiasis]. / Indikacní problémy extrakorporální litotrypse urolitiázy.

Extracorporeal lithotripsy is a modern noninvasive method for the treatment of urolithiasis. The morphological and functional state of the urinary pathways, the localization of concrement and their size and number call in 35% of the patients for additive and auxiliary operations. Such comprehensive treatment can be provided by departments where all methods for the treatment of lithiasis are readily available. Repeated lithotripsy and combined therapeutic methods of more complicated conditions protract hospitalization and reduce the number of patients. The authors tested in more than 2500 lithotripsies the possibility to apply this treatment in the great majority of lithiases. However, because of the limited capacity they had to reduce the spectrum of indications to a minimum. Retardation of treatment by a protracted waiting period could damage the patient and it is then better to indicate another therapeutic approach; or to provide adequate treatment. We hope that patients who will need treatment after a year's time, will have the opportunity to be treated sooner by lithotriptors which should be installed before long in other departments.

[Multiple carcinoma of the upper aerodigestive tract of metachronic onset]. / Carcinoma múltiple de vías aerodigestivas superiores de aparición metacrónica.

One of the most important concepts in the understanding of the biology of squamous cell carcinoma of the head and neck is "multicentric cancer" as proposed by Slaughter et al. in 1953. With prolonged survival as a result of improved cancer therapy, the possibility of a second primary lesion should always be kept in mind during patient follow-up. A late or unusual metastasis in a patient with upper aerodigestive malignancy should be suspected of having a new primary carcinoma. In the last 12 months, we have treated 72 patients with upper aerodigestive malignancy. 5 of them had a history of previous squamous cell carcinoma of head and neck treated 6-13 years before. Probable etiopathogenic factors are discussed.

[Percutaneous extraction of concretions from the kidney]. / Perkutánní extrakce konkrementu z ledviny.

The authors submit a report on 225 patients operated by the percutaneous approach on the kidney during the period between March 1985 and February 1987. From 231 operations on account of lithiasis concrements were removed in 94.8%. No major complications were observed. The mean period which elapsed from operation to discharge was 8 days in one-stage operations and 19 days in multiple-stage operations. The authors discuss the indications and some technical conditions of the method.