La mirada del cine al cáncer (I): arte, ciencia y conciencia / The look of the cinema to cancer (I): art, science and consciousness

El objetivo de este artículo es revisar la presencia de patologías oncológicas en el cine con el fin de identificar los principales trastornos de cáncer que han sido retratados en él. Del mismo modo, se intenta describir la praxis médica y la relación entre médico y paciente, así como las experiencias del paciente y la familia, la adaptación social y la intervención de otros profesionales de la salud alrededor de la enfermedad oncológica. Se revisan algunas de las películas más significativas sobre el cáncer en adultos. Se analiza una muestra representativa de 41 películas en las que el cáncer tiene distinta representatividad, clasificada como "puntual" (8 películas), "argumental" (22 películas) o "relevante" (11 películas) en la película. El cine puede ayudar a los profesionales de la salud que trabajan alrededor del cáncer, a los pacientes, a la familia y a la sociedad. En ocasiones, el cáncer que se muestra en las películas es diferente de la realidad: las películas prefieren los pacientes más jóvenes y de mayor clase social, así como los cánceres más fotogénicos. Los síntomas, las pruebas diagnósticas y los tratamientos tienden a reflejar la realidad, sobre todo en las películas argumentales producidas en las últimas décadas. Algunas de estas películas puede ser un recurso de primera mano para la formación de profesionales de la salud. El cine, una oportunidad para hablar con arte, ciencia y conciencia de la enfermedad oncológica y, sobre todo, de los pacientes con cáncer y su entorno. Una oportunidad para mejorar la relación profesional-paciente, para mejorar la humanización y para abrir el debate bioético (AU)

The aim of this article is to review the presence of oncological pathologies in the cinema with a view to identifying the main cancer disorders that have been portrayed in films. Likewise it also intends to describe the medical praxis that is employed, the relationship between physician and patient, how the experiences of the patient and the family are represented, the adaptation to social situations, and the intervention of other health care professionals related with cancer patients. Some of the most significant films about adulthood cancer are reviewed. A representative sample of 41 films was analyzed in which the cancer had a "prompt" (2 films), a "relevant" (22 films) or a "plot" character (11 films). Cinema has helped to shape certain ways of thinking about the health care professionals who work with patients, the importance of support from the family and the social role, among other things. The cancer showed by films is, sometimes, different from reality: movies prefer younger patients, higher social class and the most photogenic cancer's locations. The symptoms, diagnostic tests and treatments tend to reflect reality, especially in "plot" movies produced in the last decades. Some of those films may be a first hand resource for training health professionals. Cinema is an opportunity to talk with art, science and consciousness about oncological diseases; cinema is a tool to talk about cancer patients and their environment. Cinema is an opportunity to improve the relationship between health professionals and patients, to improve the humanization and to open the bioethical debate (AU)

Limitación bioética del esfuerzo terapéutico en pediatría / Bioethics limitation of therapeutic effort in pediatrics

Teniendo en cuenta que la demanda de la sociedad ha cambiado pasando de pedir la máxima eficacia, a pedir la máxima ayuda en base al respeto de su voluntad y el conocimiento de su necesidad, la limitación del esfuerzo terapeútico (LET) es una de las decisiones más complejas a las que hoy en día se enfrenta el profesional en la atención a las personas enfermas. Por ello, debería ser un objetivo institucional el conocer las limitaciones de la práctica, evaluarlas e incentivar la mejora y en los casos dudosos, recurrir al los Comités de Bioética Asistencial (CBA) para asesorar en la elaboración de protocolos de actuación en los casos en que el profesional o el equipo terapéutico se encuentre ante un dilema ético(AU)

Given that the demand of society has shifted to seek maximum efficiency, maximum help based on the patient autonomy respect and awareness of its necessity, the limitation of therapeutic effort is one of the decisions more complex. Therefore, it should be an institutional objective to know the limitations of practice, assess and encourage improvement and in doubtful cases, resort to Assistive Bioethics Committees to advise on the development of clinical protocols in cases which the professional or the therapeutic team is faced with an ethical dilemma(AU)

[Bioethics limitation of therapeutic effort in pediatrics]. / Limitación bioética del esfuerzo terapéutico en pediatría.

Given that the demand of society has shifted to seek maximum efficiency, maximum help based on the patient autonomy respect and awareness of its necessity, the limitation of therapeutic effort is one of the decisions more complex. Therefore, it should be an institutional objective to know the limitations of practice, assess and encourage improvement and in doubtful cases, resort to Assistive Bioethics Committees to advise on the development of clinical protocols in cases which the professional or the therapeutic team is faced with an ethical dilemma.

Prevalencia de caries en alumnos de educación básica y su asociación con el estado nutricional / Prevalence of dental decay in elementary school children and association with nutritional status

Introduction: It is thought that obesity is a risk factor in the development of dental decay in children. However, there is no agreement in the literature in this area. Objective: To define the prevalence of caries among lower class school children in the metropolitan region in Santiago, Chile, years 2006-2007, and observe its association with the children's nutritional status. Subjects and Methods: A random sample of children 5-15 years of age, in eight primary schools provided a stratified population of 1190 individuals. Oral examination provided a health index, nutritional status was determined using CDC 2000. Statistical analyses were performed utilizing Stata 9,0. Results: Prevalence of dental caries in the total population was 79,5 percent. Prevalence of decay among eutrophic, overweight and obese children was 80,0 percent, 78,1 percent y 79,9 percent respectively. Conclusion: This population presents a very high prevalence of dental caries, especially among a group classified a "normal". In this sample, there was no statistically significant association between dental decay and nutritional status.

Introducción: Se ha postulado que la obesidad constituiría un factor de riesgo para el desarrollo de caries en niños, sin embargo, la literatura publicada muestra información discordante respecto de esta asociación. Objetivo: Conocer la prevalencia de caries en escolares de clase media baja de región metropolitana de Santiago, Chile y determinar su asociación con el estado nutricional de los mismos, entre los años 2006 y 2007. Materiales y Métodos: Se ejecutó un estudio de corte transversal en 8 colegios de la Sociedad de Instrucción Primaria (SIP). Se seleccionó, mediante un muestreo aleatorio estratificado por género y curso, una muestra de 1190 escolares de 5 a 15 años. Mediante examen bucal se consignó índice COPD. Se determinó el estado nutricional mediante la utilización de la referencia CDC 2000. Para los cálculos y estimaciones estadísticas se utilizó el programa Stata 9,0. Resultados: La prevalencia de caries en la población total fue de 79,5 por ciento. La prevalencia de caries en los niños eutróficos, con sobrepeso y obesos fue de 80,0 por ciento, 78,1 por ciento y 79,9 por ciento respectivamente. Conclusión: La población evaluada presenta una alta prevalencia de caries, sobretodo en el grupo clasificado como normal. En esta muestra no se encontró una asociación estadísticamente significativa entre la prevalencia de caries y el estado nutricional.

An investigation of the fine structure, cell surface carbohydrates, and appeal of the diatom Extubocellulus sp. as prey for small flagellates.

The fine structure and surface exopolymers of a coastal planktonic nanodiatom of the sparsely reported genus Extubocellulus were studied respectively by scanning electron microscopy and confocal microscopy in conjunction with fluorescent lectins. Monitoring the suitability of the species as prey food for other protists was also investigated by video microscopy coupled with digital film. Cells are rectangular in girdle view, with a pervalvar axis longer than the apical axis. Valves are almost circular with a diameter of 2.8 to 3.6 microm. The valve face bears randomly distributed areolae (ca. 50 in 10 microm), which may be either open or occluded. Two small raised ocelluli occur at the apices, with a rim devoid of perforations and about 6-7 porelli. Glucose and N-acetyl-glucosamine moieties present on the surface of the live diatom were labelled with fluorescent lectins, and a differential pattern of distribution for both carbohydrates was observed. The potential role of fluorescent lectins as cellular probes of taxonomic value in small diatoms is compared with that of nucleotide and antibody probes. We provide the first illustrative evidence of the presence of Extubocellulus sp. in the cytoplasm of the nanoflagellate Goniomonas amphinema and of the egestion of diatom frustules. Results obtained are discussed in the light of the present knowledge of the role of carbohydrate-protein interactions in phagocytosis of prey by free-living protozoa.

Fibrosarcoma congénito; tendencia a la regresión espontánea. A propósito de un caso / Congenital fibrosarcoma; tendency to spontaneous regression. Case report

El fibrosarcoma congénito es un tumor poco habitual, de localización predominante en extremidades, siendo más rara la localización axial. El diagnóstico y tratamiento son controvertidos, debido a la escasa casuística de que se dispone. En general, tiene poca tendencia a metastatizar a distancia, aunque la recurrencia local es frecuente. A pesar de ello el pronóstico es favorable, incluso tras resecciones quirúrgicas sin bordes libres que confirmen una exéresis completa. Presentamos el caso de un fibrosarcoma pericraneal congénito sobre región parietal izquierda, de 5 x 4 x 3,5 cm. Los estudios de tomografía axial computeriazada (TAC) y resonancia nuclear magnética (RMN) cerebrales, mostraron la existencia de una tumoración extracraneal que destruía tanto la tabla externa como la interna. Se practicó exéresis quirúrgica de la lesión, recubriendo el defecto con injertos cutáneos. La evolución fue satisfactoria, sin necesidad de prescribir tratamientos complementarios; no existe evidencia de recurrencia de la lesión al año de la intervención. Consideramos que dada la potencial capacidad de regresión de estos tumores, la exéresis quirúrgica es el tratamiento de elección, sin precisar actitudes extremadamente agresivas o mutilantes (AU)

Congenital or neonatal fibrosarcoma is a rare soft-tissue tumour, that tends to involve the extremities, although axial lesions have been reported. Because the tumour is so rare and clinical experience is lacking, both diagnosis and treatment are dificult. Despite its potencial for local recurrence, metastasis is rare and prognosis is good, even with tissue infiltration and lack of complete excision. We report the case of a congenital pericranial fibrosarcoma over parietal left area, approximately 5 x 4 x 3,5 cm. CT scan and MRN demostrated a soft tissue mass, with destruction of the outer and inner tables. After local excision, skin defect was covered with skin grafts. Without further treatment the patient was doing well with no evidence of recurrence after one year. Wide local excision without creating severe dysfunction is the treatment of choice. A multidisciplinary team approach for treatment of these infants is recommended (AU)

Efecto de la infección periodontal por porphyromonas gingivalis en el desarrollo de ateroesclerosis en ratones deficientes de apolipoproteína E / Effects of porphyromona gingivalis periodontal infection upon atherosclerosis development in apolipoprotein-E

Introducción: Nuestro grupo recientemente demostró una asociación significativa entre periodontitis, placas coronarias aguda y extensión de la enfermedad coronaria aterosclerótica en pacientes con síndrome coronario agudo. Objetivo: Desarrollar un modelo experimental animal para estudiar el posible efecto pro-aterogénico de la inducción de periodontitis por Porphyromona Gingivalis (PG) en ratones deficientes en la apolipoproteína E (APO-E KO). Métodos: En 12 ratones APO-E KO mantenidos con dieta hiperlipidémica se realizaron tocaciones con PG cepa ATCC 53977 en el surco gingival de los molares mandibulares a las 8 semanas de vida. Igual número de ratones APO-E KO fue intervenido con el mismo procedimiento, pero sólo con el vehículo de las tocaciones. Estos procedimientos se repitieron a las 48, 72 y 120 hrs de la infección inicial. Luego de 4 semanas post-inoculación con PG se realizaron estudios histomorfométricos en la aorta proximal para medir la severidad de las lesiones ateromatosas y en las mandíbulas, para evaluar la pérdida del hueso alveolar. Resultados: No se observó una diferencia significativa en el daño del hueso alveolar en las mandíbulas de los animales infectados versus el grupo control. En las aortas, la razón tamaño placa/pared vascular fue mayor en el grupo infectado con PG que en el grupo control (0.132 ± 0.2 versus 0.103 ± 0.15, respectivamente), pero esta diferencia no fue estadísticamente significativa. Conclusión: El diseño experimental del presente estudio no permitió establecer si la periodontitis inducida por PG es capaz o no de acelerar el proceso aterogénico de los ratones APO-E KO. Será necesario aplicar un protocolo de infección periodontal más agresivo en estos animales para evaluar más adecuadamente el efecto de PG sobre la ateroesclerosis.

Resultados clínicos de la resincronización ventricular en pacientes con insuficiencia cardíaca severa / Results of intraventricular resynchronization in patients with severe cardiac failure

BACKGROUND: Intraventricular resynchronization with pacemakers is a promising therapy for patients with refractory cardiac failure and intraventricular conductions delay. However its long term effects are not well known. AIM: To report the results of this therapy in patients with cardiac failure. PATIENTS AND METHODS: Fourteen patients (11 male), whose mean age was 68 years, with a severe and refractory cardiac failure, have been treated in our unit using intraventricular resynchronization with pacemakers. Eight had a coronary heart disease and six a dilated myocardiopathy. The pacemaker was implanted transvenously, with conventional stimulation in atrium and right ventricle. The left ventricle was stimulated through an epicardial vein, accessed through the coronary sinus. RESULTS: In one patient the high thresholds did not allow a left ventricular stimulation. In the other 13 patients, a clinical improvement was observed in 11 (85 per cent), that has been sustained for a mean of 8.2 months. The ejection fraction improved form 23.5 to 32.4 per cent (p < 0.001), the 6 min walking test improved from 347 to 437 m (p = 0.003) and the functional capacity changes from 3.3 to 2.7 (p < 0.001). Three patients died during follow up. One was the patient in whom the stimulation failed and two had a sudden death. No complications of the procedure were observed. CONCLUSIONS: In this series, intraventricular resynchronization with pacemakers was effective in 11 of 13 patients, improving functional capacity and ejection fraction. Sudden death could be avoided adding a defibrillator to the pacemaker system.

Ciliate communities of rotating biological contactor biofilms: a multivariate approach.

Physical-chemical monitoring and characterization of ciliate communities from a full-scale rotating biological system (RBC) have been carried out for a year. RBC system operated efficiently in removing the organic matter, as the decrease of the BOD5 loading along the successive RBC units revealed. 55 species of ciliated protozoa were identified in the RBC biofilms. Differences in abundance, occurrence and type of species were found along the different units of the RBC system; the last RBC held a more stable and diverse ciliate community. The complexity of interspecific relationships among the ciliates has been outlined using multivariate methods (Cluster and Correspondence analysis). Correlation between ciliate species and physical-chemical conditions were obtained by regression analysis. Results show that 12 species of ciliates were related to an optimal efficiency in organic matter removal, Litonotus crystallinus being the most sensitive species. The presence and abundance of Litonotus crystallinus and Acineria uncinata was associated with a decrease in the organic factor. Metopus es was the only species related to a decrease in process efficiency due to its association with an increase in organic factor. The results provide statistical evidence of the use of certain ciliate species as reliable bioindicators in full-scale RBC wastewater treatment plants.

An integrated approach to analyse biofilms of a full scale wastewater treatment plant.

A rotating biological contactor (RBC) system operating in a full-scale wastewater treatment plant has been described by several approaches accounting for performance, composition and structure of biofilms in three stages through biological wastewater treatment (RBC1, RBC 2, RBC 3). RBC biofilms were effective in removing the BOD loading from 13 g BOD5 d(-1) m(-2) in RBC 1 to 6 g BOD5 d(-1) m(-2) in RBC 3. Analysis of biofilm composition showed: i) the volatile solids were similar in the three RBCs (0.6 g m(-2) VS per g m(-2) of TS); ii) the protozoan and metazoan biocenosis was mainly made up of ciliated protozoa, which were most abundant in RBC 2 (1.84 x 10(6) ciliates g(-1) VS). Relationship between ciliate species and physical-chemical profile of the system by cluster analysis indicated that the species Acineria uncinata, Amphileptus punctatus, Cinetochilum margaritaceum and Holosticha mancoidea were associated with the best RBC performance; iii) the exopolymeric matrix of the three RBC biofilms was mainly constituted by proteins, although humic substances, polysaccharides, uronic acids and DNA were also found. Analysis of biofilm structure by confocal microscopy indicated changes in biofilm organisation with depth. Results have been brought together and a graphic representation of the composition and architecture of RBC biofilms is presented.

Dynamics of protozoan and metazoan communities in a full scale wastewater treatment plant by rotating biological contactors.

Performance of a full-scale wastewater treatment plant by rotating biological contactors (RBC) system was monitored during a year by physico-chemical and microbial characterisation. Six points along wastewater treatment were selected in the plant: three points along the water line (influent, sedimentation tank and effluent) and three points along RBC system (RBC1, RBC2 and RBC3). Although a large seasonal change in the values of physico-chemical parameters was observed, operation of the plant was optimal during all year (90% of removal in BOD5 and SS influent content). Microbial characterisation was approached by determining the structure and dynamics of protozoan and metazoan communities. Protozoa were the most abundant in all stages in the plant, heterotrophic flagellates being the most representative group in the water line and ciliates in the RBC system. The same seasonal preference was only observed for heterotrophic flagellates in the water line and green flagellates in the RBC system, both groups having highest abundances in summer and spring, respectively. Identification of ciliated protozoa populations rendered 58 species of ciliates in the plant. Most of these species are typical of aerobic wastewater treatment systems except three of them, which are cited for the first time in this type of ecosystems: Chaenea stricta, Holosticha mancoidea and Oxytricha lanceolata. Along the water line 34 species were identified, and half of them only appeared occasionally (once in all the study), while along the RBC system biofilms 55 species were observed, and the majority appeared permanently in this system. Our results indicate that the type of habitat, rather than the physico-chemical water parameters, was the primary factor in determining the different distribution of protozoan and metazoan communities in the plant. In RBC biofilms, the structure of ciliate protozoa community was found to be quite sensitive to changes in physico-chemical parameters, mainly to organic loading (BOD5) variations.

Characterization of extracellular polymeric substances in rotating biological contractors and activated sludge flocs.

Extracellular polymeric substances (EPS) from biofilms of a rotating biological contactor (RBC) system and from activated sludge flocs were extracted using ultrasound and a cation exchange resin. In both wastewater treatment systems, the EPS matrix was mainly constituted of proteins, humic-like substances and polysaccharides, although other components--DNA and uronic-like substances--were also present. The composition of the biofilm EPS was different in the succesive RBC wastewater treatment stages: protein had its highest concentration in the first RBC unit, while humic substances and polysaccharides in the third RBC. Significant differences between biofilm and sludge floc EPS were also reported. The amount of proteins was 3.5 times higher for RBC biofilms than for sludge flocs, and quantities of humic substances and polysaccharides extracted from biofilms were twice as high than in sludges. Moreover, biofilm exopolymers were two times more hydrophobic than those of sludge flocs. Implications of wastewater chemistry and microbial growth strategies into EPS composition and properties are suggested.

Description of Opisthonecta matiensis n. sp. (Protozoa, Ciliophora), a new peritrich ciliate from wastewater.

Opisthonecta matiensis n. sp. was isolated from the inlet water of a wastewater treatment plant near Madrid, Spain, and studied in vivo, with silver methods, and using electronic and indirect immunofluorescence microscopy. This new species shows an amphora-like cell shape and has a size of 45-73 microns (x 58.2) x 25-40 microns (x 31.3). The oral infraciliature is formed by one haplokinety, three polykineties, and a short row of kinetosomes (epistomial membrane). The aboral infraciliature is made up of the trochal band and the scopula. From the trochal band arise three fibrillar systems: oral fibers, aboral fibers, and oblique fibers. The myoneme system is composed of a delicate peristomial ring, longitudinal branched fibers that reach the trochal band and of radial fibers extending from the scopula to the trochal band. The silverline system consists of an average of 147 lines. This new species is separated from other known forms by its smaller size, the presence of one single vacuole, and its higher number of silverlines.

Effect of ethanol ingestion on renal regulation of water and electrolytes.

Ethanol may alter the homeostasis of water and electrolytes before the occurrence of liver damage able to explain these disorders. How the kidney may become involved in water diuresis or sodium and potassium retention has not been well elucidated. During the last decade, an increasing body of evidence has guided interest toward the relevance of the biochemical basis of ethanol-induced injury to the kidney. Multiple functional abnormalities of renal tubules may be associated with ethanol-induced changes in membrane composition and lipid peroxidation of these epithelial cells. Ethanol interferes with the carrier function by decreasing (Na+K)-ATPase activity, but this activity is enhanced by chronic exposure. Recently, it was reported that ethanol oxidation by the kidney is favored in chronic ethanol-treated rats, thereby suggesting a pathogenic role for acetaldehyde in the nephrotoxic effect of ethanol ingestion. Also, increased reactive oxygen species, partly generated from acetaldehyde oxidation, may contribute to the occurrence of oxidative stress. The pathophysiology of renal regulation of water and electrolytes of alcoholic disease is analyzed on the basis of recent advances in our knowledge concerning the biochemical effects of ethanol on the kidney.

[Retinoblastoma: multidisciplinary treatment in a group of 32 patients]. / Retinoblastoma: tratamiento multidisciplinario en una serie de 32 pacientes.

Thirty-two children with retinoblastoma (RTB) were treated in our oncology unit between September 1981 and October 1989. There were 18 unilateral RTB and 14 bilateral. The median age at diagnosis was 24 months. Leukocoria was the most common sign of presentation (66%). All patients were treated with a protocol based on Reese-Ellsworth classification and the anatomo-clinic extension. Thirty patients were enucleated (7 bilaterally), 14 of which needed coadjuvant chemotherapy and 6 orbital radiotherapy. Two patients died, one from each group. The disease-free survival rate is 90.6% with a medium follow-up of 43.5 months. Seven children went blind because of bilateral enucleation and seven present facial deformity caused by radiotherapy. We underline the importance of improving the effectiveness of conservative treatment in order to reduce the number of enucleation.