Quantum dynamics of the intramolecular vibrational energy redistribution in OCS: From localization to quasi-thermalization.

We report a fully quantum-dynamical study of the intramolecular vibrational energy redistribution (IVR) in the electronic ground state of carbonyl sulfide, which is a prototype of an isolated many-body quantum system with strong internal couplings and non-Rice-Ramsperger-Kassel-Marcus (RRKM) behavior. We pay particular attention to the role of many-body localization and the approach to thermalization, which currently are topics of considerable interest, as they pertain to the very foundations of statistical mechanics and thermodynamics. We employ local-mode (valence) coordinates and consider initial excitations localized in one local mode, with energies ranging from low to near the dissociation threshold, where the classical dynamics have been shown to be chaotic. We propagate the nuclear wavepacket on the potential energy surface by means of the numerically exact multiconfiguration time-dependent Hartree method and employ mean local energies, time-dependent and time-averaged populations in quantum number space, energy distributions, entanglement entropies, local population distributions, microcanonical averages, and dissociation probabilities, as diagnostic tools. This allows us to identify a continuous localization → delocalization transition in the energy flow, associated with the onset of quantum chaos, as the excitation energy increases up to near the dissociation threshold. Moreover, we find that at this energy and ∼1 ps the molecule nearly thermalizes. Furthermore, we observe that IVR is so slow that the molecule begins to dissociate well before such quasi-thermalization is complete, in accordance with earlier classical-mechanical predictions of non-RRKM behavior.

[Factors related with post-surgical complications in elderly patients with glioblastoma multiforme]. / Factores relacionados con complicaciones posquirurgicas en pacientes de edad avanzada con glioblastoma multiforme.

INTRODUCTION: Glioblastoma multiforme is the most frequent malignant tumour of the central nervous system, and its incidence reaches 80% in those over 50 years of age. Life expectancy has increased in the population in recent times and an analysis of the post-surgical complications affecting elderly patients is of great importance for a correct surgical indication. AIMS: To analyse the factors related with post-surgical complications in elderly patients. PATIENTS AND METHODS: A sample of 88 patients diagnosed with glioblastoma multiforme between 31 and 78 years of age was analysed retrospectively. The variables taken into consideration in the study were: personal medical history, age, functional status, pre-anaesthetic status, tumour characteristics, type of surgery and post-surgical complications. RESULTS: Age was observed to have an influence on local (p = 0.006) and systemic surgical complications (p = 0.034), and on the Clavien-Dindo scale (p = 0.001). Persons with a poorer functional status and cardiovascular risk presented more systemic complications (p = 0.006 and 0.044) and a lower score on the Clavien-Dindo scale (p = 0.024 and 0.025) respectively. Likewise, more local complications are found in the case of excisional procedures than in biopsies (p = 0.027). The pre-anaesthetic status and anti-haemostatic treatments were not related with such events. CONCLUSIONS: Patients over 65 years of age present a higher incidence of pathological antecedents and a poorer pre-surgical functional status. Age, cardiovascular risk, functional status and the type of surgical procedure have significantly increased the occurrence of post-surgical complications.

TITLE: Factores relacionados con complicaciones posquirurgicas en pacientes de edad avanzada con glioblastoma multiforme.Introduccion. El glioblastoma multiforme es el tumor maligno mas frecuente del sistema nervioso central, y su incidencia es del 80% en los mayores de 50 años. En los ultimos tiempos se ha producido un aumento en la esperanza de vida de la poblacion, y el analisis de las complicaciones posquirurgicas en pacientes de edad avanzada resulta de gran relevancia para una correcta indicacion quirurgica. Objetivo. Analizar factores relacionados con las complicaciones posquirurgicas en pacientes de edad avanzada. Pacientes y metodos. Se analizan retrospectivamente 88 pacientes diagnosticados de glioblastoma multiforme entre 31 y 78 años. Las variables estudiadas son: antecedentes personales, edad, estado funcional, estado preanestesico, caracteristicas tumorales, tipo de cirugia y complicaciones posquirurgicas. Resultados. Se observa una influencia de la edad en las complicaciones quirurgicas locales (p = 0,006) y sistemicas (p = 0,034) y en la escala de Clavien-Dindo (p = 0,001). Las personas con peor estado funcional y riesgo cardiovascular presentaron mas complicaciones sistemicas (p = 0,006 y 0,044) y peor graduacion en dicha escala (p = 0,024 y 0,025). Asimismo, hallamos mas complicaciones locales en las cirugias de exeresis que en las biopsias (p = 0,027). El estado preanestesico y los tratamientos antihemostaticos no se relacionaron con dichos eventos. Conclusiones. Los pacientes mayores de 65 años presentan una mayor incidencia de antecedentes patologicos y peor estado funcional prequirurgico. La edad, el riesgo cardiovascular, el estado funcional y el tipo de cirugia han aumentado de manera significativa las complicaciones posquirurgicas.

Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit?

Secondary hypogonadism is more common than primary gonadal failure and is seen in chronic and acute illnesses. Although testosterone has a role in erections, its importance in erectile dysfunction (ED) has been controversial. Hypogonadism produced by functional suppression of pituitary gonadotropins has been shown to correct with clomiphene citrate, but with a modest effect on sexual function. We wondered if longer treatment would produce improved results. A total of 178 men with secondary hypogonadism and ED received clomiphene citrate for 4 months. Sexual function improved in 75%, with no change in 25%, while significant increases in luteinizing hormone (P<0.001) and free testosterone (P<0.001) occurred in all patients. Multivariable analysis showed that responses decreased significantly with aging (P<0.05). Decreased responses also occurred in men with diabetes, hypertension, coronary artery disease, and multiple medication use. Since these conditions are more prevalent with aging, chronic disease may be a more important determinant of sexual dysfunction. Men with anxiety-related disorders responded better to normalization of testosterone. Assessment of androgen status should be accomplished in all men with ED. For those with lower than normal age-matched levels of testosterone treatment directed at normalizing testosterone with clomiphene citrate is a viable alternative to giving androgen supplements.

Distrofia simpático refleja en el post-parto / Algodystrophie in the post-partum

No disponible

Efficacy and safety of sildenafil citrate for treatment of erectile dysfunction in a population with associated organic risk factors.

The objective of this study was to determine the efficacy and safety of sildenafil in patients with erectile dysfunction (ED) and associated organic risk factors in a multispecialty clinic. Patients (n = 521) were diagnosed with ED based on self-assessment. Associated risk factors were managed by medication or life-style modifications, or both, before treatment with sildenafil for ED. Patients received a 50-mg dose of sildenafil that could be adjusted to 100 mg or 25 mg based on tolerability and efficacy. Patients recorded the number of successful intercourse encounters for 6 to 8 weeks, and the number of adverse events. Overall, there was an 82% successful intercourse rate with sildenafil treatment. The predominant associated risk factors for ED were hypertension (39%), hypogonadism (37%), and multiple medications (34%). Common adverse events due to sildenafil treatment were mild to moderate in nature and resulted in <2% patient discontinuation. Clinicians should be particularly careful to evaluate patients presenting with ED because the condition can be accompanied by a wide spectrum of risk factors requiring monitoring and treatment. However, with adequate treatment and control of these risk factors, the use of sildenafil in a representative population of men with ED in a multispecialty clinic can achieve a higher efficacy rate than previous studies have indicated.

Unusual presentation of primary hyperparathyroidism with osteoporosis, hypercalcemia, and normal parathyroid hormone level.

We report the case of a woman with osteoporosis, chronic hypercalcemia, and normal levels of parathyroid hormone (PTH). Surgical exploration revealed hyperplasia of the parathyroid glands. Hypercalcemia was corrected immediately by surgery, and this was followed by a dramatic improvement in bone mineral density. This case represents a rarely reported presentation of primary hyperparathyroidism with an atypical laboratory finding.

Clinical experience with intraurethral alprostadil (MUSE) in the treatment of men with erectile dysfunction. A retrospective study. Medicated urethral system for erection.

OBJECTIVE: The Food and Drug Administration (USA) approved the transurethral administration of prostaglandin (alprostadil in January 1997), which had an efficacy of approximately 50% in clinical trials. We studied its effectiveness in clinical practice. METHODS: Patient and partner education was followed by an initial office trial of a medicated urethral system for erection (MUSE) after other medical risk factors were corrected during a 2- to 4-month period. The initial titration dose of alprostadil was usually 125 or 250 microg. Further titration, if needed, was instituted by the patient at home. Success was determined as the satisfactory completion of sexual intercourse in more than 66% of attempts, with a minimum of two being required. RESULTS: Two hundred and seventy patients entered the trials, and follow-up information was available in 229 (85%). The overall success rate was 56%. The dose required was 500 microg in 49.2% and 1,000 microg in 42.2%. Of the 44% in whom treatment failed, 61.4% did so because of lack of efficacy and 38.6% because of side effects (genital pain or urethral bleeding). Minor urogenital symptoms, which did not interfere with treatment, occurred in an additional 40% of patients. CONCLUSIONS: The efficacy of transurethral administration of alprostadil (56%) is higher than the initial published clinical trial data and higher than recent reported clinical experiences, although higher doses were required in our study. Men over 50 years of age, having an organic cause for erectile dysfunction, had better responses. Patient and partner education is important for successful treatment, and the in-office initial titration is an integral part of this success. Prior correction of medical risk factors may enhance the success rate.

Intervención educativa sobre la vacunación sistemática antihepatitis B en una comunidad escolar / Educative intervention in systemic antihepatitis B vaccination in a school comunity

Objetivo: Valorar el impacto de los recursos de enfermería empleados para maximizar la cobertura vacunal al implementar como sistemática la vacuna antihepatitis B en alumnos preadolescentes, así como identificar los grupos diana susceptibles de recibir una intervención educativa por parte de enfermería. Material y métodos: Estudio cuasiexperimental con grupo control. La población de estudio la conforman 143 alumnos matriculados en 6.º curso de un colegio público de zona urbana, así como sus respectivos padres. La intervención fue en dos fases: a) información a padres y profesores sobre la vacunación, aprovechando una reunión interna del colegio, y b) intervención educativa sobre los alumnos del grupo experimental. Otras covariables se recogieron mediante encuesta. Análisis estadístico: se elaboraron varios modelos de regresión logística múltiple, utilizando en cada uno de ellos como variables dependientes distintos eslabones del proceso causal: asistencia a la reunión interna informativa, implicación activa de los padres, cobertura de vacunación inicial y de primovacunación (vacunación completa). Resultados. El modelo multivariante para la vacunación inicial incluye como principal predictor la implicación activa de los padres (OR = 45,34, p < 0,001). La implicación de los padres se explica por la asistencia a la reunión (OR = 5,88, p < 0,001). La asistencia a la reunión está influida por el estado civil de la madre (casada) (OR = 2,94, p = 0,009). El modelo multivariante para la primovacunación o vacunación completa se explica por la implicación activa de los padres (OR = 19,16, p < 0,001) así como por la menor edad del alumno (OR = 0,43, p < 0,001 ). Conclusiones: La implicación activa de los padres aumenta las tasas de vacunación inicial, así como las de la primovacunación antihepatitis B en alumnos preadolescentes y, a su vez, esta implicación de los padres se ve enormemente favorecida por la intervención educativa sobre ellos. Son posibles intervenciones de enfermería eficientes y de impacto real y medible para maximizar la cobertura vacunal al implementar como sistemática la vacuna antihepatitis B en alumnos preadolescentes; de igual forma, son aplicables a la implementación de actividades de prevención primaria en una comunidad escolar (AU)

Leukocytoclastic vasculitis: a rare manifestation of propylthiouracil allergy.

OBJECTIVE: To report a case of leukocytoclastic vasculitis as a manifestation of propylthiouracil allergy. METHODS: We present the history, findings on physical examination, and results of laboratory evaluation in a 25-year-old woman. Associated reports from the literature are reviewed. RESULTS: The patient, with a history of Graves' disease, was referred for evaluation of a purpuric rash on the pinnas and buttocks bilaterally. Findings included exophthalmos and bilateral goiter with neck bruits. She was biochemically hyperthyroid. Biopsy of the skin lesions revealed leukocytoclastic vasculitis. Propylthiouracil therapy was discontinued, and prednisone was prescribed. Treatment with radioactive iodine resulted in appreciably diminished skin lesions and reduction in the size of the thyroid gland, but thyroxine and triiodothyronine levels increased. Administration of a second, higher dose of radioactive iodine with concomitant lithium carbonate resulted in clinical and biochemical improvement. Six months after initial assessment, the rash had resolved, and the patient's free thyroxine value had normalized, although the thyrotropin level was still suppressed. CONCLUSION: Leukocytoclastic vasculitis, although rarely seen as a manifestation of propylthiouracil allergy, has been reported in the medical literature and should be considered in the differential diagnosis of patients with a vasculitic rash. Treatment consists of discontinuation of the offending medication and administration of a corticosteroid and, occasionally, cyclophosphamide or plasmapheresis.

Testosterone treatment in hypogonadal men: prostate-specific antigen level and risk of prostate cancer.

OBJECTIVE: To assess prostate-specific antigen (PSA) levels in hypogonadal men after testosterone replacement by three different methods and attempt to determine any possible relationship between hypogonadism and prostate cancer in this study population. METHODS: A total of 90 consecutive men who had erectile dysfunction and were found to have hypogonadism were monitored with digital rectal examination (DRE) and measurement of PSA levels before and after testosterone replacement therapy. The patients were treated with one of three options: (1) testosterone enanthate by intramuscular injections, 200 or 300 mg every 2 or 3 weeks (N = 25); (2) testosterone nonscrotal patches, 5 mg daily (N = 16); or (3) clomiphene citrate, 50 mg orally three times a week, in patients with functional secondary hypogonadism (N = 49). Treatment was continued for 2 to 3 months, after which PSA levels were reassessed. Patients with suspicious results on DRE and increased PSA levels before or after treatment with testosterone underwent prostate biopsy. For statistical analysis, patients were categorized into two age-groups--40 to 60 years old and 61 to 80 years old. RESULTS: With all methods of testosterone replacement, PSA levels increased in both age-groups. Endogenous testosterone elevation from clomiphene stimulation raised PSA levels the highest, and testosterone patches yielded the least PSA response. Ten men underwent biopsy of the prostate. In one patient, a nodule was found on DRE; the other nine men underwent biopsy because of suspicious PSA levels. Of these patients, two were found to have adenocarcinoma, and a third man who underwent rebiopsy was also found to have cancer. Therefore, 3 of the 90 patients (3.3%) had prostate cancer. CONCLUSIONS: PSA levels increased in response to all types of testosterone replacement, regardless of whether the testosterone level was raised endogenously or exogenously. PSA levels are inappropriately low in hypogonadal men and may mask an underlying cancer. Determining PSA levels before and after testosterone treatment is recommended. Elevated PSA levels before or after testosterone therapy should prompt performance of a urologic evaluation for possible prostate biopsy.

Characterization of patients in a medical endocrine-based center for male sexual dysfunction.

OBJECTIVE: To characterize the patient population in a multidisciplinary sexual dysfunction clinic whose focal person is an endocrinologist and to summarize the initial manifestations, the demographics of the study group, and their associated medical conditions. METHODS: We undertook a retrospective analysis of the medical records of all new consultations in a center for sexual function during a recent 2-year period. RESULTS: During the period from July 1995 to July 1997, 1,050 men were seen in new consultations for sexual dysfunction at our medical facility, and complete medical records could be retrieved for 990 of them. Of the overall study group of 990 men, most (93.2%) had erectile dysfunction (versus libido or ejaculatory problems), but combinations of problems were common. Most men had organic causes of their sexual dysfunction that correlated with increasing age; however, their dysfunction was more often the result of chronic medical conditions than of advancing age itself. Most men were married (72.1%) and in long-term relationships (mean duration, more than 20 years). Hypogonadism was the most common medical condition (36.3%), a finding that reflected an endocrine referral bias. Testosterone treatment alone corrected the complaints in a minority of patients. Hypertension was a more common diagnosis than diabetes (35.8% versus 23.1%), and pituitary tumors were rare. Successful outcomes were achieved in about two-thirds of men having a strong organic cause of sexual dysfunction, but treatments were less successful when pronounced psychologic factors were present. The patient dropout rate was substantial and was similar in each of the four 6-month quarters--an indication that even as newer therapies became available, dissatisfaction was still evident. CONCLUSION: Many patients have more than one manifestation of sexual dysfunction, which may have to be addressed separately. In a sexual dysfunction clinic managed by an endocrinologist, referral bias may direct more patients with hypogonadism and fewer patients who have had transurethral retropubic prostatectomy or a radical prostatectomy. Treatment of hypogonadism corrects sexual dysfunction in only a few men, and only when other medical problems are not present. Although the percentage of men with diabetes would be expected to be high in this study, the number of patients with hypertension was higher. A considerable dropout rate during evaluation and treatment persisted throughout this study.

Cessation of smoking rapidly decreases erectile dysfunction.

OBJECTIVE: To assess the relationship between cessation of smoking and rapid improvement in erectile capacity as well as the effect of nicotine patches on nocturnal penile tumescence and rigidity. METHODS: Nocturnal penile erections were studied in 10 smokers with use of the RigiScan portable home monitor. Two nights were monitored: for the first night, the patients had not stopped smoking; for the second night, the patients had stopped smoking for 24 hours. In addition, four men were monitored after cessation of smoking and wearing nicotine patches for 1 month. RESULTS: Multiple variables studied showed a statistically significant improvement in nocturnal penile tumescence and rigidity in the men who had stopped smoking for 24 hours. Continued improvement was noted in the four men who were monitored while not smoking and wearing nicotine patches for 1 month. CONCLUSION: Stopping cigarette smoking is a factor that rapidly improves penile tumescence and rigidity. Because the improvement continues while the patient is receiving nicotine from transdermal patches, some factor or factors other than the nicotine are responsible for the erectile dysfunction.

Effects of CDP-choline on the recovery of patients with head injury.

A single blind randomized study has been conducted in 216 patients with severe or moderate head injury, with the aim of comparing the evolution of those that received only conventional treatment with the evolution of those treated with CDP-choline. Our results indicate that CDP-choline improves the global outcome of patients. We have found a trend towards a greater improvement in motor, cognitive and psychic alterations in the patients treated with CDP-choline, as well as a shortening of the stay in the hospital ward in the patients receiving this drug that initially presented with severe head injuries.

Zygote intrafallopian transfer with "donor rescue": a new option for severe male factor infertility.

Clinical pregnancies have been initiated by ZIFT using zygotes produced by reinsemination of oocytes with donor sperm ("donor rescue") after an initial 15- to 20-hour exposure to husband's sperm. A total of 54 oocytes from four couples experiencing failed fertilization by husband's sperm were reinseminated with donor sperm, resulting in 38 zygotes (70.4% fertilization). Four zygotes were transferred during ZIFT in each case and resulted in two (50%) continuing pregnancies. Additional zygotes from donor reinsemination were cryopreserved for each couple. Donor rescue expands the utility of ZIFT as a treatment for male factor infertility.