September 2001: 51-year-old man with seizures since childhood.

The September 2001 COM. A 51 year old man with refractory seizures presented with a recent seizure while at work but no other neurologic deficit. Imaging studies demonstrated a solid and cystic lesion of the right temporal lobe. Microscopic and immunohistochemical studies demonstrated an atypical ganglioglioma due to the presence of neurofibrillary tangles within the neoplastic ganglion cell component. This is the fifth case reported in the literature. Neoplastic ganglion cells and neurofibrillary tangles are discussed both separately and as integral components of this rare tumor.     

Nutritional response of growing rats to faba beans (Vicia faba L., minor) and faba bean fractions.

The effects of raw faba bean (Vicia faba L., minor) meal (VFM) and its fractions on the growth and nitrogen utilization of rats have been determined in two experiments. Two commercial varieties of VFM were tested, local VFM (409-439 g/kg diet) and Troy VFM (439 g/kg diet). The bean fractions tested were V. faba lectin-depleted protein (VFDP), V. faba lectin (VFL) and V. faba cotyledon residue (VFCR). All diets were supplemented with amino acids to target requirements. Body-weight, body N and lipid contents of rats fed on VFM were reduced significantly in comparison with control rats fed on lactalbumin. This was due, in part, to the lower digestibility of the protein, lipid and dry matter (DM) of VFM diets. As a result, net protein utilization (NPU) and biological value (BV) of faba bean proteins were less than expected. Urine and urea-N outputs of the VFM-fed rats were also elevated in both experiments. Increasing the energy content of local VFM diets led to significantly higher dry body-weight, body N and lipid contents, with the result that the NPU and BV values of the protein also increased. However, the NPU values for VFM-fed rats were still significantly lower than those for the controls in both experiments. In contrast, true N, lipid and DM digestibilities in rats given local VFM were not significantly affected by the difference in the energy content of the diets. The replacement of two-thirds of the lactalbumin in the diet with VFDP (65 g/kg) reduced dry body-weight, N and lipid contents, NPU and BV compared with the control rats, even though N, lipid and DM digestibilities were not significantly different. The nutritional performance of rats fed on lactalbumin-based diets containing 7 g VFL/kg was similar to that of the controls. Similarly, the inclusion of the cotyledon residue (237 g VFCR/kg diet) had no appreciable effect on any of the variables studied. As VFL and VFCR had no antinutritional effects in these rats, it appears that the low nutritional value of VFM for rats (NPU 0.66) results not only from the low digestibility of the bean proteins, but also from disturbances in N metabolism.     

Fast adaptive alpha-particle spectrum fitting algorithm based on genetically estimated initial parameters.

This work presents a high performance procedure for the unfolding of alpha particle spectra based on genetically estimated initial parameters. The process starts with the search for a globally optimized set of fitting parameters from a population of randomly generated solutions. The solution found with the genetic algorithm is then transferred to a Levenberg-Marquardt procedure in order to calculate the covariance matrix for the fit. The proposed method provides the set of final parameters and their associated standard deviation. Several fitted spectra demonstrate the effectiveness of the proposed method in searching for and finding initial conditions in a fast and automated process.     

Neumohemotórax catamenial: aportaciones al diagnóstico y tratamiento quirúrgico

Endometriosis is an infrequent entity defined by the presence of an area of endometrial tissue outside the uterine cavity. Definitive diagnosis of thoracic endometriosis is obtained by histological confirmation of endometrial tissue in the pleural cavity. Videothoracoscopy is the most effective diagnostic and therapeutic procedure as it facilitates sample-taking for histological confirmation and allows a therapeutic procedure to be established, treating the areas of ectopic endometrial tissue.     

Paradoxical responses in a cohort of HIV-1-infected patients with mycobacterial disease.

SETTING: Paradoxical worsening or relapse of opportunistic infections has been described after initiation of highly active anti-retroviral therapy (HAART) in human immunodeficiency virus (HIV) infected patients. DESIGN: Retrospective study of a group of 33 HIV-infected patients with mycobacterial disease analysing the incidence and characteristics of patients with and without paradoxical response after starting HAART and/or mycobacterial treatment. RESULTS: Nine patients in the group had paradoxical response. No significant difference of baseline characteristics was observed in these patients. The decrease in viral load was significantly greater among patients with paradoxical response than in patients without. CONCLUSION: No clinical difference was found in the evolution of HIV-infected patients with mycobacterial disease after the resolution of the episode of paradoxical response.     

Mortalidad materna en África

In this report, the authors describe the dramatic situation of maternal health in African countries. According to the most recent estimates, almost 1 million African women die each year (one maternal death per minute) and a significant proportion of these (between 3 and 4 million) have incapacitating genitourinary fistulae. In contrast, in industrialized countries, only 2,500 maternal deaths are registered yearly (0.47% of the total worldwide) with a maternal mortality ratio (MMR) of 20 per 100,000 live births.     

Early coronary angioplasty for acute myocardial infarction complicated by cardiogenic shock: have novel therapies led to better results?

Patients with acute myocardial infarction (MI) and cardiogenic shock constitute a very high risk subset despite an aggressive management. The objective of this study was to evaluate if the results of early coronary angioplasty in patients with acute myocardial infarction and cardiogenic shock have changed over the last years, and to address which role the recent adjuvant therapies have played in this evolution. From 1991 to April 1999, 94 patients with acute MI and cardiogenic shock were treated with coronary angioplasty within the first 12 hours from the onset of symptoms. Temporal changes of the utilization of adjuvant therapies and operators experience were studied over these years, as well as their impact on the angiographic results and in-hospital outcome. Over the years, a progressive and significant increase on the use of coronary stents and c7E3Fab was observed, as well as an increased number of primary angioplasties performed per month. The proportion of patients treated with intraaortic balloon pump did not changed significantly over the years. An angiographic successful result (< 50% residual stenosis and TIMI flow 2 or 3) and a final TIMI grade 3 flow were obtained in 76 (80.9%) and 61 (64.9%) patients, respectively. The angiographic success rate progressively increased over the years, from 72.3% in patients treated before 1994 to 94.1% in those admitted in 1998Eth 1999 (p for trend 0.0409). The proportion of patients with a final TIMI grade 3 flow also grew progressively over the years: from 36.4% before 1994 to 76.5% after 1997 (p for trend 0. 0209). The overall in-hospital mortality rate was 63.8% (60 patients), and there was no significant change in mortality rate over the years. Therefore, apart from the growing operators experience, we have observed an incremental change in the use of coronary stents and c7E3 Fab (abciximab) in patients with acute myocardial infarction and cardiogenic shock treated with early coronary angioplasty. All these factors have led to an improvement in the angiographic results, although this change has not meant a significant reduction of mortality.     

The use of PCR in the diagnosis of hyper-reactive malarial splenomegaly (HMS)

Between August 1997 and September 1998, 14 cases of hyper-reactive malarial splenomegaly (HMS) were diagnosed in the Instituto de Salud Carlos III in Madrid, Spain. These cases, from Equatorial Guinea and Cameroon, were identified using the diagnostic criteria established by Y. M. Fakunle in 1981: gross splenomegaly; high levels of anti-malarial antibodies; IgM in serum at least two standard deviations above the local mean; and clinical and immunological response to antimalarial treatment. Although malarial parasites were only detected in the Giemsa-stained blood films of four of the cases, these four and four others were found to have the DNA of such parasites in their blood when tested using a method based on a semi-nested, multiplex PCR. These result indicate that malarial parasitaemias may be more prevalent in HMS than is usually recognized.