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Las relaciones comerciales transatlánticas sobreviven a todas las vicisitudes, cambios y sobresaltos de los últimos dos años y de momento siguen aumentando en volumen e intensidad. Durante los últimos años hemos asistido al fracaso de un ambicioso intento de impulsar una mayor integración, de la mano de un acuerdo bilateral, la Asociación Transatlántica para el Comercio y la Inversión (ATCI), más conocido por su acrónimo en lengua inglesa, TTIP (Transatlantic Trade and Investment Partnership) cuya negociación se interrumpió con el cambio de inquilino en la Casa Blanca. Desde ese momento, el cambio en la política comercial norteamericana, que se ha tornado mucho más unilateral, ha abierto una nueva etapa en las relaciones comerciales transatlánticas, en las que de momento destacan algunos nuevos irritantes comerciales originados por las decisiones unilaterales. Se mantiene la incertidumbre sobre si las actuales tensiones en el diálogo bilateral se mantendrán o se podrán reconducir a una dinámica positiva que quizá dé lugar a nuevas negociaciones a una escala menor.

INTRODUCTION The GOLD guidelines, include in the COPD definition a obstruction to the airflow, define as a ratio FEV1/FVC METHODS There was selected, between 5522 cases diagnosed of COPD in accordance to the data base of the medical history of primary attention, 577 patients, between 40 and 85 years old. Spirometry were performed. The correctly performed test were evaluated by the GOLD, NICE and LLN criteria, according to age range. Kappa concordance coefficient was used to evaluate the results. RESULTS The spirometries of 469 patients were evaluated. 368 had an obstructive disease according to GOLD; 277 according to NICE and 244 according to LLN. Stratified by age The Kappa coefficient between the GOLD and LLN was 0.572 for the interval from 40 to 55 years old; 0.437 between 55 to 70 and 0.301 from 70 to 85 years old. Between the NICE and LLN criteria were 0.576; 0.559 and 0.436 for the same intervals. CONCLUSIONS As the age increases a mayor discrepancy is observed between the different criteria used to evaluate the obstruction of the airflow in the COPD, losing concordance among them.

Resumen El conocimiento de las tecnicas de mamoplastia de reduccion habilita al cirujano dedicado al cancer de mama para realizar un tratamiento quirurgico integral, con lo que se amplian y mejoran, de un modo importante, las opciones quirurgicas. La mamoplastia de reduccion, tecnica utilizada para el tratamiento de las secuelas de la cirugia conservadora del tipo I de la clasificacion de Clough, completa el proceso de reconstruccion mamaria tras mastectomia con la simetrizacion de la mama contralateral y es la base de las tecnicas de remodelacion en la cirugia oncoplastica conservadora.

Reduction mammaplasty techniques enable the breast cancer surgeon to provide an integral surgical treatment, thus significantly increasing and improving surgical options. These techniques are used to correct problems after the conservative treatment of type 1 breast cancer and to achieve symmetry between the breasts after mastectomy. They are also the basis of cosmetic reconstruction techniques in conservative oncoplastic surgery.

Resumen Introduccion El planteamiento multidisciplinario del cancer de mama en unidades especializadas se considera el mas adecuado, tanto en el beneficio para la paciente como en el consumo mas racional de recursos materiales. Con estas premisas se han elaborado las recomendaciones de la European Society of Mastology (EUSOMA) encaminadas a dotar a todos los paises europeos de equipos multidisciplinarios de alta calidad. Material y metodo En este trabajo se presentan y se analizan los resultados obtenidos de la encuesta sobre unidades de mama, promovida por la Seccion de Patologia de la Mama de la Asociacion Espanola de Cirujanos, en 241 hospitales espanoles. Resultados Destaca la elevada implicacion de los servicios de cirugia general (131 hospitales) en la atencion de la patologia mamaria, asi como el gran interes por la formacion continuada de los cirujanos espanoles (el 41,2% de los servicios posee un titulo de posgrado). En 95 (73,6%) hospitales se planifica el proceso terapeutico, mediante reunion multidisciplinaria regular. Existen protocolos escritos sobre diagnostico y tratamiento en 119 (90,8%) de los servicios que se dedican a la patologia mamaria y se aplican medios para mantener un adecuado control de la calidad asistencial en 83 (63,4%) hospitales. Conclusiones Resaltamos la necesidad de una normativa espanola sobre unidades de mama, preferiblemente adaptada a los criterios de EUSOMA, que son los admitidos por el comite encargado del Parlamento Europeo. La Asociacion Espanola de Cirujanos, a traves de la Seccion de Patologia de la Mama, debe ejercer un destacado papel a la hora de acreditar a los medicos de las unidades de mama y potenciar la formacion continuada de estos.

The effects of social support and locus of control on the psychological well-being in a sample of 160 women were analyzed: two groups of immigrants—Moroccan ( n =50) and Peruvian ( n =55)—and a comparison group of Spanish women ( n =55). Two regression analyses were carried out using five social support variables, two demographic variables and locus of control as predictors. The best predictors of psychological well-being were the number of Spaniards in the support network and their perception of personal control. Two analyses of covariance were used to determine the modulating character of nationality and marital status in the relation between social and personal resources and well-being, with an interactive effect being observed between nationality and marital status. Among Moroccan women, married women were perceived as less well-being than single women, the opposite of that found in the other two groups.

Androgen receptor (AR) immunohistochemistry was performed in an archival collection of adult human cryptorchid testes to determine whether AR cellular distribution and intensity of immunostaining were functions of the severity of cellular dysgenesis. The seminiferous tubule histology of cryptorchid testes collected from adults is marked by three specific patterns. 1) Seminiferous tubules are characterized as maintaining focal areas of germinal cell differentiation (albeit incomplete) that are interspersed with 2) tubules composed of Sertoli cells only, these latter cells being principally of the adult type, although dysgenetic and immature Sertoli cells may also be detected. 3) In contrast, there is a class of tubule that is characterized as being composed exclusively of Sertoli cells that are extremely dysgenetic in appearance. The majority of adult-type Sertoli cells found in the first types of tubules exhibited either robust or moderate AR staining intensity. Peritubular cells of these tubules also expressed a similar AR staining intensity. In contrast, in the more dysgenetic and immature type Sertoli cells found in the second type of tubules, the intensity of AR staining was significantly less, if not missing altogether. Finally, in the most dysgenetic tubules, Sertoli cell AR staining was never detected. To our knowledge, this is the first report in the literature that addresses the intensity of AR immunostaining in Sertoli cells of cryptorchid testes. The results presented herein are consistent with the interpretation that the intensity of AR staining in Sertoli cells diminishes as a function of the severity to which the cells are afflicted within a cryptorchid testis and that focal absence of AR expression in Sertoli cells correlates with a lack of local spermatogenesis in the tubules.

Objective.—To evaluate the morphometric, immunohistochemical, and ultrastructural lesions of the testes in prepubertal and adult patients with androgen insensitivity syndrome. Methods.—We examined the testicular biopsy using immunohistochemistry for vimentin, smooth muscle actin, and collagen IV antigens. Quantification of seminiferous tubules and testicular interstitium was performed in prepubertal and adult patients with androgen insensitivity syndrome and results were compared with normal testes from both infants and adults. Results.—The adult testes presented nodular and diffuse lesions that consisted of Sertoli-cell-only seminiferous tubules. Two types of Sertoli cells could be distinguished, namely, immature vimentin-positive Sertoli cells and nearly mature Sertoli cells. In the nodules, the lamina propria was thin and contained a scant number of actin-positive peritubular cells. Leydig cells were hyperplastic. The prepubertal patients showed only diffuse lesions characterized by Sertoli cell hyperplasia, decreased germ cell numbers, and a discontinuous immunoreaction to collagen IV. Conclusions.—The testicular lesions in androgen insensitivity syndrome are probably caused by primary alterations that begin during gestation. These lesions become progressively more pronounced at puberty, when the nodular lesion pattern (adenomas) is completely developed.

The immunohistochemical reaction to oncostatin M (OSM) was studied in normal human testes at different ages (fetuses, newborns, children, pubertal boys, adults, and elderly men), as well as in several testicular disorders including carcinoma-in-situ cells (CIS), germ cell tumors, benign functioning Leydig cell tumor, androgen insensitivity syndrome, Klinefelter's syndrome, and cryptorchidism. Positive OSM immunostained Sertoli cells were only observed in fetuses. In normal testes, intense OSM immunoreaction was found in the Leydig cells of fetuses, newborns, and adults. Leydig cell immunoreaction was weak in elderly men and absent in children and pubertal boys. In some testicular disorders (Leydig cell tumor, cryptorchidism, and CIS), Leydig cell immunoreaction was as intense as in normal adult testes. This immunoreaction was heterogeneous in androgen insensitivity syndrome and was absent in Klinefelter's syndrome and intratubular seminoma. No recognizable Leydig cells were observed in the other testicular tumors. The findings of our study suggest that, in humans, the down-regulation of OSM immunoexpression in Sertoli cells occurs early, and that OSM immunoreaction in the Leydig cells is associated with functionally active and differentiated Leydig cells.

The distribution of the androgen receptor (AR) in archival human testes was determined immunocytochemically using an affinity-purified peptide-specific rabbit antibody, PG21, and employing a modified biotin-streptavidin-immunoperoxidase method that incorporated a biotin amplification step. In combination with microwave epitope retrieval, the biotin amplification step increased the sensitivity of the immunostaining assay approximately 20-fold. Thus, the useful range at which PG21 rendered a robust, specific immunostaining signal without also increasing nonspecific background was extended dramatically. Broadening the useful range of the PG21 antibody made it possible to resolve the relative amounts of immunopositive AR in different cell types of the human testis. At a high PG21 concentration, for example, all AR-positive cells exhibited a robust immunostaining intensity, but it was not possible to distinguish between nuclei exhibiting either high or moderate immunostaining intensities. In contrast, as the concentration of PG21 was decreased, distinct populations of testicular cells exhibited differential AR immunostaining intensities in their nuclei. AR immunostaining of Sertoli cell nuclei was present at low PG21 concentrations at which no immunostaining of peritubular myoid cells or Leydig cells could be detected. In turn, AR immunostaining of peritubular myoid cells was detected at PG21 concentrations that did not immunostain Leydig cells. Moreover, within the seminiferous epithelium, Sertoli cell nuclear AR staining intensity was less at stages V and VI of the cycle of the seminiferous epithelium than that at stage III, and stage III staining intensity was greater than that at stages I and II. This AR immunostaining pattern in human Sertoli cell nuclei as a function of the cycle of the seminiferous epithelium is reminiscent of the pattern observed in rodent species. Finally, no AR immunostaining of germ cells was observed at any of the PG21 concentrations examined.

Se propone en este trabajo, como interrogación, la hipótesis según la cual el poema lírico es un relato. Se señalan las condiciones mínimas exigibles para que pueda hablarse de relato o narración en sentido técnico y se constata, teórica y prácticamente, que esas condiciones se cumplen en el poema lírico. Se matiza, sin embargo, que, siendo el lirismo un plus, exceso o incremento textual que la ficción narrativa normal no tiene, el poema lírico es un relato de características peculiares. Por ello, se concluye afirmando que todo texto/poema lírico es una ficción narrativa, aunque no toda ficción narrativa es/sea un texto/poema lírico.

ResumenLa importante evidencia empirica a favor de una relacion positiva entre el apoyo social y la salud y el bienestar de los individuos no oculta, sin embargo, la existencia de problemas conceptuales, teoricos y metodologicos en torno a este importante topica de la Psicologia Social. En el presente trabajo se analizan algunos de esos problemas y se aborda la naturaleza del apoyo social desde una perspectiva integradora que tiene en cuenta una triple dimension: la estructural, que contempla los aspectos morfologicos; la contextual, en la que se examina el denominado Sistema de Apoyo Social; y por ultimo la dimension procesal en la que se analiza la conducta misma de apoyo.

A hormonal and quantitative light microscopy study of one man with macro-orchidism associated with mental retardation and fragile X chromosome (case no. 1) and three men with idiopathic macro-orchidism (cases no. 2 to 4) is reported. Hormonal study revealed slightly increased follicle-stimulating hormone serum levels in cases no. 1 to 3. The testes from cases no. 1 (orchidoepididymoectomy specimen) and 2 (testicular biopsy) presented interstitial edema and three different tubular patterns that were arranged in a mosaic-like manner. Type I tubules had an increased diameter (less than 220 microns), dilated lumen, and thin seminiferous epithelium usually consisting of Sertoli cells, spermatogonia, primary spermatocytes, and sometimes a few spermatids. Type II tubules had a normal diameter (180 to 220 microns) and germ cell development varied between complete spermatogenesis and Sertoli-cell-only tubules. Type III tubules had decreased diameter (less than 180 microns), atrophic seminiferous epithelium, and thickened tunica propria. The appearance of the nuclei of the Sertoli cells in the three types of tubules could be either mature or immature. Some of the mature Sertoli cells presented a granular cytoplasm. A few of these granular cells grouped together, forming nests that protruded into the tubular lumen. The testicular biopsies from cases no. 3 and 4 only presented type II tubules that contained both mature and immature Sertoli cells. Quantitative study revealed that the large testicular size was principally due to an increased tubular length in all four cases. Although the seminiferous tubule lesions and interstitial edema suggest an obstructive process, the testicular excretory ducts (studied in case no. 1) appeared normal or only slightly dilated. It is possible that the seminiferous tubule lesions (dilated lumen and germ cell depletion) might be secondary to the Sertoli cell lesions (granular cytoplasm and nuclear immature-like pattern.

The optimal treatment of breast cancer consists of a multidisciplinary approach in specialized units, benefitting patients and leading to more rational resource use. Based on these premises, the European Society of Mastology (EUSOMA) drew up recommendations designed to provide all European countries with high-quality multidisciplinary teams.We present and analyze the results obtained from a survey of breast cancer units in 241 Spanish hospitals performed by the Breast Diseases Group of the Spanish Association of Surgeons.Breast disease was treated in general surgery departments in 131 hospitals and Spanish surgeons showed strong interest in continuing training (41.2% had a postgraduate degree in mastology). Multidisciplinary discussions at weekly intervals took place in 95 hospitals (73.6%) hospitals for planning a diagnostic and therapeutic course of action specific for each patient. Written protocols for diagnosis and treatment were used in 119 departments (90.8%) and quality control measures were applied in 83 (63.4%).We stress the need for mandatory requirements in Spain for breast cancer units, preferably adapted to the EUSOMA criteria, which are accepted by the relevant committee of the European Parliament. Through its Breast Diseases Group, the Spanish Association of Surgeons should be involved in accreditation standards for breast surgeons and should promote adequate specialization programs.

Elaboramos, por medio del análisis de conglomerados, una clasificación de las redes de apoyo social de los inmigrantes africanos afincados en Andalucía. Como variables criterio, utilizamos diversos indicadores del tamaño, la composición, la disponibilidad, la utilización y la suficiencia de la estructura personal de ayuda. Con un colectivo de 600 africanos, obtuvimos cuatro categorías: 1) redes pequeñas con predominio de amigos compatriotas; 2) redes mínimas con predominio de amigos compatriotas; 3) redes mixtas de tamaño medio centradas en los amigos, y 4) redes de tamaño medio centradas en la familia. La tipología distingue significativamente los niveles de bienestar psicológico, el estilo de utilización de servicios y otras características psicológicas, sociales y demográficas.

Keratins are intermediate filaments of the cytoskeleton of epithelial cells. They express themselves in simple (Ks. 7, 8, 18, 19 y 20) or stratitified epithelia (Ks. 1, 2, 5, 9, 10, 11, 16). The different expression of these multigenic cytoskeletal proteins is related to cell specific differentiation programs (OSBORN & WEBER, 1983; NAGLE, 1988); For these reasons the analysis of keratins are very relevant for the study of new aspects of histology, histopathology and developmental biology. Moreover, evaluation of keratins by immunofluorescent or immunohistochemistry is useful for the proper identification and characterization of normal, displasic and neoplasic cells (OSBORN & WEBER, 1983; NAGLE). The different patterns of expression of keratins are related to the degree of differentiation of inmature epithelial cells, as well as the degree of differentiation of malignant tumours (FUCHS & GREEN, 1980; FRANKE et al., 1981b; MOLL et al, 1892a; SCHAAFSMA & RAMAEKERS, 1994). Lastly, evaluation of the changes of immunoexpresion of keratins is useful for the differential diagnosis between typical and atypical squamous metaplasia, including moderate and severe epithelial displasia and intraepithelial neoplasia -formerly known as carcinoma in situ- (MOLL et al., 1982a; TSENG et al., 1982; QUINLAN et al., 1985; HUSZAR et al., 1986; GIGI-LEITNER et al; HEID et al.,1988)

Parathion is a widely used organophosphoric pesticide which has also been reported to interfere with mouse spermatogenesis. Moreover it has been related to prenatal toxicity in mammals.

We reviewed the literature on protozoan infections in the male genital tract, with special reference to histopathological findings and their repercussions on different andrological functions.A literature search of the MEDLINE data base from 1966 to May 1995 was done and related articles were identified. The considered terms were parasitology and the male genital organs. Additional searches on infertility, semen and sexually transmitted diseases were performed.Protozoan infections of the male genital tract are rare and only a few species of parasites are involved. Trichomonas vaginalis, Trypanosoma species, Leishmania donovani, Entamoeba histolytica, Acanthamoeba species, Toxoplasma gondii and Plasmodium falciparum have been described in the male genital tract as producing testicular damage or secondary hypogonadism via hypothalamic-hypophyseal axis alterations.Topics of interest were the role of sexual transmission by some parasites, principally T. vaginalis, relationship with subfertility or infertility in the male subject, clinical significance in differential diagnosis with other inflammatory processes, and for some parasites the relationship with opportunistic behavior and immunodeficiency syndromes, including the acquired immunodeficiency syndrome.

A semi-quantitative study of the extra-parenchymal Leydig cells in the tunica albuginea testis and spermatic cord was performed on histological sections immunostained with anti-testosterone antibodies in the testes and spermatic cords obtained from human foetuses, adults and elderly men without testicular or related diseases (autopsy specimens), as well as from adult men with cryptorchidism (surgical specimens). The albugineal Leydig cells appeared in small groups in the vicinity of blood vessels. The Leydig cells of the spermatic cord usually appeared inside or around nerve trunks. The percentages of testes and spermatic cords with extra-parenchymal Leydig cells were higher in the cryptorchid testis group than in the normal male groups. The number of Leydig cells per mm2 in the tunica albuginea testis was higher in normal adult males than in foetuses. This number decreased in elderly men and increased markedly in cryptorchidism. The number of Leydig cells per mm2 in the spermatic cord was also higher in normal adults than in foetuses and it did not change with either advancing age or cryptorchidism. In foetuses, the percentage of cells intensely immunostained by anti-testosterone antibodies in the tunica albuginea and spermatic cord did not differ significantly from that found in the testicular parenchyma, whereas in the other three groups (adult, elderly, and cryptorchid men) the percentages of these cells in the tunica albuginea and spermatic cord were significantly lower than in the testicular parenchyma.

A histometric study of the development of the human epididymis from the fetal period to adulthood has been carried out in males without testicular or related pathology, distributed into the following groups: (I) fetuses (between the 28th and 37th week of pregnancy); (II) newborns (1–30 days of age); (III) infants (2–4 months of age); (IV) infants (5–12 months of age); (V) infants (1–4 years of age); (VI) children (5–14 years [prepubertal]); and (VII) adults (15–60 years of age). For each age group and each epididymal portion (efferent ducts, caput, corpus and cauda epididymidis) the parameters measured were (1) total surface (epithelium + muscular layer + lumen); (2) the surface occupied by the lumen; (3) the surface occupied by the muscular layer; (4) total diameter of the duct; (5) total diameter of the lumen; and (6) the height of the epithelium. The results of the present study revealed that the development of the efferent ducts and ductus epididymidis follows a biphasic pattern. A progressive development occurs from the fetal period to infants 2–4-months of age. However, this development is transient and regresses during infancy (groups IV and V). At childhood (group VI), a definitive development is initiated and completed at puberty (group VII). These changes seem to be related to the androgen-dependence of the epididymis, the different stages of testicular maturation, and the steroidogenic activity of Leydig cells.

La "Colección Provincia" de poesía es una de las realidades culturales más gra nadas e importantes de León. Pero no de las más conocidas. El objeto de estas lineas cs dar noticia de esta realidad con unas pinceladas rápidas y concretas. Antonio Gamoneda, poeta de calidades por nadie discutidas, es el creador y animador de esta colección; a él debo (y agradezco) muchos de los datos que aquí aparecen.